85S12705 JG-F
By: Perry, et al. S.B. No. 11
(Bonnen of Galveston, Cook, Geren, Oliveira)
Substitute the following for S.B. No. 11: No.
A BILL TO BE ENTITLED
AN ACT
relating to general procedures and requirements for certain
do-not-resuscitate orders; creating a criminal offense.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 166, Health and Safety Code, is amended
by adding Subchapter E to read as follows:
SUBCHAPTER E. HEALTH CARE FACILITY DO-NOT-RESUSCITATE ORDERS
Sec. 166.201. DEFINITION. In this subchapter, "DNR order"
means an order instructing a health care professional not to
attempt cardiopulmonary resuscitation on a patient whose
circulatory or respiratory function ceases.
Sec. 166.202. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies to a DNR order issued in a health care facility
or hospital.
(b) This subchapter does not apply to an out-of-hospital DNR
order as defined by Section 166.081.
Sec. 166.203. GENERAL PROCEDURES AND REQUIREMENTS FOR
DO-NOT-RESUSCITATE ORDERS. (a) A DNR order issued for a patient is
valid only if the patient's attending physician issues the order,
the order is dated, and the order:
(1) is issued in compliance with:
(A) the written and dated directions of a patient
who was competent at the time the patient wrote the directions;
(B) 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 Section 166.003(2)(E)
or (F);
(C) the directions in an advance directive
enforceable under Section 166.005 or executed in accordance with
Section 166.032, 166.034, or 166.035;
(D) the directions of a patient's legal guardian
or agent under a medical power of attorney acting in accordance with
Subchapter D; or
(E) a treatment decision made in accordance with
Section 166.039; or
(2) 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:
(A) the patient's death is imminent, regardless
of the provision of cardiopulmonary resuscitation; and
(B) the DNR order is medically appropriate.
(b) The DNR order takes effect at the time the order is
issued, provided the order is placed in the patient's medical
record as soon as practicable.
(c) Before placing in a patient's medical record a DNR order
issued under Subsection (a)(2), the physician, physician
assistant, nurse, or other person acting on behalf of a health care
facility or hospital shall:
(1) inform the patient of the order's issuance; or
(2) if the patient is incompetent, make a reasonably
diligent effort to contact or cause to be contacted and inform of
the order's issuance:
(A) the patient's known agent under a medical
power of attorney or legal guardian; or
(B) for a patient who does not have a known agent
under a medical power of attorney or legal guardian, a person
described by Section 166.039(b)(1), (2), or (3).
(d) To the extent a DNR order described by Subsection (a)(1)
conflicts with a treatment decision or advance directive validly
executed or issued under this chapter, the treatment decision made
in compliance with this subchapter, advance directive validly
executed or issued as described by this subchapter, or DNR order
dated and validly executed or issued in compliance with this
subchapter later in time controls.
Sec. 166.204. NOTICE REQUIREMENTS FOR DO-NOT-RESUSCITATE
ORDERS. (a) If an individual arrives at a health care facility or
hospital that is treating a patient for whom a DNR order is issued
under Section 166.203(a)(2) and the individual notifies a
physician, physician assistant, or nurse providing direct care to
the patient of the individual's arrival, the physician, physician
assistant, or nurse who has actual knowledge of the order shall
disclose the order to the individual, provided the individual is:
(1) the patient's known agent under a medical power of
attorney or legal guardian; or
(2) for a patient who does not have a known agent under
a medical power of attorney or legal guardian, a person described by
Section 166.039(b)(1), (2), or (3).
(b) Failure to comply with Subsection (a) does not affect
the validity of a DNR order issued under this subchapter.
(c) Any person, including a health care facility or
hospital, who makes a good faith effort to comply with Subsection
(a) of this section or Section 166.203(c) and contemporaneously
records the person's effort to comply with Subsection (a) of this
section or Section 166.203(c) in the patient's medical record is
not civilly or criminally liable or subject to disciplinary action
from the appropriate licensing authority for any act or omission
related to providing notice under Subsection (a) of this section or
Section 166.203(c).
(d) A physician, physician assistant, or nurse may satisfy
the notice requirement under Subsection (a) by notifying the
patient's known agent under a medical power of attorney or legal
guardian or, for a patient who does not have a known agent or
guardian, one person in accordance with the priority established
under Section 166.039(b). The physician, physician assistant, or
nurse is not required to notify additional persons beyond the first
person notified.
(e) On admission to a health care facility or hospital, the
facility or hospital shall provide to the patient or person
authorized to make treatment decisions on behalf of the patient
notice of the policies of the facility or hospital regarding the
rights of the patient and person authorized to make treatment
decisions on behalf of the patient under this subchapter.
Sec. 166.205. REVOCATION OF DO-NOT-RESUSCITATE ORDER;
LIMITATION OF LIABILITY. (a) A physician providing direct care to
a patient for whom a DNR order is issued shall revoke the patient's
DNR order if the patient or, as applicable, the patient's agent
under a medical power of attorney or the patient's legal guardian if
the patient is incompetent:
(1) effectively revokes an advance directive, in
accordance with Section 166.042, for which a DNR order is issued
under Section 166.203(a); or
(2) expresses to any person providing direct care to
the patient a revocation of consent to or intent to revoke a DNR
order issued under Section 166.203(a).
(b) A person providing direct care to a patient under the
supervision of a physician shall notify the physician of the
request to revoke a DNR order under Subsection (a).
(c) A patient's attending physician may at any time revoke a
DNR order issued under Section 166.203(a)(2).
(d) Except as otherwise provided by this subchapter, a
person is not civilly or criminally liable for failure to act on a
revocation described by or made under this section unless the
person has actual knowledge of the revocation.
Sec. 166.206. PROCEDURE FOR FAILURE TO EXECUTE
DO-NOT-RESUSCITATE ORDER OR PATIENT INSTRUCTIONS. (a) If an
attending physician, health care facility, or hospital does not
wish to execute or comply with a DNR order or the patient's
instructions concerning the provision of cardiopulmonary
resuscitation, the physician, facility, or hospital shall inform
the patient, the legal guardian or qualified relatives of the
patient, or the agent of the patient under a medical power of
attorney of the benefits and burdens of cardiopulmonary
resuscitation.
(b) If, after receiving notice under Subsection (a), the
patient or another person authorized to act on behalf of the patient
and the attending physician, health care facility, or hospital
remain in disagreement, the physician, facility, or hospital shall
make a reasonable effort to transfer the patient to another
physician, facility, or hospital willing to execute or comply with
a DNR order or the patient's instructions concerning the provision
of cardiopulmonary resuscitation.
(c) The procedures required by this section may not be
construed to control or supersede Section 166.203(a).
Sec. 166.207. LIMITATION ON LIABILITY FOR ISSUING DNR ORDER
OR WITHHOLDING CARDIOPULMONARY RESUSCITATION. A physician, health
care professional, health care facility, hospital, or entity that
in good faith issues a DNR order under this subchapter or that, in
accordance with this subchapter, causes cardiopulmonary
resuscitation to be withheld or withdrawn from a patient in
accordance with a DNR order issued under this subchapter is not
civilly or criminally liable or subject to review or disciplinary
action by the appropriate licensing authority for that action.
Sec. 166.208. LIMITATION ON LIABILITY FOR FAILURE TO
EFFECTUATE DNR ORDER. A physician, health care professional,
health care facility, hospital, or entity that has no actual
knowledge of a DNR order is not civilly or criminally liable or
subject to review or disciplinary action by the appropriate
licensing authority for failing to act in accordance with the
order.
Sec. 166.209. ENFORCEMENT. (a) A physician, physician
assistant, nurse, or other person commits an offense if the person
intentionally conceals, cancels, effectuates, or falsifies another
person's DNR order or if the person intentionally conceals or
withholds personal knowledge of another person's revocation of a
DNR order in violation of this subchapter. An offense under this
subsection is a Class A misdemeanor. This subsection does not
preclude prosecution for any other applicable offense.
(b) A physician, health care professional, health care
facility, hospital, or entity is subject to review and disciplinary
action by the appropriate licensing authority for intentionally:
(1) failing to effectuate a DNR order in violation of
this subchapter; or
(2) issuing a DNR order in violation of this
subchapter.
SECTION 2. The executive commissioner of the Health and
Human Services Commission shall adopt rules necessary to implement
Subchapter E, Chapter 166, Health and Safety Code, as added by this
Act, as soon as practicable after the effective date of this Act.
SECTION 3. Subchapter E, Chapter 166, Health and Safety
Code, as added by this Act, applies only to a do-not-resuscitate
order issued on or after the effective date of this Act.
SECTION 4. This Act takes effect April 1, 2018.