By: Hughes, et al. S.B. No. 917
(In the Senate - Filed March 2, 2021; March 11, 2021, read
first time and referred to Committee on Health & Human Services;
May 13, 2021, reported adversely, with favorable Committee
Substitute by the following vote: Yeas 5, Nays 4; May 13, 2021,
sent to printer.)
Click here to see the committee vote
COMMITTEE SUBSTITUTE FOR S.B. No. 917 By: Perry
A BILL TO BE ENTITLED
AN ACT
relating to advance directives or health care or treatment
decisions made by or on behalf of patients.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. This Act may be cited as the Respecting Texas
Patients' Right to Life Act of 2021.
SECTION 2. The purpose of this Act is to protect the right
of patients and their families to decide whether and under what
circumstances to choose or reject life-sustaining treatment. This
Act amends the applicable provisions of the Advance Directives Act
(Chapter 166, Health and Safety Code) to ensure that, when an
attending physician is unwilling to respect a patient's advance
directive or a patient's or family's decision to choose the
treatment necessary to prevent the patient's death,
life-sustaining medical treatment will be provided for 90 days
after an ethics or medical committee's review so that the patient
can be transferred to a health care provider willing to honor the
directive or treatment decision.
SECTION 3. Section 166.045(c), Health and Safety Code, is
amended to read as follows:
(c) If an attending physician refuses to comply with a
directive or treatment decision to provide life-sustaining
treatment to a patient [and does not wish to follow the procedure
established under Section 166.046], life-sustaining treatment
shall be provided to the patient for 90 days under the procedures
prescribed by Section 166.046 so that[, but only until a reasonable
opportunity has been afforded for the transfer of] the patient can
be transferred to another physician or health care facility willing
to comply with the directive or treatment decision.
SECTION 4. Sections 166.046(a), (b), (d), (e), and (e-1),
Health and Safety Code, are amended to read as follows:
(a) If an attending physician refuses to honor a patient's
advance directive or a health care or treatment decision made by or
on behalf of a patient, other than a directive or decision to
provide artificial nutrition and hydration to the patient, the
physician's refusal shall be reviewed by an ethics or medical
committee. The attending physician may not be a member of that
committee. The patient shall be given life-sustaining treatment
during the review.
(b) The patient or the person responsible for the health
care decisions of the individual who has made the decision
regarding the directive or treatment decision:
(1) may be given a written description of the ethics or
medical committee review process and any other policies and
procedures related to this section adopted by the health care
facility;
(2) shall be informed of the committee review process
not less than 48 hours before the meeting called to discuss the
patient's directive, unless the time period is waived by mutual
agreement;
(3) at the time of being so informed, shall be
provided:
(A) a copy of the appropriate statement set forth
in Section 166.052; and
(B) a copy of the registry list of health care
providers and referral groups that have volunteered their readiness
to consider accepting transfer or to assist in locating a provider
willing to accept transfer that is posted on the website maintained
by the department under Section 166.053; and
(4) is entitled to:
(A) attend the meeting;
(B) receive a written explanation of the
recommendations made [decision reached] during the review process;
(C) receive a copy of the portion of the
patient's medical record related to the treatment received by the
patient in the facility for the lesser of:
(i) the period of the patient's current
admission to the facility; or
(ii) the preceding 30 calendar days; and
(D) receive a copy of all of the patient's
reasonably available diagnostic results and reports related to the
medical record provided under Paragraph (C).
(d) If the attending physician, the patient, or the person
responsible for the health care decisions of the individual does
not agree with the recommendations made [decision reached] during
the review process under Subsection (b), the physician shall make a
reasonable effort to transfer the patient to a physician who is
willing to comply with the directive. If the patient is a patient in
a health care facility, the facility's personnel shall assist the
physician in arranging the patient's transfer to:
(1) another physician;
(2) an alternative care setting within that facility;
or
(3) another facility.
(e) If the patient or the person responsible for the health
care decisions of the patient is requesting life-sustaining
treatment that the attending physician [has decided] and the ethics
or medical committee consider [has affirmed is] medically
inappropriate treatment, the patient shall be given available
life-sustaining treatment pending transfer under Subsection (d).
This subsection does not authorize withholding or withdrawing pain
management medication, medical procedures necessary to provide
comfort, or any other health care provided to alleviate a patient's
pain. [The patient is responsible for any costs incurred in
transferring the patient to another facility.] The attending
physician, any other physician responsible for the care of the
patient, and the health care facility are not obligated to provide
life-sustaining treatment after the 90th [10th] day after both the
written recommendation [decision] and the patient's medical record
required under Subsection (b) are provided to the patient or the
person responsible for the health care decisions of the patient
unless ordered to do so under Subsection (g), except that
artificially administered nutrition and hydration must be provided
unless, based on reasonable medical judgment, providing
artificially administered nutrition and hydration would:
(1) hasten the patient's death;
(2) be medically contraindicated such that the
provision of the treatment seriously exacerbates life-threatening
medical problems not outweighed by the benefit of the provision of
the treatment;
(3) result in substantial irremediable physical pain
not outweighed by the benefit of the provision of the treatment;
(4) be medically ineffective in prolonging life; or
(5) be contrary to the patient's or surrogate's
clearly documented desire not to receive artificially administered
nutrition or hydration.
(e-1) If during a previous admission to a facility a
patient's attending physician and the review process under
Subsection (b) have determined that life-sustaining treatment is
inappropriate, and the patient is readmitted to the same facility
within six months from the date of the recommendations made
[decision reached] during the review process conducted upon the
previous admission, Subsections (b) through (e) need not be
followed if the patient's attending physician and a consulting
physician who is a member of the ethics or medical committee of the
facility document on the patient's readmission that the patient's
condition either has not improved or has deteriorated since the
review process was conducted.
SECTION 5. Section 166.051, Health and Safety Code, is
amended to read as follows:
Sec. 166.051. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
This subchapter does not impair or supersede any legal right or
responsibility a person may have to effect the withholding or
withdrawal of life-sustaining treatment in a lawful manner,
provided that if an attending physician or health care facility is
unwilling to honor a patient's advance directive or a treatment
decision to provide life-sustaining treatment, life-sustaining
treatment must [is required to] be provided to the patient in
accordance with this chapter[, but only until a reasonable
opportunity has been afforded for transfer of the patient to
another physician or health care facility willing to comply with
the advance directive or treatment decision].
SECTION 6. Section 166.052(a), Health and Safety Code, is
amended to read as follows:
(a) In cases in which the attending physician refuses to
honor an advance directive or health care or treatment decision
requesting the provision of life-sustaining treatment, the
statement required by Section 166.046(b)(3)(A) shall be in
substantially the following form:
When There Is A Disagreement About Medical Treatment: The Physician
Recommends Against Certain Life-Sustaining Treatment That You Wish
To Continue
You have been given this information because you have
requested life-sustaining treatment* for yourself as the patient or
on behalf of the patient, as applicable, which the attending
physician believes is not medically appropriate. This information
is being provided to help you understand state law, your rights, and
the resources available to you in such circumstances. It outlines
the process for resolving disagreements about treatment among
patients, families, and physicians. It is based upon Section
166.046 of the Texas Advance Directives Act, codified in Chapter
166, Texas Health and Safety Code.
When an attending physician refuses to comply with an advance
directive or other request for life-sustaining treatment because of
the physician's judgment that the treatment would be medically
inappropriate, the case will be reviewed by an ethics or medical
committee. Life-sustaining treatment will be provided through the
review.
You will receive notification of this review at least 48
hours before a meeting of the committee related to your case. You
are entitled to attend the meeting. With your agreement, the
meeting may be held sooner than 48 hours, if possible.
You are entitled to receive a written explanation of the
recommendations made [decision reached] during the review process.
If after this review process both the attending physician and
the ethics or medical committee conclude that life-sustaining
treatment is medically inappropriate and yet you continue to
request such treatment, then the following procedure will occur:
1. The physician, with the help of the health care facility,
will assist you in trying to find a physician and facility willing
to provide the requested treatment.
2. You are being given a list of health care providers,
licensed physicians, health care facilities, and referral groups
that have volunteered their readiness to consider accepting
transfer, or to assist in locating a provider willing to accept
transfer, maintained by the Department of State Health Services.
You may wish to contact providers, facilities, or referral groups
on the list or others of your choice to get help in arranging a
transfer.
3. The patient will continue to be given life-sustaining
treatment until the patient can be transferred to a willing
provider for up to 90 [10] days from the time you were given both the
committee's written decision that life-sustaining treatment is not
appropriate and the patient's medical record. The patient will
continue to be given after the 90-day [10-day] period treatment to
enhance pain management and reduce suffering, including
artificially administered nutrition and hydration, unless, based
on reasonable medical judgment, providing artificially
administered nutrition and hydration would hasten the patient's
death, be medically contraindicated such that the provision of the
treatment seriously exacerbates life-threatening medical problems
not outweighed by the benefit of the provision of the treatment,
result in substantial irremediable physical pain not outweighed by
the benefit of the provision of the treatment, be medically
ineffective in prolonging life, or be contrary to the patient's or
surrogate's clearly documented desires.
4. [If a transfer can be arranged, the patient will be
responsible for the costs of the transfer.
[5.] If a provider cannot be found willing to give the
requested treatment within 90 [10] days, life-sustaining treatment
may be withdrawn unless a court of law has granted an extension.
5. [6.] You may ask the appropriate district or county court
to extend the 90-day [10-day] period if the court finds that there
is a reasonable expectation that you may find a physician or health
care facility willing to provide life-sustaining treatment if the
extension is granted. Patient medical records will be provided to
the patient or surrogate in accordance with Section 241.154, Texas
Health and Safety Code.
*"Life-sustaining treatment" means treatment that, based on
reasonable medical judgment, sustains the life of a patient and
without which the patient will die. The term includes both
life-sustaining medications and artificial life support, such as
mechanical breathing machines, kidney dialysis treatment, and
artificially administered nutrition and hydration. The term does
not include the administration of pain management medication or the
performance of a medical procedure considered to be necessary to
provide comfort care, or any other medical care provided to
alleviate a patient's pain.
SECTION 7. The changes in law made by this Act apply only to
a health care or treatment decision made on or after the effective
date of this Act.
SECTION 8. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2021.
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