BILL ANALYSIS |
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C.S.H.B. 2063 |
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By: Bonnen, Greg |
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State Affairs |
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Committee Report (Substituted) |
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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 hospice setting. C.S.H.B. 2063 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 hospice setting.
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CRIMINAL JUSTICE IMPACT
It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.
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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.
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ANALYSIS
C.S.H.B. 2063 amends the Health and Safety Code to make a do-not-resuscitate (DNR) order issued for a patient in a health care facility or hospice setting valid only if 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 order is issued in compliance with the following: the written 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 or other life-sustaining treatment on a patient whose circulatory or respiratory function ceases.
C.S.H.B. 2063, if an individual who is the patient's spouse, reasonably available adult child, or parent arrives at the facility and notifies the facility of the individual's arrival after a DNR order is issued that 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, requires the DNR order to be disclosed to such an individual, in accordance with a certain priority. The bill authorizes the facility to satisfy that disclosure requirement by notifying one person in accordance with that established priority and expressly does not require the facility to notify additional persons beyond the first person notified.
C.S.H.B. 2063 establishes that a DNR order takes effect at the time the order is issued, provided that the order was placed in the patient's medical record as soon as practicable. The bill requires a health care facility or hospice service provider on admission to the facility or on initial provision of hospice services, as applicable, to provide to the patient or person authorized to make treatment decisions on behalf of the patient notice of the policies of the facility or service provider regarding the rights of the patient and the person authorized to make treatment decisions on behalf of the patient under the bill's provisions.
C.S.H.B. 2063 expressly applies to a DNR order used in a health care facility, including a hospital or an assisted living facility, or in hospice settings, including hospice services provided by a home and community support services agency 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.
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EFFECTIVE DATE
January 15, 2018.
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COMPARISON OF ORIGINAL AND SUBSTITUTE
While C.S.H.B. 2063 may differ from the original in minor or nonsubstantive ways, the following comparison is organized and formatted in a manner that indicates the substantial differences between the introduced and committee substitute versions of the bill.
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