Texas 2023 - 88th Regular

Texas Senate Bill SB1724 Compare Versions

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1	1	88R11055 LRM-F
2	2	By: Springer S.B. No. 1724
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to advance directives and health care treatment decisions
8	8	made by or on behalf of patients, including a review of those
9	9	directives and decisions.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subchapter B, Chapter 166, Health and Safety
12	12	Code, is amended by adding Section 166.0445 to read as follows:
13	13	Sec. 166.0445. LIMITATION ON LIABILITY FOR PERFORMING
14	14	REQUIRED MEDICAL PROCEDURE. (a) A physician or health care
15	15	professional acting under the direction of a physician is not
16	16	subject to civil liability for conducting a medical procedure
17	17	required under Section 166.046(d-1).
18	18	(b) A physician or health care professional acting under the
19	19	direction of a physician is not subject to criminal liability for
20	20	conducting a medical procedure required under Section 166.046(d-1)
21	21	unless:
22	22	(1) the physician or health care professional in
23	23	conducting the medical procedure acted with a specific intent to
24	24	cause the death of the patient and that conduct hastened the
25	25	patient's death; and
26	26	(2) the hastening of the patient's death is not
27	27	attributable to the risks associated with the medical procedure.
28	28	(c) A physician or health care professional acting under the
29	29	direction of a physician has not engaged in unprofessional conduct
30	30	by conducting a medical procedure required under Section
31	31	166.046(d-1) unless the physician or health care professional fails
32	32	to exercise reasonable medical judgment in conducting the medical
33	33	procedure. For purposes of this subsection, the standard of care
34	34	that a physician or health care professional must exercise is the
35	35	degree of care a physician or health care professional of ordinary
36	36	prudence and skill would have exercised under the same or similar
37	37	circumstances in the same or a similar community.
38	38	SECTION 2. Section 166.046, Health and Safety Code, is
39	39	amended by amending Subsections (a), (b), (c), (d), (e), and (g) and
40	40	adding Subsections (a-1), (a-2), (b-1), (b-2), and (d-1) to read as
41	41	follows:
42	42	(a) This section applies only to the treatment and care of a
43	43	qualified patient who is declared incompetent or otherwise mentally
44	44	or physically incapable of communication.
45	45	(a-1) If an attending physician refuses to honor a patient's
46	46	advance directive or a health care or treatment decision made by or
47	47	on behalf of a patient, the physician's refusal shall be reviewed by
48	48	an ethics or medical committee. The attending physician may not be
49	49	a member of that committee. The patient shall be given
50	50	life-sustaining treatment during the review.
51	51	(a-2) An ethics or medical committee that reviews a
52	52	physician's refusal to honor a patient's advance directive or
53	53	health care treatment decision under Subsection (a-1) shall
54	54	consider the patient's well-being in conducting the review. If the
55	55	review requires the committee to make a determination on whether
56	56	life-sustaining treatment requested in a patient's advance
57	57	directive or by the person responsible for the patient's health
58	58	care decisions is medically inappropriate, the committee shall
59	59	consider whether provision of the life-sustaining treatment:
60	60	(1) will prolong the natural process of dying or
61	61	hasten the patient's death;
62	62	(2) will cause harm or undesirable side effects
63	63	without a proportionate benefit to the patient;
64	64	(3) will exacerbate life-threatening medical problems
65	65	that outweigh the treatment benefits;
66	66	(4) will result in substantial irremediable physical
67	67	pain or other measurable suffering that outweigh the treatment
68	68	benefits;
69	69	(5) without regard to any judgment on the patient's
70	70	quality of life, will be medically ineffective at:
71	71	(A) improving the patient's current condition;
72	72	or
73	73	(B) reducing the patient's current medical
74	74	support level;
75	75	(6) is consistent with the prevailing standard of
76	76	care; or
77	77	(7) is contrary to the patient's clearly documented
78	78	desires.
79	79	(b) The [patient or the] person responsible for the
80	80	patient's health care decisions [of the individual] who has made
81	81	the decision regarding the directive or treatment decision or, for
82	82	a patient for whom a review is conducted under Subsection (a-1) and
83	83	who did not designate a person to make health care or treatment
84	84	decisions or who does not have a legal guardian or agent under a
85	85	medical power of attorney, a person in the priority order described
86	86	by Section 166.039(b):
87	87	(1) must [may be given a written description of the
88	88	ethics or medical committee review process and any other policies
89	89	and procedures related to this section adopted by the health care
90	90	facility;
91	91	[(2) shall] be informed in writing [of the committee
92	92	review process] not less than seven calendar days [48 hours] before
93	93	the meeting called to discuss the patient's directive, unless the
94	94	time period is waived by written mutual agreement, of:
95	95	(A) the ethics or medical committee review
96	96	process and any other related policies and procedures adopted by
97	97	the health care facility, including any attendance and
98	98	confidentiality policy described by Subsection (b-1);
99	99	(B) the rights described in Subdivisions
100	100	(3)(A)-(D);
101	101	(C) the date, time, and location of the meeting;
102	102	(D) the name, title, and work contact information
103	103	of the facility's personnel who, in the event of a disagreement
104	104	described by Subsection (d-1), will be responsible for overseeing
105	105	the transfer of the patient to another physician or facility that is
106	106	willing to comply with the directive; and
107	107	(E) the factors the committee is required to
108	108	consider under Subsection (a-2);
109	109	(2) [(3)] at the time of being [so] informed under
110	110	Subdivision (1), shall be provided:
111	111	(A) a copy of the appropriate statement set forth
112	112	in Section 166.052; and
113	113	(B) a copy of the registry list of health care
114	114	providers and referral groups that have volunteered their readiness
115	115	to consider accepting transfer or to assist in locating a provider
116	116	willing to accept transfer that is posted on the website maintained
117	117	by the department under Section 166.053; and
118	118	(3) [(4)] is entitled to:
119	119	(A) attend and participate in the meeting;
120	120	(B) receive before or during the meeting a
121	121	written statement of the full name and title of each committee
122	122	member who will participate in the meeting;
123	123	(C) subject to Subsection (b-2):
124	124	(i) be accompanied at the meeting by up to
125	125	10 individuals selected by the patient or surrogate, including
126	126	legal counsel, physicians, health care professionals, or patient
127	127	advocates; and
128	128	(ii) have an opportunity during the meeting
129	129	to either directly or through another individual:
130	130	(a) explain the justification for the
131	131	health care or treatment request made by or on behalf of the
132	132	patient;
133	133	(b) respond to information relating
134	134	to the patient that is submitted or presented during the meeting;
135	135	and
136	136	(c) state any concerns the patient or
137	137	surrogate has regarding compliance with this section or Section
138	138	166.0465;
139	139	(D) receive a written notice [explanation] of:
140	140	(i) the decision reached during the review
141	141	process;
142	142	(ii) an explanation of the decision,
143	143	including, if applicable, the committee's reasoning for affirming
144	144	that life-sustaining treatment requested in the patient's advance
145	145	directive or by the person responsible for the patient's health
146	146	care decisions is medically inappropriate;
147	147	(iii) a statement that the committee has
148	148	complied with Subsection (a-2) and Section 166.0465; and
149	149	(iv) a list of the health care facilities
150	150	contacted before the meeting as part of the transfer efforts made
151	151	under Subsection (d) and, for each facility on the list that denied
152	152	the request to transfer the patient, any reason provided by the
153	153	facility for denying the request;
154	154	(E) [(C)] receive a copy of the portion of the
155	155	patient's medical record related to the treatment received by the
156	156	patient in the facility for the lesser of:
157	157	(i) the period of the patient's current
158	158	admission to the facility; or
159	159	(ii) the preceding 30 calendar days; and
160	160	(F) [(D)] receive a copy of all of the patient's
161	161	reasonably available diagnostic results and reports related to the
162	162	medical record provided under Paragraph (E) [(C)].
163	163	(b-1) A health care facility may adopt and implement a
164	164	written attendance and confidentiality policy for meetings held
165	165	under this section that is reasonable and necessary to:
166	166	(1) facilitate information sharing and discussion of
167	167	the patient's medical status and treatment requirements; and
168	168	(2) preserve the effectiveness of the meeting.
169	169	(b-2) Notwithstanding Subsection (b)(3), the following
170	170	individuals may not participate in the deliberations of an ethics
171	171	or medical committee under this section:
172	172	(1) the physicians or health care professionals
173	173	providing treatment and care to the patient; or
174	174	(2) the patient, the person entitled to written notice
175	175	of the meeting under Subsection (b)(1), or any person attending
176	176	under Subsection (b)(3)(C).
177	177	(c) The written notices [explanation] required by
178	178	Subsections (b)(3)(D)(i) and (ii) [Subsection (b)(4)(B)] must be
179	179	included in the patient's medical record.
180	180	(d) After written notice is provided under Subsection
181	181	(b)(1), [If] the patient's attending physician [, the patient, or
182	182	the person responsible for the health care decisions of the
183	183	individual does not agree with the decision reached during the
184	184	review process under Subsection (b), the physician] shall make a
185	185	reasonable effort to transfer the patient to a physician who is
186	186	willing to comply with the directive. If the patient is a patient
187	187	in a health care facility, the facility's personnel shall assist
188	188	the physician in arranging the patient's transfer to:
189	189	(1) another physician;
190	190	(2) an alternative care setting within that facility;
191	191	or
192	192	(3) another facility.
193	193	(d-1) In this subsection, "medical procedure" means only a
194	194	tracheostomy or a percutaneous endoscopic gastrostomy. If the
195	195	person responsible for a patient's health care decisions does not
196	196	agree with the decision reached during the review process under
197	197	Subsection (b), the attending physician or another physician
198	198	responsible for the care of the patient shall perform on the patient
199	199	each medical procedure that satisfies the following conditions:
200	200	(1) in the physician's judgment, the medical procedure
201	201	is reasonable and necessary to help effect the patient's transfer
202	202	under Subsection (d);
203	203	(2) based on the physician's discussion with the
204	204	facility, performing the medical procedure will increase the
205	205	likelihood of effecting the patient's transfer under Subsection (d)
206	206	to a health care facility that is willing to consider accepting or
207	207	able to accept the patient;
208	208	(3) in the physician's medical judgment, performing
209	209	the medical procedure is:
210	210	(A) within the prevailing standard of medical
211	211	care; and
212	212	(B) not medically contraindicated or medically
213	213	inappropriate under the circumstances;
214	214	(4) the physician has the training and experience to
215	215	perform the medical procedure;
216	216	(5) if the patient is receiving care in a health care
217	217	facility, the physician has been granted privileges by the facility
218	218	that authorize the physician to perform the medical procedure at
219	219	the facility;
220	220	(6) the health care facility at which the medical
221	221	procedure will be performed has the resources for the performance
222	222	of the procedure; and
223	223	(7) the person responsible for the health care
224	224	decisions of the patient provides consent on behalf of the patient
225	225	for the medical procedure.
226	226	(e) If the patient's advance directive [patient] or the
227	227	person responsible for the health care decisions of the patient is
228	228	requesting life-sustaining treatment that the attending physician
229	229	has decided and the ethics or medical committee has affirmed is
230	230	medically inappropriate treatment, the patient shall be given
231	231	available life-sustaining treatment pending transfer under
232	232	Subsection (d). This subsection does not authorize withholding or
233	233	withdrawing pain management medication, medical procedures
234	234	necessary to provide comfort, or any other health care provided to
235	235	alleviate a patient's pain. The patient is responsible for any
236	236	costs incurred in transferring the patient to another
237	237	facility. The attending physician, any other physician
238	238	responsible for the care of the patient, and the health care
239	239	facility are not obligated to provide life-sustaining treatment
240	240	after the 21st business [10th] day after both the written decision
241	241	and the patient's medical record required under Subsection (b) are
242	242	provided to [the patient or] the person responsible for the health
243	243	care decisions of the patient unless ordered to extend the time [do
244	244	so] under Subsection (g), except that artificially administered
245	245	nutrition and hydration must be provided unless, based on
246	246	reasonable medical judgment, providing artificially administered
247	247	nutrition and hydration would:
248	248	(1) hasten the patient's death;
249	249	(2) be medically contraindicated such that the
250	250	provision of the treatment seriously exacerbates life-threatening
251	251	medical problems not outweighed by the benefit of the provision of
252	252	the treatment;
253	253	(3) result in substantial irremediable physical pain
254	254	not outweighed by the benefit of the provision of the treatment;
255	255	(4) be medically ineffective in prolonging life; or
256	256	(5) be contrary to the patient's or surrogate's
257	257	clearly documented desire not to receive artificially administered
258	258	nutrition or hydration.
259	259	(g) At the request of [the patient or] the person
260	260	responsible for the health care decisions of the patient, the
261	261	appropriate district or county court shall extend the time period
262	262	provided under Subsection (e) only if the court finds, by a
263	263	preponderance of the evidence, that there is a reasonable
264	264	expectation that a physician or health care facility that will
265	265	honor the patient's directive will be found if the time extension is
266	266	granted.
267	267	SECTION 3. Subchapter B, Chapter 166, Health and Safety
268	268	Code, is amended by adding Section 166.0465 to read as follows:
269	269	Sec. 166.0465. ETHICS OR MEDICAL COMMITTEE DECISION RELATED
270	270	TO PATIENT DISABILITY. (a) In this section, "disability" has the
271	271	meaning assigned by the Americans with Disabilities Act of 1990 (42
272	272	U.S.C. Section 12101 et seq.).
273	273	(b) During the review process under Section 166.046(b), the
274	274	ethics or medical committee may not consider a patient's disability
275	275	that existed before the patient's current admission unless the
276	276	disability is relevant in determining whether life-sustaining
277	277	treatment is medically appropriate.
278	278	SECTION 4. Sections 166.052(a) and (b), Health and Safety
279	279	Code, are amended to read as follows:
280	280	(a) In cases in which the attending physician refuses to
281	281	honor an advance directive or health care or treatment decision
282	282	requesting the provision of life-sustaining treatment, the
283	283	statement required by Section 166.046(b)(2)(A) [166.046(b)(3)(A)]
284	284	shall be in substantially the following form:
285	285	When There Is A Disagreement About Medical Treatment: The
286	286	Physician Recommends Against Certain Life-Sustaining Treatment
287	287	That You Wish To Continue
288	288	You have been given this information because you have
289	289	requested life-sustaining treatment* for yourself as the patient or
290	290	on behalf of the patient, as applicable, which the attending
291	291	physician believes is not medically appropriate. This information
292	292	is being provided to help you understand state law, your rights, and
293	293	the resources available to you in such circumstances. It outlines
294	294	the process for resolving disagreements about treatment among
295	295	patients, families, and physicians. It is based upon Section
296	296	166.046 of the Texas Advance Directives Act, codified in Chapter
297	297	166, Texas Health and Safety Code.
298	298	When an attending physician refuses to comply with an advance
299	299	directive or other request for life-sustaining treatment because of
300	300	the physician's judgment that the treatment would be medically
301	301	inappropriate, the case will be reviewed by an ethics or medical
302	302	committee. Life-sustaining treatment will be provided through the
303	303	review.
304	304	You will receive notification of this review at least seven
305	305	calendar days [48 hours] before a meeting of the committee related
306	306	to your case. You are entitled to attend the meeting. With your
307	307	agreement, the meeting may be held sooner than seven calendar days
308	308	[48 hours], if possible.
309	309	You are entitled to receive a written explanation of the
310	310	decision reached during the review process.
311	311	If after this review process both the attending physician and
312	312	the ethics or medical committee conclude that life-sustaining
313	313	treatment is medically inappropriate and yet you continue to
314	314	request such treatment, then the following procedure will occur:
315	315	1. The physician, with the help of the health care facility,
316	316	will assist you in trying to find a physician and facility willing
317	317	to provide the requested treatment.
318	318	2. You are being given a list of health care providers,
319	319	licensed physicians, health care facilities, and referral groups
320	320	that have volunteered their readiness to consider accepting
321	321	transfer, or to assist in locating a provider willing to accept
322	322	transfer, maintained by the Department of State Health
323	323	Services. You may wish to contact providers, facilities, or
324	324	referral groups on the list or others of your choice to get help in
325	325	arranging a transfer.
326	326	3. The patient will continue to be given life-sustaining
327	327	treatment until the patient can be transferred to a willing
328	328	provider for up to 21 business [10] days from the time you were
329	329	given both the committee's written decision that life-sustaining
330	330	treatment is not appropriate and the patient's medical record. The
331	331	patient will continue to be given after that [the 10-day] period
332	332	treatment to enhance pain management and reduce suffering,
333	333	including artificially administered nutrition and hydration,
334	334	unless, based on reasonable medical judgment, providing
335	335	artificially administered nutrition and hydration would hasten the
336	336	patient's death, be medically contraindicated such that the
337	337	provision of the treatment seriously exacerbates life-threatening
338	338	medical problems not outweighed by the benefit of the provision of
339	339	the treatment, result in substantial irremediable physical pain not
340	340	outweighed by the benefit of the provision of the treatment, be
341	341	medically ineffective in prolonging life, or be contrary to the
342	342	patient's or surrogate's clearly documented desires.
343	343	4. If a transfer can be arranged, the patient will be
344	344	responsible for the costs of the transfer.
345	345	5. If a provider cannot be found willing to give the
346	346	requested treatment within 21 business [10] days, life-sustaining
347	347	treatment may be withdrawn unless a court of law has granted an
348	348	extension.
349	349	6. You may ask the appropriate district or county court to
350	350	extend that [the 10-day] period if the court finds that there is a
351	351	reasonable expectation that you may find a physician or health care
352	352	facility willing to provide life-sustaining treatment if the
353	353	extension is granted. Patient medical records will be provided to
354	354	the patient or surrogate in accordance with Section 241.154, Texas
355	355	Health and Safety Code.
356	356	*"Life-sustaining treatment" means treatment that, based on
357	357	reasonable medical judgment, sustains the life of a patient and
358	358	without which the patient will die. The term includes both
359	359	life-sustaining medications and artificial life support, such as
360	360	mechanical breathing machines, kidney dialysis treatment, and
361	361	artificially administered nutrition and hydration. The term does
362	362	not include the administration of pain management medication or the
363	363	performance of a medical procedure considered to be necessary to
364	364	provide comfort care, or any other medical care provided to
365	365	alleviate a patient's pain.
366	366	(b) In cases in which the attending physician refuses to
367	367	comply with an advance directive or treatment decision requesting
368	368	the withholding or withdrawal of life-sustaining treatment, the
369	369	statement required by Section 166.046(b)(2)(A) [166.046(b)(3)(A)]
370	370	shall be in substantially the following form:
371	371	When There Is A Disagreement About Medical Treatment: The
372	372	Physician Recommends Life-Sustaining Treatment That You Wish To
373	373	Stop
374	374	You have been given this information because you have
375	375	requested the withdrawal or withholding of life-sustaining
376	376	treatment* for yourself as the patient or on behalf of the patient,
377	377	as applicable, and the attending physician disagrees with and
378	378	refuses to comply with that request. The information is being
379	379	provided to help you understand state law, your rights, and the
380	380	resources available to you in such circumstances. It outlines the
381	381	process for resolving disagreements about treatment among
382	382	patients, families, and physicians. It is based upon Section
383	383	166.046 of the Texas Advance Directives Act, codified in Chapter
384	384	166, Texas Health and Safety Code.
385	385	When an attending physician refuses to comply with an advance
386	386	directive or other request for withdrawal or withholding of
387	387	life-sustaining treatment for any reason, the case will be reviewed
388	388	by an ethics or medical committee. Life-sustaining treatment will
389	389	be provided through the review.
390	390	You will receive notification of this review at least seven
391	391	calendar days [48 hours] before a meeting of the committee related
392	392	to your case. You are entitled to attend the meeting. With your
393	393	agreement, the meeting may be held sooner than seven calendar days
394	394	[48 hours], if possible.
395	395	You are entitled to receive a written explanation of the
396	396	decision reached during the review process.
397	397	If you or the attending physician do not agree with the
398	398	decision reached during the review process, and the attending
399	399	physician still refuses to comply with your request to withhold or
400	400	withdraw life-sustaining treatment, then the following procedure
401	401	will occur:
402	402	1. The physician, with the help of the health care facility,
403	403	will assist you in trying to find a physician and facility willing
404	404	to withdraw or withhold the life-sustaining treatment.
405	405	2. You are being given a list of health care providers,
406	406	licensed physicians, health care facilities, and referral groups
407	407	that have volunteered their readiness to consider accepting
408	408	transfer, or to assist in locating a provider willing to accept
409	409	transfer, maintained by the Department of State Health
410	410	Services. You may wish to contact providers, facilities, or
411	411	referral groups on the list or others of your choice to get help in
412	412	arranging a transfer.
413	413	*"Life-sustaining treatment" means treatment that, based on
414	414	reasonable medical judgment, sustains the life of a patient and
415	415	without which the patient will die. The term includes both
416	416	life-sustaining medications and artificial life support, such as
417	417	mechanical breathing machines, kidney dialysis treatment, and
418	418	artificially administered nutrition and hydration. The term does
419	419	not include the administration of pain management medication or the
420	420	performance of a medical procedure considered to be necessary to
421	421	provide comfort care, or any other medical care provided to
422	422	alleviate a patient's pain.
423	423	SECTION 5. Subchapter B, Chapter 166, Health and Safety
424	424	Code, is amended by adding Section 166.054 to read as follows:
425	425	Sec. 166.054. REPORTING REQUIREMENTS REGARDING ETHICS OR
426	426	MEDICAL COMMITTEE PROCESSES. (a) Not later than the 180th day
427	427	after the date written notice is provided under Section
428	428	166.046(b)(1), a health care facility shall prepare and submit to
429	429	the department a report that contains information on:
430	430	(1) the number of days that elapsed from the patient's
431	431	admission to the facility to the date notice was provided under
432	432	Section 166.046(b)(1);
433	433	(2) whether the ethics or medical committee met to
434	434	review the case under Section 166.046 and, if the committee did
435	435	meet, the number of days that elapsed from the date notice was
436	436	provided under Section 166.046(b)(1) to the date the meeting was
437	437	held;
438	438	(3) whether the patient was:
439	439	(A) transferred to a physician within the same
440	440	facility who was willing to comply with the patient's advance
441	441	directive or a health care or treatment decision made by or on
442	442	behalf of a patient;
443	443	(B) transferred to a different facility; or
444	444	(C) discharged from the facility to a private
445	445	residence or other setting that is not a health care facility;
446	446	(4) whether the patient died while receiving
447	447	life-sustaining treatment;
448	448	(5) whether life-sustaining treatment was withheld or
449	449	withdrawn from the patient after expiration of the time described
450	450	by Section 166.046(e);
451	451	(6) the age group of the patient selected from the
452	452	following categories:
453	453	(A) 17 years of age or younger;
454	454	(B) 18 years of age or older and younger than 66
455	455	years of age; or
456	456	(C) 66 years of age or older;
457	457	(7) the health insurance coverage status of the
458	458	patient selected from the following categories:
459	459	(A) private health insurance coverage;
460	460	(B) public health plan coverage; or
461	461	(C) uninsured;
462	462	(8) the patient's sex; and
463	463	(9) the patient's race.
464	464	(b) The department shall ensure information provided in
465	465	each report submitted by a health care facility under Subsection
466	466	(a) is kept confidential and not disclosed in any manner, except as
467	467	provided by this section.
468	468	(c) Not later than April 1 of each year, the department
469	469	shall prepare and publish on the department's Internet website a
470	470	report that contains:
471	471	(1) aggregate information compiled from the reports
472	472	submitted to the department under Subsection (a) during the
473	473	preceding year on:
474	474	(A) the total number of written notices provided
475	475	under Section 166.046(b)(1);
476	476	(B) the average number of days described by
477	477	Subsection (a)(1);
478	478	(C) the total number of meetings held by ethics
479	479	or medical committees to review cases under Section 166.046;
480	480	(D) the average number of days described by
481	481	Subsection (a)(2);
482	482	(E) the total number of patients described by
483	483	Subsections (a)(3)(A), (B), and (C);
484	484	(F) the total number of patients described by
485	485	Subsection (a)(4); and
486	486	(G) the total number of patients for whom
487	487	life-sustaining treatment was withheld or withdrawn after
488	488	expiration of the time described by Section 166.046(e); and
489	489	(2) if the total number of reports submitted under
490	490	Subsection (a) for the preceding year is 10 or more, aggregate
491	491	information compiled from those reports on the total number of
492	492	patients categorized by:
493	493	(A) sex;
494	494	(B) race;
495	495	(C) age group, based on the categories described
496	496	by Subsection (a)(6); and
497	497	(D) health insurance coverage status, based on
498	498	the categories described by Subsection (a)(7).
499	499	(d) If the department receives fewer than 10 reports under
500	500	Subsection (a) for inclusion in an annual report required under
501	501	Subsection (c), the department shall include in the next annual
502	502	report prepared after the department receives 10 or more reports
503	503	the aggregate information for all years for which the information
504	504	was not included in a preceding annual report. The department shall
505	505	include in the next annual report a statement that identifies each
506	506	year during which an underlying report was submitted to the
507	507	department under Subsection (a).
508	508	(e) The annual report required by Subsection (c) or (d) may
509	509	not include any information that could be used alone or in
510	510	combination with other reasonably available information to
511	511	identify any individual, entity, or facility.
512	512	(f) The executive commissioner shall adopt rules to:
513	513	(1) establish a standard form for the reporting
514	514	requirements of this section; and
515	515	(2) protect and aggregate any information the
516	516	department receives under this section.
517	517	(g) Information submitted to the department under this
518	518	section:
519	519	(1) is not admissible in a civil or criminal
520	520	proceeding in which a physician, health care professional acting
521	521	under the direction of a physician, or health care facility is a
522	522	defendant;
523	523	(2) may not be used in relation to any disciplinary
524	524	action by a licensing or regulatory agency with oversight over a
525	525	physician, health care professional acting under the direction of a
526	526	physician, or health care facility; and
527	527	(3) is not public information or subject to disclosure
528	528	under Chapter 552, Government Code.
529	529	SECTION 6. Section 166.202(a), Health and Safety Code, is
530	530	amended to read as follows:
531	531	(a) This subchapter applies to a DNR order issued for a
532	532	patient admitted to [in] a health care facility or hospital.
533	533	SECTION 7. Sections 166.203(a), (b), and (c), Health and
534	534	Safety Code, are amended to read as follows:
535	535	(a) A DNR order issued for a patient is valid only if [the
536	536	patient's attending physician issues the order,] the order is
537	537	dated[,] and [the order]:
538	538	(1) is issued by a physician providing direct care to
539	539	the patient in compliance with:
540	540	(A) the written and dated directions of a patient
541	541	who was competent at the time the patient wrote the directions;
542	542	(B) the oral directions of a competent patient
543	543	delivered to or observed by two competent adult witnesses, at least
544	544	one of whom must be a person not listed under Section 166.003(2)(E)
545	545	or (F);
546	546	(C) the directions in an advance directive
547	547	enforceable under Section 166.005 or executed in accordance with
548	548	Section 166.032, 166.034, [or] 166.035, 166.082, 166.084, or
549	549	166.085;
550	550	(D) the directions of a patient's:
551	551	(i) legal guardian;
552	552	(ii) [or] agent under a medical power of
553	553	attorney acting in accordance with Subchapter D; or
554	554	(iii) proxy as designated and authorized by
555	555	a directive executed in accordance with Subchapter B to make a
556	556	treatment decision for the patient if the patient becomes
557	557	incompetent or otherwise mentally or physically incapable of
558	558	communication; or
559	559	(E) a treatment decision made in accordance with
560	560	Section 166.039; or
561	561	(2) is issued by the patient's attending physician
562	562	and:
563	563	(A) the order is not contrary to the directions
564	564	of a patient who was competent at the time the patient conveyed the
565	565	directions; and
566	566	(B) [,] in the reasonable medical judgment of the
567	567	patient's attending physician:
568	568	(i) [(A)] the patient's death is imminent,
569	569	regardless of the provision of cardiopulmonary resuscitation; and
570	570	(ii) [(B)] the DNR order is medically
571	571	appropriate.
572	572	(b) The DNR order takes effect at the time the order is
573	573	issued, provided the order is placed in the patient's medical
574	574	record as soon as practicable and may be issued in a format
575	575	acceptable under the policies of the health care facility or
576	576	hospital.
577	577	(c) Unless notice is provided in accordance with Section
578	578	166.204(a-1), before [Before] placing in a patient's medical record
579	579	a DNR order issued under Subsection (a)(2), a [the] physician,
580	580	physician assistant, nurse, or other person acting on behalf of a
581	581	health care facility or hospital shall:
582	582	(1) inform the patient of the order's issuance; or
583	583	(2) if the patient is incompetent, make a reasonably
584	584	diligent effort to contact or cause to be contacted and inform of
585	585	the order's issuance:
586	586	(A) the patient's known agent under a medical
587	587	power of attorney or legal guardian; or
588	588	(B) for a patient who does not have a known agent
589	589	under a medical power of attorney or legal guardian, a person
590	590	described by Section 166.039(b)(1), (2), or (3).
591	591	SECTION 8. Section 166.204, Health and Safety Code, is
592	592	amended by amending Subsection (a) and adding Subsection (a-1) to
593	593	read as follows:
594	594	(a) If a physician issues a DNR order under Section
595	595	166.203(a)(2), a physician, a physician assistant, a nurse, or
596	596	another person acting on behalf of a health care facility or
597	597	hospital shall provide notice of the order to the appropriate
598	598	persons in accordance with Subsection (a-1) or Section 166.203(c).
599	599	(a-1) If an individual arrives at a health care facility or
600	600	hospital that is treating a patient for whom a DNR order is issued
601	601	under Section 166.203(a)(2) and the individual notifies a
602	602	physician, physician assistant, or nurse providing direct care to
603	603	the patient of the individual's arrival, the physician, physician
604	604	assistant, or nurse who has actual knowledge of the order shall,
605	605	unless notice has been provided in accordance with Section
606	606	166.203(c), disclose the order to the individual, provided the
607	607	individual is:
608	608	(1) the patient's known agent under a medical power of
609	609	attorney or legal guardian; or
610	610	(2) for a patient who does not have a known agent under
611	611	a medical power of attorney or legal guardian, a person described by
612	612	Section 166.039(b)(1), (2), or (3).
613	613	SECTION 9. Sections 166.205(a) and (b), Health and Safety
614	614	Code, are amended to read as follows:
615	615	(a) A physician providing direct care to a patient for whom
616	616	a DNR order is issued shall revoke the patient's DNR order if [the
617	617	patient or, as applicable, the patient's agent under a medical
618	618	power of attorney or the patient's legal guardian if the patient is
619	619	incompetent]:
620	620	(1) the advance directive that serves as the basis of
621	621	the DNR order is properly revoked in accordance with this
622	622	chapter; [effectively revokes an advance directive, in accordance
623	623	with Section 166.042, for which a DNR order is issued under Section
624	624	166.203(a); or]
625	625	(2) the patient expresses to any person providing
626	626	direct care to the patient a revocation of consent to or intent to
627	627	revoke a DNR order issued under Section 166.203(a); or
628	628	(3) the DNR order was issued under Section
629	629	166.203(a)(1)(D) or (E) or Section 166.203(a)(2), and the person
630	630	responsible for making health care or treatment decisions on behalf
631	631	of the patient expresses to any person providing direct care to the
632	632	patient a revocation of consent to or intent to revoke the DNR
633	633	order.
634	634	(b) A person providing direct care to a patient under the
635	635	supervision of a physician shall notify the physician of the
636	636	request to revoke a DNR order or of the revocation of an advance
637	637	directive under Subsection (a).
638	638	SECTION 10. Sections 166.206(a) and (b), Health and Safety
639	639	Code, are amended to read as follows:
640	640	(a) If a [an attending] physician, health care facility, or
641	641	hospital does not wish to execute or comply with a DNR order or the
642	642	patient's instructions concerning the provision of cardiopulmonary
643	643	resuscitation, the physician, facility, or hospital shall inform
644	644	the patient, the legal guardian or qualified relatives of the
645	645	patient, or the agent of the patient under a medical power of
646	646	attorney of the benefits and burdens of cardiopulmonary
647	647	resuscitation.
648	648	(b) If, after receiving notice under Subsection (a), the
649	649	patient or another person authorized to act on behalf of the patient
650	650	and the [attending] physician, health care facility, or hospital
651	651	remain in disagreement, the physician, facility, or hospital shall
652	652	make a reasonable effort to transfer the patient to another
653	653	physician, facility, or hospital willing to execute or comply with
654	654	a DNR order or the patient's instructions concerning the provision
655	655	of cardiopulmonary resuscitation.
656	656	SECTION 11. Section 166.209, Health and Safety Code, is
657	657	amended to read as follows:
658	658	Sec. 166.209. ENFORCEMENT. (a) Subject to Sections
659	659	166.205(d), 166.207, and 166.208 and Subsection (c), a [A]
660	660	physician, physician assistant, nurse, or other person commits an
661	661	offense if, with the specific intent to violate this subchapter,
662	662	the person:
663	663	(1) [intentionally] conceals, cancels, effectuates,
664	664	or falsifies another person's DNR order in violation of this
665	665	subchapter; or
666	666	(2) [if the person intentionally] conceals or
667	667	withholds personal knowledge of another person's revocation of a
668	668	DNR order in violation of this subchapter.
669	669	(a-1) An offense under Subsection (a) [this subsection] is a
670	670	Class A misdemeanor. This section [subsection] does not preclude
671	671	prosecution for any other applicable offense.
672	672	(b) Subject to Sections 166.205(d), 166.207, and 166.208, a
673	673	[A] physician, health care professional, health care facility,
674	674	hospital, or entity is subject to review and disciplinary action by
675	675	the appropriate licensing authority for intentionally:
676	676	(1) failing to effectuate a DNR order in violation of
677	677	this subchapter; or
678	678	(2) issuing a DNR order in violation of this
679	679	subchapter.
680	680	(c) A person does not commit an offense under Subsection (a)
681	681	if the person's act or omission was based on a reasonable belief
682	682	that the act or omission was in compliance with the wishes of the
683	683	patient or the person having authority to make health care
684	684	treatment decisions on behalf of the patient.
685	685	SECTION 12. Section 313.004, Health and Safety Code, is
686	686	amended by amending Subsections (a) and (c) and adding Subsection
687	687	(a-1) to read as follows:
688	688	(a) If an adult patient of a home and community support
689	689	services agency or in a hospital or nursing home, or an adult inmate
690	690	of a county or municipal jail, is comatose, incapacitated, or
691	691	otherwise mentally or physically incapable of communication and
692	692	does not have a legal guardian or an agent under a medical power of
693	693	attorney who is reasonably available, an adult surrogate from the
694	694	following list, in order of priority, who has decision-making
695	695	capacity, is reasonably available after a reasonably diligent
696	696	inquiry, and is willing to consent to medical treatment on behalf of
697	697	the patient may consent to medical treatment on behalf of the
698	698	patient:
699	699	(1) the patient's spouse;
700	700	(2) the patient's [an adult child of the patient who
701	701	has the waiver and consent of all other qualified] adult children
702	702	[of the patient to act as the sole decision-maker];
703	703	(3) [a majority of] the patient's parents [reasonably
704	704	available adult children]; or
705	705	(4) the patient's nearest living relative [parents; or
706	706	[(5) the individual clearly identified to act for the
707	707	patient by the patient before the patient became incapacitated, the
708	708	patient's nearest living relative, or a member of the clergy].
709	709	(a-1) If the patient does not have a legal guardian, an
710	710	agent under a medical power of attorney, or a person listed in
711	711	Subsection (a) who is reasonably available, a treatment decision
712	712	may be concurred by another physician who is not involved in the
713	713	treatment of the patient.
714	714	(c) Any medical treatment consented to under Subsection (a)
715	715	or (a-1) must be based on knowledge of what the patient would
716	716	desire, if known.
717	717	SECTION 13. Chapter 166, Health and Safety Code, as amended
718	718	by this Act, applies only to a review, consultation, disagreement,
719	719	or other action relating to a health care or treatment decision made
720	720	on or after the effective date of this Act. A review, consultation,
721	721	disagreement, or other action relating to a health care or
722	722	treatment decision made before the effective date of this Act is
723	723	governed by the law in effect immediately before the effective date
724	724	of this Act, and the former law is continued in effect for that
725	725	purpose.
726	726	SECTION 14. Section 166.209, Health and Safety Code, as
727	727	amended by this Act, applies only to conduct that occurs on or after
728	728	the effective date of this Act. Conduct that occurs before the
729	729	effective date of this Act is governed by the law in effect on the
730	730	date the conduct occurred, and the former law is continued in effect
731	731	for that purpose.
732	732	SECTION 15. This Act takes effect September 1, 2023.