Texas 2015 - 84th Regular

Texas Senate Bill SB1163 Compare Versions

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

Old	New	Differences
1	1	84R11643 AJZ-F
2	2	By: Hancock S.B. No. 1163
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. Section 166.002, Health and Safety Code, is
11	11	amended by adding Subdivision (16) to read as follows:
12	12	(16) "Reasonable medical judgment" means a medical
13	13	judgment that would be made by a reasonably prudent physician,
14	14	knowledgeable about the case and the treatment possibilities with
15	15	respect to the medical conditions involved.
16	16	SECTION 2. Sections 166.045(c) and (d), Health and Safety
17	17	Code, are amended to read as follows:
18	18	(c) If an attending physician refuses to comply with a
19	19	directive or treatment decision for a reason permitted by Section
20	20	166.046(a-1) and not prohibited by Section 166.0455 and does not
21	21	wish to follow the procedure established under Section 166.046,
22	22	life-sustaining treatment shall be provided to the patient, but
23	23	only until a reasonable opportunity has been afforded for the
24	24	transfer of the patient to another physician or health care
25	25	facility willing to comply with the directive or treatment
26	26	decision.
27	27	(d) A physician, health professional acting under the
28	28	direction of a physician, or health care facility is not civilly or
29	29	criminally liable or subject to review or disciplinary action by
30	30	the person's appropriate licensing board if the person has complied
31	31	with the procedures and limitations outlined in Sections 166.0455
32	32	and [Section] 166.046.
33	33	SECTION 3. Subchapter B, Chapter 166, Health and Safety
34	34	Code, is amended by adding Section 166.0455 to read as follows:
35	35	Sec. 166.0455. LIMITATION ON REFUSAL TO EFFECTUATE CERTAIN
36	36	ADVANCE DIRECTIVES OR TREATMENT DECISIONS. A physician or other
37	37	health care professional, a health care facility, or an ethics or
38	38	medical committee shall not override or refuse to honor and comply
39	39	with a patient's advance directive or a health care or treatment
40	40	decision made by or on behalf of a patient that directs the
41	41	provision of life-sustaining treatment and shall not consider
42	42	life-sustaining treatment to be inappropriate treatment under
43	43	Section 166.046 based on:
44	44	(1) the lesser value the physician or professional,
45	45	facility, or committee places on sustaining the life of an elderly,
46	46	disabled, or terminally ill patient compared to the value of
47	47	sustaining the life of a patient who is younger, not disabled, or
48	48	not terminally ill; or
49	49	(2) a disagreement between the physician or
50	50	professional, facility, or committee and the patient, or the person
51	51	authorized to make a treatment decision for the patient under
52	52	Section 166.039, over the greater weight the patient or person
53	53	places on sustaining the patient's life than the risk of
54	54	disability.
55	55	SECTION 4. Section 166.046, Health and Safety Code, is
56	56	amended by amending Subsections (a) and (g) and adding Subsections
57	57	(a-1) and (c-1) to read as follows:
58	58	(a) If an attending physician refuses to honor or comply
59	59	with a patient's advance directive or a health care or treatment
60	60	decision made by or on behalf of a patient for a reason permitted by
61	61	Subsection (a-1) and not prohibited by Section 166.0455, the
62	62	physician's refusal shall be reviewed by an ethics or medical
63	63	committee. The attending physician may not be a member of that
64	64	committee. The patient shall be given life-sustaining treatment
65	65	during the review. A person may not coerce or attempt to coerce a
66	66	physician not to comply with a patient's advance directive or a
67	67	health care or treatment decision made by or on behalf of a patient
68	68	by threatening or implementing adverse employment decisions or
69	69	professional discipline.
70	70	(a-1) The ethics or medical committee reviewing the
71	71	physician's refusal under Subsection (a) shall not consider
72	72	life-sustaining treatment inappropriate unless, based on
73	73	reasonable medical judgment, the life-sustaining treatment
74	74	requested by or on behalf of the patient is:
75	75	(1) futile because the treatment is physiologically
76	76	ineffective in achieving the specific intended benefit to the
77	77	patient as intended by or on behalf of the patient; or
78	78	(2) medically inappropriate because providing the
79	79	treatment to the patient would clearly create a substantially
80	80	greater risk of causing or hastening the death of the patient than
81	81	would withholding or withdrawing the treatment.
82	82	(c-1) The ethics or medical committee shall not approve
83	83	withdrawing or withholding life-sustaining treatment if the ethics
84	84	or medical committee determines during the review described by
85	85	Subsection (a) that the physician refused to honor a patient's
86	86	advance directive or a health care or treatment decision made by or
87	87	on behalf of the patient for a reason prohibited by Section
88	88	166.0455.
89	89	(g) At the request of the patient or the person responsible
90	90	for the health care decisions of the patient, the appropriate
91	91	[district or county] court shall extend the time period provided
92	92	under Subsection (e) [only] if the court finds, by a preponderance
93	93	of the evidence, that there is a reasonable expectation that a
94	94	physician or health care facility that will honor the patient's
95	95	directive will be found if the time extension is granted.
96	96	SECTION 5. Subchapter B, Chapter 166, Health and Safety
97	97	Code, is amended by adding Section 166.0465 to read as follows:
98	98	Sec. 166.0465. COURT PROCEEDINGS; APPEAL; FILING FEE AND
99	99	COURT COSTS. (a) A patient, the person responsible for the
100	100	patient's health care decisions, or the person who has made the
101	101	decision regarding the advance directive or treatment decision may
102	102	file a motion for injunctive relief in any county court at law,
103	103	court having probate jurisdiction, or district court, including a
104	104	family district court, based on:
105	105	(1) a request for extension of time to effect a patient
106	106	transfer for relief under Section 166.046(g); or
107	107	(2) an allegation that a physician or other health
108	108	care professional, health care facility, or ethics or medical
109	109	committee is violating or threatening to violate this chapter.
110	110	(b) The person filing a motion under Subsection (a) shall
111	111	immediately serve a copy of the motion on the defendant.
112	112	(c) The court shall promptly set a time for a hearing on a
113	113	motion filed under Subsection (a) and shall keep a record of all
114	114	testimony and other oral proceedings in the action. The court shall
115	115	rule on the motion and issue written findings of fact and
116	116	conclusions of law not later than the fifth business day after the
117	117	date the motion is filed with the court.
118	118	(d) The time for the hearing and the date by which the court
119	119	must rule on the motion under Subsection (c) may be extended, for
120	120	good cause shown, by the court.
121	121	(e) Any party may appeal the decision of the court under
122	122	Subsection (c) to the court of appeals having jurisdiction over
123	123	civil matters in the county in which the motion was filed by filing
124	124	a notice of appeal with the clerk of the court that ruled on the
125	125	motion not later than the first business day after the date the
126	126	decision of the court was issued.
127	127	(f) On receipt of a notice of appeal under Subsection (e),
128	128	the clerk of the court that ruled on the motion shall deliver a copy
129	129	of the notice of appeal and record on appeal to the clerk of the
130	130	court of appeals. On receipt of the notice and record, the clerk of
131	131	the court of appeals shall place the appeal on the docket of the
132	132	court, and the court of appeals shall promptly issue an expedited
133	133	briefing schedule and set a time for a hearing.
134	134	(g) The court of appeals shall rule on an appeal under
135	135	Subsection (f) not later than the fifth business day after the date
136	136	the notice of appeal is filed with the court that ruled on the
137	137	motion.
138	138	(h) The times for the filing of briefs, the hearing, and the
139	139	date by which the court of appeals must rule on the appeal under
140	140	Subsection (g) may be extended, for good cause shown, by the court
141	141	of appeals.
142	142	(i) Any party may file a petition for review of the decision
143	143	of the court of appeals under Subsection (g) with the clerk of the
144	144	supreme court not later than the third business day after the date
145	145	the decision of the court of appeals was issued. Other parties may
146	146	file responses not later than the third business day after the date
147	147	the petition for review was filed. The supreme court shall grant,
148	148	deny, refuse, or dismiss the petition, without regard to whether a
149	149	reply to any response has been filed, not later than the third
150	150	business day after the date the response was due. If the supreme
151	151	court grants the petition for review, the court shall exercise the
152	152	court's sound discretion in determining how expeditiously to hear
153	153	and decide the case.
154	154	(j) If a motion is filed under Subsection (a) and the
155	155	dispute concerns whether life-sustaining treatment should be
156	156	provided to the patient, life-sustaining treatment must be provided
157	157	through midnight of the day by which a notice of appeal must be
158	158	filed unless the court directs that the life-sustaining treatment
159	159	be provided for a longer period. If a notice of appeal under
160	160	Subsection (e) is filed, life-sustaining treatment must be provided
161	161	through midnight of the day by which a petition for review to the
162	162	supreme court must be filed, unless the court of appeals directs
163	163	that the life-sustaining treatment be provided for a longer period.
164	164	If a petition for review to the supreme court is filed under
165	165	Subsection (i), life-sustaining treatment must be provided through
166	166	midnight of the day on which the supreme court denies, refuses, or
167	167	dismisses the petition or issues a ruling on the merits, unless the
168	168	supreme court directs that the life-sustaining treatment be
169	169	provided for a longer period.
170	170	(k) A filing fee or court cost may not be assessed for any
171	171	proceeding in a trial or appellate court under this section.
172	172	SECTION 6. Section 166.051, Health and Safety Code, is
173	173	amended to read as follows:
174	174	Sec. 166.051. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
175	175	This subchapter does not impair or supersede any legal right or
176	176	responsibility a person may have to effect the withholding or
177	177	withdrawal of life-sustaining treatment in a lawful manner,
178	178	provided that if an attending physician or health care facility is
179	179	unwilling to honor and comply with a patient's advance directive or
180	180	a treatment decision to provide life-sustaining treatment for a
181	181	reason permitted by Section 166.046(a-1) and not prohibited by
182	182	Section 166.0455, life-sustaining treatment is required to be
183	183	provided the patient, but only until a reasonable opportunity has
184	184	been afforded for transfer of the patient to another physician or
185	185	health care facility willing to comply with the advance directive
186	186	or treatment decision.
187	187	SECTION 7. Sections 166.052(a) and (b), Health and Safety
188	188	Code, are amended to read as follows:
189	189	(a) In cases in which the attending physician refuses to
190	190	honor an advance directive or treatment decision requesting the
191	191	provision of life-sustaining treatment, the statement required by
192	192	Section 166.046(b)(3)(A) [166.046(b)(2)(A)] shall be in
193	193	substantially the following form:
194	194	When There Is A Disagreement About Medical Treatment: The
195	195	Physician Recommends Against Life-Sustaining Treatment That You
196	196	Wish To Continue
197	197	You have been given this information because you have
198	198	requested life-sustaining treatment,* which the attending
199	199	physician believes is not appropriate. This information is being
200	200	provided to help you understand state law, your rights, and the
201	201	resources available to you in such circumstances. It outlines the
202	202	process for resolving disagreements about treatment among
203	203	patients, families, and physicians. It is based upon Section
204	204	166.046 of the Texas Advance Directives Act, codified in Chapter
205	205	166, [of the Texas] Health and Safety Code.
206	206	When an attending physician refuses to comply with an advance
207	207	directive or other request for life-sustaining treatment because of
208	208	the physician's judgment that the treatment would be inappropriate,
209	209	the case will be reviewed by an ethics or medical committee.
210	210	Life-sustaining treatment will be provided through the review.
211	211	You will receive notification of this review at least 48
212	212	hours before a meeting of the committee related to your case. You
213	213	are entitled to attend the meeting. With your agreement, the
214	214	meeting may be held sooner than 48 hours, if possible.
215	215	A physician or other health care professional, a health care
216	216	facility, or an ethics or medical committee may not deny a patient
217	217	life-sustaining treatment based on:
218	218	1. the lesser value the physician or professional,
219	219	facility, or committee places on sustaining the life of an elderly,
220	220	disabled, or terminally ill patient compared to the value of
221	221	sustaining the life of a patient who is younger, not disabled, or
222	222	not terminally ill; or
223	223	2. a disagreement between the physician or professional,
224	224	facility, or committee and the patient, or the person authorized to
225	225	make a treatment decision for the patient under Section 166.039,
226	226	over the greater weight the patient or person places on sustaining
227	227	the patient's life than the risk of disability.
228	228	Life-sustaining treatment may be denied if the treatment is:
229	229	1. futile because the treatment is physiologically
230	230	ineffective in achieving the specific intended benefit to the
231	231	patient as intended by or on behalf of the patient; or
232	232	2. medically inappropriate because providing the treatment
233	233	to the patient would clearly create a substantially greater risk of
234	234	causing or hastening the death of the patient than would
235	235	withholding or withdrawing it.
236	236	You are entitled to receive a written explanation of the
237	237	decision reached during the review process.
238	238	If after this review process both the attending physician and
239	239	the ethics or medical committee conclude that life-sustaining
240	240	treatment is inappropriate and yet you continue to request such
241	241	treatment, then the following procedure will occur:
242	242	1. The physician, with the help of the health care facility,
243	243	will assist you in trying to find a physician and facility willing
244	244	to provide the requested treatment.
245	245	2. You are being given a list of health care providers and
246	246	referral groups that have volunteered their readiness to consider
247	247	accepting transfer, or to assist in locating a provider willing to
248	248	accept transfer, maintained by the Texas Health Care Information
249	249	Council. You may wish to contact providers or referral groups on
250	250	the list or others of your choice to get help in arranging a
251	251	transfer.
252	252	3. The patient will continue to be given life-sustaining
253	253	treatment until he or she can be transferred to a willing provider
254	254	for up to 10 days from the time you were given the committee's
255	255	written decision that life-sustaining treatment is not
256	256	appropriate.
257	257	4. If a transfer can be arranged, the patient will be
258	258	responsible for the costs of the transfer.
259	259	5. If a provider cannot be found willing to give the
260	260	requested treatment within 10 days, life-sustaining treatment may
261	261	be withdrawn unless a court of law has ruled otherwise [granted an
262	262	extension].
263	263	6. You may ask the [appropriate district or county] court to
264	264	extend the 10-day period if the court finds that there is a
265	265	reasonable expectation that a physician or health care facility
266	266	willing to provide life-sustaining treatment will be found if the
267	267	extension is granted.
268	268	7. The law gives you the right to seek a court order to
269	269	require a physician or other health care professional, health care
270	270	facility, or ethics or medical committee to comply with your rights
271	271	under the Texas Advance Directives Act if the physician or
272	272	professional, facility, or committee is violating or threatening to
273	273	violate a provision of that Act. You may wish to talk to legal
274	274	counsel for further information about your right to seek a court
275	275	order.
276	276	*"Life-sustaining treatment" means treatment that, based on
277	277	reasonable medical judgment, sustains the life of a patient and
278	278	without which the patient will die. The term includes both
279	279	life-sustaining medications and artificial life support, such as
280	280	mechanical breathing machines, kidney dialysis treatment, and
281	281	artificial nutrition and hydration. The term does not include the
282	282	administration of pain management medication or the performance of
283	283	a medical procedure considered to be necessary to provide comfort
284	284	care, or any other medical care provided to alleviate a patient's
285	285	pain.
286	286	(b) In cases in which the attending physician refuses to
287	287	comply with an advance directive or treatment decision requesting
288	288	the withholding or withdrawal of life-sustaining treatment, the
289	289	statement required by Section 166.046(b)(3)(A) shall be in
290	290	substantially the following form:
291	291	When There Is A Disagreement About Medical Treatment: The
292	292	Physician Recommends Life-Sustaining Treatment That You Wish To
293	293	Stop
294	294	You have been given this information because you have
295	295	requested the withdrawal or withholding of life-sustaining
296	296	treatment* and the attending physician refuses to comply with that
297	297	request. The information is being provided to help you understand
298	298	state law, your rights, and the resources available to you in such
299	299	circumstances. It outlines the process for resolving disagreements
300	300	about treatment among patients, families, and physicians. It is
301	301	based upon Section 166.046 of the Texas Advance Directives Act,
302	302	codified in Chapter 166, [of the Texas] Health and Safety Code.
303	303	When an attending physician refuses to comply with an advance
304	304	directive or other request for withdrawal or withholding of
305	305	life-sustaining treatment for any reason, the case will be reviewed
306	306	by an ethics or medical committee. Life-sustaining treatment will
307	307	be provided through the review.
308	308	You will receive notification of this review at least 48
309	309	hours before a meeting of the committee related to your case. You
310	310	are entitled to attend the meeting. With your agreement, the
311	311	meeting may be held sooner than 48 hours, if possible.
312	312	You are entitled to receive a written explanation of the
313	313	decision reached during the review process.
314	314	If you or the attending physician do not agree with the
315	315	decision reached during the review process, and the attending
316	316	physician still refuses to comply with your request to withhold or
317	317	withdraw life-sustaining treatment, then the following procedure
318	318	will occur:
319	319	1. The physician, with the help of the health care facility,
320	320	will assist you in trying to find a physician and facility willing
321	321	to withdraw or withhold the life-sustaining treatment.
322	322	2. You are being given a list of health care providers and
323	323	referral groups that have volunteered their readiness to consider
324	324	accepting transfer, or to assist in locating a provider willing to
325	325	accept transfer, maintained by the Texas Health Care Information
326	326	Council. You may wish to contact providers or referral groups on
327	327	the list or others of your choice to get help in arranging a
328	328	transfer.
329	329	3. The law gives you a right to seek a court order to require
330	330	a physician or other health care professional, health care
331	331	facility, or ethics or medical committee to comply with your rights
332	332	under the Texas Advance Directives Act if the physician, facility,
333	333	or committee is violating or threatening to violate a provision of
334	334	that Act. You may wish to talk to legal counsel for further
335	335	information about your right to seek a court order.
336	336	*"Life-sustaining treatment" means treatment that, based on
337	337	reasonable medical judgment, sustains the life of a patient and
338	338	without which the patient will die. The term includes both
339	339	life-sustaining medications and artificial life support, such as
340	340	mechanical breathing machines, kidney dialysis treatment, and
341	341	artificial nutrition and hydration. The term does not include the
342	342	administration of pain management medication or the performance of
343	343	a medical procedure considered to be necessary to provide comfort
344	344	care, or any other medical care provided to alleviate a patient's
345	345	pain.
346	346	SECTION 8. Section 166.158(c), Health and Safety Code, is
347	347	amended to read as follows:
348	348	(c) A principal's health or residential care provider who
349	349	finds it impossible to follow a directive by the agent because of a
350	350	conflict with this subchapter or the medical power of attorney
351	351	shall inform the agent as soon as is reasonably possible. The agent
352	352	may select another attending physician. The procedures and
353	353	limitations established under Sections 166.045, 166.0455, and
354	354	166.046 apply if the agent's directive concerns providing,
355	355	withholding, or withdrawing life-sustaining treatment.
356	356	SECTION 9. Section 166.166, Health and Safety Code, is
357	357	amended to read as follows:
358	358	Sec. 166.166. OTHER RIGHTS OR RESPONSIBILITIES NOT
359	359	AFFECTED. This subchapter does not limit or impair any legal right
360	360	or responsibility that any person, including a physician or health
361	361	or residential care provider, may have to make or implement health
362	362	care decisions on behalf of a person, provided that if an attending
363	363	physician or health care facility is unwilling to honor and comply
364	364	with a patient's advance directive or a treatment decision to
365	365	provide life-sustaining treatment for a reason permitted by Section
366	366	166.046(a-1) and not prohibited by Section 166.0455,
367	367	life-sustaining treatment is required to be provided the patient,
368	368	but only until a reasonable opportunity has been afforded for
369	369	transfer of the patient to another physician or health care
370	370	facility willing to comply with the advance directive or treatment
371	371	decision.
372	372	SECTION 10. Not later than December 1, 2015, the Supreme
373	373	Court of Texas shall issue the rules and prescribe the forms
374	374	necessary for the process established by Section 166.0465, Health
375	375	and Safety Code, as added by this Act. The rules shall prescribe
376	376	the method of service of the application under Section 166.0465,
377	377	Health and Safety Code, and may require filing and service of
378	378	notices, petitions, and briefs electronically to the extent the
379	379	Supreme Court of Texas considers appropriate.
380	380	SECTION 11. The changes in law made by this Act apply only
381	381	to a health care or treatment decision made on or after the
382	382	effective date of this Act.
383	383	SECTION 12. This Act takes effect immediately if it
384	384	receives a vote of two-thirds of all the members elected to each
385	385	house, as provided by Section 39, Article III, Texas Constitution.
386	386	If this Act does not receive the vote necessary for immediate
387	387	effect, this Act takes effect September 1, 2015.