Texas 2021 - 87th Regular

Texas Senate Bill SB1944 Compare Versions

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

Old	New	Differences
1	1	87R11767 SRA-F
2	2	By: Lucio, et al. S.B. No. 1944
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to end-of-life issues and hospice care.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subchapter A, Chapter 166, Health and Safety
10	10	Code, is amended by adding Section 166.012 to read as follows:
11	11	Sec. 166.012. PATIENT AND PROVIDER AUTONOMY. This chapter
12	12	does not:
13	13	(1) authorize a surrogate or patient's proxy to
14	14	supersede the patient's wishes or desires, if known by the patient's
15	15	physician, family member, or surrogate;
16	16	(2) subject to Section 166.046, require a health care
17	17	provider to continue treatment or care considered outside the
18	18	appropriate scope of care or in violation of the provider's ethical
19	19	duties; or
20	20	(3) prohibit a health care provider or facility from
21	21	performing any test or diagnostic necessary to determine the
22	22	patient's medical condition or related functions.
23	23	SECTION 2. Section 166.046, Health and Safety Code, is
24	24	amended by adding Subsections (a-1), (a-2), and (b-1) and amending
25	25	Subsections (b), (c), and (e) to read as follows:
26	26	(a-1) When an ethics or medical committee review is
27	27	initiated under this chapter, the ethics or medical committee
28	28	shall:
29	29	(1) inform the patient or surrogate that the patient
30	30	or surrogate may discontinue the process under this section by
31	31	providing written notice to the ethics or medical committee;
32	32	(2) appoint a patient liaison familiar with
33	33	end-of-life issues and hospice care options to assist the patient
34	34	or surrogate throughout the process described by this section; and
35	35	(3) advise the patient or surrogate that the patient's
36	36	attending physician may present medical facts at the meeting of the
37	37	ethics or medical committee.
38	38	(a-2) The patient's attending physician may attend and
39	39	present facts at an ethics or medical committee review meeting
40	40	initiated under this chapter but may not participate as a member of
41	41	the committee in the review of that case.
42	42	(b) When a meeting of the ethics or medical committee is
43	43	required under this section, not later than the seventh calendar
44	44	day before the date scheduled for that meeting, unless this period
45	45	is waived by mutual agreement, the committee shall provide to the
46	46	patient or surrogate [The patient or the person responsible for the
47	47	health care decisions of the individual who has made the decision
48	48	regarding the directive or treatment decision]:
49	49	(1) [may be given] a written description of the ethics
50	50	or medical committee review process and any other policies and
51	51	procedures related to this section adopted by the health care
52	52	facility;
53	53	(2) notice that the patient or surrogate is entitled
54	54	to receive the continued assistance of a patient liaison to assist
55	55	the patient or surrogate throughout the review process;
56	56	(3) notice that the patient or surrogate may:
57	57	(A) seek a second opinion at the patient's or
58	58	surrogate's expense from other medical professionals regarding the
59	59	patient's medical status and treatment requirements; and
60	60	(B) communicate the resulting information to the
61	61	members of the committee for consideration before the meeting;
62	62	(4) [shall be informed of the committee review process
63	63	not less than 48 hours before the meeting called to discuss the
64	64	patient's directive, unless the time period is waived by mutual
65	65	agreement;
66	66	[(3) at the time of being so informed, shall be
67	67	provided:
68	68	[(A)] a copy of the appropriate statement set
69	69	forth in Section 166.052; and
70	70	(5) [(B)] a copy of the registry list of health care
71	71	providers, health care facilities, and referral groups that, in
72	72	compliance with any state laws prohibiting barratry, have
73	73	volunteered their readiness to consider accepting transfer or to
74	74	assist in locating a provider willing to accept transfer that is
75	75	posted on the website maintained by the department under Section
76	76	166.053.
77	77	(b-1) The patient or surrogate[; and
78	78	[(4)] is entitled to:
79	79	(1) an invitation to [(A)] attend and participate in
80	80	the meeting of the ethics or medical committee, excluding the
81	81	committee's deliberations, if the patient or surrogate elects to
82	82	attend or participate;
83	83	(2) be accompanied at the meeting by as many as five
84	84	persons, or more persons at the committee's discretion, for
85	85	support, subject to the facility's reasonable written attendance
86	86	policy as necessary to:
87	87	(A) facilitate information sharing and
88	88	discussion of the patient's medical status and treatment
89	89	requirements; and
90	90	(B) preserve the order and decorum of the
91	91	meeting;
92	92	(3) receive a written explanation of the decision
93	93	reached during the review process;
94	94	(4) [(C)] receive a copy of the portion of the
95	95	patient's medical record related to the treatment received by the
96	96	patient in the facility for the lesser of:
97	97	(A) [(i)] the period of the patient's current
98	98	admission to the facility; or
99	99	(B) [(ii)] the preceding 30 calendar days; and
100	100	(5) [(D)] receive a copy of all of the patient's
101	101	reasonably available diagnostic results and reports related to the
102	102	medical record provided under Subdivision (4) [Paragraph (C)].
103	103	(c) The written explanation required by Subsection (b-1)(3)
104	104	[(b)(4)(B)] must be included in the patient's medical record.
105	105	(e) If the patient or the person responsible for the health
106	106	care decisions of the patient is requesting life-sustaining
107	107	treatment that the attending physician has decided and the ethics
108	108	or medical committee has affirmed is medically inappropriate
109	109	treatment, the patient shall be given available life-sustaining
110	110	treatment pending transfer under Subsection (d). This subsection
111	111	does not authorize withholding or withdrawing pain management
112	112	medication, medical procedures necessary to provide comfort, or any
113	113	other health care provided to alleviate a patient's pain. The
114	114	patient is responsible for any costs incurred in transferring the
115	115	patient to another facility. The attending physician, any other
116	116	physician responsible for the care of the patient, and the health
117	117	care facility are not obligated to provide life-sustaining
118	118	treatment after the 14th calendar [10th] day after both the written
119	119	decision and the patient's medical record required under Subsection
120	120	(b-1) [(b)] are provided to the patient or the person responsible
121	121	for the health care decisions of the patient unless ordered to do so
122	122	under Subsection (g), except that artificially administered
123	123	nutrition and hydration must be provided unless, based on
124	124	reasonable medical judgment, providing artificially administered
125	125	nutrition and hydration would:
126	126	(1) hasten the patient's death;
127	127	(2) be medically contraindicated such that the
128	128	provision of the treatment seriously exacerbates life-threatening
129	129	medical problems not outweighed by the benefit of the provision of
130	130	the treatment;
131	131	(3) result in substantial irremediable physical pain
132	132	not outweighed by the benefit of the provision of the treatment;
133	133	(4) be medically ineffective in prolonging life; or
134	134	(5) be contrary to the patient's or surrogate's
135	135	clearly documented desire not to receive artificially administered
136	136	nutrition or hydration.
137	137	SECTION 3. Subchapter B, Chapter 166, Health and Safety
138	138	Code, is amended by adding Section 166.0465 to read as follows:
139	139	Sec. 166.0465. ETHICS OR MEDICAL COMMITTEE POLICIES;
140	140	CONFLICTS OF INTEREST AND DISCRIMINATION. Each health care
141	141	facility that provides review by an ethics or medical committee
142	142	under Section 166.046 shall adopt and implement a policy on:
143	143	(1) preventing financial and health care professional
144	144	conflicts of interest that may arise during a review under that
145	145	section;
146	146	(2) allowing participation on, and interaction with,
147	147	the committee by telephone, videoconference, or other secure
148	148	electronic means; and
149	149	(3) prohibiting consideration of a patient's permanent
150	150	physical or mental disability during the review unless the
151	151	disability is relevant in determining whether a medical or surgical
152	152	intervention is medically appropriate.
153	153	SECTION 4. Sections 166.052(a) and (b), Health and Safety
154	154	Code, are amended to read as follows:
155	155	(a) In cases in which the attending physician refuses to
156	156	honor an advance directive or health care or treatment decision
157	157	requesting the provision of life-sustaining treatment, the
158	158	statement required by Section 166.046(b)(4) [166.046(b)(3)(A)]
159	159	shall be in substantially the following form:
160	160	When There Is A Disagreement About Medical Treatment: The
161	161	Physician Recommends Against Certain Life-Sustaining Treatment
162	162	That You Wish To Continue
163	163	You have been given this information because you have
164	164	requested life-sustaining treatment* for yourself as the patient or
165	165	on behalf of the patient, as applicable, which the attending
166	166	physician believes is not medically appropriate. This information
167	167	is being provided to help you understand state law, your rights, and
168	168	the resources available to you in such circumstances. It outlines
169	169	the process for resolving disagreements about treatment among
170	170	patients, families, and physicians. It is based upon Section
171	171	166.046 of the Texas Advance Directives Act, codified in Chapter
172	172	166, Texas Health and Safety Code.
173	173	When an attending physician refuses to comply with an advance
174	174	directive or other request for life-sustaining treatment because of
175	175	the physician's judgment that the treatment would be medically
176	176	inappropriate, the case will be reviewed by an ethics or medical
177	177	committee. Life-sustaining treatment will be provided through the
178	178	review.
179	179	You will receive notification of this review at least seven
180	180	calendar days [48 hours] before a meeting of the committee related
181	181	to your case. You are entitled to attend the meeting. With your
182	182	agreement, the meeting may be held sooner than seven calendar days
183	183	[48 hours], if possible.
184	184	You are entitled to receive a written explanation of the
185	185	decision reached during the review process.
186	186	If after this review process both the attending physician and
187	187	the ethics or medical committee conclude that life-sustaining
188	188	treatment is medically inappropriate and yet you continue to
189	189	request such treatment, then the following procedure will occur:
190	190	1. The physician, with the help of the health care facility,
191	191	will assist you in trying to find a physician and facility willing
192	192	to provide the requested treatment.
193	193	2. You are being given a list of health care providers,
194	194	licensed physicians, health care facilities, and referral groups
195	195	that have volunteered their readiness to consider accepting
196	196	transfer, or to assist in locating a provider willing to accept
197	197	transfer, maintained by the Department of State Health Services.
198	198	You may wish to contact providers, facilities, or referral groups
199	199	on the list or others of your choice to get help in arranging a
200	200	transfer.
201	201	3. The patient will continue to be given life-sustaining
202	202	treatment until the patient can be transferred to a willing
203	203	provider for up to 14 calendar [10] days from the time you were
204	204	given both the committee's written decision that life-sustaining
205	205	treatment is not appropriate and the patient's medical record. The
206	206	patient will continue to be given after the 14-calendar-day
207	207	[10-day] period treatment to enhance pain management and reduce
208	208	suffering, including artificially administered nutrition and
209	209	hydration, unless, based on reasonable medical judgment, providing
210	210	artificially administered nutrition and hydration would hasten the
211	211	patient's death, be medically contraindicated such that the
212	212	provision of the treatment seriously exacerbates life-threatening
213	213	medical problems not outweighed by the benefit of the provision of
214	214	the treatment, result in substantial irremediable physical pain not
215	215	outweighed by the benefit of the provision of the treatment, be
216	216	medically ineffective in prolonging life, or be contrary to the
217	217	patient's or surrogate's clearly documented desires.
218	218	4. If a transfer can be arranged, the patient will be
219	219	responsible for the costs of the transfer.
220	220	5. If a provider cannot be found willing to give the
221	221	requested treatment within 14 calendar [10] days, life-sustaining
222	222	treatment may be withdrawn unless a court of law has granted an
223	223	extension.
224	224	6. You may ask the appropriate district or county court to
225	225	extend the 14-calendar-day [10-day] period if the court finds that
226	226	there is a reasonable expectation that you may find a physician or
227	227	health care facility willing to provide life-sustaining treatment
228	228	if the extension is granted. Patient medical records will be
229	229	provided to the patient or surrogate in accordance with Section
230	230	241.154, Texas Health and Safety Code.
231	231	*"Life-sustaining treatment" means treatment that, based on
232	232	reasonable medical judgment, sustains the life of a patient and
233	233	without which the patient will die. The term includes both
234	234	life-sustaining medications and artificial life support, such as
235	235	mechanical breathing machines, kidney dialysis treatment, and
236	236	artificially administered nutrition and hydration. The term does
237	237	not include the administration of pain management medication or the
238	238	performance of a medical procedure considered to be necessary to
239	239	provide comfort care, or any other medical care provided to
240	240	alleviate a patient's pain.
241	241	(b) In cases in which the attending physician refuses to
242	242	comply with an advance directive or treatment decision requesting
243	243	the withholding or withdrawal of life-sustaining treatment, the
244	244	statement required by Section 166.046(b)(4) [166.046(b)(3)(A)]
245	245	shall be in substantially the following form:
246	246	When There Is A Disagreement About Medical Treatment: The
247	247	Physician Recommends Life-Sustaining Treatment That You Wish To
248	248	Stop
249	249	You have been given this information because you have
250	250	requested the withdrawal or withholding of life-sustaining
251	251	treatment* for yourself as the patient or on behalf of the patient,
252	252	as applicable, and the attending physician disagrees with and
253	253	refuses to comply with that request. The information is being
254	254	provided to help you understand state law, your rights, and the
255	255	resources available to you in such circumstances. It outlines the
256	256	process for resolving disagreements about treatment among
257	257	patients, families, and physicians. It is based upon Section
258	258	166.046 of the Texas Advance Directives Act, codified in Chapter
259	259	166, Texas Health and Safety Code.
260	260	When an attending physician refuses to comply with an advance
261	261	directive or other request for withdrawal or withholding of
262	262	life-sustaining treatment for any reason, the case will be reviewed
263	263	by an ethics or medical committee. Life-sustaining treatment will
264	264	be provided through the review.
265	265	You will receive notification of this review at least seven
266	266	calendar days [48 hours] before a meeting of the committee related
267	267	to your case. You are entitled to attend the meeting. With your
268	268	agreement, the meeting may be held sooner than seven calendar days
269	269	[48 hours], if possible.
270	270	You are entitled to receive a written explanation of the
271	271	decision reached during the review process.
272	272	If you or the attending physician do not agree with the
273	273	decision reached during the review process, and the attending
274	274	physician still refuses to comply with your request to withhold or
275	275	withdraw life-sustaining treatment, then the following procedure
276	276	will occur:
277	277	1. The physician, with the help of the health care facility,
278	278	will assist you in trying to find a physician and facility willing
279	279	to withdraw or withhold the life-sustaining treatment.
280	280	2. You are being given a list of health care providers,
281	281	licensed physicians, health care facilities, and referral groups
282	282	that have volunteered their readiness to consider accepting
283	283	transfer, or to assist in locating a provider willing to accept
284	284	transfer, maintained by the Department of State Health
285	285	Services. You may wish to contact providers, facilities, or
286	286	referral groups on the list or others of your choice to get help in
287	287	arranging a transfer.
288	288	*"Life-sustaining treatment" means treatment that, based on
289	289	reasonable medical judgment, sustains the life of a patient and
290	290	without which the patient will die. The term includes both
291	291	life-sustaining medications and artificial life support, such as
292	292	mechanical breathing machines, kidney dialysis treatment, and
293	293	artificially administered nutrition and hydration. The term does
294	294	not include the administration of pain management medication or the
295	295	performance of a medical procedure considered to be necessary to
296	296	provide comfort care, or any other medical care provided to
297	297	alleviate a patient's pain.
298	298	SECTION 5. Subchapter B, Chapter 166, Health and Safety
299	299	Code, is amended by adding Section 166.054 to read as follows:
300	300	Sec. 166.054. REPORTING REQUIREMENTS REGARDING ETHICS OR
301	301	MEDICAL COMMITTEE PROCESSES. (a) On submission of a health care
302	302	facility's application to renew its license, a facility in which
303	303	one or more meetings of an ethics or medical committee are held
304	304	under this chapter shall file a report with the department that
305	305	contains aggregate information regarding the number of cases
306	306	initiated by an ethics or medical committee under Section 166.046
307	307	and the disposition of those cases by the facility.
308	308	(b) Aggregate data submitted to the department under this
309	309	section may include only the following:
310	310	(1) the total number of patients for whom a review by
311	311	the ethics or medical committee was initiated under Section
312	312	166.046(b);
313	313	(2) the number of patients under Subdivision (1) who
314	314	were transferred to:
315	315	(A) another physician within the same facility;
316	316	or
317	317	(B) a different facility;
318	318	(3) the number of patients under Subdivision (1) who
319	319	were discharged to home;
320	320	(4) the number of patients under Subdivision (1) for
321	321	whom treatment was withheld or withdrawn pursuant to surrogate
322	322	consent:
323	323	(A) before the decision was rendered following a
324	324	review under Section 166.046(b);
325	325	(B) after the decision was rendered following a
326	326	review under Section 166.046(b); or
327	327	(C) during or after the 14-calendar-day period
328	328	described by Section 166.046(e);
329	329	(5) the average length of stay before a review meeting
330	330	is held under Section 166.046(b); and
331	331	(6) the number of patients under Subdivision (1) who
332	332	died while still receiving life-sustaining treatment:
333	333	(A) before the review meeting under Section
334	334	166.046(b);
335	335	(B) during the 14-calendar-day period described
336	336	by Section 166.046(e); or
337	337	(C) during any extension of the 14-calendar-day
338	338	period described by Section 166.046(e).
339	339	(c) The report required by this section may not contain any
340	340	data specific to an individual patient or physician.
341	341	(d) The executive commissioner shall adopt rules to:
342	342	(1) establish a standard form for the reporting
343	343	requirements of this section; and
344	344	(2) post on the department's Internet website the data
345	345	submitted under Subsection (b) in the format provided by rule.
346	346	(e) Data collected as required by, or submitted to the
347	347	department under, this section:
348	348	(1) is not admissible in a civil or criminal
349	349	proceeding in which a physician, health care professional acting
350	350	under the direction of a physician, or health care facility is a
351	351	defendant; and
352	352	(2) may not be used in relation to any disciplinary
353	353	action by a licensing board or other body with professional or
354	354	administrative oversight over a physician, health care
355	355	professional acting under the direction of a physician, or health
356	356	care facility.
357	357	SECTION 6. Section 166.202(a), Health and Safety Code, is
358	358	amended to read as follows:
359	359	(a) This subchapter applies to a DNR order issued for a
360	360	patient who has been admitted to [in] a health care facility or
361	361	hospital.
362	362	SECTION 7. Sections 166.203(a), (b), and (c), Health and
363	363	Safety Code, are amended to read as follows:
364	364	(a) A DNR order issued for a patient is valid only if a
365	365	physician providing direct care to the patient [patient's attending
366	366	physician] issues the order, the order is dated, and the order:
367	367	(1) is issued in compliance with:
368	368	(A) the written and dated directions of a patient
369	369	who was competent at the time the patient wrote the directions;
370	370	(B) the oral directions of a competent patient
371	371	delivered to or observed by two competent adult witnesses, at least
372	372	one of whom must be a person not listed under Section 166.003(2)(E)
373	373	or (F);
374	374	(C) the directions in an advance directive
375	375	enforceable under Section 166.005 or executed in accordance with
376	376	Section 166.032, 166.034, [or] 166.035, 166.082, 166.084, or
377	377	166.085;
378	378	(D) the directions of:
379	379	(i) a patient's legal guardian;
380	380	(ii) a patient's [or] agent under a medical
381	381	power of attorney acting in accordance with Subchapter D; or
382	382	(iii) a patient's proxy as designated and
383	383	authorized by a directive executed or issued in accordance with
384	384	Subchapter B to make a treatment decision for the patient if the
385	385	patient becomes incompetent or otherwise mentally or physically
386	386	incapable of communication; or
387	387	(E) a treatment decision made in accordance with
388	388	Section 166.039; or
389	389	(2) is not contrary to the directions of a patient who
390	390	was competent at the time the patient conveyed the directions and,
391	391	in the reasonable medical judgment of the [patient's attending]
392	392	physician issuing the order:
393	393	(A) the patient's death is imminent, regardless
394	394	of the provision of cardiopulmonary resuscitation; and
395	395	(B) the DNR order is medically appropriate.
396	396	(b) The DNR order:
397	397	(1) may be issued and entered in any format acceptable
398	398	under the policies of the health care facility or hospital; and
399	399	(2) takes effect at the time the order is issued,
400	400	provided the order is placed in the patient's medical record as soon
401	401	as practicable.
402	402	(c) Unless notice has already been provided in accordance
403	403	with Section 166.204(a-1), before [Before] placing in a patient's
404	404	medical record a DNR order issued under Subsection (a)(2), a [the]
405	405	physician, a physician assistant, a nurse, or another [other]
406	406	person acting on behalf of a health care facility or hospital shall:
407	407	(1) inform the patient of the order's issuance; or
408	408	(2) if the patient is incompetent, make a reasonably
409	409	diligent effort to contact or cause to be contacted and inform of
410	410	the order's issuance:
411	411	(A) the patient's known agent under a medical
412	412	power of attorney or legal guardian; or
413	413	(B) for a patient who does not have a known agent
414	414	under a medical power of attorney or legal guardian, a person
415	415	described by Section 166.039(b)(1), (2), or (3).
416	416	SECTION 8. Section 166.204, Health and Safety Code, is
417	417	amended by amending Subsection (a) and adding Subsection (a-1) to
418	418	read as follows:
419	419	(a) If a physician issues a DNR order under Section
420	420	166.203(a)(2), a physician, a physician assistant, a nurse, or
421	421	another person acting on behalf of a health care facility or
422	422	hospital shall provide notice of the order to the appropriate
423	423	persons in accordance with Subsection (a-1) of this section or
424	424	Section 166.203(c).
425	425	(a-1) Unless notice has already been provided in accordance
426	426	with Section 166.203(c), if [If] an individual arrives at a health
427	427	care facility or hospital that is treating a patient for whom a DNR
428	428	order is issued under Section 166.203(a)(2) and the individual
429	429	notifies a physician, physician assistant, or nurse providing
430	430	direct care to the patient of the individual's arrival, the
431	431	physician, physician assistant, or nurse who has actual knowledge
432	432	of the order shall disclose the order to the individual, provided
433	433	the individual is:
434	434	(1) the patient's known agent under a medical power of
435	435	attorney or legal guardian; or
436	436	(2) for a patient who does not have a known agent under
437	437	a medical power of attorney or legal guardian, a person described by
438	438	Section 166.039(b)(1), (2), or (3).
439	439	SECTION 9. Sections 166.205(a), (b), and (c), Health and
440	440	Safety Code, are amended to read as follows:
441	441	(a) A physician providing direct care to a patient for whom
442	442	a DNR order is issued shall revoke the patient's DNR order if:
443	443	(1) the advance directive on which the DNR order is
444	444	based is properly revoked in accordance with applicable provisions
445	445	of this chapter; or
446	446	(2) the patient or the individual at whose direction
447	447	the DNR order was issued[, as applicable, the patient's agent under
448	448	a medical power of attorney or the patient's legal guardian if the
449	449	patient is incompetent:
450	450	[(1) effectively revokes an advance directive, in
451	451	accordance with Section 166.042, for which a DNR order is issued
452	452	under Section 166.203(a); or
453	453	[(2)] expresses to any person providing direct care to
454	454	the patient a revocation of consent to or intent to revoke a DNR
455	455	order issued under Section 166.203(a).
456	456	(b) A person providing direct care to a patient under the
457	457	supervision of a physician shall notify the physician of the
458	458	revocation of the advance directive or the request to revoke a DNR
459	459	order under Subsection (a).
460	460	(c) The [A patient's attending] physician who issued [may at
461	461	any time revoke] a DNR order issued under Section 166.203(a)(2), or
462	462	any other attending physician providing direct care to the patient
463	463	in accordance with applicable hospital policies, may at any time
464	464	revoke the DNR order.
465	465	SECTION 10. Sections 166.206(a) and (b), Health and Safety
466	466	Code, are amended to read as follows:
467	467	(a) If a [an attending] physician, health care facility, or
468	468	hospital does not wish to execute or comply with a DNR order or the
469	469	patient's instructions concerning the provision of cardiopulmonary
470	470	resuscitation, the physician, facility, or hospital shall inform
471	471	the patient, the legal guardian or qualified relatives of the
472	472	patient, or the agent of the patient under a medical power of
473	473	attorney of the benefits and burdens of cardiopulmonary
474	474	resuscitation.
475	475	(b) If, after receiving notice under Subsection (a), the
476	476	patient or another person authorized to act on behalf of the patient
477	477	and the [attending] physician, health care facility, or hospital
478	478	remain in disagreement, the physician, facility, or hospital shall
479	479	make a reasonable effort to transfer the patient to another
480	480	physician, facility, or hospital willing to execute or comply with
481	481	a DNR order or the patient's instructions concerning the provision
482	482	of cardiopulmonary resuscitation.
483	483	SECTION 11. Section 166.209, Health and Safety Code, is
484	484	amended to read as follows:
485	485	Sec. 166.209. ENFORCEMENT. (a) Subject to Sections
486	486	166.205(d), 166.207, and 166.208, a [A] physician, physician
487	487	assistant, nurse, or other person commits an offense if, with the
488	488	specific intent to violate the requirements of this subchapter, the
489	489	person intentionally:
490	490	(1) conceals, cancels, effectuates, or falsifies
491	491	another person's DNR order; or
492	492	(2) [if the person intentionally] conceals or
493	493	withholds personal knowledge of another person's revocation of a
494	494	DNR order [in violation of this subchapter].
495	495	(a-1) An offense under Subsection (a) [this subsection] is a
496	496	Class A misdemeanor. This section [subsection] does not preclude
497	497	prosecution for any other applicable offense.
498	498	(b) Subject to Sections 166.205(d), 166.207, and 166.208, a
499	499	[A] physician, health care professional, health care facility,
500	500	hospital, or entity is subject to review and disciplinary action by
501	501	the appropriate licensing authority for intentionally:
502	502	(1) failing to effectuate a DNR order in violation of
503	503	this subchapter; or
504	504	(2) issuing a DNR order in violation of this
505	505	subchapter.
506	506	SECTION 12. Section 313.004(a), Health and Safety Code, is
507	507	amended to read as follows:
508	508	(a) If an adult patient of a home and community support
509	509	services agency or in a hospital or nursing home, or an adult inmate
510	510	of a county or municipal jail, is comatose, incapacitated, or
511	511	otherwise mentally or physically incapable of communication and
512	512	does not have a legal guardian or an agent under a medical power of
513	513	attorney who can concur with the patient's attending physician, an
514	514	adult surrogate from the following list, in order of priority, who
515	515	has decision-making capacity, is available after a reasonably
516	516	diligent inquiry, and is willing to consent to medical treatment on
517	517	behalf of the patient, may consent to medical treatment on behalf of
518	518	the patient in concurrence with the patient's attending physician:
519	519	(1) the patient's spouse;
520	520	(2) the patient's reasonably available adult children
521	521	[an adult child of the patient who has the waiver and consent of all
522	522	other qualified adult children of the patient to act as the sole
523	523	decision-maker];
524	524	(3) [a majority of] the patient's parents [reasonably
525	525	available adult children];
526	526	(4) the patient's nearest living relative [parents];
527	527	or
528	528	(5) if the patient does not have a legal guardian or an
529	529	agent under a medical power of attorney and a person listed in this
530	530	subsection is not available, another licensed physician who is not
531	531	involved in the direct treatment of the patient [the individual
532	532	clearly identified to act for the patient by the patient before the
533	533	patient became incapacitated, the patient's nearest living
534	534	relative, or a member of the clergy].
535	535	SECTION 13. Not later than March 1, 2022, the executive
536	536	commissioner of the Health and Human Services Commission shall
537	537	adopt the rules necessary to implement the changes in law made by
538	538	this Act to Chapter 166, Health and Safety Code.
539	539	SECTION 14. Chapter 166, Health and Safety Code, as amended
540	540	by this Act, applies only to a review, consultation, disagreement,
541	541	or other action relating to a health care or treatment decision made
542	542	on or after April 1, 2022. A review, consultation, disagreement, or
543	543	other action relating to a health care or treatment decision made
544	544	before April 1, 2022, is governed by the law in effect immediately
545	545	before the effective date of this Act, and the former law is
546	546	continued in effect for that purpose.
547	547	SECTION 15. Chapter 166, Health and Safety Code, as amended
548	548	by this Act, applies only to a do-not-resuscitate order issued on or
549	549	after the effective date of this Act. A do-not-resuscitate order
550	550	issued before the effective date of this Act is governed by the law
551	551	in effect on the date the order was issued, and that law is
552	552	continued in effect for that purpose.
553	553	SECTION 16. (a) A health care facility shall adopt the
554	554	policy required by Section 166.0465, Health and Safety Code, as
555	555	added by this Act, not later than April 1, 2022.
556	556	(b) A policy adopted under Section 166.0465, Health and
557	557	Safety Code, as added by this Act, applies only to an ethics or
558	558	medical committee review conducted on or after April 1, 2022.
559	559	SECTION 17. This Act takes effect September 1, 2021.