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AN ACT
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relating to general procedures and requirements for certain |
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do-not-resuscitate orders; creating a criminal offense. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 166, Health and Safety Code, is amended |
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by adding Subchapter E to read as follows: |
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SUBCHAPTER E. HEALTH CARE FACILITY DO-NOT-RESUSCITATE ORDERS |
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Sec. 166.201. DEFINITION. In this subchapter, "DNR order" |
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means an order instructing a health care professional not to |
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attempt cardiopulmonary resuscitation on a patient whose |
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circulatory or respiratory function ceases. |
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Sec. 166.202. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies to a DNR order issued in a health care facility |
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or hospital. |
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(b) This subchapter does not apply to an out-of-hospital DNR |
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order as defined by Section 166.081. |
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Sec. 166.203. GENERAL PROCEDURES AND REQUIREMENTS FOR |
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DO-NOT-RESUSCITATE ORDERS. (a) A DNR order issued for a patient |
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is valid only if the patient's attending physician issues the |
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order, the order is dated, and the order: |
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(1) is issued in compliance with: |
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(A) the written and dated directions of a patient |
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who was competent at the time the patient wrote the directions; |
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(B) the oral directions of a competent patient |
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delivered to or observed by two competent adult witnesses, at least |
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one of whom must be a person not listed under Section 166.003(2)(E) |
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or (F); |
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(C) the directions in an advance directive |
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enforceable under Section 166.005 or executed in accordance with |
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Section 166.032, 166.034, or 166.035; |
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(D) the directions of a patient's legal guardian |
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or agent under a medical power of attorney acting in accordance with |
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Subchapter D; or |
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(E) a treatment decision made in accordance with |
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Section 166.039; or |
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(2) is not contrary to the directions of a patient who |
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was competent at the time the patient conveyed the directions and, |
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in the reasonable medical judgment of the patient's attending |
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physician: |
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(A) the patient's death is imminent, regardless |
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of the provision of cardiopulmonary resuscitation; and |
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(B) the DNR order is medically appropriate. |
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(b) The DNR order takes effect at the time the order is |
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issued, provided the order is placed in the patient's medical |
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record as soon as practicable. |
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(c) Before placing in a patient's medical record a DNR order |
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issued under Subsection (a)(2), the physician, physician |
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assistant, nurse, or other person acting on behalf of a health care |
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facility or hospital shall: |
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(1) inform the patient of the order's issuance; or |
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(2) if the patient is incompetent, make a reasonably |
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diligent effort to contact or cause to be contacted and inform of |
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the order's issuance: |
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(A) the patient's known agent under a medical |
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power of attorney or legal guardian; or |
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(B) for a patient who does not have a known agent |
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under a medical power of attorney or legal guardian, a person |
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described by Section 166.039(b)(1), (2), or (3). |
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(d) To the extent a DNR order described by Subsection (a)(1) |
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conflicts with a treatment decision or advance directive validly |
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executed or issued under this chapter, the treatment decision made |
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in compliance with this subchapter, advance directive validly |
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executed or issued as described by this subchapter, or DNR order |
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dated and validly executed or issued in compliance with this |
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subchapter later in time controls. |
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Sec. 166.204. NOTICE REQUIREMENTS FOR DO-NOT-RESUSCITATE |
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ORDERS. (a) If an individual arrives at a health care facility or |
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hospital that is treating a patient for whom a DNR order is issued |
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under Section 166.203(a)(2) and the individual notifies a |
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physician, physician assistant, or nurse providing direct care to |
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the patient of the individual's arrival, the physician, physician |
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assistant, or nurse who has actual knowledge of the order shall |
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disclose the order to the individual, provided the individual is: |
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(1) the patient's known agent under a medical power of |
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attorney or legal guardian; or |
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(2) for a patient who does not have a known agent under |
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a medical power of attorney or legal guardian, a person described by |
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Section 166.039(b)(1), (2), or (3). |
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(b) Failure to comply with Subsection (a) does not affect |
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the validity of a DNR order issued under this subchapter. |
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(c) Any person, including a health care facility or |
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hospital, who makes a good faith effort to comply with Subsection |
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(a) of this section or Section 166.203(c) and contemporaneously |
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records the person's effort to comply with Subsection (a) of this |
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section or Section 166.203(c) in the patient's medical record is |
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not civilly or criminally liable or subject to disciplinary action |
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from the appropriate licensing authority for any act or omission |
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related to providing notice under Subsection (a) of this section or |
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Section 166.203(c). |
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(d) A physician, physician assistant, or nurse may satisfy |
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the notice requirement under Subsection (a) by notifying the |
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patient's known agent under a medical power of attorney or legal |
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guardian or, for a patient who does not have a known agent or |
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guardian, one person in accordance with the priority established |
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under Section 166.039(b). The physician, physician assistant, or |
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nurse is not required to notify additional persons beyond the first |
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person notified. |
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(e) On admission to a health care facility or hospital, the |
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facility or hospital shall provide to the patient or person |
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authorized to make treatment decisions on behalf of the patient |
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notice of the policies of the facility or hospital regarding the |
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rights of the patient and person authorized to make treatment |
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decisions on behalf of the patient under this subchapter. |
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Sec. 166.205. REVOCATION OF DO-NOT-RESUSCITATE ORDER; |
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LIMITATION OF LIABILITY. (a) A physician providing direct care to |
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a patient for whom a DNR order is issued shall revoke the patient's |
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DNR order if the patient or, as applicable, the patient's agent |
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under a medical power of attorney or the patient's legal guardian if |
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the patient is incompetent: |
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(1) effectively revokes an advance directive, in |
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accordance with Section 166.042, for which a DNR order is issued |
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under Section 166.203(a); or |
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(2) expresses to any person providing direct care to |
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the patient a revocation of consent to or intent to revoke a DNR |
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order issued under Section 166.203(a). |
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(b) A person providing direct care to a patient under the |
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supervision of a physician shall notify the physician of the |
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request to revoke a DNR order under Subsection (a). |
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(c) A patient's attending physician may at any time revoke a |
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DNR order issued under Section 166.203(a)(2). |
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(d) Except as otherwise provided by this subchapter, a |
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person is not civilly or criminally liable for failure to act on a |
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revocation described by or made under this section unless the |
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person has actual knowledge of the revocation. |
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Sec. 166.206. PROCEDURE FOR FAILURE TO EXECUTE |
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DO-NOT-RESUSCITATE ORDER OR PATIENT INSTRUCTIONS. (a) If an |
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attending physician, health care facility, or hospital does not |
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wish to execute or comply with a DNR order or the patient's |
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instructions concerning the provision of cardiopulmonary |
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resuscitation, the physician, facility, or hospital shall inform |
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the patient, the legal guardian or qualified relatives of the |
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patient, or the agent of the patient under a medical power of |
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attorney of the benefits and burdens of cardiopulmonary |
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resuscitation. |
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(b) If, after receiving notice under Subsection (a), the |
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patient or another person authorized to act on behalf of the patient |
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and the attending physician, health care facility, or hospital |
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remain in disagreement, the physician, facility, or hospital shall |
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make a reasonable effort to transfer the patient to another |
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physician, facility, or hospital willing to execute or comply with |
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a DNR order or the patient's instructions concerning the provision |
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of cardiopulmonary resuscitation. |
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(c) The procedures required by this section may not be |
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construed to control or supersede Section 166.203(a). |
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Sec. 166.207. LIMITATION ON LIABILITY FOR ISSUING DNR ORDER |
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OR WITHHOLDING CARDIOPULMONARY RESUSCITATION. A physician, health |
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care professional, health care facility, hospital, or entity that |
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in good faith issues a DNR order under this subchapter or that, in |
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accordance with this subchapter, causes cardiopulmonary |
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resuscitation to be withheld or withdrawn from a patient in |
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accordance with a DNR order issued under this subchapter is not |
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civilly or criminally liable or subject to review or disciplinary |
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action by the appropriate licensing authority for that action. |
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Sec. 166.208. LIMITATION ON LIABILITY FOR FAILURE TO |
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EFFECTUATE DNR ORDER. A physician, health care professional, |
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health care facility, hospital, or entity that has no actual |
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knowledge of a DNR order is not civilly or criminally liable or |
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subject to review or disciplinary action by the appropriate |
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licensing authority for failing to act in accordance with the |
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order. |
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Sec. 166.209. ENFORCEMENT. (a) A physician, physician |
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assistant, nurse, or other person commits an offense if the person |
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intentionally conceals, cancels, effectuates, or falsifies another |
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person's DNR order or if the person intentionally conceals or |
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withholds personal knowledge of another person's revocation of a |
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DNR order in violation of this subchapter. An offense under this |
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subsection is a Class A misdemeanor. This subsection does not |
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preclude prosecution for any other applicable offense. |
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(b) A physician, health care professional, health care |
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facility, hospital, or entity is subject to review and disciplinary |
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action by the appropriate licensing authority for intentionally: |
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(1) failing to effectuate a DNR order in violation of |
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this subchapter; or |
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(2) issuing a DNR order in violation of this |
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subchapter. |
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SECTION 2. The executive commissioner of the Health and |
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Human Services Commission shall adopt rules necessary to implement |
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Subchapter E, Chapter 166, Health and Safety Code, as added by this |
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Act, as soon as practicable after the effective date of this Act. |
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SECTION 3. Subchapter E, Chapter 166, Health and Safety |
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Code, as added by this Act, applies only to a do-not-resuscitate |
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order issued on or after the effective date of this Act. |
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SECTION 4. This Act takes effect April 1, 2018. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I hereby certify that S.B. No. 11 passed the Senate on |
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July 26, 2017, by the following vote: Yeas 21, Nays 10; and that |
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the Senate concurred in House amendment on August 15, 2017, by the |
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following vote: Yeas 21, Nays 10. |
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______________________________ |
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Secretary of the Senate |
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I hereby certify that S.B. No. 11 passed the House, with |
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amendment, on August 13, 2017, by the following vote: Yeas 122, |
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Nays 20, one present not voting. |
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______________________________ |
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Chief Clerk of the House |
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Approved: |
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______________________________ |
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Date |
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______________________________ |
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Governor |