By: Moncrief, et al. S.B. No. 876 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the administration of restraint, seclusion, and 1-3 emergency psychoactive medication to residents of certain health 1-4 care facilities. 1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-6 SECTION 1. Subtitle G, Title 4, Health and Safety Code, is 1-7 amended by adding Chapter 322 to read as follows: 1-8 CHAPTER 322. ADMINISTRATION OF RESTRAINT, SECLUSION, AND EMERGENCY 1-9 PSYCHOACTIVE MEDICATION IN CERTAIN 1-10 HEALTH CARE FACILITIES 1-11 Sec. 322.001. FINDINGS. The legislature finds that: 1-12 (1) an individual has the right to be free from the 1-13 imposition of restraint or seclusion for management of the 1-14 individual's behavior unless the individual is presenting an 1-15 imminent risk of harm to self or others; 1-16 (2) an individual has the right to be free from the 1-17 imposition of restraint or seclusion as a means of coercion or 1-18 discipline of, or retaliation against, the individual and free from 1-19 the imposition of restraint or coercion for the convenience of a 1-20 health care worker; 1-21 (3) an individual has the right to an individualized 1-22 plan for the individual's treatment or care that provides for 1-23 freedom of movement in a safe environment; and 1-24 (4) an individual should not be restrained or secluded 1-25 except in accordance with safe and appropriate techniques 2-1 corresponding to the individual's condition. 2-2 Sec. 322.002. DEFINITIONS. In this chapter: 2-3 (1) "Facility" means: 2-4 (A) a child-care institution, as defined by 2-5 Section 42.002, Human Resources Code, that is licensed by the 2-6 Department of Protective and Regulatory Services as a residential 2-7 treatment center or an institution serving children with mental 2-8 retardation; 2-9 (B) an intermediate care facility licensed by 2-10 the Texas Department of Human Services under Chapter 252 or 2-11 operated by the Texas Department of Mental Health and Mental 2-12 Retardation and exempt under Section 252.003 from the licensing 2-13 requirements of that chapter; 2-14 (C) a mental hospital or mental health facility, 2-15 as defined by Section 571.003; 2-16 (D) a nursing facility, as defined by Section 2-17 242.301; or 2-18 (E) an assisted living facility, as defined by 2-19 Section 247.002. 2-20 (2) "Health and human services agency" means an agency 2-21 listed in Section 531.001, Government Code. 2-22 Sec. 322.003. APPLICABILITY. This chapter applies to a 2-23 health and human services agency that regulates the care or 2-24 treatment of a resident of a facility. 2-25 Sec. 322.004. ADOPTION OF PROCEDURES. (a) A health and 2-26 human services agency by rule shall adopt procedures for 3-1 administering to a resident of a facility: 3-2 (1) mechanical restraint; 3-3 (2) personal restraint; 3-4 (3) seclusion; 3-5 (4) emergency psychoactive medication; and 3-6 (5) supportive and protective devices. 3-7 (b) The procedures must be consistent with this chapter and 3-8 with the right of a resident to be free from: 3-9 (1) physical or mental abuse; 3-10 (2) corporal punishment; and 3-11 (3) the use of restraints or seclusion: 3-12 (A) as punishment; 3-13 (B) as a substitute for treatment or 3-14 habilitation; 3-15 (C) for the convenience of facility staff; or 3-16 (D) to compensate for a lack of facility staff. 3-17 Sec. 322.005. STAFF TRAINING. A facility shall provide to 3-18 its staff, annually or more frequently if necessary, 3-19 competency-based training on: 3-20 (1) the prevention and de-escalation of a resident's 3-21 aggressive behavior; and 3-22 (2) the safe administration of mechanical and personal 3-23 restraints. 3-24 Sec. 322.006. REPORT OF DEATH OR INJURY DURING OR AFTER 3-25 RESTRAINT, SECLUSION, OR EMERGENCY PSYCHOACTIVE MEDICATION. (a) A 3-26 facility shall report to the appropriate law enforcement or 4-1 regulatory agencies for investigation each death of or serious 4-2 injury to a resident of the facility that occurs during the 4-3 administration of, or less than 48 hours after the termination of 4-4 the administration of, restraint, seclusion, or emergency 4-5 psychoactive medication to the resident. 4-6 (b) Each health and human services agency by rule shall 4-7 adopt methods and procedures for reports required by Subsection (a) 4-8 to be made by a facility under the agency's jurisdiction. 4-9 Sec. 322.007. REPORTS ON ADMINISTRATION OF RESTRAINT, 4-10 SECLUSION, AND PSYCHOACTIVE MEDICATION. (a) Each quarter, a 4-11 health and human services agency that regulates a facility shall 4-12 collect information related to the facility's administration to the 4-13 facility's residents in emergencies of restraint, seclusion, and 4-14 psychoactive medication. 4-15 (b) The information must include: 4-16 (1) the age, race, sex, and number of residents on 4-17 whom restraint, seclusion, or psychoactive medication is 4-18 administered; and 4-19 (2) autopsy findings for each death of a resident that 4-20 occurs before the 15th day after the date of the use of restraint, 4-21 seclusion, or psychoactive medication, if an autopsy is performed. 4-22 (c) The agency annually shall submit an analysis of the 4-23 information collected under this section to the Health and Human 4-24 Services Commission, the governor, and the presiding officer of 4-25 each house of the legislature. 4-26 (d) Each health and human services agency by rule shall 5-1 adopt methods and procedures for reporting the analysis required by 5-2 Subsection (c). The agency must de-identify any information 5-3 regarding individual residents or facilities. 5-4 Sec. 322.008. CERTAIN RESTRAINTS PROHIBITED. A person may 5-5 not administer a restraint to a resident of a facility that: 5-6 (1) maintains the resident in a face-down posture 5-7 while pressure is placed on the resident's back; 5-8 (2) obstructs the resident's airway; 5-9 (3) impairs the resident's breathing; or 5-10 (4) restricts the resident's ability to communicate. 5-11 Sec. 322.009. NEGOTIATED RULEMAKING. A health and human 5-12 services agency in adopting rules under this subchapter that affect 5-13 a facility under the jurisdiction of the agency shall use the 5-14 procedures provided by Chapter 2008, Government Code. 5-15 Sec. 322.010. MEMORANDUM OF UNDERSTANDING. (a) The 5-16 commissioner of health and human services and the health and human 5-17 services agencies required to adopt rules under this chapter shall 5-18 execute a memorandum of understanding to ensure that procedures and 5-19 definitions of terms adopted by the agencies in rules under this 5-20 chapter are consistent: 5-21 (1) among the agencies; and 5-22 (2) with federal and state laws and rules regarding 5-23 the use of restraint, seclusion, or emergency psychoactive 5-24 medication. 5-25 (b) The Health and Human Services Commission shall adopt the 5-26 memorandum by rule. 6-1 (c) The commissioner of health and human services and the 6-2 health and human services agencies shall review the memorandum 6-3 annually and revise the memorandum as necessary. 6-4 SECTION 2. A health and human services agency described by 6-5 Section 322.003, Health and Safety Code, as added by this Act, 6-6 shall adopt rules as necessary to implement Chapter 322, Health and 6-7 Safety Code, as added by this Act, not later than March 1, 2002. 6-8 SECTION 3. This Act takes effect September 1, 2001, except 6-9 that Section 1 takes effect March 1, 2002.