Texas 2009 - 81st Regular

Texas House Bill HB2964 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R14608 T
2	2	By: Coleman H.B. No. 2964
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to advance directives and health care and treatment
8	8	decisions.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Sections 166.046(a), (b) and (e), Health and
11	11	Safety Code, are amended to read as follows:
12	12	Sec. 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR
13	13	TREATMENT DECISION. (a) If an attending physician refuses to
14	14	honor a patient's advance directive or a health care or treatment
15	15	decision made by or on behalf of a patient, the physician's refusal
16	16	shall be reviewed by an ethics or medical committee. The attending
17	17	physician may not be a member of that committee. The patient shall
18	18	be given life-sustaining treatment during the review. If
19	19	artificial nutrition and hydration are the only life-sustaining
20	20	treatment being provided to a patient with a terminal condition,
21	21	the process established under this section may not be invoked
22	22	unless reasonable medical evidence indicates the provision of
23	23	artificial nutrition and hydration may hasten the patient's death
24	24	or exacerbate other medical problems and the risk of serious
25	25	medical pain or discomfort that cannot be alleviated based on
26	26	reasonable medical judgment outweighs the benefit of continued
27	27	artificial nutrition and hydration.
28	28	(b) The patient or the person responsible for the health
29	29	care decisions of the individual who has made the decision
30	30	regarding the directive or treatment decision:
31	31	(1) may be given a written description of the ethics or
32	32	medical committee review process and any other policies and
33	33	procedures related to this section adopted by the health care
34	34	facility;
35	35	(2) shall be informed of the committee review process
36	36	not less than 48 hours before the meeting called to discuss the
37	37	patient's directive, unless the time period is waived by mutual
38	38	agreement;
39	39	(3) at the time of being so informed, shall be
40	40	provided:
41	41	(A) a copy of the appropriate statement set forth
42	42	in Section 166.052; [and]
43	43	(B) a copy of the registry list of health care
44	44	providers and referral groups that have volunteered their readiness
45	45	to consider accepting transfer or to assist in locating a provider
46	46	willing to accept transfer that is posted on the website maintained
47	47	by the department [Texas Health Care Information Council] under
48	48	Section 166.053[.] and
49	49	(C) a patient liaison, appointed by the ethics of
50	50	medical committee, familiar with end-of-life issues and hospice
51	51	care options to assist the person responsible for the health care
52	52	decisions of the individual throughout the process described by
53	53	this section.
54	54	(4) is entitled to:
55	55	(A) attend the meeting; and
56	56	(B) receive a written explanation of the decision
57	57	reached during the review process.
58	58	(e) If the patient or the person responsible for the health
59	59	care decisions of the patient is requesting life-sustaining
60	60	treatment that the attending physician has decided and the review
61	61	process has affirmed is inappropriate treatment, the patient shall
62	62	be given available life-sustaining treatment pending transfer
63	63	under Subsection (d). The patient is responsible for any costs
64	64	incurred in transferring the patient to another facility. The
65	65	physician and the health care facility are not obligated to provide
66	66	life-sustaining treatment, except for the provision of artificial
67	67	nutrition and hydration, unless providing the artificial nutrition
68	68	and hydration would hasten death or seriously exacerbate other
69	69	major medical conditions and the risk of serious medical pain or
70	70	discomfort that cannot be alleviated based on reasonable medical
71	71	judgment outweighs the benefit of continued artificial nutrition
72	72	and hydration, after the 14th calendar [10th] day after the written
73	73	decision required under Subsection (b) is provided to the patient
74	74	or the person responsible for the health care decisions of the
75	75	patient.
76	76	SECTION 2. Sections 166.052(a) and (b), Health and Safety
77	77	Code, are amended to read as follows: (a) In cases in which the
78	78	attending physician refuses to honor an advance directive or
79	79	treatment decision requesting the provision of life-sustaining
80	80	treatment, the statement required by 166.046(b)(2)(A) shall be in
81	81	substantially the following form:
82	82	You have been given this information because you have requested
83	83	life-sustaining treatment,* which the attending physician believes
84	84	is not appropriate. This information is being provided to help you
85	85	understand state law, your rights, and the resources available to
86	86	you in such circumstances. It outlines the process for resolving
87	87	disagreements about treatment among patients, families, and
88	88	physicians. It is based upon Section 166.046 of the Texas Advance
89	89	Directives Act, codified in Chapter 166 of the Texas Health and
90	90	Safety Code
91	91	When There Is A Disagreement About Medical Treatment: The
92	92	Physician Recommends Against Life-Sustaining Treatment That You
93	93	Wish To Continue
94	94	When an attending physician refuses to comply with an advance
95	95	directive or other request for life-sustaining treatment because of
96	96	the physician's judgment that the treatment would be inappropriate,
97	97	the case will be reviewed by an ethics or medical committee.
98	98	Life-sustaining treatment will be provided through the review.
99	99	You will receive notification of this review at least 48
100	100	hours before a meeting of the committee related to your case. You
101	101	are entitled to attend the meeting. With your agreement, the
102	102	meeting may be held sooner than 48 hours, if possible. The committee
103	103	will appoint a patient liaison to assist you through this process.
104	104	You are entitled to receive a written explanation of the
105	105	decision reached during the review process.
106	106	If after this review process both the attending physician and
107	107	the ethics or medical committee conclude that life-sustaining
108	108	treatment is inappropriate and yet you continue to request such
109	109	treatment, then the following procedure will occur:
110	110	1. The physician, with the help of the health care facility,
111	111	will assist you in trying to find a physician and facility willing
112	112	to provide the requested treatment.
113	113	2. You are being given a list of health care providers and
114	114	referral groups that have volunteered their readiness to consider
115	115	accepting transfer, or to assist in locating a provider willing to
116	116	accept transfer, maintained by the Department of State [Texas]
117	117	Health Services [Care Information Council]. You may wish to
118	118	contact providers or referral groups on the list or others of your
119	119	choice to get help in arranging a transfer.
120	120	3. The patient will continue to be given life-sustaining
121	121	treatment, including artificial nutrition and hydration unless
122	122	reasonable medical evidence indicates the provision of artificial
123	123	nutrition and hydration may hasten the patient's death or
124	124	exacerbate other medical problems and the risk of serious medical
125	125	pain or discomfort that cannot be alleviated based on reasonable
126	126	medical judgment outweighs the benefit of continued artificial
127	127	nutrition and hydration, until he or she can be transferred to a
128	128	willing provider for up to 14 calendar [10] days from the time you
129	129	were given the committee's written decision that life-sustaining
130	130	treatment is not appropriate.
131	131	4. If a transfer can be arranged, the patient will be
132	132	responsible for the costs of the transfer.
133	133	5. If a provider cannot be found willing to give the
134	134	requested treatment within 14 calendar [10] days, life-sustaining
135	135	treatment may be withdrawn unless a court of law has granted an
136	136	extension.
137	137	6. You may ask the appropriate district or county court to
138	138	extend the 14-day [10-day] period if the court finds that there is a
139	139	reasonable expectation that a physician or health care facility
140	140	willing to provide life-sustaining treatment will be found if the
141	141	extension is granted.
142	142	*"Life-sustaining treatment" means treatment that, based on
143	143	reasonable medical judgment, sustains the life of a patient and
144	144	without which the patient will die. The term includes both
145	145	life-sustaining medications and artificial life support, such as
146	146	mechanical breathing machines, kidney dialysis treatment, and
147	147	artificial nutrition and hydration. The term does not include the
148	148	administration of pain management medication or the performance of
149	149	a medical procedure considered to be necessary to provide comfort
150	150	care, or any other medical care provided to alleviate a patient's
151	151	pain.
152	152	(b) In cases in which the attending physician refuses to
153	153	comply with an advance directive or treatment decision requesting
154	154	the withholding or withdrawal of life-sustaining treatment, the
155	155	statement required by Section 166.046(b)(3)(A) shall be in
156	156	substantially the following form:
157	157	You have been given this information because you have
158	158	requested the withdrawal or withholding of life-sustaining
159	159	treatment* and the attending physician refuses to comply with that
160	160	request. The information is being provided to help you understand
161	161	state law, your rights, and the resources available to you in such
162	162	circumstances. It outlines the process for resolving disagreements
163	163	about treatment among patients, families, and physicians. It is
164	164	based upon Section 166.046 of the Texas Advance Directives Act,
165	165	codified in Chapter 166 of the Texas Health and Safety Code.
166	166	When There Is A Disagreement About Medical Treatment: The
167	167	Physician Recommends Life-Sustaining Treatment That You Wish To
168	168	Stop
169	169	When an attending physician refuses to comply with an advance
170	170	directive or other request for withdrawal or withholding of
171	171	life-sustaining treatment for any reason, the case will be reviewed
172	172	by an ethics or medical committee. Life-sustaining treatment will
173	173	be provided through the review.
174	174	You will receive notification of this review at least 48
175	175	hours before a meeting of the committee related to your case. You
176	176	are entitled to attend the meeting. With your agreement, the
177	177	meeting may be held sooner than 48 hours, if possible. The
178	178	committee will appoint a patient liaison to assist you through this
179	179	process.
180	180	You are entitled to receive a written explanation of the
181	181	decision reached during the review process.
182	182	If you or the attending physician do not agree with the
183	183	decision reached during the review process, and the attending
184	184	physician still refuses to comply with your request to withhold or
185	185	withdraw life-sustaining treatment, then the following procedure
186	186	will occur:
187	187	1. The physician, with the help of the health care facility,
188	188	will assist you in trying to find a physician and facility willing
189	189	to withdraw or withhold the life-sustaining treatment.
190	190	2. You are being given a list of health care providers and
191	191	referral groups that have volunteered their readiness to consider
192	192	accepting transfer, or to assist in locating a provider willing to
193	193	accept transfer, maintained by the Department of State [Texas]
194	194	Health Services [Care Information Council]. You may wish to
195	195	contact providers or referral groups on the list or others of your
196	196	choice to get help in arranging a transfer.
197	197	*"Life-sustaining treatment" means treatment that, based on
198	198	reasonable medical judgment, sustains the life of a patient and
199	199	without which the patient will die. The term includes both
200	200	life-sustaining medications and artificial life support, such as
201	201	mechanical breathing machines, kidney dialysis treatment, and
202	202	artificial nutrition and hydration. The term does not include the
203	203	administration of pain management medication or the performance of
204	204	a medical procedure considered to be necessary to provide comfort
205	205	care, or any other medical care provided to alleviate a patient's
206	206	pain.
207	207	SECTION 3. An advance directive form executed under Chapter
208	208	166, Health and Safety Code, before the effective date of this Act
209	209	is valid and shall be honored as if the form were executed on or
210	210	after the effective date of this Act.
211	211	SECTION 4. This Act takes effect September 1, 2009.