78R8244 T
By: Nelson S.B. No. 1320
A BILL TO BE ENTITLED
AN ACT
relating to certain advance directives for medical treatment and
medical treatment decisions.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subsection (7) of Section 166.002, Health and
Safety Code, is amended to read as follows:
(7) "Health care or treatment decision" means consent,
refusal to consent, or withdrawal of consent to health care,
treatment, service, or a procedure to maintain, diagnose, or treat
an individual's physical or mental condition, including such a
decision on behalf of a minor in accordance with the Family Code and
subject to applicable federal law and regulations relating to child
abuse and neglect to the extent applicable to the state based upon
its receipt of federal funds.
SECTION 2. Section 166.046, Health and Safety Code, is
amended by amending the heading of the section and subsections (a),
(b) and (e), inserting new subsections (f) and (g), and renumbering
the remaining subsections accordingly, to read as follows:
Sec. 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR
TREATMENT DECISION. (a) If an attending physician refuses to
honor a patient's advance directive or a health care treatment
decision made by or on behalf of a patient [under Section 166.039],
the physician's refusal shall be reviewed by an ethics or medical
committee. The attending physician may not be a member of that
committee. The patient shall be given life-sustaining treatment
during the review.
(b) The patient or the person responsible for the health
care decisions of the individual who has made the decision
regarding the directive or treatment decision:
(1) shall be informed of the committee review process
not less than 48 hours before the meeting called to discuss the
patient's directive, unless the time period is waived by mutual
agreement; [and]
(2) at the time of being so informed, shall be
provided:
(A) a copy of the appropriate statement set forth
in Section 166.052 of this subchapter; and
(B) a copy of the registry list of health care
providers and referral groups that have volunteered their readiness
to consider accepting transfer or to assist in locating a provider
willing to accept transfer, which is posted on the website
maintained by the Texas Health Care Information Council under
Section 166.053 of this subchapter; and
(3) is entitled to:
(A) attend the meeting; and
(B) receive a written explanation of the decision
reached during the review process.
(e) If the patient or the person responsible for the health
care decisions of the patient is requesting life-sustaining
treatment that the attending physician and the review process have
decided is inappropriate treatment, the patient shall be given
available life-sustaining treatment pending transfer under
Subsection (d). The patient is responsible for any costs incurred
in transferring the patient to another facility. The physician and
the health care facility are not obligated to provide
life-sustaining treatment after the 10th day after the written
decision required under Subsection (b) is provided to the patient
or the person responsible for the health care decisions of the
patient unless ordered to do so under Subsection (i) [(g)].
(f) A physician, nurse or other person acting under the
direction of a physician who participates in the stopping or
withholding of cardiopulmonary resuscitation from a qualified
patient, is not civilly or criminally liable for failure to provide
resuscitation if, in reasonable medical judgment, the patient's
death would occur within minutes to hours regardless of the
provision of resuscitation.
(g) If during a previous admission to a facility, a
patient's attending physician and the review process under
Subsection (b) have determined that life-sustaining treatment is
inappropriate, and the patient is readmitted to the same facility
within six months from the date of the decision reached during the
review process conducted upon the previous admission, the review
process described in this section may be omitted if the patient's
attending physician and a consulting physician who is a member of
the ethics or medical committee of the facility document on the
patient's readmission that the patient's condition either has not
changed or has deteriorated since the review process was conducted.
(h) [(f)] Life-sustaining treatment under this section may
not be entered in the patient's medical record as medically
unnecessary treatment until the time period provided under
Subsection (e) has expired.
(i) [(g)] At the request of the patient or the person
responsible for the health care decisions of the patient, the
appropriate district or county court shall extend the time period
provided under Subsection (e) only if the court finds, by a
preponderance of the evidence, that there is a reasonable
expectation that a physician or health care facility that will
honor the patient's directive will be found if the time extension is
granted.
(j) [(h)] This section may not be construed to impose an
obligation on a facility or a home and community support services
agency licensed under Chapter 142 or similar organization that is
beyond the scope of the services or resources of the facility or
agency. This section does not apply to hospice services provided by
a home and community support services agency licensed under Chapter
142.
SECTION 3. Chapter 166, Health and Safety Code, is amended
by adding a new Section 166.052 to read as follows:
Sec. 166.052. STATEMENTS EXPLAINING PATIENT'S RIGHT TO
TRANSFER. (a) In cases in which the attending physician refuses to
honor an advance directive or treatment decision requesting the
provision of life-sustaining treatment, the statement required by
Section 166.046(b)(2)(A) shall be in substantially the following
form:
When There Is An Ethical Disagreement About Medical Treatment: The
Physician Recommends Against Life-Sustaining Treatment That You Wish
To Continue
You have been given this information because you have requested
life-sustaining treatment* to which the attending physician
objects. This information is being provided to help you understand
state law, your rights and the resources available to you in such
circumstances. It outlines the process for resolving ethical
disagreements among patients, families and physicians. It is based
upon the Texas Advance Directive Act, codified at Texas Health and
Safety Code Section 166.046.
°
When an attending physician is unable to honor an advance
directive or other request for life-sustaining treatment because of
the physician's judgement that it would be inappropriate, he or she
will request that the case be reviewed by an ethics or medical
committee. Life-sustaining treatment will be provided through the
review.
° You will receive notification of this review no less than 48
hours before a meeting of the committee related to your case. You
are entitled to attend the meeting. With your agreement, the
meeting may be held sooner than 48 hours if possible.
°
If you wish, you are entitled to receive a written explanation of
the decision reached during the review process.
If after this review process both the attending physician and the
ethics or medical committee conclude that life-sustaining
treatment is inappropriate, and yet you continue to request such
treatment, then the following procedure will occur:
1. The physician, with the help of the health care facility, will
assist you in trying to find a physician and facility willing to
provide the requested treatment.
2. You are being given a list of health care providers and referral
groups that have volunteered their readiness to consider accepting
transfer, or to assist in locating a provider willing to accept
transfer, maintained by the Texas Health Care Information Council.
You may wish to contact providers or referral groups on the list to
get help in arranging a transfer.
3. The patient will continue to be given the requested treatment
until he or she can be transferred to a willing provider or until 10
days has passed from the time you were given the committee's written
decision that life-sustaining treatment is not appropriate.
4. If a transfer can be arranged, the patient will be responsible
for the costs of the transfer.
5. If within 10 days a provider cannot be found willing to give the
requested treatment, life-sustaining treatment may be halted
unless a court of law has granted an extension.
6. You may ask the appropriate district or county court to extend
the 10-day period if the court finds that there is a reasonable
expectation that a physician or health care facility willing to
provide life-sustaining treatment will be found if the extension is
granted. You will probably need a lawyer's help if you wish to
consider seeking this type of extension.
* "Life-sustaining treatment" means treatment that, based on
reasonable medical judgment, sustains the life of a patient and
without which the patient will die. The term includes both
life-sustaining medications and artificial life support, such as
mechanical breathing machines, kidney dialysis treatment, and
artificial nutrition and hydration. The term does not include the
administration of pain management medication or the performance of
a medical procedure considered to be necessary to provide comfort
care, or any other medical care provided to alleviate a patient's
pain.
(b) In cases in which the attending physician refuses to
honor an advance directive or treatment decision requesting the
withholding or withdrawal of life-sustaining treatment, the
statement required by Section 166.046(b)(2)(A) shall be in
substantially the following form:
When There Is An Ethical Disagreement About Medical Treatment: The
Physician Recommends Life-Sustaining Treatment That You Wish To Stop
You have been given this information because you have requested the
withdrawal or withholding of life-sustaining treatment* and the
attending physician is unwilling to honor that request. The
information is being provided to help you understand state law,
your rights and the resources available to you in such
circumstances. It outlines the process for resolving ethical
disagreements among patients, families and physicians. It is based
upon the Texas Advance Directive Act, codified at Texas Health and
Safety Code Section 166.046.
°
When an attending physician is unable to honor an advance
directive or other request for withdrawal or withholding of
treatment for any reason, he or she will request that the case be
reviewed by an ethics or medical committee. Life-sustaining
treatment will be provided through the review.
°
You will receive notification of this review no less than 48
hours before a meeting of the committee related to your case. You
are entitled to attend the meeting. With your agreement, the
meeting may be held sooner than 48 hours if possible.
°
If you wish, you are entitled to receive a written explanation of
the decision reached during the review process.
If you or the attending physician do not agree with the decision
reached during the review process, and the attending physician
still declines to comply with your request to withhold or withdraw
life-sustaining treatment:
1. The physician, with the help of the health care facility, will
assist you in trying to find a physician and facility willing to
withdraw or withhold the life-sustaining treatment.
2. You are being given a list of health care providers and referral
groups that have volunteered their readiness to consider accepting
transfer, or to assist in locating a provider willing to accept
transfer, maintained by the Texas Health Care Information Council.
You may wish to contact providers or referral groups on the list to
get help in arranging a transfer.
* "Life-sustaining treatment" means treatment that, based on
reasonable medical judgment, sustains the life of a patient and
without which the patient will die. The term includes both
life-sustaining medications and artificial life support, such as
mechanical breathing machines, kidney dialysis treatment, and
artificial nutrition and hydration. The term does not include the
administration of pain management medication or the performance of
a medical procedure considered to be necessary to provide comfort
care, or any other medical care provided to alleviate a patient's
pain.
(c) An attending physician or health care facility may, if
it chooses, include any additional information concerning the
physician's or facility's policy, perspective, experience, or
review procedure.
SECTION 4. Chapter 166, Health and Safety Code, is amended
by adding a new Section 166.053 to read as follows:
Sec. 166.053. REGISTRY TO ASSIST TRANSFERS. (a) The Texas
Health Care Information Council shall maintain a registry listing
the identity of and contact information for health care providers
and referral groups, situated inside and outside the State of
Texas, that have voluntarily notified the Council they may consider
accepting, or may assist in locating a provider willing to accept
transfer of a patient under Sections 166.045 or 166.046.
(b) The listing of a provider or referral group in the
registry described in this section does not obligate the provider
or group to accept transfer of, or provide services to, any
particular patient.
(c) The Texas Health Care Information Council shall post the
current registry list on its website in a form appropriate for easy
comprehension by patients and persons responsible for the health
care decisions of patients and shall provide a clearly identifiable
link from its home page to the registry page. The list shall
separately indicate those providers and groups that have indicated
their interest in assisting the transfer of:
(1) those patients on whose behalf life-sustaining
treatment is being sought;
(2) those patients on whose behalf the withholding or
withdrawal of life-sustaining treatment is being sought; and
(3) patients described in both subdivisions (1) and
(2) of this subsection.
(d) The registry list described in this section shall
include the following disclaimer:
"This registry lists providers and groups that have
indicated to the Texas Health Care Information Council
their interest in assisting the transfer of patients
in the circumstances described, and is provided for
information purposes only. Neither the Texas Health
Care Information Council nor the State of Texas
endorses or assumes any responsibility for any
representation, claim or act of the listed providers
or groups."
SECTION 5. Section C, Chapter 166, Health and Safety Code,
is amended by adding a new Section 166.102 to read as follows:
Sec. 166.102. PHYSICIAN'S DO-NOT-RESUSCITATE ORDER MAY BE
HONORED BY NON-EMS HEALTH CARE PROFESSIONALS. (a) Except as
provided by Subsection (b) of this section, a health care
professional may honor a physician's do-not-resuscitate order in an
out-of-hospital setting.
(b) Subsection (a) does not apply to emergency medical
services personnel, who shall honor only a properly completed
Out-of-Hospital DNR Order in accordance with this subchapter.
SECTION 6. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2003.