By: Hughes, et al.  S.B. No. 917
         (In the Senate - Filed March 2, 2021; March 11, 2021, read
  first time and referred to Committee on Health & Human Services;
  May 13, 2021, reported adversely, with favorable Committee
  Substitute by the following vote:  Yeas 5, Nays 4; May 13, 2021,
  sent to printer.)
Click here to see the committee vote
 
  COMMITTEE SUBSTITUTE FOR S.B. No. 917 By:  Perry
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to advance directives or health care or treatment
  decisions made by or on behalf of patients.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  This Act may be cited as the Respecting Texas
  Patients' Right to Life Act of 2021.
         SECTION 2.  The purpose of this Act is to protect the right
  of patients and their families to decide whether and under what
  circumstances to choose or reject life-sustaining treatment. This
  Act amends the applicable provisions of the Advance Directives Act
  (Chapter 166, Health and Safety Code) to ensure that, when an
  attending physician is unwilling to respect a patient's advance
  directive or a patient's or family's decision to choose the
  treatment necessary to prevent the patient's death,
  life-sustaining medical treatment will be provided for 90 days
  after an ethics or medical committee's review so that the patient
  can be transferred to a health care provider willing to honor the
  directive or treatment decision.
         SECTION 3.  Section 166.045(c), Health and Safety Code, is
  amended to read as follows:
         (c)  If an attending physician refuses to comply with a
  directive or treatment decision to provide life-sustaining
  treatment to a patient [and does not wish to follow the procedure
  established under Section 166.046], life-sustaining treatment
  shall be provided to the patient for 90 days under the procedures
  prescribed by Section 166.046 so that[, but only until a reasonable
  opportunity has been afforded for the transfer of] the patient can
  be transferred to another physician or health care facility willing
  to comply with the directive or treatment decision.
         SECTION 4.  Sections 166.046(a), (b), (d), (e), and (e-1),
  Health and Safety Code, are amended to read as follows:
         (a)  If an attending physician refuses to honor a patient's
  advance directive or a health care or treatment decision made by or
  on behalf of a patient, other than a directive or decision to
  provide artificial nutrition and hydration to the patient, the
  physician's refusal shall be reviewed by an ethics or medical
  committee. The attending physician may not be a member of that
  committee. The patient shall be given life-sustaining treatment
  during the review.
         (b)  The patient or the person responsible for the health
  care decisions of the individual who has made the decision
  regarding the directive or treatment decision:
               (1)  may be given a written description of the ethics or
  medical committee review process and any other policies and
  procedures related to this section adopted by the health care
  facility;
               (2)  shall be informed of the committee review process
  not less than 48 hours before the meeting called to discuss the
  patient's directive, unless the time period is waived by mutual
  agreement;
               (3)  at the time of being so informed, shall be
  provided:
                     (A)  a copy of the appropriate statement set forth
  in Section 166.052; and
                     (B)  a copy of the registry list of health care
  providers and referral groups that have volunteered their readiness
  to consider accepting transfer or to assist in locating a provider
  willing to accept transfer that is posted on the website maintained
  by the department under Section 166.053; and
               (4)  is entitled to:
                     (A)  attend the meeting;
                     (B)  receive a written explanation of the
  recommendations made [decision reached] during the review process;
                     (C)  receive a copy of the portion of the
  patient's medical record related to the treatment received by the
  patient in the facility for the lesser of:
                           (i)  the period of the patient's current
  admission to the facility; or
                           (ii)  the preceding 30 calendar days; and
                     (D)  receive a copy of all of the patient's
  reasonably available diagnostic results and reports related to the
  medical record provided under Paragraph (C).
         (d)  If the attending physician, the patient, or the person
  responsible for the health care decisions of the individual does
  not agree with the recommendations made [decision reached] during
  the review process under Subsection (b), the physician shall make a
  reasonable effort to transfer the patient to a physician who is
  willing to comply with the directive. If the patient is a patient in
  a health care facility, the facility's personnel shall assist the
  physician in arranging the patient's transfer to:
               (1)  another physician;
               (2)  an alternative care setting within that facility;
  or
               (3)  another facility.
         (e)  If the patient or the person responsible for the health
  care decisions of the patient is requesting life-sustaining
  treatment that the attending physician [has decided] and the ethics
  or medical committee consider [has affirmed is] medically
  inappropriate treatment, the patient shall be given available
  life-sustaining treatment pending transfer under Subsection (d).  
  This subsection does not authorize withholding or withdrawing pain
  management medication, medical procedures necessary to provide
  comfort, or any other health care provided to alleviate a patient's
  pain.  [The patient is responsible for any costs incurred in
  transferring the patient to another facility.]  The attending
  physician, any other physician responsible for the care of the
  patient, and the health care facility are not obligated to provide
  life-sustaining treatment after the 90th [10th] day after both the
  written recommendation [decision] and the patient's medical record
  required under Subsection (b) are provided to the patient or the
  person responsible for the health care decisions of the patient
  unless ordered to do so under Subsection (g), except that
  artificially administered nutrition and hydration must be provided
  unless, based on reasonable medical judgment, providing
  artificially administered nutrition and hydration would:
               (1)  hasten the patient's death;
               (2)  be medically contraindicated such that the
  provision of the treatment seriously exacerbates life-threatening
  medical problems not outweighed by the benefit of the provision of
  the treatment;
               (3)  result in substantial irremediable physical pain
  not outweighed by the benefit of the provision of the treatment;
               (4)  be medically ineffective in prolonging life; or
               (5)  be contrary to the patient's or surrogate's
  clearly documented desire not to receive artificially administered
  nutrition or hydration.
         (e-1)  If during a previous admission to a facility a
  patient's attending physician and the review process under
  Subsection (b) have determined that life-sustaining treatment is
  inappropriate, and the patient is readmitted to the same facility
  within six months from the date of the recommendations made
  [decision reached] during the review process conducted upon the
  previous admission, Subsections (b) through (e) need not be
  followed if the patient's attending physician and a consulting
  physician who is a member of the ethics or medical committee of the
  facility document on the patient's readmission that the patient's
  condition either has not improved or has deteriorated since the
  review process was conducted.
         SECTION 5.  Section 166.051, Health and Safety Code, is
  amended to read as follows:
         Sec. 166.051.  LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.  
  This subchapter does not impair or supersede any legal right or
  responsibility a person may have to effect the withholding or
  withdrawal of life-sustaining treatment in a lawful manner,
  provided that if an attending physician or health care facility is
  unwilling to honor a patient's advance directive or a treatment
  decision to provide life-sustaining treatment, life-sustaining
  treatment must [is required to] be provided to the patient in
  accordance with this chapter[, but only until a reasonable
  opportunity has been afforded for transfer of the patient to
  another physician or health care facility willing to comply with
  the advance directive or treatment decision].
         SECTION 6.  Section 166.052(a), Health and Safety Code, is
  amended to read as follows:
         (a)  In cases in which the attending physician refuses to
  honor an advance directive or health care or treatment decision
  requesting the provision of life-sustaining treatment, the
  statement required by Section 166.046(b)(3)(A) shall be in
  substantially the following form:
  When There Is A Disagreement About Medical Treatment: The Physician
  Recommends Against Certain Life-Sustaining Treatment That You Wish
  To Continue
         You have been given this information because you have
  requested life-sustaining treatment* for yourself as the patient or
  on behalf of the patient, as applicable, which the attending
  physician believes is not medically appropriate. This information
  is being provided to help you understand state law, your rights, and
  the resources available to you in such circumstances. It outlines
  the process for resolving disagreements about treatment among
  patients, families, and physicians. It is based upon Section
  166.046 of the Texas Advance Directives Act, codified in Chapter
  166, Texas Health and Safety Code.
         When an attending physician refuses to comply with an advance
  directive or other request for life-sustaining treatment because of
  the physician's judgment that the treatment would be medically
  inappropriate, the case will be reviewed by an ethics or medical
  committee. Life-sustaining treatment will be provided through the
  review.
         You will receive notification of this review at least 48
  hours before a meeting of the committee related to your case. You
  are entitled to attend the meeting. With your agreement, the
  meeting may be held sooner than 48 hours, if possible.
         You are entitled to receive a written explanation of the
  recommendations made [decision reached] during the review process.
         If after this review process both the attending physician and
  the ethics or medical committee conclude that life-sustaining
  treatment is medically inappropriate and yet you continue to
  request such treatment, then the following procedure will occur:
         1.  The physician, with the help of the health care facility,
  will assist you in trying to find a physician and facility willing
  to provide the requested treatment.
         2.  You are being given a list of health care providers,
  licensed physicians, health care facilities, and referral groups
  that have volunteered their readiness to consider accepting
  transfer, or to assist in locating a provider willing to accept
  transfer, maintained by the Department of State Health Services.
  You may wish to contact providers, facilities, or referral groups
  on the list or others of your choice to get help in arranging a
  transfer.
         3.  The patient will continue to be given life-sustaining
  treatment until the patient can be transferred to a willing
  provider for up to 90 [10] days from the time you were given both the
  committee's written decision that life-sustaining treatment is not
  appropriate and the patient's medical record. The patient will
  continue to be given after the 90-day [10-day] period treatment to
  enhance pain management and reduce suffering, including
  artificially administered nutrition and hydration, unless, based
  on reasonable medical judgment, providing artificially
  administered nutrition and hydration would hasten the patient's
  death, be medically contraindicated such that the provision of the
  treatment seriously exacerbates life-threatening medical problems
  not outweighed by the benefit of the provision of the treatment,
  result in substantial irremediable physical pain not outweighed by
  the benefit of the provision of the treatment, be medically
  ineffective in prolonging life, or be contrary to the patient's or
  surrogate's clearly documented desires.
         4.  [If a transfer can be arranged, the patient will be
  responsible for the costs of the transfer.
         [5.]  If a provider cannot be found willing to give the
  requested treatment within 90 [10] days, life-sustaining treatment
  may be withdrawn unless a court of law has granted an extension.
         5. [6.]  You may ask the appropriate district or county court
  to extend the 90-day [10-day] period if the court finds that there
  is a reasonable expectation that you may find a physician or health
  care facility willing to provide life-sustaining treatment if the
  extension is granted. Patient medical records will be provided to
  the patient or surrogate in accordance with Section 241.154, Texas
  Health and Safety Code.
         *"Life-sustaining treatment" means treatment that, based on
  reasonable medical judgment, sustains the life of a patient and
  without which the patient will die. The term includes both
  life-sustaining medications and artificial life support, such as
  mechanical breathing machines, kidney dialysis treatment, and
  artificially administered nutrition and hydration. The term does
  not include the administration of pain management medication or the
  performance of a medical procedure considered to be necessary to
  provide comfort care, or any other medical care provided to
  alleviate a patient's pain.
         SECTION 7.  The changes in law made by this Act apply only to
  a health care or treatment decision made on or after the effective
  date of this Act.
         SECTION 8.  This Act takes effect immediately if it receives
  a vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution.  If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2021.
 
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