Texas 2019 - 86th Regular

Texas House Bill HB3369 Compare Versions

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

Old	New	Differences
1	1	86R13693 SCL-F
2	2	By: Parker H.B. No. 3369
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;
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; or
55	55	(3) the financial condition of the patient.
56	56	SECTION 4. Section 166.046, Health and Safety Code, is
57	57	amended by amending Subsections (a), (b), (c), (d), (e), and (g) and
58	58	adding Subsections (a-1), (a-2), and (c-1) to read as follows:
59	59	(a) If an attending physician refuses to honor or comply
60	60	with a patient's advance directive or a health care or treatment
61	61	decision made by or on behalf of a patient for a reason permitted by
62	62	Subsection (a-1) and not prohibited by Section 166.0455, the
63	63	physician's refusal shall be reviewed by an ethics or medical
64	64	committee. The attending physician may not be a member of that
65	65	committee. The patient shall be given life-sustaining treatment
66	66	during the review. A person may not coerce or attempt to coerce a
67	67	physician not to comply with a patient's advance directive or a
68	68	health care or treatment decision made by or on behalf of a patient
69	69	by threatening or implementing adverse employment decisions or
70	70	professional discipline.
71	71	(a-1) The ethics or medical committee reviewing the
72	72	physician's refusal under Subsection (a) shall not consider
73	73	life-sustaining treatment inappropriate unless, based on
74	74	reasonable medical judgment, the life-sustaining treatment
75	75	requested by or on behalf of the patient is:
76	76	(1) futile because the treatment is physiologically
77	77	ineffective in achieving the specific intended benefit to the
78	78	patient as intended by or on behalf of the patient; or
79	79	(2) medically inappropriate because providing the
80	80	treatment to the patient would clearly create a substantially
81	81	greater risk of causing or hastening the death of the patient than
82	82	would withholding or withdrawing the treatment.
83	83	(a-2) An ethics or medical committee shall record a meeting
84	84	held under this section.
85	85	(b) The patient, the patient's attorney, the patient's
86	86	advocate, or the person responsible for the health care decisions
87	87	of the individual who has made the decision regarding the directive
88	88	or treatment decision:
89	89	(1) may be given a written description of the ethics or
90	90	medical committee review process and any other policies and
91	91	procedures related to this section adopted by the health care
92	92	facility;
93	93	(2) unless the patient or person responsible for the
94	94	health care decisions of the patient requests an earlier meeting,
95	95	must [shall] be informed in writing [of the committee review
96	96	process] not less than seven days [48 hours] before the meeting
97	97	called to discuss the patient's directive of:
98	98	(A) the committee review process;
99	99	(B) the right to representation by an attorney
100	100	and patient advocate present at the committee review meeting;
101	101	(C) the date, time, and location of the meeting;
102	102	and
103	103	(D) the name and title of each of the individuals
104	104	attending the meeting [, unless the time period is waived by mutual
105	105	agreement];
106	106	(3) at the time of being so informed, shall be
107	107	provided:
108	108	(A) a copy of the appropriate statement set forth
109	109	in Section 166.052; and
110	110	(B) a copy of the registry list of health care
111	111	providers and referral groups that have volunteered their readiness
112	112	to consider accepting transfer or to assist in locating a provider
113	113	willing to accept transfer that is posted on the website maintained
114	114	by the department under Section 166.053; and
115	115	(4) is entitled to:
116	116	(A) attend and participate in the entire meeting;
117	117	(B) receive a written explanation of the decision
118	118	reached during the review process;
119	119	(C) receive a copy of the portion of the
120	120	patient's medical record related to the treatment received by the
121	121	patient in the facility for the lesser of:
122	122	(i) the period of the patient's current
123	123	admission to the facility; or
124	124	(ii) the preceding 30 calendar days; [and]
125	125	(D) receive a copy of all of the patient's
126	126	reasonably available diagnostic results and reports related to the
127	127	medical record provided under Paragraph (C);
128	128	(E) during the committee review meeting, have an
129	129	opportunity to:
130	130	(i) address the committee and ask questions
131	131	of the committee and others attending the meeting; and
132	132	(ii) respond to the attending physician's
133	133	or ethics or medical committee's statements; and
134	134	(F) after the ethics or medical committee has
135	135	rendered a decision:
136	136	(i) receive a written explanation of the
137	137	ethics or medical committee's decision, including, if applicable,
138	138	an explanation of why the requested treatment may be futile and
139	139	physiologically ineffective or medically inappropriate as
140	140	described by Subsection (a-1); and
141	141	(ii) receive a recording of the committee
142	142	review meeting.
143	143	(c) The written explanation required by Subsections
144	144	[Subsection] (b)(4)(B) and (F) must be included in the patient's
145	145	medical record.
146	146	(c-1) The ethics or medical committee shall not approve
147	147	withdrawing or withholding life-sustaining treatment if the ethics
148	148	or medical committee determines during the review described by
149	149	Subsection (a) that the physician refused to honor a patient's
150	150	advance directive or a health care or treatment decision made by or
151	151	on behalf of the patient for a reason prohibited by Section
152	152	166.0455.
153	153	(d) If the attending physician, the patient, or the person
154	154	responsible for the health care decisions of the individual does
155	155	not agree with the decision reached during the review process under
156	156	Subsection (b), the physician shall make a reasonable effort, in
157	157	accordance with rules adopted by the executive commissioner, to
158	158	transfer the patient to a physician who is willing to comply with
159	159	the directive. If the patient is a patient in a health care
160	160	facility, the facility's personnel shall assist the physician in
161	161	arranging the patient's transfer to:
162	162	(1) another physician;
163	163	(2) an alternative care setting within that facility;
164	164	or
165	165	(3) another facility.
166	166	(e) If the patient or the person responsible for the health
167	167	care decisions of the patient is requesting life-sustaining
168	168	treatment that the attending physician has decided and the ethics
169	169	or medical committee has affirmed is medically inappropriate
170	170	treatment, the patient shall be given available life-sustaining
171	171	treatment pending transfer under Subsection (d). This subsection
172	172	does not authorize withholding or withdrawing pain management
173	173	medication, medical procedures necessary to provide comfort, or any
174	174	other health care provided to alleviate a patient's pain. The
175	175	patient is responsible for any costs incurred in transferring the
176	176	patient to another facility. The attending physician, any other
177	177	physician responsible for the care of the patient, and the health
178	178	care facility are not obligated to provide life-sustaining
179	179	treatment after the 45th [10th] day after both the written decision
180	180	and the patient's medical record required under Subsection (b) are
181	181	provided to the patient or the person responsible for the health
182	182	care decisions of the patient unless ordered to do so under
183	183	Subsection (g), except that artificially administered nutrition
184	184	and hydration must be provided unless, based on reasonable medical
185	185	judgment, providing artificially administered nutrition and
186	186	hydration would:
187	187	(1) hasten the patient's death;
188	188	(2) be medically contraindicated such that the
189	189	provision of the treatment seriously exacerbates life-threatening
190	190	medical problems not outweighed by the benefit of the provision of
191	191	the treatment;
192	192	(3) result in substantial irremediable physical pain
193	193	not outweighed by the benefit of the provision of the treatment;
194	194	(4) be medically ineffective in prolonging life; or
195	195	(5) be contrary to the patient's or surrogate's
196	196	clearly documented desire not to receive artificially administered
197	197	nutrition or hydration.
198	198	(g) At the request of the patient or the person responsible
199	199	for the health care decisions of the patient, the appropriate
200	200	[district or county] court shall extend the time period provided
201	201	under Subsection (e) [only] if the court finds, by a preponderance
202	202	of the evidence, that there is a reasonable expectation that a
203	203	physician or health care facility that will honor the patient's
204	204	directive will be found if the time extension is granted.
205	205	SECTION 5. Subchapter B, Chapter 166, Health and Safety
206	206	Code, is amended by adding Sections 166.0463 and 166.0465 to read as
207	207	follows:
208	208	Sec. 166.0463. ETHICS OR MEDICAL COMMITTEE MEMBERS. (a) An
209	209	individual may not be a member of an ethics or medical committee of
210	210	a health care facility if the individual or individual's spouse:
211	211	(1) is employed by or participates in the management
212	212	of the facility or another affiliated facility;
213	213	(2) owns or controls, directly or indirectly, an
214	214	interest in the facility or another affiliated facility; or
215	215	(3) uses or receives a substantial amount of tangible
216	216	goods, services, or money from the facility or another affiliated
217	217	facility.
218	218	(b) An ethics or medical committee must include as members:
219	219	(1) if the patient is an adherent or member of a
220	220	recognized religious organization, a chaplain, spiritual advisor,
221	221	or spiritual care professional of that religious organization;
222	222	(2) an individual with experience as an advocate for
223	223	patients and patients' family caregivers; and
224	224	(3) a representative of an established patient
225	225	advocacy organization.
226	226	Sec. 166.0465. COURT PROCEEDINGS; APPEAL; FILING FEE AND
227	227	COURT COSTS. (a) A patient, the person responsible for the
228	228	patient's health care decisions, or the person who has made the
229	229	decision regarding the advance directive or treatment decision may
230	230	file a motion for injunctive relief in any county court at law,
231	231	court having probate jurisdiction, or district court, including a
232	232	family district court, based on:
233	233	(1) a request for extension of time to effect a patient
234	234	transfer for relief under Section 166.046(g); or
235	235	(2) an allegation that a physician or other health
236	236	care professional, health care facility, or ethics or medical
237	237	committee is violating or threatening to violate this chapter.
238	238	(b) The person filing a motion under Subsection (a) shall
239	239	immediately serve a copy of the motion on the defendant.
240	240	(c) The court shall promptly set a time for a hearing on a
241	241	motion filed under Subsection (a) and shall keep a record of all
242	242	testimony and other oral proceedings in the action. The court shall
243	243	rule on the motion and issue written findings of fact and
244	244	conclusions of law not later than the fifth business day after the
245	245	date the motion is filed with the court.
246	246	(d) The time for the hearing and the date by which the court
247	247	must rule on the motion under Subsection (c) may be extended, for
248	248	good cause shown, by the court.
249	249	(e) Any party may appeal the decision of the court under
250	250	Subsection (c) to the court of appeals having jurisdiction over
251	251	civil matters in the county in which the motion was filed by filing
252	252	a notice of appeal with the clerk of the court that ruled on the
253	253	motion not later than the first business day after the date the
254	254	decision of the court was issued.
255	255	(f) On receipt of a notice of appeal under Subsection (e),
256	256	the clerk of the court that ruled on the motion shall deliver a copy
257	257	of the notice of appeal and record on appeal to the clerk of the
258	258	court of appeals. On receipt of the notice and record, the clerk of
259	259	the court of appeals shall place the appeal on the docket of the
260	260	court, and the court of appeals shall promptly issue an expedited
261	261	briefing schedule and set a time for a hearing.
262	262	(g) The court of appeals shall rule on an appeal under
263	263	Subsection (f) not later than the fifth business day after the date
264	264	the notice of appeal is filed with the court that ruled on the
265	265	motion.
266	266	(h) The times for the filing of briefs, the hearing, and the
267	267	date by which the court of appeals must rule on the appeal under
268	268	Subsection (g) may be extended, for good cause shown, by the court
269	269	of appeals.
270	270	(i) Any party may file a petition for review of the decision
271	271	of the court of appeals under Subsection (g) with the clerk of the
272	272	supreme court not later than the third business day after the date
273	273	the decision of the court of appeals was issued. Other parties may
274	274	file responses not later than the third business day after the date
275	275	the petition for review was filed. The supreme court shall grant,
276	276	deny, refuse, or dismiss the petition, without regard to whether a
277	277	reply to any response has been filed, not later than the third
278	278	business day after the date the response was due. If the supreme
279	279	court grants the petition for review, the court shall exercise the
280	280	court's sound discretion in determining how expeditiously to hear
281	281	and decide the case.
282	282	(j) If a motion is filed under Subsection (a) and the
283	283	dispute concerns whether life-sustaining treatment should be
284	284	provided to the patient, life-sustaining treatment must be provided
285	285	through midnight of the day by which a notice of appeal must be
286	286	filed unless the court directs that the life-sustaining treatment
287	287	be provided for a longer period. If a notice of appeal under
288	288	Subsection (e) is filed, life-sustaining treatment must be provided
289	289	through midnight of the day by which a petition for review to the
290	290	supreme court must be filed, unless the court of appeals directs
291	291	that the life-sustaining treatment be provided for a longer period.
292	292	If a petition for review to the supreme court is filed under
293	293	Subsection (i), life-sustaining treatment must be provided through
294	294	midnight of the day on which the supreme court denies, refuses, or
295	295	dismisses the petition or issues a ruling on the merits, unless the
296	296	supreme court directs that the life-sustaining treatment be
297	297	provided for a longer period.
298	298	(k) A filing fee or court cost may not be assessed for any
299	299	proceeding in a trial or appellate court under this section.
300	300	SECTION 6. Section 166.051, Health and Safety Code, is
301	301	amended to read as follows:
302	302	Sec. 166.051. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
303	303	This subchapter does not impair or supersede any legal right or
304	304	responsibility a person may have to effect the withholding or
305	305	withdrawal of life-sustaining treatment in a lawful manner,
306	306	provided that if an attending physician or health care facility is
307	307	unwilling to honor and comply with a patient's advance directive or
308	308	a treatment decision to provide life-sustaining treatment for a
309	309	reason permitted by Section 166.046(a-1) and not prohibited by
310	310	Section 166.0455, life-sustaining treatment is required to be
311	311	provided the patient, but only until a reasonable opportunity has
312	312	been afforded for transfer of the patient to another physician or
313	313	health care facility willing to comply with the advance directive
314	314	or treatment decision.
315	315	SECTION 7. Sections 166.052(a) and (b), Health and Safety
316	316	Code, are amended to read as follows:
317	317	(a) In cases in which the attending physician refuses to
318	318	honor an advance directive or health care or treatment decision
319	319	requesting the provision of life-sustaining treatment, the
320	320	statement required by Section 166.046(b)(3)(A) shall be in
321	321	substantially the following form:
322	322	When There Is A Disagreement About Medical Treatment: The
323	323	Physician Recommends Against Certain Life-Sustaining Treatment
324	324	That You Wish To Continue
325	325	You have been given this information because you have
326	326	requested life-sustaining treatment* for yourself as the patient or
327	327	on behalf of the patient, as applicable, which the attending
328	328	physician believes is not medically appropriate. This information
329	329	is being provided to help you understand state law, your rights, and
330	330	the resources available to you in such circumstances. It outlines
331	331	the process for resolving disagreements about treatment among
332	332	patients, families, and physicians. It is based upon Section
333	333	166.046 of the Texas Advance Directives Act, codified in Chapter
334	334	166, Texas Health and Safety Code.
335	335	When an attending physician refuses to comply with an advance
336	336	directive or other request for life-sustaining treatment because of
337	337	the physician's judgment that the treatment would be medically
338	338	inappropriate, the case will be reviewed by an ethics or medical
339	339	committee. Life-sustaining treatment will be provided through the
340	340	review.
341	341	You will receive notification of this review at least seven
342	342	days [48 hours] before a meeting of the committee related to your
343	343	case. You are entitled to attend and participate in the entire
344	344	meeting with an attorney and patient advocate. With your
345	345	agreement, the meeting may be held sooner than 48 hours, if
346	346	possible.
347	347	A physician or other health care professional, a health care
348	348	facility, or an ethics or medical committee may not deny a patient
349	349	life-sustaining treatment based on:
350	350	1. the lesser value the physician or professional,
351	351	facility, or committee places on sustaining the life of an elderly,
352	352	disabled, or terminally ill patient compared to the value of
353	353	sustaining the life of a patient who is younger, not disabled, or
354	354	not terminally ill;
355	355	2. a disagreement between the physician or professional,
356	356	facility, or committee and the patient, or the person authorized to
357	357	make a treatment decision for the patient under Section 166.039,
358	358	over the greater weight the patient or person places on sustaining
359	359	the patient's life than the risk of disability; or
360	360	3. the patient's financial condition.
361	361	Life-sustaining treatment may be denied if the treatment is:
362	362	1. futile because the treatment is physiologically
363	363	ineffective in achieving the specific intended benefit to the
364	364	patient as intended by or on behalf of the patient; or
365	365	2. medically inappropriate because providing the treatment
366	366	to the patient would clearly create a substantially greater risk of
367	367	causing or hastening the death of the patient than would
368	368	withholding or withdrawing it.
369	369	You are entitled to receive a written explanation of the
370	370	decision reached during the review process and the medical judgment
371	371	and reason leading to the decision.
372	372	If after this review process both the attending physician and
373	373	the ethics or medical committee conclude that life-sustaining
374	374	treatment is medically inappropriate and yet you continue to
375	375	request such treatment, then the following procedure will occur:
376	376	1. The physician, with the help of the health care facility,
377	377	will assist you in trying to find a physician and facility willing
378	378	to provide the requested treatment.
379	379	2. You are being given a list of health care providers,
380	380	licensed physicians, health care facilities, and referral groups
381	381	that have volunteered their readiness to consider accepting
382	382	transfer, or to assist in locating a provider willing to accept
383	383	transfer, maintained by the Department of State Health Services.
384	384	You may wish to contact providers, facilities, or referral groups
385	385	on the list or others of your choice to get help in arranging a
386	386	transfer.
387	387	3. The patient will continue to be given life-sustaining
388	388	treatment until the patient can be transferred to a willing
389	389	provider for up to 45 [10] days from the time you were given both the
390	390	committee's written decision and explanation that life-sustaining
391	391	treatment is not appropriate and the patient's medical record. The
392	392	patient will continue to be given after the 45-day [10-day] period
393	393	treatment to enhance pain management and reduce suffering,
394	394	including artificially administered nutrition and hydration,
395	395	unless, based on reasonable medical judgment, providing
396	396	artificially administered nutrition and hydration would hasten the
397	397	patient's death, be medically contraindicated such that the
398	398	provision of the treatment seriously exacerbates life-threatening
399	399	medical problems not outweighed by the benefit of the provision of
400	400	the treatment, result in substantial irremediable physical pain not
401	401	outweighed by the benefit of the provision of the treatment, be
402	402	medically ineffective in prolonging life, or be contrary to the
403	403	patient's or surrogate's clearly documented desires.
404	404	4. If a transfer can be arranged, the patient will be
405	405	responsible for the costs of the transfer.
406	406	5. If a provider cannot be found willing to give the
407	407	requested treatment within 45 [10] days, life-sustaining treatment
408	408	may be withdrawn unless a court of law has ruled otherwise [granted
409	409	an extension].
410	410	6. You may ask the [appropriate district or county] court to
411	411	extend the 45-day [10-day] period if the court finds that there is a
412	412	reasonable expectation that you may find a physician or health care
413	413	facility willing to provide life-sustaining treatment if the
414	414	extension is granted. Patient medical records will be provided to
415	415	the patient or surrogate in accordance with Section 241.154, Texas
416	416	Health and Safety Code.
417	417	7. The law gives you the right to seek a court order to
418	418	require a physician or other health care professional, health care
419	419	facility, or ethics or medical committee to comply with your rights
420	420	under the Texas Advance Directives Act if the physician or
421	421	professional, facility, or committee is violating or threatening to
422	422	violate a provision of that Act. You may wish to talk to legal
423	423	counsel for further information about your right to seek a court
424	424	order.
425	425	*"Life-sustaining treatment" means treatment that, based on
426	426	reasonable medical judgment, sustains the life of a patient and
427	427	without which the patient will die. The term includes both
428	428	life-sustaining medications and artificial life support, such as
429	429	mechanical breathing machines, kidney dialysis treatment, and
430	430	artificially administered nutrition and hydration. The term does
431	431	not include the administration of pain management medication or the
432	432	performance of a medical procedure considered to be necessary to
433	433	provide comfort care, or any other medical care provided to
434	434	alleviate a patient's pain.
435	435	(b) In cases in which the attending physician refuses to
436	436	comply with an advance directive or treatment decision requesting
437	437	the withholding or withdrawal of life-sustaining treatment, the
438	438	statement required by Section 166.046(b)(3)(A) shall be in
439	439	substantially the following form:
440	440	When There Is A Disagreement About Medical Treatment: The
441	441	Physician Recommends Life-Sustaining Treatment That You Wish To
442	442	Stop
443	443	You have been given this information because you have
444	444	requested the withdrawal or withholding of life-sustaining
445	445	treatment* for yourself as the patient or on behalf of the patient,
446	446	as applicable, and the attending physician disagrees with and
447	447	refuses to comply with that request. The information is being
448	448	provided to help you understand state law, your rights, and the
449	449	resources available to you in such circumstances. It outlines the
450	450	process for resolving disagreements about treatment among
451	451	patients, families, and physicians. It is based upon Section
452	452	166.046 of the Texas Advance Directives Act, codified in Chapter
453	453	166, Texas Health and Safety Code.
454	454	When an attending physician refuses to comply with an advance
455	455	directive or other request for withdrawal or withholding of
456	456	life-sustaining treatment for any reason, the case will be reviewed
457	457	by an ethics or medical committee. Life-sustaining treatment will
458	458	be provided through the review.
459	459	You will receive notification of this review at least seven
460	460	days [48 hours] before a meeting of the committee related to your
461	461	case. You are entitled to attend and participate in the entire
462	462	meeting with an attorney and patient advocate. With your
463	463	agreement, the meeting may be held sooner than 48 hours, if
464	464	possible.
465	465	You are entitled to receive a written explanation of the
466	466	decision reached during the review process and the medical judgment
467	467	and reason leading to the decision.
468	468	If you or the attending physician do not agree with the
469	469	decision reached during the review process, and the attending
470	470	physician still refuses to comply with your request to withhold or
471	471	withdraw life-sustaining treatment, then the following procedure
472	472	will occur:
473	473	1. The physician, with the help of the health care facility,
474	474	will assist you in trying to find a physician and facility willing
475	475	to withdraw or withhold the life-sustaining treatment.
476	476	2. You are being given a list of health care providers,
477	477	licensed physicians, health care facilities, and referral groups
478	478	that have volunteered their readiness to consider accepting
479	479	transfer, or to assist in locating a provider willing to accept
480	480	transfer, maintained by the Department of State Health
481	481	Services. You may wish to contact providers, facilities, or
482	482	referral groups on the list or others of your choice to get help in
483	483	arranging a transfer.
484	484	3. The law gives you a right to seek a court order to require
485	485	a physician or other health care professional, health care
486	486	facility, or ethics or medical committee to comply with your rights
487	487	under the Texas Advance Directives Act if the physician, facility,
488	488	or committee is violating or threatening to violate a provision of
489	489	that Act. You may wish to talk to legal counsel for further
490	490	information about your right to seek a court order.
491	491	*"Life-sustaining treatment" means treatment that, based on
492	492	reasonable medical judgment, sustains the life of a patient and
493	493	without which the patient will die. The term includes both
494	494	life-sustaining medications and artificial life support, such as
495	495	mechanical breathing machines, kidney dialysis treatment, and
496	496	artificially administered nutrition and hydration. The term does
497	497	not include the administration of pain management medication or the
498	498	performance of a medical procedure considered to be necessary to
499	499	provide comfort care, or any other medical care provided to
500	500	alleviate a patient's pain.
501	501	SECTION 8. Subchapter B, Chapter 166, Health and Safety
502	502	Code, is amended by adding Section 166.054 to read as follows:
503	503	Sec. 166.054. REPORTING REQUIREMENTS REGARDING ETHICS OR
504	504	MEDICAL COMMITTEE. (a) A health care facility shall submit an
505	505	annual report to the commission, in the form and manner prescribed
506	506	by commission rule, of all meetings of an ethics or medical
507	507	committee held under Section 166.046 during the preceding year.
508	508	(b) The report required by Subsection (a) must include:
509	509	(1) whether the health care facility held any ethics
510	510	or medical committee meetings during the preceding year; and
511	511	(2) for each meeting held during the preceding year:
512	512	(A) whether treatment was withheld or withdrawn
513	513	without the consent of the patient or person authorized to make
514	514	treatment decisions on behalf of the patient after the meeting; and
515	515	(B) whether the patient died while receiving
516	516	life-sustaining treatment at the facility.
517	517	SECTION 9. Section 166.158(c), Health and Safety Code, is
518	518	amended to read as follows:
519	519	(c) A principal's health or residential care provider who
520	520	finds it impossible to follow a directive by the agent because of a
521	521	conflict with this subchapter or the medical power of attorney
522	522	shall inform the agent as soon as is reasonably possible. The agent
523	523	may select another attending physician. The procedures and
524	524	limitations established under Sections 166.045, 166.0455, and
525	525	166.046 apply if the agent's directive concerns providing,
526	526	withholding, or withdrawing life-sustaining treatment.
527	527	SECTION 10. Section 166.166, Health and Safety Code, is
528	528	amended to read as follows:
529	529	Sec. 166.166. OTHER RIGHTS OR RESPONSIBILITIES NOT
530	530	AFFECTED. This subchapter does not limit or impair any legal right
531	531	or responsibility that any person, including a physician or health
532	532	or residential care provider, may have to make or implement health
533	533	care decisions on behalf of a person, provided that if an attending
534	534	physician or health care facility is unwilling to honor and comply
535	535	with a patient's advance directive or a treatment decision to
536	536	provide life-sustaining treatment for a reason permitted by Section
537	537	166.046(a-1) and not prohibited by Section 166.0455,
538	538	life-sustaining treatment is required to be provided the patient,
539	539	but only until a reasonable opportunity has been afforded for
540	540	transfer of the patient to another physician or health care
541	541	facility willing to comply with the advance directive or treatment
542	542	decision.
543	543	SECTION 11. Not later than December 1, 2019, the executive
544	544	commissioner of the Health and Human Services Commission shall
545	545	adopt rules for the transfer of a patient as provided by Section
546	546	166.046(d), Health and Safety Code, as amended by this Act.
547	547	SECTION 12. Not later than December 1, 2019, the Supreme
548	548	Court of Texas shall issue the rules and prescribe the forms
549	549	necessary for the process established by Section 166.0465, Health
550	550	and Safety Code, as added by this Act. The rules shall prescribe
551	551	the method of service of the application under Section 166.0465,
552	552	Health and Safety Code, and may require filing and service of
553	553	notices, petitions, and briefs electronically to the extent the
554	554	Supreme Court of Texas considers appropriate.
555	555	SECTION 13. The changes in law made by this Act apply only
556	556	to a health care or treatment decision made on or after the
557	557	effective date of this Act.
558	558	SECTION 14. This Act takes effect immediately if it
559	559	receives a vote of two-thirds of all the members elected to each
560	560	house, as provided by Section 39, Article III, Texas Constitution.
561	561	If this Act does not receive the vote necessary for immediate
562	562	effect, this Act takes effect September 1, 2019.