Texas 2019 - 86th Regular

Texas Senate Bill SB2129 Compare Versions

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

Old	New	Differences
1	1	86R10404 SCL-F
2	2	By: Creighton S.B. No. 2129
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 decision
26	26	in accordance with Section 166.046.
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), (b), (c), and (g) and adding
57	57	Subsections (a-1), (a-2), (c-1), and (d-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	(a-2) An ethics or medical committee shall record a meeting
83	83	held under this section. The recording must:
84	84	(1) include audio; and
85	85	(2) be on a tangible medium, including a disc, tape,
86	86	wire, film, or electronic storage drive.
87	87	(b) The patient, the patient's attorney, the patient's
88	88	advocate, or the person responsible for the health care decisions
89	89	of the individual who has made the decision regarding the directive
90	90	or treatment decision:
91	91	(1) may be given a written description of the ethics or
92	92	medical committee review process and any other policies and
93	93	procedures related to this section adopted by the health care
94	94	facility;
95	95	(2) unless the patient or person responsible for the
96	96	health care decisions of the patient requests an earlier meeting,
97	97	must [shall] be informed in writing [of the committee review
98	98	process] not less than seven days [48 hours] before the meeting
99	99	called to discuss the patient's directive of:
100	100	(A) the committee review process;
101	101	(B) the right to representation by an attorney
102	102	and patient advocate present at the committee review meeting;
103	103	(C) the date, time, and location of the meeting;
104	104	and
105	105	(D) the name and title of each of the individuals
106	106	on the ethics or medical committee [, unless the time period is
107	107	waived by mutual agreement];
108	108	(3) at the time of being so informed, shall be
109	109	provided:
110	110	(A) a copy of the appropriate statement set forth
111	111	in Section 166.052; and
112	112	(B) a copy of the registry list of health care
113	113	providers and referral groups that have volunteered their readiness
114	114	to consider accepting transfer or to assist in locating a provider
115	115	willing to accept transfer that is posted on the website maintained
116	116	by the department under Section 166.053; and
117	117	(4) is entitled to:
118	118	(A) attend and participate in the entire meeting;
119	119	(B) receive a written explanation of the decision
120	120	reached during the review process;
121	121	(C) receive a copy of the portion of the
122	122	patient's medical record related to the treatment received by the
123	123	patient in the facility for the lesser of:
124	124	(i) the period of the patient's current
125	125	admission to the facility; or
126	126	(ii) the preceding 30 calendar days; [and]
127	127	(D) receive a copy of all of the patient's
128	128	reasonably available diagnostic results and reports related to the
129	129	medical record provided under Paragraph (C);
130	130	(E) during the committee review meeting, have an
131	131	opportunity to:
132	132	(i) explain the justification for the
133	133	treatment decision made by or on behalf of the patient;
134	134	(ii) if applicable, receive a written
135	135	explanation of the manner in which the attending physician's and
136	136	ethics or medical committee's decision to refuse to honor or comply
137	137	with the treatment decision made by or on behalf of the patient
138	138	complies with Section 166.0455; and
139	139	(iii) respond to the attending physician's
140	140	or ethics or medical committee's description, prognosis, or
141	141	assessment of the patient, treatment decision, and compliance with
142	142	this section and Section 166.0455; and
143	143	(F) after the ethics or medical committee has
144	144	rendered a decision:
145	145	(i) receive a written explanation of the
146	146	ethics or medical committee's decision; and
147	147	(ii) receive an audio recording of the
148	148	committee review meeting.
149	149	(c) The written explanation required by Subsections
150	150	[Subsection] (b)(4)(B), (E), and (F) must be included in the
151	151	patient's medical record.
152	152	(c-1) The ethics or medical committee shall not approve
153	153	withdrawing or withholding life-sustaining treatment if the ethics
154	154	or medical committee determines during the review described by
155	155	Subsection (a) that the physician refused to honor a patient's
156	156	advance directive or a health care or treatment decision made by or
157	157	on behalf of the patient for a reason prohibited by Section
158	158	166.0455.
159	159	(d-1) The attending physician may comply with Subsection
160	160	(d) by:
161	161	(1) providing to the patient or person responsible for
162	162	the health care decisions of the patient:
163	163	(A) a list of at least 10 facilities able to
164	164	provide the level of care requested;
165	165	(B) a written explanation of whether the patient
166	166	could be discharged to the patient's home and the health care
167	167	services required to provide the requested treatment; and
168	168	(C) the explanations and recommendations
169	169	described by Subdivision (3), if applicable;
170	170	(2) contacting the appropriate administrators and
171	171	physicians at the facilities on the list described by Subdivision
172	172	(1) to initiate a transfer;
173	173	(3) if all of the facilities on the list described by
174	174	Subdivision (1) refuse the transfer, for each facility:
175	175	(A) requesting a written explanation of the
176	176	facility's reasons for refusal; and
177	177	(B) developing a written recommendation that
178	178	includes:
179	179	(i) the reason for the facility's refusal;
180	180	(ii) the actions the physician, facility,
181	181	and patient or person responsible for the health care decisions of
182	182	the patient may take to transfer to the facility; and
183	183	(iii) the name of any administrator and
184	184	physician contacted by the attending physician under Paragraph (A);
185	185	and
186	186	(4) facilitating the transfer of the patient to any
187	187	appropriate facility willing to accept the patient.
188	188	(g) At the request of the patient or the person responsible
189	189	for the health care decisions of the patient, the appropriate
190	190	[district or county] court shall extend the time period provided
191	191	under Subsection (e) [only] if the court finds, by a preponderance
192	192	of the evidence, that there is a reasonable expectation that a
193	193	physician or health care facility that will honor the patient's
194	194	directive will be found if the time extension is granted.
195	195	SECTION 5. Subchapter B, Chapter 166, Health and Safety
196	196	Code, is amended by adding Sections 166.0463 and 166.0465 to read as
197	197	follows:
198	198	Sec. 166.0463. ETHICS OR MEDICAL COMMITTEE MEMBERS. (a) An
199	199	individual may not be a member of an ethics or medical committee of
200	200	a health care facility if the individual or individual's spouse:
201	201	(1) is employed by or participates in the management
202	202	of the facility or another affiliated facility;
203	203	(2) owns or controls, directly or indirectly, an
204	204	interest in the facility or another affiliated facility; or
205	205	(3) uses or receives a substantial amount of tangible
206	206	goods, services, or money from the facility or another affiliated
207	207	facility.
208	208	(b) An ethics or medical committee must include as members:
209	209	(1) if the patient is an adherent or member of a
210	210	recognized religious organization, a chaplain, spiritual advisor,
211	211	or spiritual care professional of that religious organization;
212	212	(2) an individual with experience as an advocate for
213	213	patients and patients' family caregivers; and
214	214	(3) a representative of an established patient
215	215	advocacy organization.
216	216	Sec. 166.0465. COURT PROCEEDINGS; APPEAL; FILING FEE AND
217	217	COURT COSTS. (a) A patient, the person responsible for the
218	218	patient's health care decisions, or the person who has made the
219	219	decision regarding the advance directive or treatment decision may
220	220	file a motion for injunctive relief in any county court at law,
221	221	court having probate jurisdiction, or district court, including a
222	222	family district court, based on:
223	223	(1) a request for extension of time to effect a patient
224	224	transfer for relief under Section 166.046(g); or
225	225	(2) an allegation that a physician or other health
226	226	care professional, health care facility, or ethics or medical
227	227	committee is violating or threatening to violate this chapter.
228	228	(b) The person filing a motion under Subsection (a) shall
229	229	immediately serve a copy of the motion on the defendant.
230	230	(c) The court shall promptly set a time for a hearing on a
231	231	motion filed under Subsection (a) and shall keep a record of all
232	232	testimony and other oral proceedings in the action. The court shall
233	233	rule on the motion and issue written findings of fact and
234	234	conclusions of law not later than the fifth business day after the
235	235	date the motion is filed with the court.
236	236	(d) The time for the hearing and the date by which the court
237	237	must rule on the motion under Subsection (c) may be extended, for
238	238	good cause shown, by the court.
239	239	(e) Any party may appeal the decision of the court under
240	240	Subsection (c) to the court of appeals having jurisdiction over
241	241	civil matters in the county in which the motion was filed by filing
242	242	a notice of appeal with the clerk of the court that ruled on the
243	243	motion not later than the first business day after the date the
244	244	decision of the court was issued.
245	245	(f) On receipt of a notice of appeal under Subsection (e),
246	246	the clerk of the court that ruled on the motion shall deliver a copy
247	247	of the notice of appeal and record on appeal to the clerk of the
248	248	court of appeals. On receipt of the notice and record, the clerk of
249	249	the court of appeals shall place the appeal on the docket of the
250	250	court, and the court of appeals shall promptly issue an expedited
251	251	briefing schedule and set a time for a hearing.
252	252	(g) The court of appeals shall rule on an appeal under
253	253	Subsection (f) not later than the fifth business day after the date
254	254	the notice of appeal is filed with the court that ruled on the
255	255	motion.
256	256	(h) The times for the filing of briefs, the hearing, and the
257	257	date by which the court of appeals must rule on the appeal under
258	258	Subsection (g) may be extended, for good cause shown, by the court
259	259	of appeals.
260	260	(i) Any party may file a petition for review of the decision
261	261	of the court of appeals under Subsection (g) with the clerk of the
262	262	supreme court not later than the third business day after the date
263	263	the decision of the court of appeals was issued. Other parties may
264	264	file responses not later than the third business day after the date
265	265	the petition for review was filed. The supreme court shall grant,
266	266	deny, refuse, or dismiss the petition, without regard to whether a
267	267	reply to any response has been filed, not later than the third
268	268	business day after the date the response was due. If the supreme
269	269	court grants the petition for review, the court shall exercise the
270	270	court's sound discretion in determining how expeditiously to hear
271	271	and decide the case.
272	272	(j) If a motion is filed under Subsection (a) and the
273	273	dispute concerns whether life-sustaining treatment should be
274	274	provided to the patient, life-sustaining treatment must be provided
275	275	through midnight of the day by which a notice of appeal must be
276	276	filed unless the court directs that the life-sustaining treatment
277	277	be provided for a longer period. If a notice of appeal under
278	278	Subsection (e) is filed, life-sustaining treatment must be provided
279	279	through midnight of the day by which a petition for review to the
280	280	supreme court must be filed, unless the court of appeals directs
281	281	that the life-sustaining treatment be provided for a longer period.
282	282	If a petition for review to the supreme court is filed under
283	283	Subsection (i), life-sustaining treatment must be provided through
284	284	midnight of the day on which the supreme court denies, refuses, or
285	285	dismisses the petition or issues a ruling on the merits, unless the
286	286	supreme court directs that the life-sustaining treatment be
287	287	provided for a longer period.
288	288	(k) A filing fee or court cost may not be assessed for any
289	289	proceeding in a trial or appellate court under this section.
290	290	SECTION 6. Section 166.051, Health and Safety Code, is
291	291	amended to read as follows:
292	292	Sec. 166.051. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
293	293	This subchapter does not impair or supersede any legal right or
294	294	responsibility a person may have to effect the withholding or
295	295	withdrawal of life-sustaining treatment in a lawful manner,
296	296	provided that if an attending physician or health care facility is
297	297	unwilling to honor and comply with a patient's advance directive or
298	298	a treatment decision to provide life-sustaining treatment for a
299	299	reason permitted by Section 166.046(a-1) and not prohibited by
300	300	Section 166.0455, life-sustaining treatment is required to be
301	301	provided the patient, but only until a reasonable opportunity has
302	302	been afforded for transfer of the patient to another physician or
303	303	health care facility willing to comply with the advance directive
304	304	or treatment decision in accordance with Section 166.046.
305	305	SECTION 7. Sections 166.052(a) and (b), Health and Safety
306	306	Code, are amended to read as follows:
307	307	(a) In cases in which the attending physician refuses to
308	308	honor an advance directive or health care or treatment decision
309	309	requesting the provision of life-sustaining treatment, the
310	310	statement required by Section 166.046(b)(3)(A) shall be in
311	311	substantially the following form:
312	312	When There Is A Disagreement About Medical Treatment: The
313	313	Physician Recommends Against Certain Life-Sustaining Treatment
314	314	That You Wish To Continue
315	315	You have been given this information because you have
316	316	requested life-sustaining treatment* for yourself as the patient or
317	317	on behalf of the patient, as applicable, which the attending
318	318	physician believes is not medically appropriate. This information
319	319	is being provided to help you understand state law, your rights, and
320	320	the resources available to you in such circumstances. It outlines
321	321	the process for resolving disagreements about treatment among
322	322	patients, families, and physicians. It is based upon Section
323	323	166.046 of the Texas Advance Directives Act, codified in Chapter
324	324	166, Texas Health and Safety Code.
325	325	When an attending physician refuses to comply with an advance
326	326	directive or other request for life-sustaining treatment because of
327	327	the physician's judgment that the treatment would be medically
328	328	inappropriate, the case will be reviewed by an ethics or medical
329	329	committee. Life-sustaining treatment will be provided through the
330	330	review.
331	331	You will receive notification of this review at least seven
332	332	days [48 hours] before a meeting of the committee related to your
333	333	case. You are entitled to attend and participate in the entire
334	334	meeting. With your agreement, the meeting may be held sooner than
335	335	48 hours, if possible.
336	336	A physician or other health care professional, a health care
337	337	facility, or an ethics or medical committee may not deny a patient
338	338	life-sustaining treatment based on:
339	339	1. the lesser value the physician or professional,
340	340	facility, or committee places on sustaining the life of an elderly,
341	341	disabled, or terminally ill patient compared to the value of
342	342	sustaining the life of a patient who is younger, not disabled, or
343	343	not terminally ill; or
344	344	2. a disagreement between the physician or professional,
345	345	facility, or committee and the patient, or the person authorized to
346	346	make a treatment decision for the patient under Section 166.039,
347	347	over the greater weight the patient or person places on sustaining
348	348	the patient's life than the risk of disability.
349	349	Life-sustaining treatment may be denied if the treatment is:
350	350	1. futile because the treatment is physiologically
351	351	ineffective in achieving the specific intended benefit to the
352	352	patient as intended by or on behalf of the patient; or
353	353	2. medically inappropriate because providing the treatment
354	354	to the patient would clearly create a substantially greater risk of
355	355	causing or hastening the death of the patient than would
356	356	withholding or withdrawing it.
357	357	You are entitled to receive a written explanation of the
358	358	decision reached during the review process and the medical judgment
359	359	and reason leading to the decision in accordance with Section
360	360	166.0455, Health and Safety Code.
361	361	If after this review process both the attending physician and
362	362	the ethics or medical committee conclude that life-sustaining
363	363	treatment is medically inappropriate and yet you continue to
364	364	request such treatment, then the following procedure will occur:
365	365	1. The physician, with the help of the health care facility,
366	366	will assist you in trying to find a physician and facility willing
367	367	to provide the requested treatment.
368	368	2. You are being given a list of health care providers,
369	369	licensed physicians, health care facilities, and referral groups
370	370	that have volunteered their readiness to consider accepting
371	371	transfer, or to assist in locating a provider willing to accept
372	372	transfer, maintained by the Department of State Health Services.
373	373	You may wish to contact providers, facilities, or referral groups
374	374	on the list or others of your choice to get help in arranging a
375	375	transfer.
376	376	3. The patient will continue to be given life-sustaining
377	377	treatment until the patient can be transferred to a willing
378	378	provider for up to 10 days from the time you were given both the
379	379	committee's written decision and explanation that life-sustaining
380	380	treatment is not appropriate and the patient's medical record. The
381	381	patient will continue to be given after the 10-day period treatment
382	382	to enhance pain management and reduce suffering, including
383	383	artificially administered nutrition and hydration, unless, based
384	384	on reasonable medical judgment, providing artificially
385	385	administered nutrition and hydration would hasten the patient's
386	386	death, be medically contraindicated such that the provision of the
387	387	treatment seriously exacerbates life-threatening medical problems
388	388	not outweighed by the benefit of the provision of the treatment,
389	389	result in substantial irremediable physical pain not outweighed by
390	390	the benefit of the provision of the treatment, be medically
391	391	ineffective in prolonging life, or be contrary to the patient's or
392	392	surrogate's clearly documented desires.
393	393	4. If a transfer can be arranged, the patient will be
394	394	responsible for the costs of the transfer.
395	395	5. If a provider cannot be found willing to give the
396	396	requested treatment within 10 days, life-sustaining treatment may
397	397	be withdrawn unless a court of law has ruled otherwise [granted an
398	398	extension].
399	399	6. You may ask the [appropriate district or county] court to
400	400	extend the 10-day period if the court finds that there is a
401	401	reasonable expectation that you may find a physician or health care
402	402	facility willing to provide life-sustaining treatment if the
403	403	extension is granted. Patient medical records will be provided to
404	404	the patient or surrogate in accordance with Section 241.154, Texas
405	405	Health and Safety Code.
406	406	7. The law gives you the right to seek a court order to
407	407	require a physician or other health care professional, health care
408	408	facility, or ethics or medical committee to comply with your rights
409	409	under the Texas Advance Directives Act if the physician or
410	410	professional, facility, or committee is violating or threatening to
411	411	violate a provision of that Act. You may wish to talk to legal
412	412	counsel for further information about your right to seek a court
413	413	order.
414	414	*"Life-sustaining treatment" means treatment that, based on
415	415	reasonable medical judgment, sustains the life of a patient and
416	416	without which the patient will die. The term includes both
417	417	life-sustaining medications and artificial life support, such as
418	418	mechanical breathing machines, kidney dialysis treatment, and
419	419	artificially administered nutrition and hydration. The term does
420	420	not include the administration of pain management medication or the
421	421	performance of a medical procedure considered to be necessary to
422	422	provide comfort care, or any other medical care provided to
423	423	alleviate a patient's pain.
424	424	(b) In cases in which the attending physician refuses to
425	425	comply with an advance directive or treatment decision requesting
426	426	the withholding or withdrawal of life-sustaining treatment, the
427	427	statement required by Section 166.046(b)(3)(A) shall be in
428	428	substantially the following form:
429	429	When There Is A Disagreement About Medical Treatment: The
430	430	Physician Recommends Life-Sustaining Treatment That You Wish To
431	431	Stop
432	432	You have been given this information because you have
433	433	requested the withdrawal or withholding of life-sustaining
434	434	treatment* for yourself as the patient or on behalf of the patient,
435	435	as applicable, and the attending physician disagrees with and
436	436	refuses to comply with that request. The information is being
437	437	provided to help you understand state law, your rights, and the
438	438	resources available to you in such circumstances. It outlines the
439	439	process for resolving disagreements about treatment among
440	440	patients, families, and physicians. It is based upon Section
441	441	166.046 of the Texas Advance Directives Act, codified in Chapter
442	442	166, Texas Health and Safety Code.
443	443	When an attending physician refuses to comply with an advance
444	444	directive or other request for withdrawal or withholding of
445	445	life-sustaining treatment for any reason, the case will be reviewed
446	446	by an ethics or medical committee. Life-sustaining treatment will
447	447	be provided through the review.
448	448	You will receive notification of this review at least seven
449	449	days [48 hours] before a meeting of the committee related to your
450	450	case. You are entitled to attend and participate in the entire
451	451	meeting. With your agreement, the meeting may be held sooner than
452	452	48 hours, if possible.
453	453	You are entitled to receive a written explanation of the
454	454	decision reached during the review process and the medical judgment
455	455	and reason leading to the decision in accordance with Section
456	456	166.0455.
457	457	If you or the attending physician do not agree with the
458	458	decision reached during the review process, and the attending
459	459	physician still refuses to comply with your request to withhold or
460	460	withdraw life-sustaining treatment, then the following procedure
461	461	will occur:
462	462	1. The physician, with the help of the health care facility,
463	463	will assist you in trying to find a physician and facility willing
464	464	to withdraw or withhold the life-sustaining treatment.
465	465	2. You are being given a list of health care providers,
466	466	licensed physicians, health care facilities, and referral groups
467	467	that have volunteered their readiness to consider accepting
468	468	transfer, or to assist in locating a provider willing to accept
469	469	transfer, maintained by the Department of State Health
470	470	Services. You may wish to contact providers, facilities, or
471	471	referral groups on the list or others of your choice to get help in
472	472	arranging a transfer.
473	473	3. The law gives you a right to seek a court order to require
474	474	a physician or other health care professional, health care
475	475	facility, or ethics or medical committee to comply with your rights
476	476	under the Texas Advance Directives Act if the physician, facility,
477	477	or committee is violating or threatening to violate a provision of
478	478	that Act. You may wish to talk to legal counsel for further
479	479	information about your right to seek a court order.
480	480	*"Life-sustaining treatment" means treatment that, based on
481	481	reasonable medical judgment, sustains the life of a patient and
482	482	without which the patient will die. The term includes both
483	483	life-sustaining medications and artificial life support, such as
484	484	mechanical breathing machines, kidney dialysis treatment, and
485	485	artificially administered nutrition and hydration. The term does
486	486	not include the administration of pain management medication or the
487	487	performance of a medical procedure considered to be necessary to
488	488	provide comfort care, or any other medical care provided to
489	489	alleviate a patient's pain.
490	490	SECTION 8. Subchapter B, Chapter 166, Health and Safety
491	491	Code, is amended by adding Section 166.054 to read as follows:
492	492	Sec. 166.054. REPORTING REQUIREMENTS REGARDING ETHICS OR
493	493	MEDICAL COMMITTEE. (a) A health care facility shall complete and
494	494	submit an annual report to the commission, in the form and manner
495	495	prescribed by commission rule, of all meetings of an ethics or
496	496	medical committee held under Section 166.046 during the preceding
497	497	year.
498	498	(b) The report required by Subsection (a) must include:
499	499	(1) whether the health care facility held any ethics
500	500	or medical committee meetings during the preceding year; and
501	501	(2) for each meeting held during the preceding year:
502	502	(A) the patient's age, sex, race, and state and
503	503	county of residence;
504	504	(B) the patient's type of health benefit plan, if
505	505	applicable;
506	506	(C) the date of the meeting;
507	507	(D) whether the patient was transferred to
508	508	another physician in the same facility;
509	509	(E) whether the patient was transferred to
510	510	another facility;
511	511	(F) whether the patient was discharged to the
512	512	patient's home;
513	513	(G) whether treatment was withheld or withdrawn
514	514	without the consent of the patient or person authorized to make
515	515	treatment decisions on behalf of the patient after the meeting;
516	516	(H) whether treatment was withheld or withdrawn
517	517	with the consent of the patient or the person authorized to make
518	518	treatment decisions on behalf of the patient after the meeting; and
519	519	(I) whether the patient died while receiving
520	520	life-sustaining treatment at the facility.
521	521	(c) The commission shall publish on its Internet website an
522	522	annual report compiled by the commission containing aggregate data
523	523	of the information in each report submitted under Subsection (a),
524	524	including:
525	525	(1) the total number of patients for whom a review by
526	526	the ethics or medical committee is held under Section 166.046 in the
527	527	reported year;
528	528	(2) de-identified demographic data of patients,
529	529	including age, sex, and state and county of residence, and health
530	530	benefit plan status;
531	531	(3) de-identified data on facilities that initiated
532	532	the ethics or medical committee meeting, including:
533	533	(A) the county in which the facilities are
534	534	located;
535	535	(B) the type of facilities; and
536	536	(C) whether the facilities are nonprofit,
537	537	for-profit, or a public hospital;
538	538	(4) the decisions of the ethics or medical committee;
539	539	(5) the total number of patients transferred to
540	540	another physician in the same facility;
541	541	(6) the total number of patients transferred to
542	542	another facility;
543	543	(7) the total number of patients discharged to the
544	544	patient's home;
545	545	(8) the total number of patients for whom treatment
546	546	was withheld or withdrawn without the consent of the patient or
547	547	person authorized to make treatment decisions on behalf of the
548	548	patient after the ethics or medical committee meeting;
549	549	(9) the total number of patients for whom treatment
550	550	was withheld or withdrawn with the consent of the patient or person
551	551	authorized to make treatment decisions on behalf of the patient
552	552	after the ethics or medical committee meeting;
553	553	(10) the total number of patients who died while
554	554	receiving life-sustaining treatment at the facility;
555	555	(11) the total number of facilities reporting no
556	556	ethics or medical committee meetings during the reported year; and
557	557	(12) the total number of facilities reporting ethics
558	558	or medical committee meetings during the reported year.
559	559	(d) The report required by Subsection (c) may not contain
560	560	any identifying data of a patient, facility, or physician.
561	561	SECTION 9. Section 166.158(c), Health and Safety Code, is
562	562	amended to read as follows:
563	563	(c) A principal's health or residential care provider who
564	564	finds it impossible to follow a directive by the agent because of a
565	565	conflict with this subchapter or the medical power of attorney
566	566	shall inform the agent as soon as is reasonably possible. The agent
567	567	may select another attending physician. The procedures and
568	568	limitations established under Sections 166.045, 166.0455, and
569	569	166.046 apply if the agent's directive concerns providing,
570	570	withholding, or withdrawing life-sustaining treatment.
571	571	SECTION 10. Section 166.166, Health and Safety Code, is
572	572	amended to read as follows:
573	573	Sec. 166.166. OTHER RIGHTS OR RESPONSIBILITIES NOT
574	574	AFFECTED. This subchapter does not limit or impair any legal right
575	575	or responsibility that any person, including a physician or health
576	576	or residential care provider, may have to make or implement health
577	577	care decisions on behalf of a person, provided that if an attending
578	578	physician or health care facility is unwilling to honor and comply
579	579	with a patient's advance directive or a treatment decision to
580	580	provide life-sustaining treatment for a reason permitted by Section
581	581	166.046(a-1) and not prohibited by Section 166.0455,
582	582	life-sustaining treatment is required to be provided the patient,
583	583	but only until a reasonable opportunity has been afforded for
584	584	transfer of the patient to another physician or health care
585	585	facility willing to comply with the advance directive or treatment
586	586	decision in accordance with Section 166.046.
587	587	SECTION 11. Not later than December 1, 2019, the Supreme
588	588	Court of Texas shall issue the rules and prescribe the forms
589	589	necessary for the process established by Section 166.0465, Health
590	590	and Safety Code, as added by this Act. The rules shall prescribe
591	591	the method of service of the application under Section 166.0465,
592	592	Health and Safety Code, and may require filing and service of
593	593	notices, petitions, and briefs electronically to the extent the
594	594	Supreme Court of Texas considers appropriate.
595	595	SECTION 12. The changes in law made by this Act apply only
596	596	to a health care or treatment decision made on or after the
597	597	effective date of this Act.
598	598	SECTION 13. This Act takes effect immediately if it
599	599	receives a vote of two-thirds of all the members elected to each
600	600	house, as provided by Section 39, Article III, Texas Constitution.
601	601	If this Act does not receive the vote necessary for immediate
602	602	effect, this Act takes effect September 1, 2019.