| 1 | 1 | | By: Bonnen of Galveston H.B. No. 43 |
|---|
| 2 | 2 | | |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | A BILL TO BE ENTITLED |
|---|
| 5 | 5 | | AN ACT |
|---|
| 6 | 6 | | relating to general procedures and requirements for |
|---|
| 7 | 7 | | do-not-resuscitate orders. |
|---|
| 8 | 8 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 9 | 9 | | SECTION 1. Subchapter A, Chapter 166, Health and Safety |
|---|
| 10 | 10 | | Code, is amended by adding Section 166.012 to read as follows: |
|---|
| 11 | 11 | | Sec. 166.012. GENERAL PROCEDURES AND REQUIREMENTS FOR |
|---|
| 12 | 12 | | DO-NOT-RESUSCITATE ORDERS. (a) In this section, "DNR order" means |
|---|
| 13 | 13 | | an order instructing a health care professional not to attempt |
|---|
| 14 | 14 | | cardiopulmonary resuscitation or other life-sustaining treatment |
|---|
| 15 | 15 | | on a patient whose circulatory or respiratory function ceases. |
|---|
| 16 | 16 | | (b) This section applies to a DNR order used in a health care |
|---|
| 17 | 17 | | facility, including a hospital or an assisted living facility, or |
|---|
| 18 | 18 | | in hospice settings, including hospice services provided by a home |
|---|
| 19 | 19 | | and community support services agency. This section does not apply |
|---|
| 20 | 20 | | to an out-of-hospital DNR order as defined by Section 166.081. |
|---|
| 21 | 21 | | (c) A DNR order issued for a patient is valid only if the |
|---|
| 22 | 22 | | order: |
|---|
| 23 | 23 | | (1) is issued in compliance with: |
|---|
| 24 | 24 | | (A) the written directions of a patient who was |
|---|
| 25 | 25 | | competent at the time the patient wrote the directions; |
|---|
| 26 | 26 | | (B) the oral directions of a competent patient |
|---|
| 27 | 27 | | delivered to or observed by two competent adult witnesses, at least |
|---|
| 28 | 28 | | one of whom must be a person not listed under Section 166.003(2); |
|---|
| 29 | 29 | | (C) the directions in an advance directive |
|---|
| 30 | 30 | | enforceable under Section 166.005 or executed in accordance with |
|---|
| 31 | 31 | | Section 166.032, 166.034, or 166.035; |
|---|
| 32 | 32 | | (D) the directions of a patient's legal guardian |
|---|
| 33 | 33 | | or agent under a medical power of attorney acting in accordance with |
|---|
| 34 | 34 | | Subchapter D; or |
|---|
| 35 | 35 | | (E) a treatment decision made in accordance with |
|---|
| 36 | 36 | | Section 166.039; or |
|---|
| 37 | 37 | | (2) is not contrary to the directions of a patient who |
|---|
| 38 | 38 | | was competent at the time the patient conveyed the directions and, |
|---|
| 39 | 39 | | in the reasonable medical judgment of the patient's attending |
|---|
| 40 | 40 | | physician: |
|---|
| 41 | 41 | | (A) the patient's death is imminent, regardless |
|---|
| 42 | 42 | | of the provision of cardiopulmonary resuscitation; and |
|---|
| 43 | 43 | | (B) the DNR order is medically appropriate. |
|---|
| 44 | 44 | | (d) If an individual described by Section 166.039(b)(1), |
|---|
| 45 | 45 | | (2), or (3) arrives at the facility and notifies the facility of the |
|---|
| 46 | 46 | | individual's arrival after a DNR order is issued under Subsection |
|---|
| 47 | 47 | | (c)(2), the order must be disclosed to the individual in accordance |
|---|
| 48 | 48 | | with the priority established under Section 166.039(b). |
|---|
| 49 | 49 | | (e) The facility may satisfy the notice requirement under |
|---|
| 50 | 50 | | Subsection (d) by notifying one person in accordance with the |
|---|
| 51 | 51 | | priority established under Section 166.039(b). The facility is not |
|---|
| 52 | 52 | | required to notify additional persons beyond the first person |
|---|
| 53 | 53 | | notified. |
|---|
| 54 | 54 | | (f) A DNR order takes effect at the time the order is issued, |
|---|
| 55 | 55 | | provided that the order was placed in the patient's medical record |
|---|
| 56 | 56 | | as soon as practicable. |
|---|
| 57 | 57 | | (g) On admission to a health care facility or on initial |
|---|
| 58 | 58 | | provision of hospice services, as applicable, the facility or |
|---|
| 59 | 59 | | service provider shall provide to the patient or person authorized |
|---|
| 60 | 60 | | to make treatment decisions on behalf of the patient notice of the |
|---|
| 61 | 61 | | policies of the facility or service provider regarding the rights |
|---|
| 62 | 62 | | of the patient and person authorized to make treatment decisions on |
|---|
| 63 | 63 | | behalf of the patient under this section. |
|---|
| 64 | 64 | | SECTION 2. The executive commissioner of the Health and |
|---|
| 65 | 65 | | Human Services Commission shall adopt rules necessary to implement |
|---|
| 66 | 66 | | Section 166.012, Health and Safety Code, as added by this Act, as |
|---|
| 67 | 67 | | soon as practicable after the effective date of this Act. |
|---|
| 68 | 68 | | SECTION 3. Section 166.012, Health and Safety Code, as |
|---|
| 69 | 69 | | added by this Act, applies only to a do-not-resuscitate order |
|---|
| 70 | 70 | | issued on or after the effective date of this Act. |
|---|
| 71 | 71 | | SECTION 4. This Act takes effect January 15, 2018. |
|---|