1-1 By: Lindsay S.B. No. 355
1-2 (In the Senate - Filed January 23, 2001; January 25, 2001,
1-3 read first time and referred to Committee on Health and Human
1-4 Services; April 2, 2001, reported adversely, with favorable
1-5 Committee Substitute by the following vote: Yeas 9, Nays 0;
1-6 April 2, 2001, sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 355 By: Madla
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to a nursing home resident's right to informed consent
1-11 regarding the prescription of certain drugs.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Subsection (a), Section 242.501, Health and
1-14 Safety Code, is amended to read as follows:
1-15 (a) The department by rule shall adopt a statement of the
1-16 rights of a resident. The statement must be consistent with
1-17 Chapter 102, Human Resources Code, but shall reflect the unique
1-18 circumstances of a resident at an institution. At a minimum, the
1-19 statement of the rights of a resident must address the resident's
1-20 constitutional, civil, and legal rights and the resident's right:
1-21 (1) to be free from abuse and exploitation;
1-22 (2) to safe, decent, and clean conditions;
1-23 (3) to be treated with courtesy, consideration, and
1-24 respect;
1-25 (4) to not be subjected to discrimination based on
1-26 age, race, religion, sex, nationality, or disability and to
1-27 practice the resident's own religious beliefs;
1-28 (5) to privacy, including privacy during visits and
1-29 telephone calls;
1-30 (6) to complain about the institution and to organize
1-31 or participate in any program that presents residents' concerns to
1-32 the administrator of the institution;
1-33 (7) to have information about the resident in the
1-34 possession of the institution maintained as confidential;
1-35 (8) to retain the services of a physician the resident
1-36 chooses, at the resident's own expense or through a health care
1-37 plan, and to have a physician explain to the resident, in language
1-38 that the resident understands, the resident's complete medical
1-39 condition, the recommended treatment, and the expected results of
1-40 the treatment, including any expected effects, clinically possible
1-41 side effects, and risks associated with psychoactive medications;
1-42 (9) to participate in developing a plan of care, to
1-43 refuse treatment, and to refuse to participate in experimental
1-44 research;
1-45 (10) to a written statement or admission agreement
1-46 describing the services provided by the institution and the related
1-47 charges;
1-48 (11) to manage the resident's own finances or to
1-49 delegate that responsibility to another person;
1-50 (12) to access money and property that the resident
1-51 has deposited with the institution and to an accounting of the
1-52 resident's money and property that are deposited with the
1-53 institution and of all financial transactions made with or on
1-54 behalf of the resident;
1-55 (13) to keep and use personal property, secure from
1-56 theft or loss;
1-57 (14) to not be relocated within the institution,
1-58 except in accordance with standards adopted by the department under
1-59 Section 242.403;
1-60 (15) to receive visitors;
1-61 (16) to receive unopened mail and to receive
1-62 assistance in reading or writing correspondence;
1-63 (17) to participate in activities inside and outside
1-64 the institution;
2-1 (18) to wear the resident's own clothes;
2-2 (19) to discharge himself or herself from the
2-3 institution unless the resident is an adjudicated mental
2-4 incompetent;
2-5 (20) to not be discharged from the institution except
2-6 as provided in the standards adopted by the department under
2-7 Section 242.403; [and]
2-8 (21) to be free from any physical or chemical
2-9 restraints imposed for the purposes of discipline or convenience,
2-10 and not required to treat the resident's medical symptoms; and
2-11 (22) to receive information about prescribed
2-12 psychoactive medication from a treating physician and pharmacist,
2-13 to have any psychoactive medications prescribed and administered in
2-14 a responsible manner, as mandated by Section 242.505, and to refuse
2-15 to consent to the prescription of psychoactive medications.
2-16 SECTION 2. Subchapter L, Chapter 242, Health and Safety
2-17 Code, is amended by adding Section 242.505 to read as follows:
2-18 Sec. 242.505. PRESCRIPTION OF PSYCHOACTIVE MEDICATION.
2-19 (a) In this section:
2-20 (1) "Medication-related emergency" means a situation
2-21 in which it is immediately necessary to administer medication to a
2-22 resident to prevent:
2-23 (A) imminent probable death or substantial
2-24 bodily harm to the resident; or
2-25 (B) imminent physical or emotional harm to
2-26 another because of threats, attempts, or other acts the resident
2-27 overtly or continually makes or commits.
2-28 (2) "Psychoactive medication" means a medication that
2-29 is prescribed for the treatment of symptoms of psychosis or other
2-30 severe mental or emotional disorders and that is used to exercise
2-31 an effect on the central nervous system to influence and modify
2-32 behavior, cognition, or affective state when treating the symptoms
2-33 of mental illness. The term includes the following categories when
2-34 used as described by this subdivision:
2-35 (A) antipsychotics or neuroleptics;
2-36 (B) antidepressants;
2-37 (C) agents for control of mania or depression;
2-38 (D) antianxiety agents;
2-39 (E) sedatives, hypnotics, or other
2-40 sleep-promoting drugs; and
2-41 (F) psychomotor stimulants.
2-42 (b) A person may not prescribe a psychoactive medication to
2-43 a resident who does not consent to the prescription unless:
2-44 (1) the resident is having a medication-related
2-45 emergency; or
2-46 (2) the person authorized by law to consent on behalf
2-47 of the resident has consented to the prescription.
2-48 (c) Consent to the prescription of psychoactive medication
2-49 given by a resident or by a person authorized by law to consent on
2-50 behalf of the resident is valid only if:
2-51 (1) the consent is given voluntarily and without
2-52 coercive or undue influence;
2-53 (2) the treating physician or a person designated by
2-54 the physician provided the following information, in a standard
2-55 format approved by the department, to the resident and, if
2-56 applicable, to the person authorized by law to consent on behalf of
2-57 the resident:
2-58 (A) the specific condition to be treated;
2-59 (B) the beneficial effects on that condition
2-60 expected from the medication;
2-61 (C) the probable health and mental health
2-62 consequences of not consenting to the medication;
2-63 (D) the probable clinically significant side
2-64 effects and risks associated with the medication;
2-65 (E) the generally accepted alternatives to the
2-66 medication, if any, and why the physician recommends that they be
2-67 rejected; and
2-68 (F) the proposed course of the medication;
2-69 (3) the resident and, if appropriate, the person
3-1 authorized by law to consent on behalf of the resident are informed
3-2 in writing that consent may be revoked; and
3-3 (4) the consent is evidenced in the resident's
3-4 clinical record by a signed form prescribed by the facility or by a
3-5 statement of the treating physician or a person designated by the
3-6 physician that documents that consent was given by the appropriate
3-7 person and the circumstances under which the consent was obtained.
3-8 (d) If the treating physician designates another person to
3-9 provide the information under Subsection (c), not later than two
3-10 working days after that person provides the information, excluding
3-11 weekends and legal holidays, the physician shall meet with the
3-12 resident and, if appropriate, the person authorized by law to
3-13 consent on behalf of the resident, to review the information and
3-14 answer any questions.
3-15 (e) A resident's refusal to consent to receive psychoactive
3-16 medication shall be documented in the resident's clinical record.
3-17 (f) In prescribing psychoactive medication, a treating
3-18 physician shall:
3-19 (1) prescribe, consistent with clinically appropriate
3-20 medical care, the medication that has the fewest side effects or
3-21 the least potential for adverse side effects, unless the class of
3-22 medication has been demonstrated or justified not to be effective
3-23 clinically; and
3-24 (2) prescribe the smallest therapeutically acceptable
3-25 dosages of medication for the resident's condition.
3-26 (g) If a physician prescribes psychoactive medication to a
3-27 resident without the resident's consent because the resident is
3-28 having a medication-related emergency:
3-29 (1) the physician shall document in the resident's
3-30 clinical record in specific medical or behavioral terms the
3-31 necessity of the order and that the physician has evaluated but
3-32 rejected other generally accepted, less intrusive forms of
3-33 treatment, if any; and
3-34 (2) treatment of the resident with the psychoactive
3-35 medication shall be provided in the manner, consistent with
3-36 clinically appropriate medical care, least restrictive of the
3-37 resident's personal liberty.
3-38 SECTION 3. This Act takes effect immediately if it receives
3-39 a vote of two-thirds of all the members elected to each house, as
3-40 provided by Section 39, Article III, Texas Constitution. If this
3-41 Act does not receive the vote necessary for immediate effect, this
3-42 Act takes effect September 1, 2001.
3-43 * * * * *