By: Zaffirini S.B. No. 59
(In the Senate - Filed November 12, 2002; January 27, 2003,
read first time and referred to Committee on Health and Human
Services; April 9, 2003, reported adversely, with favorable
Committee Substitute by the following vote: Yeas 7, Nays 0;
April 9, 2003, sent to printer.)
COMMITTEE SUBSTITUTE FOR S.B. No. 59 By: Zaffirini
A BILL TO BE ENTITLED
AN ACT
relating to the management of behavior of residents of certain
facilities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle G, Title 4, Health and Safety Code, is
amended by adding Chapter 322 to read as follows:
CHAPTER 322. USE OF RESTRAINT AND SECLUSION IN CERTAIN
HEALTH CARE FACILITIES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 322.001. DEFINITIONS. In this chapter:
(1) "Facility" means:
(A) a child-care institution, as defined by
Section 42.002, Human Resources Code, including a state-operated
facility, that is a residential treatment center or a child-care
institution serving children with mental retardation;
(B) an intermediate care facility licensed by the
Texas Department of Human Services under Chapter 252 or operated by
the Texas Department of Mental Health and Mental Retardation and
exempt under Section 252.003 from the licensing requirements of
that chapter;
(C) a mental hospital or mental health facility,
as defined by Section 571.003;
(D) an institution, as defined by Section
242.002;
(E) an assisted living facility, as defined by
Section 247.002; or
(F) a treatment facility, as defined by Section
464.001.
(2) "Health and human services agency" means an agency
listed in Section 531.001, Government Code.
(3) "Seclusion" means the involuntary separation of a
resident from other residents alone in any area from which the
resident is prevented from leaving.
[Sections 322.002–322.050 reserved for expansion]
SUBCHAPTER B. RESTRAINTS AND SECLUSION
Sec. 322.051. CERTAIN RESTRAINTS PROHIBITED. (a) A person
may not administer a restraint to a resident of a facility that:
(1) obstructs the resident's airway;
(2) impairs the resident's breathing by putting
pressure on the torso; or
(3) interferes with the resident's ability to
communicate.
(b) A person may use a prone or supine hold on the resident
of a facility only if the person:
(1) limits the hold to no longer than the time period
specified by rules adopted under Section 322.052;
(2) uses the hold only as a last resort when other less
restrictive interventions are ineffective under the circumstances;
and
(3) uses the hold only when a staff member ensures the
resident's breathing is not impaired.
Sec. 322.052. ADOPTION OF RESTRAINT AND SECLUSION
PROCEDURES. (a) Each health and human services agency that
regulates the care or treatment of a resident at a facility shall
adopt rules to:
(1) define acceptable restraint holds that minimize
the risk of harm to a facility resident in accordance with this
subchapter; and
(2) govern the use of seclusion of facility residents.
(b) The rules must permit prone and supine holds only as
transitional holds for use on a resident of a facility.
(c) A facility may adopt procedures for the facility's use
of restraint and seclusion on a resident that regulate the use of
restraint and seclusion more restrictively than is required by a
rule of the regulating health and human services agency.
Sec. 322.053. NOTIFICATION. A health and human services
agency shall adopt rules to ensure that each facility resident and
the resident's legally authorized representative is notified of the
agency's rules and policies related to restraints and seclusion.
Sec. 322.054. MEDICAID WAIVER PROGRAM. A contractor that
provides supervised living under a Medicaid waiver program for a
facility shall comply with this chapter and rules adopted under
this chapter in the same manner as a facility.
SECTION 2. Subchapter B, Chapter 242, Health and Safety
Code, is amended by adding Section 242.0373 to read as follows:
Sec. 242.0373. RESTRAINT AND SECLUSION. A person providing
services to a resident of an institution shall comply with Chapter
322 and the rules adopted under that chapter.
SECTION 3. Subchapter B, Chapter 247, Health and Safety
Code, is amended by adding Section 247.0255 to read as follows:
Sec. 247.0255. RESTRAINT AND SECLUSION. A person providing
services to a resident of an assisted living facility shall comply
with Chapter 322 and the rules adopted under that chapter.
SECTION 4. Subchapter A, Chapter 252, Health and Safety
Code, is amended by adding Section 252.0085 to read as follows:
Sec. 252.0085. RESTRAINT AND SECLUSION. A person providing
services to a resident of a facility licensed by the department
under this chapter or operated by the Texas Department of Mental
Health and Mental Retardation and exempt under Section 252.003 from
the licensing requirements of this chapter shall comply with
Chapter 322 and the rules adopted under that chapter.
SECTION 5. Subchapter A, Chapter 464, Health and Safety
Code, is amended by adding Section 464.0095 to read as follows:
Sec. 464.0095. RESTRAINT AND SECLUSION. A person providing
services to a program client at a treatment facility shall comply
with Chapter 322 and the rules adopted under that chapter.
SECTION 6. Chapter 571, Health and Safety Code, is amended
by adding Section 571.0067 to read as follows:
Sec. 571.0067. RESTRAINT AND SECLUSION. A person providing
services to a patient of a mental hospital or mental health facility
shall comply with Chapter 322 and the rules adopted under that
chapter.
SECTION 7. Subchapter C, Chapter 42, Human Resources Code,
is amended by adding Section 42.0422 to read as follows:
Sec. 42.0422. RESTRAINT AND SECLUSION. A person providing
services to a resident of a child-care institution, including a
state-operated facility that is a residential treatment center or a
child-care institution serving children with mental retardation
shall comply with Chapter 322, Health and Safety Code, and the rules
adopted under that chapter.
SECTION 8. (a) In this section:
(1) "Commissioner" means the commissioner of health
and human services.
(2) "Emergency" means a situation in which attempted
preventive de-escalatory or redirection techniques have not
effectively reduced the potential for injury and it is immediately
necessary to intervene to prevent:
(A) imminent probable death or substantial
bodily harm to the person because the person overtly or continually
is threatening to or attempting to commit suicide or serious bodily
harm; or
(B) imminent physical harm to another because the
person overtly or continually makes or commits threats, attempts,
or other acts.
(3) "Facility" has the meaning assigned by Section
322.001, Health and Safety Code, as added by this Act.
(4) "Health and human services agency" means a health
and human services agency listed in Section 531.001, Government
Code, that regulates the care or treatment of a resident of a
facility.
(b) The commissioner shall, not later than November 1, 2003,
establish a work group to develop and recommend best practices in
policy, training, safety, and risk management for a health and
human services agency to adopt to govern the management of facility
residents' behavior.
(c) The commissioner shall determine the number of members
to serve on the work group. The commissioner shall appoint as
members of the work group:
(1) a representative of the Texas Department of
Health;
(2) a representative of the Texas Department of Human
Services;
(3) a representative of the Texas Department of Mental
Health and Mental Retardation;
(4) a representative of the Department of Protective
and Regulatory Services;
(5) a representative of the Texas Commission on
Alcohol and Drug Abuse; and
(6) additional members who are recognized experts or
who represent the interest of residents, including advocates,
family members, physicians, representatives of hospitals licensed
under Chapter 241 or 577, Health and Safety Code, social workers,
and psychiatric nurses.
(d) The work group shall conduct a study and shall:
(1) develop a comprehensive reporting system that:
(A) collects and analyzes data related to the use
of:
(i) behavioral and physical interventions
by employees of a facility to manage the behavior of the residents
of a facility in an emergency; and
(ii) medication administered by employees
to a resident without the resident's consent in an emergency;
(B) complies with federal reporting
requirements;
(C) documents the death or serious injury of a
facility resident related to physical intervention or restraint,
including the administration of medication, by an employee; and
(D) documents the death or serious injury of an
employee during a physical intervention or restraint;
(2) make recommendations to prevent the death of or
serious injury to residents of a facility related to physical
intervention or restraint, including the administration of
medication;
(3) recommend de-escalation techniques and minimum
standards to manage the behavior of the residents of a facility;
(4) identify best practices for verbal, behavioral,
and physical interventions by employees that include specific holds
and techniques for the physical restraint of facility residents;
(5) recommend best practices related to specific
populations, including any consideration that should be given to a
facility's community or institutional setting; and
(6) recommend best practices related to seclusion of
residents.
(e) In developing the best practices, the work group shall:
(1) focus on the verbal, behavioral, and physical
interventions used by facility employees to manage the behavior of
the residents of a facility; and
(2) ensure uniformity in definitions, reporting, and
training used by health and human services agencies.
(f) Not later than November 1, 2004, each health and human
services agency shall adopt rules necessary to implement Sections
322.051, 322.052, and 322.053, Health and Safety Code, as added by
this Act.
(g) Not later than November 1, 2004, the commissioner shall
file a report with the appropriate committees of the senate and the
house of representatives. The report must describe the work
group's recommended best practices.
(h) Not later than November 1, 2004, each health and human
services agency shall adopt rules necessary to implement the best
practices recommended by the work group.
(i) Not later than January 1, 2005, the commissioner shall
file a report with the appropriate committees of the senate and the
house of representatives for consideration by the 79th Legislature.
The report must describe the actions taken by health and human
services agencies to implement the best practices identified by the
work group, including appropriate staff and training.
SECTION 9. This Act takes effect September 1, 2003.
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