BILL ANALYSIS |
|
C.S.S.B. 11 |
|
By: Perry |
|
State Affairs |
|
Committee Report (Substituted) |
|
BACKGROUND AND PURPOSE
Interested parties contend that the law relating to do-not-resuscitate (DNR) orders does not provide adequate direction for the execution of a DNR order within a health care facility or hospital. C.S.S.B. 11 seeks to remedy this situation by setting out provisions relating to the proper execution of a valid DNR order for use in a health care facility or hospital.
|
||||||||||
|
CRIMINAL JUSTICE IMPACT
It is the committee's opinion that this bill expressly does one or more of the following: creates a criminal offense, increases the punishment for an existing criminal offense or category of offenses, or changes the eligibility of a person for community supervision, parole, or mandatory supervision.
|
||||||||||
|
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.S.B. 11 amends the Health and Safety Code to make a do-not-resuscitate (DNR) order issued for a patient in a health care facility or hospital valid only if the patient's attending physician issues the order, the order is dated, and the order is not contrary to the directions of a patient who was competent at the time the patient conveyed the directions and, in the reasonable medical judgment of the patient's attending physician, the patient's death is imminent, regardless of the provision of cardiopulmonary resuscitation, and the DNR order is medically appropriate or only if the patient's attending physician issues the order, the order is dated, and the order is issued in compliance with the following: the written and dated directions of a patient who was competent at the time the patient wrote the directions; the oral directions of a competent patient delivered to or observed by two competent adult witnesses, at least one of whom must be a person not listed under certain statutory provisions relating to witnesses of an advance directive; the directions in an enforceable advance directive executed in another jurisdiction or an applicable advance directive executed by certain adults or on behalf of a qualified patient who is younger than 18 years of age; the directions of a patient's legal guardian or agent acting under a lawful medical power of attorney; or a treatment decision made in accordance with statutory provisions relating to a person who has not executed or issued a directive and is incompetent or incapable of communication. The bill defines "DNR order" for purposes of its provisions as an order instructing a health care professional not to attempt cardiopulmonary resuscitation on a patient whose circulatory or respiratory function ceases.
C.S.S.B. 11 establishes that a DNR order takes effect at the time the order is issued, provided the order is placed in the patient's medical record as soon as practicable. The bill requires the physician, physician assistant, nurse, or other person acting on behalf of a health care facility or hospital, before placing in a patient's medical record a DNR order that is not contrary to the directions of a patient who was competent at the time the patient conveyed the directions and that is issued under circumstances in which in the reasonable medical judgment of the patient's attending physician the patient's death is imminent, regardless of the provision of cardiopulmonary resuscitation, and the DNR order is medically appropriate, to inform the patient of the order's issuance or, if the patient is incompetent, make a reasonably diligent effort to contact or cause to be contacted and inform of the order's issuance the patient's known agent under a medical power of attorney or legal guardian or, for a patient who does not have a known agent under a medical power of attorney or legal guardian, the patient's spouse, the patient's reasonably available adult children, or the patient's parents. The bill establishes that, to the extent a DNR order issued in compliance as provided by the bill conflicts with a treatment decision or advance directive validly executed or issued under the Advance Directives Act, the treatment decision made in compliance with the bill's provisions, advance directive validly executed or issued as described by those provisions, or DNR order dated and validly executed or issued in compliance with those provisions later in time controls. The bill sets out provisions relating to notice requirements for DNR orders and the revocation of DNR orders and a related limitation of liability.
C.S.S.B. 11 requires an attending physician, health care facility, or hospital that does not wish to execute or comply with a DNR order or the patient's instructions concerning the provision of cardiopulmonary resuscitation to inform the patient, the legal guardian or qualified relatives of the patient, or the agent of the patient under a medical power of attorney of the benefits and burdens of cardiopulmonary resuscitation. The bill requires the attending physician, facility, or hospital, if, after receiving such notice, the patient or another person authorized to act on behalf of the patient and the attending physician, health care facility, or hospital remain in disagreement, to make a reasonable effort to transfer the patient to another physician, facility, or hospital willing to execute or comply with a DNR order or the patient's instructions concerning the provision of cardiopulmonary resuscitation. The bill prohibits these procedures from being construed to control or supersede certain other bill provisions relating to the validity of a DNR order.
C.S.S.B. 11 exempts a physician, health care professional, health care facility, hospital, or entity that in good faith issues a DNR order under the bill's provisions or that, in accordance with those provisions, causes cardiopulmonary resuscitation to be withheld or withdrawn from a patient in accordance with a DNR order issued under those provisions from civil or criminal liability or from being subject to review or disciplinary action by the appropriate licensing authority for that action. The bill exempts a physician, health care professional, health care facility, hospital, or entity that has no actual knowledge of a DNR order from civil or criminal liability or from being subject to review or disciplinary action by the appropriate licensing authority for failing to act in accordance with the order.
C.S.S.B. 11 creates a Class A misdemeanor offense for a physician, physician assistant, nurse, or other person who intentionally conceals, cancels, effectuates, or falsifies another person's DNR order or who intentionally conceals or withholds personal knowledge of another person's revocation of a DNR order in violation of the bill's provisions. The bill establishes that such offense does not preclude prosecution for any other applicable offense. The bill subjects a physician, health care professional, health care facility, hospital, or entity to review and disciplinary action by the appropriate licensing authority for intentionally failing to effectuate a DNR order in violation of the bill's provisions or for intentionally issuing a DNR order in violation of those provisions.
C.S.S.B. 11 expressly applies to a DNR order issued in a health care facility or hospital and expressly does not apply to an out‑of‑hospital DNR order as defined under the Advance Directives Act. The bill requires the executive commissioner of the Health and Human Services Commission to adopt rules necessary to implement the bill's provisions.
|
||||||||||
|
EFFECTIVE DATE
April 1, 2018.
|
||||||||||
|
COMPARISON OF SENATE ENGROSSED AND SUBSTITUTE
While C.S.S.B. 11 may differ from the engrossed in minor or nonsubstantive ways, the following comparison is organized and formatted in a manner that indicates the substantial differences between the engrossed and committee substitute versions of the bill.
|
||||||||||
|