Texas 2017 - 85th 1st C.S.

Texas Senate Bill SB11 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	S.B. No. 11
	1	+	85S12705 JG-F
	2	+	By: Perry, et al. S.B. No. 11
	3	+	(Bonnen of Galveston, Cook, Geren, Oliveira)
	4	+	Substitute the following for S.B. No. 11: No.
2	5
3	6
	7	+	A BILL TO BE ENTITLED
4	8		AN ACT
5	9		relating to general procedures and requirements for certain
6	10		do-not-resuscitate orders; creating a criminal offense.
7	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	12		SECTION 1. Chapter 166, Health and Safety Code, is amended
9	13		by adding Subchapter E to read as follows:
10	14		SUBCHAPTER E. HEALTH CARE FACILITY DO-NOT-RESUSCITATE ORDERS
11	15		Sec. 166.201. DEFINITION. In this subchapter, "DNR order"
12	16		means an order instructing a health care professional not to
13	17		attempt cardiopulmonary resuscitation on a patient whose
14	18		circulatory or respiratory function ceases.
15	19		Sec. 166.202. APPLICABILITY OF SUBCHAPTER. (a) This
16	20		subchapter applies to a DNR order issued in a health care facility
17	21		or hospital.
18	22		(b) This subchapter does not apply to an out-of-hospital DNR
19	23		order as defined by Section 166.081.
20	24		Sec. 166.203. GENERAL PROCEDURES AND REQUIREMENTS FOR
21		-	DO-NOT-RESUSCITATE ORDERS. (a) A DNR order issued for a patient
22		-	is valid only if the patient's attending physician issues the
23		-	~~order,~~ the order is dated, and the order:
	25	+	DO-NOT-RESUSCITATE ORDERS. (a) A DNR order issued for a patient is
	26	+	valid only if the patient's attending physician issues the order,
	27	+	the order is dated, and the order:
24	28		(1) is issued in compliance with:
25	29		(A) the written and dated directions of a patient
26	30		who was competent at the time the patient wrote the directions;
27	31		(B) the oral directions of a competent patient
28	32		delivered to or observed by two competent adult witnesses, at least
29	33		one of whom must be a person not listed under Section 166.003(2)(E)
30	34		or (F);
31	35		(C) the directions in an advance directive
32	36		enforceable under Section 166.005 or executed in accordance with
33	37		Section 166.032, 166.034, or 166.035;
34	38		(D) the directions of a patient's legal guardian
35	39		or agent under a medical power of attorney acting in accordance with
36	40		Subchapter D; or
37	41		(E) a treatment decision made in accordance with
38	42		Section 166.039; or
39	43		(2) is not contrary to the directions of a patient who
40	44		was competent at the time the patient conveyed the directions and,
41	45		in the reasonable medical judgment of the patient's attending
42	46		physician:
43	47		(A) the patient's death is imminent, regardless
44	48		of the provision of cardiopulmonary resuscitation; and
45	49		(B) the DNR order is medically appropriate.
46	50		(b) The DNR order takes effect at the time the order is
47	51		issued, provided the order is placed in the patient's medical
48	52		record as soon as practicable.
49	53		(c) Before placing in a patient's medical record a DNR order
50	54		issued under Subsection (a)(2), the physician, physician
51	55		assistant, nurse, or other person acting on behalf of a health care
52	56		facility or hospital shall:
53	57		(1) inform the patient of the order's issuance; or
54	58		(2) if the patient is incompetent, make a reasonably
55	59		diligent effort to contact or cause to be contacted and inform of
56	60		the order's issuance:
57	61		(A) the patient's known agent under a medical
58	62		power of attorney or legal guardian; or
59	63		(B) for a patient who does not have a known agent
60	64		under a medical power of attorney or legal guardian, a person
61	65		described by Section 166.039(b)(1), (2), or (3).
62	66		(d) To the extent a DNR order described by Subsection (a)(1)
63	67		conflicts with a treatment decision or advance directive validly
64	68		executed or issued under this chapter, the treatment decision made
65	69		in compliance with this subchapter, advance directive validly
66	70		executed or issued as described by this subchapter, or DNR order
67	71		dated and validly executed or issued in compliance with this
68	72		subchapter later in time controls.
69	73		Sec. 166.204. NOTICE REQUIREMENTS FOR DO-NOT-RESUSCITATE
70	74		ORDERS. (a) If an individual arrives at a health care facility or
71	75		hospital that is treating a patient for whom a DNR order is issued
72	76		under Section 166.203(a)(2) and the individual notifies a
73	77		physician, physician assistant, or nurse providing direct care to
74	78		the patient of the individual's arrival, the physician, physician
75	79		assistant, or nurse who has actual knowledge of the order shall
76	80		disclose the order to the individual, provided the individual is:
77	81		(1) the patient's known agent under a medical power of
78	82		attorney or legal guardian; or
79	83		(2) for a patient who does not have a known agent under
80	84		a medical power of attorney or legal guardian, a person described by
81	85		Section 166.039(b)(1), (2), or (3).
82	86		(b) Failure to comply with Subsection (a) does not affect
83	87		the validity of a DNR order issued under this subchapter.
84	88		(c) Any person, including a health care facility or
85	89		hospital, who makes a good faith effort to comply with Subsection
86	90		(a) of this section or Section 166.203(c) and contemporaneously
87	91		records the person's effort to comply with Subsection (a) of this
88	92		section or Section 166.203(c) in the patient's medical record is
89	93		not civilly or criminally liable or subject to disciplinary action
90	94		from the appropriate licensing authority for any act or omission
91	95		related to providing notice under Subsection (a) of this section or
92	96		Section 166.203(c).
93	97		(d) A physician, physician assistant, or nurse may satisfy
94	98		the notice requirement under Subsection (a) by notifying the
95	99		patient's known agent under a medical power of attorney or legal
96	100		guardian or, for a patient who does not have a known agent or
97	101		guardian, one person in accordance with the priority established
98	102		under Section 166.039(b). The physician, physician assistant, or
99	103		nurse is not required to notify additional persons beyond the first
100	104		person notified.
101	105		(e) On admission to a health care facility or hospital, the
102	106		facility or hospital shall provide to the patient or person
103	107		authorized to make treatment decisions on behalf of the patient
104	108		notice of the policies of the facility or hospital regarding the
105	109		rights of the patient and person authorized to make treatment
106	110		decisions on behalf of the patient under this subchapter.
107	111		Sec. 166.205. REVOCATION OF DO-NOT-RESUSCITATE ORDER;
108	112		LIMITATION OF LIABILITY. (a) A physician providing direct care to
109	113		a patient for whom a DNR order is issued shall revoke the patient's
110	114		DNR order if the patient or, as applicable, the patient's agent
111	115		under a medical power of attorney or the patient's legal guardian if
112	116		the patient is incompetent:
113	117		(1) effectively revokes an advance directive, in
114	118		accordance with Section 166.042, for which a DNR order is issued
115	119		under Section 166.203(a); or
116	120		(2) expresses to any person providing direct care to
117	121		the patient a revocation of consent to or intent to revoke a DNR
118	122		order issued under Section 166.203(a).
119	123		(b) A person providing direct care to a patient under the
120	124		supervision of a physician shall notify the physician of the
121	125		request to revoke a DNR order under Subsection (a).
122	126		(c) A patient's attending physician may at any time revoke a
123	127		DNR order issued under Section 166.203(a)(2).
124	128		(d) Except as otherwise provided by this subchapter, a
125	129		person is not civilly or criminally liable for failure to act on a
126	130		revocation described by or made under this section unless the
127	131		person has actual knowledge of the revocation.
128	132		Sec. 166.206. PROCEDURE FOR FAILURE TO EXECUTE
129	133		DO-NOT-RESUSCITATE ORDER OR PATIENT INSTRUCTIONS. (a) If an
130	134		attending physician, health care facility, or hospital does not
131	135		wish to execute or comply with a DNR order or the patient's
132	136		instructions concerning the provision of cardiopulmonary
133	137		resuscitation, the physician, facility, or hospital shall inform
134	138		the patient, the legal guardian or qualified relatives of the
135	139		patient, or the agent of the patient under a medical power of
136	140		attorney of the benefits and burdens of cardiopulmonary
137	141		resuscitation.
138	142		(b) If, after receiving notice under Subsection (a), the
139	143		patient or another person authorized to act on behalf of the patient
140	144		and the attending physician, health care facility, or hospital
141	145		remain in disagreement, the physician, facility, or hospital shall
142	146		make a reasonable effort to transfer the patient to another
143	147		physician, facility, or hospital willing to execute or comply with
144	148		a DNR order or the patient's instructions concerning the provision
145	149		of cardiopulmonary resuscitation.
146	150		(c) The procedures required by this section may not be
147	151		construed to control or supersede Section 166.203(a).
148	152		Sec. 166.207. LIMITATION ON LIABILITY FOR ISSUING DNR ORDER
149	153		OR WITHHOLDING CARDIOPULMONARY RESUSCITATION. A physician, health
150	154		care professional, health care facility, hospital, or entity that
151	155		in good faith issues a DNR order under this subchapter or that, in
152	156		accordance with this subchapter, causes cardiopulmonary
153	157		resuscitation to be withheld or withdrawn from a patient in
154	158		accordance with a DNR order issued under this subchapter is not
155	159		civilly or criminally liable or subject to review or disciplinary
156	160		action by the appropriate licensing authority for that action.
157	161		Sec. 166.208. LIMITATION ON LIABILITY FOR FAILURE TO
158	162		EFFECTUATE DNR ORDER. A physician, health care professional,
159	163		health care facility, hospital, or entity that has no actual
160	164		knowledge of a DNR order is not civilly or criminally liable or
161	165		subject to review or disciplinary action by the appropriate
162	166		licensing authority for failing to act in accordance with the
163	167		order.
164	168		Sec. 166.209. ENFORCEMENT. (a) A physician, physician
165	169		assistant, nurse, or other person commits an offense if the person
166	170		intentionally conceals, cancels, effectuates, or falsifies another
167	171		person's DNR order or if the person intentionally conceals or
168	172		withholds personal knowledge of another person's revocation of a
169	173		DNR order in violation of this subchapter. An offense under this
170	174		subsection is a Class A misdemeanor. This subsection does not
171	175		preclude prosecution for any other applicable offense.
172	176		(b) A physician, health care professional, health care
173	177		facility, hospital, or entity is subject to review and disciplinary
174	178		action by the appropriate licensing authority for intentionally:
175	179		(1) failing to effectuate a DNR order in violation of
176	180		this subchapter; or
177	181		(2) issuing a DNR order in violation of this
178	182		subchapter.
179	183		SECTION 2. The executive commissioner of the Health and
180	184		Human Services Commission shall adopt rules necessary to implement
181	185		Subchapter E, Chapter 166, Health and Safety Code, as added by this
182	186		Act, as soon as practicable after the effective date of this Act.
183	187		SECTION 3. Subchapter E, Chapter 166, Health and Safety
184	188		Code, as added by this Act, applies only to a do-not-resuscitate
185	189		order issued on or after the effective date of this Act.
186	190		SECTION 4. This Act takes effect April 1, 2018.
187		-	______________________________ ______________________________
188		-	President of the Senate Speaker of the House
189		-	I hereby certify that S.B. No. 11 passed the Senate on
190		-	July 26, 2017, by the following vote: Yeas 21, Nays 10; and that
191		-	the Senate concurred in House amendment on August 15, 2017, by the
192		-	following vote: Yeas 21, Nays 10.
193		-	______________________________
194		-	Secretary of the Senate
195		-	I hereby certify that S.B. No. 11 passed the House, with
196		-	amendment, on August 13, 2017, by the following vote: Yeas 122,
197		-	Nays 20, one present not voting.
198		-	______________________________
199		-	Chief Clerk of the House
200		-	Approved:
201		-	______________________________
202		-	Date
203		-	______________________________
204		-	Governor