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A BILL TO BE ENTITLED
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AN ACT
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relating to certain do-not-resuscitate orders and advance |
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directives; providing penalties. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 166, Health and Safety |
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Code, is amended by adding Section 166.012 to read as follows: |
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Sec. 166.012. RULES; DNR ORDERS APPLICABLE IN-HOSPITAL. |
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The executive commissioner of the Health and Human Services |
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Commission shall, on recommendations of the department, adopt all |
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reasonable and necessary rules to carry out the purposes of this |
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chapter, including rules to explicitly specify that a |
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do-not-resuscitate order contained in an advance directive that is |
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applicable in a hospital setting is valid only if it is issued in |
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compliance with: |
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(1) the directions of the patient, if competent; |
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(2) the directions in an advance directive issued in |
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accordance with Section 166.005 or 166.032; |
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(3) the directions of the patient's legal guardian or |
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agent under a medical power of attorney; or |
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(4) a treatment decision made in accordance with |
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Section 166.039. |
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SECTION 2. Section 166.081(6), Health and Safety Code, is |
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amended to read as follows: |
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(6) "Out-of-hospital DNR order": |
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(A) means a legally binding out-of-hospital |
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do-not-resuscitate order, in the form specified by the board under |
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Section 166.083, prepared and signed in accordance with Section |
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166.082, 166.084, or 166.085 [by the attending physician of a
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person], that documents the instructions of a person or the |
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person's legally authorized representative and directs health care |
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professionals acting in an out-of-hospital setting not to initiate |
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or continue the following life-sustaining treatment: |
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(i) cardiopulmonary resuscitation; |
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(ii) advanced airway management; |
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(iii) artificial ventilation; |
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(iv) defibrillation; |
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(v) transcutaneous cardiac pacing; and |
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(vi) other life-sustaining treatment |
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specified by the board under Section 166.101(a); and |
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(B) does not include authorization to withhold |
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medical interventions or therapies considered necessary to provide |
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comfort care or to alleviate pain or to provide fluids [water] or |
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nutrition, including fluids or nutrition by mouth or by nasogastric |
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tube or artificial nutrition and hydration. |
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SECTION 3. Section 166.092, Health and Safety Code, is |
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amended by adding Subsections (a-1), (b-1), and (b-2) to read as |
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follows: |
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(a-1) A legal guardian, a qualified relative, or the agent |
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of the declarant having a medical power of attorney may revoke an |
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out-of-hospital DNR order if the person has reason to believe that |
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the order was not executed in accordance with this subchapter. The |
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person may revoke the order by: |
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(1) identifying himself or herself as a legal |
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guardian, a qualified relative, or the agent of the declarant |
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having a medical power of attorney; |
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(2) orally stating that the person has reason to |
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believe that the order was not executed in accordance with law; and |
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(3) destroying the order form and removing the DNR |
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identification device, if any, or orally stating the person's |
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intent to revoke the order. |
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(b-1) A revocation under Subsection (a-1) takes effect only |
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when a person who identifies himself or herself as a legal guardian, |
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a qualified relative, or the agent of the declarant having a medical |
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power of attorney states in the presence of the responding health |
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care professionals or the attending physician at the scene that the |
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person has reason to believe that the order was not executed in |
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accordance with law and communicates the intent to revoke the order |
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to the responding health care professionals or the attending |
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physician at the scene. The responding health care professionals |
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shall record the time, date, and place of the revocation in |
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accordance with the statewide out-of-hospital DNR protocol and |
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rules adopted under this chapter and any applicable local |
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out-of-hospital DNR protocol. The attending physician or the |
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physician's designee shall record in the person's medical record |
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the time, date, and place of the revocation and, if different, the |
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time, date, and place that the physician received notice of the |
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revocation. The attending physician or the physician's designee |
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shall also enter the word "VOID" on each page of the copy of the |
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order in the person's medical record. |
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(b-2) If a health care professional fails to comply with a |
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revocation under Subsection (a-1), the legal guardian, qualified |
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relative, or agent of the declarant having a medical power of |
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attorney may obtain an injunction to enforce the revocation. |
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SECTION 4. Section 166.097, Health and Safety Code, is |
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amended by adding Subsection (c) to read as follows: |
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(c) A physician commits an offense if the physician |
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knowingly executes an out-of-hospital DNR order that is not in |
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compliance with the provisions of this subchapter. An offense |
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under this subsection is a felony of the third degree. |
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SECTION 5. Section 166.101(a), Health and Safety Code, is |
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amended to read as follows: |
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(a) The board shall, on the recommendation of the |
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department, adopt all reasonable and necessary rules to carry out |
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the purposes of this subchapter, including rules: |
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(1) adopting a statewide out-of-hospital DNR order |
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protocol that sets out standard procedures for the withholding of |
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cardiopulmonary resuscitation and certain other life-sustaining |
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treatment by health care professionals acting in out-of-hospital |
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settings that addresses each of the methods for executing the order |
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described in Section 166.082, subject to Sections 166.084 and |
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166.085; |
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(2) designating life-sustaining treatment that may be |
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included in an out-of-hospital DNR order, including all procedures |
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listed in Sections 166.081(6)(A)(i) through (v); and |
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(3) governing recordkeeping in circumstances in which |
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an out-of-hospital DNR order or DNR identification device is |
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encountered by responding health care professionals. |
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SECTION 6. Not later than December 1, 2011, the executive |
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commissioner of the Health and Human Services Commission shall |
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adopt the rules required by Section 166.012, Health and Safety |
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Code, as added by this Act, and Section 166.101(a), Health and |
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Safety Code, as amended by this Act. |
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SECTION 7. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2011. |