BILL ANALYSIS

C.S.H.B. 577

By: McClendon

Public Health

Committee Report (Substituted)

BACKGROUND AND PURPOSE

Emergency services personnel who are first responders to an emergency outside of a hospital must quickly evaluate whether a patient needs immediate medical attention, life support measures, or rapid transport to the hospital.  If such personnel are required to review, evaluate, and interpret written documents other than an out-of-hospital do-not-resuscitate (DNR) order, they could be prevented from attending to a patient's emergency medical needs at the scene or while traveling to a hospital.  

C.S.H.B. 577 seeks to allow emergency personnel to focus on the immediate medical needs of a patient when responding to an emergency outside of the hospital environment by establishing that such personnel have no duty to review, examine, interpret, or honor a person's written directive other than certain out-of-hospital DNR orders and by providing for the termination of cardiopulmonary resuscitation on the order of certain physicians or an emergency medical services system's medical director or online physician. 

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

C.S.H.B. 577 amends the Health and Safety Code to establish that emergency medical services personnel responding to a call for assistance have no duty to review, examine, interpret, or honor a person's written directive, including a written directive in the form prescribed by provisions of law relating to directives to physicians, other than a properly executed or issued out-of-hospital do-not-resuscitate (DNR) order or prescribed DNR identification device. 

C.S.H.B. 577 authorizes a person's personal physician who is present while a person is receiving emergency prehospital care, and who assumes responsibility for the care of the person under applicable requirements of the Texas Administrative Code while the person is receiving emergency prehospital care, to order the termination of cardiopulmonary resuscitation only if, based on the physician's professional medical judgment, the physician determines that resuscitation should be discontinued.  The bill requires the emergency medical services system's medical director or online physician, if a person's personal physician is not present or does not assume responsibility for the care of the person while the person is receiving emergency prehospital care, to be responsible for directing the emergency medical services personnel who are providing emergency prehospital care to a person and authorizes the director or online physician, under such circumstances, to order the termination of cardiopulmonary resuscitation only if, based on the medical director's or online physician's professional medical judgment, the medical director or online physician determines that resuscitation should be discontinued.  The bill specifies that emergency medical personnel who are providing emergency prehospital care to a person are subject to provisions of law relating to advance written directives.  The bill provides for the meaning of "cardiopulmonary resuscitation" by reference. 

EFFECTIVE DATE

On passage, or, if the bill does not receive the necessary vote, September 1, 2011.

COMPARISON OF ORIGINAL AND SUBSTITUTE

C.S.H.B. 577 omits provisions included in the original providing for the meaning of "emergency medical services personnel" and "emergency prehospital care" by reference to the Health and Safety Code.  The substitute differs from the original by establishing that emergency medical services personnel responding to a call for assistance have no duty to review, examine, interpret, or honor a person's written directive other than a properly executed or issued out-of-hospital do-not-resuscitate (DNR) order or prescribed DNR identification device, whereas the original establishes that emergency medical services personnel who are providing emergency prehospital care to a person are not required to review, examine, interpret, or honor a person's written directive.

C.S.H.B. 577 differs from the original by authorizing a person's personal physician who is present while a person is receiving emergency prehospital care and who assumes responsibility for the care of the person under such circumstances to order the termination of cardiopulmonary resuscitation under certain conditions, whereas the original makes that authorization applicable to a physician who is present while a person is receiving emergency prehospital care. 

C.S.H.B. 577 contains a provision not included in the original requiring  the emergency medical services system's medical director or online physician, if a person's personal physician is not present or does not assume responsibility for the care of the person while the person is receiving emergency prehospital care, to be responsible for directing the emergency medical services personnel who are providing emergency prehospital care to the person and authorizing the director or online physician, under such circumstances, to order the termination of cardiopulmonary resuscitation only under specified conditions.