Texas 2021 - 87th Regular

Texas Senate Bill SB917 Compare Versions

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	1	+	87R602 SCL-F
1	2		By: Hughes, et al. S.B. No. 917
2		-	(In the Senate - Filed March 2, 2021; March 11, 2021, read
3		-	first time and referred to Committee on Health & Human Services;
4		-	May 13, 2021, reported adversely, with favorable Committee
5		-	Substitute by the following vote: Yeas 5, Nays 4; May 13, 2021,
6		-	sent to printer.)
7		-	Click here to see the committee vote
8		-	COMMITTEE SUBSTITUTE FOR S.B. No. 917 By: Perry
9	3
10	4
11	5		A BILL TO BE ENTITLED
12	6		AN ACT
13	7		relating to advance directives or health care or treatment
14	8		decisions made by or on behalf of patients.
15	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
16	10		SECTION 1. This Act may be cited as the Respecting Texas
17	11		Patients' Right to Life Act of 2021.
18	12		SECTION 2. The purpose of this Act is to protect the right
19	13		of patients and their families to decide whether and under what
20	14		circumstances to choose or reject life-sustaining treatment. This
21	15		Act amends the applicable provisions of the Advance Directives Act
22	16		(Chapter 166, Health and Safety Code) to ensure that, when an
23	17		attending physician is unwilling to respect a patient's advance
24	18		directive or a patient's or family's decision to choose the
25	19		treatment necessary to prevent the patient's death,
26		-	life-sustaining medical treatment will be provided for 90 days
27		-	after an ethics or medical committee's review so that the patient
28		-	can be transferred to a health care provider willing to honor the
29		-	directive or treatment decision.
	20	+	life-sustaining medical treatment will be provided until the
	21	+	patient can be transferred to a health care provider willing to
	22	+	honor the directive or treatment decision.
30	23		SECTION 3. Section 166.045(c), Health and Safety Code, is
31	24		amended to read as follows:
32	25		(c) If an attending physician refuses to comply with a
33	26		directive or treatment decision to provide life-sustaining
34	27		treatment to a patient [and does not wish to follow the procedure
35	28		established under Section 166.046], life-sustaining treatment
36		-	shall be provided to the patient ~~for 90 days under the procedures~~
37		-	~~prescribed by Section 166.046 so that[, but only until a reasonable~~
38		-	~~opportunity has been afforded for the transfer of]~~ ~~the patient can~~
39		-	~~be transferred~~ to ~~another physician or health care facility willing~~
40		-	to ~~comply with~~ the ~~directive or treatment decision~~.
41		-	SECTION 4. Sections 166.046(a), (b), (d), (e), ~~and~~ (e-1),
42		-	Health and Safety Code, are amended to read as follows:
	29	+	shall be provided to the patient[, but only] until [a reasonable
	30	+	opportunity has been afforded for the transfer of] the patient is
	31	+	transferred to another physician or health care facility willing to
	32	+	comply with the directive or treatment decision to provide
	33	+	life-sustaining treatment to the patient.
	34	+	SECTION 4. Sections 166.046(a), (b), (d), (e), (e-1), and
	35	+	(f), Health and Safety Code, are amended to read as follows:
43	36		(a) If an attending physician refuses to honor a patient's
44	37		advance directive or a health care or treatment decision made by or
45	38		on behalf of a patient, other than a directive or decision to
46	39		provide artificial nutrition and hydration to the patient, the
47	40		physician's refusal shall be reviewed by an ethics or medical
48	41		committee. The attending physician may not be a member of that
49	42		committee. The patient shall be given life-sustaining treatment
50		-	during the review.
	43	+	during the review and until the patient is transferred to another
	44	+	physician or health care facility willing to comply with the
	45	+	directive or treatment decision to provide life-sustaining
	46	+	treatment to the patient.
51	47		(b) The patient or the person responsible for the health
52	48		care decisions of the individual who has made the decision
53	49		regarding the directive or treatment decision:
54	50		(1) may be given a written description of the ethics or
55	51		medical committee review process and any other policies and
56	52		procedures related to this section adopted by the health care
57	53		facility;
58	54		(2) shall be informed of the committee review process
59	55		not less than 48 hours before the meeting called to discuss the
60	56		patient's directive, unless the time period is waived by mutual
61	57		agreement;
62	58		(3) at the time of being so informed, shall be
63		-	provided:
64		-	(A) a copy of the appropriate statement set ~~forth~~
65		-	in Section 166.052; and
66		-	(B) a copy of the registry list of health care
	59	+	provided[:
	60	+	[(A) a copy of the appropriate statement set
	61	+	forth in Section 166.052; and
	62	+	[(B)] a copy of the registry list of health care
67	63		providers and referral groups that have volunteered their readiness
68	64		to consider accepting transfer or to assist in locating a provider
69	65		willing to accept transfer that is posted on the website maintained
70	66		by the department under Section 166.053; and
71	67		(4) is entitled to:
72	68		(A) attend the meeting;
73	69		(B) receive a written explanation of the
74	70		recommendations made [decision reached] during the review process;
75	71		(C) receive a copy of the portion of the
76	72		patient's medical record related to the treatment received by the
77	73		patient in the facility for the lesser of:
78	74		(i) the period of the patient's current
79	75		admission to the facility; or
80	76		(ii) the preceding 30 calendar days; and
81	77		(D) receive a copy of all of the patient's
82	78		reasonably available diagnostic results and reports related to the
83	79		medical record provided under Paragraph (C).
84	80		(d) If the attending physician, the patient, or the person
85	81		responsible for the health care decisions of the individual does
86	82		not agree with the recommendations made [decision reached] during
87	83		the review process under Subsection (b), the physician shall make a
88	84		reasonable effort to transfer the patient to a physician who is
89	85		willing to comply with the directive. If the patient is a patient in
90	86		a health care facility, the facility's personnel shall assist the
91	87		physician in arranging the patient's transfer to:
92	88		(1) another physician;
93	89		(2) an alternative care setting within that facility;
94	90		or
95	91		(3) another facility.
96	92		(e) If the patient or the person responsible for the health
97	93		care decisions of the patient is requesting life-sustaining
98	94		treatment that the attending physician [has decided] and the ethics
99	95		or medical committee consider [has affirmed is] medically
100	96		inappropriate treatment, the patient shall be given available
101	97		life-sustaining treatment pending transfer under Subsection (d).
102	98		This subsection does not authorize withholding or withdrawing pain
103	99		management medication, medical procedures necessary to provide
104	100		comfort, or any other health care provided to alleviate a patient's
105		-	pain. [The patient is responsible for any costs ~~incurred in~~
106		-	transferring the patient to another facility.] The ~~attending~~
107		-	physician, any other physician responsible for the care ~~of the~~
108		-	patient, and the health care facility are not obligated to ~~provide~~
109		-	life-sustaining treatment after the ~~90th [~~10th] day after both the
110		-	written ~~recommendation [~~decision] and the patient's medical record
111		-	~~required under~~ Subsection (b) are provided to the patient or the
112		-	~~person~~ responsible for the health care decisions of the patient
113		-	~~unless~~ ordered to do so under Subsection (g), except that
114		-	~~artificially~~ administered nutrition and hydration must be provided
115		-	~~unless, based~~ on reasonable medical judgment, providing
116		-	~~artificially~~ administered nutrition and hydration would:
	101	+	pain. Artificially [The patient is responsible for any costs
	102	+	incurred in transferring the patient to another facility. The
	103	+	attending physician, any other physician responsible for the care
	104	+	of the patient, and the health care facility are not obligated to
	105	+	provide life-sustaining treatment after the 10th day after both the
	106	+	written decision and the patient's medical record required under
	107	+	Subsection (b) are provided to the patient or the person
	108	+	responsible for the health care decisions of the patient unless
	109	+	ordered to do so under Subsection (g), except that artificially]
	110	+	administered nutrition and hydration must be provided unless, based
	111	+	on reasonable medical judgment, providing artificially
	112	+	administered nutrition and hydration would:
117	113		(1) hasten the patient's death;
118	114		(2) be medically contraindicated such that the
119	115		provision of the treatment seriously exacerbates life-threatening
120	116		medical problems not outweighed by the benefit of the provision of
121	117		the treatment;
122	118		(3) result in substantial irremediable physical pain
123	119		not outweighed by the benefit of the provision of the treatment;
124	120		(4) be medically ineffective in prolonging life; or
125	121		(5) be contrary to the patient's or surrogate's
126	122		clearly documented desire not to receive artificially administered
127	123		nutrition or hydration.
128	124		(e-1) If during a previous admission to a facility a
129	125		patient's attending physician and the review process under
130	126		Subsection (b) have determined that life-sustaining treatment is
131	127		inappropriate, and the patient is readmitted to the same facility
132	128		within six months from the date of the recommendations made
133	129		[decision reached] during the review process conducted upon the
134	130		previous admission, Subsections (b) through (e) need not be
135	131		followed if the patient's attending physician and a consulting
136	132		physician who is a member of the ethics or medical committee of the
137	133		facility document on the patient's readmission that the patient's
138	134		condition either has not improved or has deteriorated since the
139	135		review process was conducted.
	136	+	(f) Life-sustaining treatment under this section may not be
	137	+	entered in the patient's medical record as medically unnecessary
	138	+	treatment [until the time period provided under Subsection (e) has
	139	+	expired].
140	140		SECTION 5. Section 166.051, Health and Safety Code, is
141	141		amended to read as follows:
142	142		Sec. 166.051. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
143	143		This subchapter does not impair or supersede any legal right or
144	144		responsibility a person may have to effect the withholding or
145	145		withdrawal of life-sustaining treatment in a lawful manner,
146	146		provided that if an attending physician or health care facility is
147	147		unwilling to honor a patient's advance directive or a treatment
148	148		decision to provide life-sustaining treatment, life-sustaining
149	149		treatment must [is required to] be provided to the patient in
150	150		accordance with this chapter[, but only until a reasonable
151	151		opportunity has been afforded for transfer of the patient to
152	152		another physician or health care facility willing to comply with
153	153		the advance directive or treatment decision].
154		-	SECTION 6. Section 166.052(a), Health and Safety Code, is
155		-	amended to read as follows:
156		-	(a) In cases in which the attending physician refuses to
157		-	honor an advance directive or health care or treatment decision
158		-	requesting the provision of life-sustaining treatment, the
159		-	statement required by Section 166.046(b)(3)(A) shall be in
160		-	substantially the following form:
161		-	When There Is A Disagreement About Medical Treatment: The Physician
162		-	Recommends Against Certain Life-Sustaining Treatment That You Wish
163		-	To Continue
164		-	You have been given this information because you have
165		-	requested life-sustaining treatment* for yourself as the patient or
166		-	on behalf of the patient, as applicable, which the attending
167		-	physician believes is not medically appropriate. This information
168		-	is being provided to help you understand state law, your rights, and
169		-	the resources available to you in such circumstances. It outlines
170		-	the process for resolving disagreements about treatment among
171		-	patients, families, and physicians. It is based upon Section
172		-	166.046 of the Texas Advance Directives Act, codified in Chapter
173		-	166, Texas Health and Safety Code.
174		-	When an attending physician refuses to comply with an advance
175		-	directive or other request for life-sustaining treatment because of
176		-	the physician's judgment that the treatment would be medically
177		-	inappropriate, the case will be reviewed by an ethics or medical
178		-	committee. Life-sustaining treatment will be provided through the
179		-	review.
180		-	You will receive notification of this review at least 48
181		-	hours before a meeting of the committee related to your case. You
182		-	are entitled to attend the meeting. With your agreement, the
183		-	meeting may be held sooner than 48 hours, if possible.
184		-	You are entitled to receive a written explanation of the
185		-	recommendations made [decision reached] during the review process.
186		-	If after this review process both the attending physician and
187		-	the ethics or medical committee conclude that life-sustaining
188		-	treatment is medically inappropriate and yet you continue to
189		-	request such treatment, then the following procedure will occur:
190		-	1. The physician, with the help of the health care facility,
191		-	will assist you in trying to find a physician and facility willing
192		-	to provide the requested treatment.
193		-	2. You are being given a list of health care providers,
194		-	licensed physicians, health care facilities, and referral groups
195		-	that have volunteered their readiness to consider accepting
196		-	transfer, or to assist in locating a provider willing to accept
197		-	transfer, maintained by the Department of State Health Services.
198		-	You may wish to contact providers, facilities, or referral groups
199		-	on the list or others of your choice to get help in arranging a
200		-	transfer.
201		-	3. The patient will continue to be given life-sustaining
202		-	treatment until the patient can be transferred to a willing
203		-	provider for up to 90 [10] days from the time you were given both the
204		-	committee's written decision that life-sustaining treatment is not
205		-	appropriate and the patient's medical record. The patient will
206		-	continue to be given after the 90-day [10-day] period treatment to
207		-	enhance pain management and reduce suffering, including
208		-	artificially administered nutrition and hydration, unless, based
209		-	on reasonable medical judgment, providing artificially
210		-	administered nutrition and hydration would hasten the patient's
211		-	death, be medically contraindicated such that the provision of the
212		-	treatment seriously exacerbates life-threatening medical problems
213		-	not outweighed by the benefit of the provision of the treatment,
214		-	result in substantial irremediable physical pain not outweighed by
215		-	the benefit of the provision of the treatment, be medically
216		-	ineffective in prolonging life, or be contrary to the patient's or
217		-	surrogate's clearly documented desires.
218		-	4. [If a transfer can be arranged, the patient will be
219		-	responsible for the costs of the transfer.
220		-	[5.] If a provider cannot be found willing to give the
221		-	requested treatment within 90 [10] days, life-sustaining treatment
222		-	may be withdrawn unless a court of law has granted an extension.
223		-	5. [6.] You may ask the appropriate district or county court
224		-	to extend the 90-day [10-day] period if the court finds that there
225		-	is a reasonable expectation that you may find a physician or health
226		-	care facility willing to provide life-sustaining treatment if the
227		-	extension is granted. Patient medical records will be provided to
228		-	the patient or surrogate in accordance with Section 241.154, Texas
229		-	Health and Safety Code.
230		-	*"Life-sustaining treatment" means treatment that, based on
231		-	reasonable medical judgment, sustains the life of a patient and
232		-	without which the patient will die. The term includes both
233		-	life-sustaining medications and artificial life support, such as
234		-	mechanical breathing machines, kidney dialysis treatment, and
235		-	artificially administered nutrition and hydration. The term does
236		-	not include the administration of pain management medication or the
237		-	performance of a medical procedure considered to be necessary to
238		-	provide comfort care, or any other medical care provided to
239		-	alleviate a patient's pain.
240		-	SECTION 7. The changes in law made by this Act apply only to
241		-	a health care or treatment decision made on or after the effective
242		-	date of this Act.
	154	+	SECTION 6. Section 25.0021(b), Government Code, is amended
	155	+	to read as follows:
	156	+	(b) A statutory probate court as that term is defined in
	157	+	Section 22.007(c), Estates Code, has:
	158	+	(1) the general jurisdiction of a probate court as
	159	+	provided by the Estates Code; and
	160	+	(2) the jurisdiction provided by law for a county
	161	+	court to hear and determine actions, cases, matters, or proceedings
	162	+	instituted under:
	163	+	(A) Section [166.046,] 192.027, 193.007,
	164	+	552.015, 552.019, 711.004, or 714.003, Health and Safety Code;
	165	+	(B) Chapter 462, Health and Safety Code; or
	166	+	(C) Subtitle C or D, Title 7, Health and Safety
	167	+	Code.
	168	+	SECTION 7. Sections 166.046(g) and 166.052, Health and
	169	+	Safety Code, are repealed.
243	170		SECTION 8. This Act takes effect immediately if it receives
244	171		a vote of two-thirds of all the members elected to each house, as
245	172		provided by Section 39, Article III, Texas Constitution. If this
246	173		Act does not receive the vote necessary for immediate effect, this
247	174		Act takes effect September 1, 2021.
248		-	* * * * *