1-1 By: Moncrief, et al. S.B. No. 876 1-2 (In the Senate - Filed February 22, 2001; February 26, 2001, 1-3 read first time and referred to Committee on Health and Human 1-4 Services; April 10, 2001, reported adversely, with favorable 1-5 Committee Substitute by the following vote: Yeas 6, Nays 1; 1-6 April 10, 2001, sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 876 By: Moncrief 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to the administration of restraint, seclusion, and 1-11 emergency psychoactive medication to residents of certain health 1-12 care facilities. 1-13 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-14 SECTION 1. Subtitle G, Title 4, Health and Safety Code, is 1-15 amended by adding Chapter 322 to read as follows: 1-16 CHAPTER 322. ADMINISTRATION OF RESTRAINT, SECLUSION, AND EMERGENCY 1-17 PSYCHOACTIVE MEDICATION IN CERTAIN 1-18 HEALTH CARE FACILITIES 1-19 Sec. 322.001. FINDINGS. The legislature finds that: 1-20 (1) an individual has the right to be free from the 1-21 imposition of restraint or seclusion for management of the 1-22 individual's behavior unless the individual is presenting an 1-23 imminent risk of harm to self or others; 1-24 (2) an individual has the right to be free from the 1-25 imposition of restraint or seclusion as a means of coercion or 1-26 discipline of, or retaliation against, the individual and free from 1-27 the imposition of restraint or coercion for the convenience of a 1-28 health care worker; 1-29 (3) an individual has the right to an individualized 1-30 plan for the individual's treatment or care that provides for 1-31 freedom of movement in a safe environment; and 1-32 (4) an individual should not be restrained or secluded 1-33 except in accordance with safe and appropriate techniques 1-34 corresponding to the individual's condition. 1-35 Sec. 322.002. DEFINITIONS. In this chapter: 1-36 (1) "Facility" means: 1-37 (A) a child-care institution, as defined by 1-38 Section 42.002, Human Resources Code, that is licensed by the 1-39 Department of Protective and Regulatory Services as a residential 1-40 treatment center or an institution serving children with mental 1-41 retardation; 1-42 (B) an intermediate care facility licensed by 1-43 the Texas Department of Human Services under Chapter 252 or 1-44 operated by the Texas Department of Mental Health and Mental 1-45 Retardation and exempt under Section 252.003 from the licensing 1-46 requirements of that chapter; 1-47 (C) a mental hospital or mental health facility, 1-48 as defined by Section 571.003; 1-49 (D) a nursing facility, as defined by Section 1-50 242.301; or 1-51 (E) an assisted living facility, as defined by 1-52 Section 247.002. 1-53 (2) "Health and human services agency" means an agency 1-54 listed in Section 531.001, Government Code. 1-55 Sec. 322.003. APPLICABILITY. This chapter applies to a 1-56 health and human services agency that regulates the care or 1-57 treatment of a resident of a facility. 1-58 Sec. 322.004. ADOPTION OF PROCEDURES. (a) A health and 1-59 human services agency by rule shall adopt procedures for 1-60 administering to a resident of a facility: 1-61 (1) mechanical restraint; 1-62 (2) personal restraint; 1-63 (3) seclusion; 1-64 (4) emergency psychoactive medication; and 2-1 (5) supportive and protective devices. 2-2 (b) The procedures must be consistent with this chapter and 2-3 with the right of a resident to be free from: 2-4 (1) physical or mental abuse; 2-5 (2) corporal punishment; and 2-6 (3) the use of restraints or seclusion: 2-7 (A) as punishment; 2-8 (B) as a substitute for treatment or 2-9 habilitation; 2-10 (C) for the convenience of facility staff; or 2-11 (D) to compensate for a lack of facility staff. 2-12 Sec. 322.005. STAFF TRAINING. A facility shall provide to 2-13 its staff, annually or more frequently if necessary, 2-14 competency-based training on: 2-15 (1) the prevention and de-escalation of a resident's 2-16 aggressive behavior; and 2-17 (2) the safe administration of mechanical and personal 2-18 restraints. 2-19 Sec. 322.006. REPORT OF DEATH OR INJURY DURING OR AFTER 2-20 RESTRAINT, SECLUSION, OR EMERGENCY PSYCHOACTIVE MEDICATION. (a) A 2-21 facility shall report to the appropriate law enforcement or 2-22 regulatory agencies for investigation each death of or serious 2-23 injury to a resident of the facility that occurs during the 2-24 administration of, or less than 48 hours after the termination of 2-25 the administration of, restraint, seclusion, or emergency 2-26 psychoactive medication to the resident. 2-27 (b) Each health and human services agency by rule shall 2-28 adopt methods and procedures for reports required by Subsection (a) 2-29 to be made by a facility under the agency's jurisdiction. 2-30 Sec. 322.007. REPORTS ON ADMINISTRATION OF RESTRAINT, 2-31 SECLUSION, AND PSYCHOACTIVE MEDICATION. (a) Each quarter, a 2-32 health and human services agency that regulates a facility shall 2-33 collect information related to the facility's administration to the 2-34 facility's residents in emergencies of restraint, seclusion, and 2-35 psychoactive medication. 2-36 (b) The information must include: 2-37 (1) the age, race, sex, and number of residents on 2-38 whom restraint, seclusion, or psychoactive medication is 2-39 administered; and 2-40 (2) autopsy findings for each death of a resident that 2-41 occurs before the 15th day after the date of the use of restraint, 2-42 seclusion, or psychoactive medication, if an autopsy is performed. 2-43 (c) The agency annually shall submit an analysis of the 2-44 information collected under this section to the Health and Human 2-45 Services Commission, the governor, and the presiding officer of 2-46 each house of the legislature. 2-47 (d) Each health and human services agency by rule shall 2-48 adopt methods and procedures for reporting the analysis required by 2-49 Subsection (c). The agency must de-identify any information 2-50 regarding individual residents or facilities. 2-51 Sec. 322.008. CERTAIN RESTRAINTS PROHIBITED. A person may 2-52 not administer a restraint to a resident of a facility that: 2-53 (1) maintains the resident in a face-down posture 2-54 while pressure is placed on the resident's back; 2-55 (2) obstructs the resident's airway; 2-56 (3) impairs the resident's breathing; or 2-57 (4) restricts the resident's ability to communicate. 2-58 Sec. 322.009. NEGOTIATED RULEMAKING. A health and human 2-59 services agency in adopting rules under this subchapter that affect 2-60 a facility under the jurisdiction of the agency shall use the 2-61 procedures provided by Chapter 2008, Government Code. 2-62 Sec. 322.010. MEMORANDUM OF UNDERSTANDING. (a) The 2-63 commissioner of health and human services and the health and human 2-64 services agencies required to adopt rules under this chapter shall 2-65 execute a memorandum of understanding to ensure that procedures and 2-66 definitions of terms adopted by the agencies in rules under this 2-67 chapter are consistent: 2-68 (1) among the agencies; and 2-69 (2) with federal and state laws and rules regarding 3-1 the use of restraint, seclusion, or emergency psychoactive 3-2 medication. 3-3 (b) The Health and Human Services Commission shall adopt the 3-4 memorandum by rule. 3-5 (c) The commissioner of health and human services and the 3-6 health and human services agencies shall review the memorandum 3-7 annually and revise the memorandum as necessary. 3-8 SECTION 2. A health and human services agency described by 3-9 Section 322.003, Health and Safety Code, as added by this Act, 3-10 shall adopt rules as necessary to implement Chapter 322, Health and 3-11 Safety Code, as added by this Act, not later than March 1, 2002. 3-12 SECTION 3. This Act takes effect September 1, 2001, except 3-13 that Section 1 takes effect March 1, 2002. 3-14 * * * * *