Texas 2023 - 88th Regular

Texas Senate Bill SB1952 Compare Versions

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1	1	By: Hughes, Parker S.B. No. 1952
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to advance directives and health care treatment decisions
7	7	made by or on behalf of patients, including a review of those
8	8	directives and decisions.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter B, Chapter 166, Health and Safety
11	11	Code, is amended by adding Section 166.0445 to read as follows:
12	12	Sec. 166.0445. LIMITATION ON LIABILITY FOR PERFORMING
13	13	REQUIRED MEDICAL PROCEDURE. (a) A physician or health care
14	14	professional acting under the direction of a physician is not
15	15	subject to civil liability for conducting a medical procedure
16	16	required under Section 166.046(d-1).
17	17	(b) A physician or health care professional acting under the
18	18	direction of a physician is not subject to criminal liability for
19	19	conducting a medical procedure required under Section 166.046(d-1)
20	20	unless:
21	21	(1) the physician or health care professional in
22	22	conducting the medical procedure acted with a specific intent to
23	23	cause the death of the patient and that conduct hastened the
24	24	patient's death; and
25	25	(2) the hastening of the patient's death is not
26	26	attributable to the risks associated with the medical procedure.
27	27	(c) A physician or health care professional acting under the
28	28	direction of a physician has not engaged in unprofessional conduct
29	29	by conducting a medical procedure required under Section
30	30	166.046(d-1) unless the physician or health care professional fails
31	31	to exercise reasonable medical judgment in conducting the medical
32	32	procedure. For purposes of this subsection, the standard of care
33	33	that a physician or health care professional must exercise is the
34	34	degree of care a physician or health care professional of ordinary
35	35	prudence and skill would have exercised under the same or similar
36	36	circumstances in the same or a similar community.
37	37	SECTION 2. Section 166.046, Health and Safety Code, is
38	38	amended by amending Subsections (a), (b), (c), (d), (e), and (g) and
39	39	adding Subsections (a-1), (a-2), (b-1), (b-2), and (d-1) to read as
40	40	follows:
41	41	(a) This section applies only to the treatment and care of a
42	42	qualified patient who is declared incompetent or otherwise mentally
43	43	or physically incapable of communication.
44	44	(a-1) If an attending physician refuses to honor a patient's
45	45	advance directive or a health care or treatment decision made by or
46	46	on behalf of a patient, the physician's refusal shall be reviewed by
47	47	an ethics or medical committee. The attending physician may not be
48	48	a member of that committee. The patient shall be given
49	49	life-sustaining treatment during the review.
50	50	(a-2) An ethics or medical committee that reviews a
51	51	physician's refusal to honor a patient's advance directive or
52	52	health care treatment decision under Subsection (a-1) shall
53	53	consider the patient's well-being in conducting the review. If the
54	54	review requires the committee to make a determination on whether
55	55	life-sustaining treatment requested in a patient's advance
56	56	directive or by the person responsible for the patient's health
57	57	care decisions is medically inappropriate, the committee shall
58	58	consider whether provision of the life-sustaining treatment:
59	59	(1) will prolong the natural process of dying or
60	60	hasten the patient's death;
61	61	(2) will cause harm or undesirable side effects
62	62	without a proportionate benefit to the patient;
63	63	(3) will exacerbate life-threatening medical problems
64	64	that outweigh the treatment benefits;
65	65	(4) will result in substantial irremediable physical
66	66	pain or other measurable suffering that outweigh the treatment
67	67	benefits;
68	68	(5) without regard to any judgment on the patient's
69	69	quality of life, will be medically ineffective at:
70	70	(A) improving the patient's current condition;
71	71	or
72	72	(B) reducing the patient's current medical
73	73	support level;
74	74	(6) is consistent with the prevailing standard of
75	75	care; or
76	76	(7) is contrary to the patient's clearly documented
77	77	desires.
78	78	(b) The [patient or the] person responsible for the
79	79	patient's health care decisions [of the individual] who has made
80	80	the decision regarding the directive or treatment decision or, for
81	81	a patient for whom a review is conducted under Subsection (a-1) and
82	82	who did not designate a person to make health care or treatment
83	83	decisions or who does not have a legal guardian or agent under a
84	84	medical power of attorney, a person in the priority order described
85	85	by Section 166.039(b):
86	86	(1) must [may be given a written description of the
87	87	ethics or medical committee review process and any other policies
88	88	and procedures related to this section adopted by the health care
89	89	facility;
90	90	[(2) shall] be informed in writing [of the committee
91	91	review process] not less than seven calendar days [48 hours] before
92	92	the meeting called to discuss the patient's directive, unless the
93	93	time period is waived by written mutual agreement, of:
94	94	(A) the ethics or medical committee review
95	95	process and any other related policies and procedures adopted by
96	96	the health care facility, including any attendance and
97	97	confidentiality policy described by Subsection (b-1);
98	98	(B) the rights described in Subdivisions
99	99	(3)(A)-(D);
100	100	(C) the date, time, and location of the meeting;
101	101	(D) the name, title, and work contact information
102	102	of the facility's personnel who, in the event of a disagreement
103	103	described by Subsection (d-1), will be responsible for overseeing
104	104	the transfer of the patient to another physician or facility that is
105	105	willing to comply with the directive; and
106	106	(E) the factors the committee is required to
107	107	consider under Subsection (a-2);
108	108	(2) [(3)] at the time of being [so] informed under
109	109	Subdivision (1), shall be provided:
110	110	(A) a copy of the appropriate statement set forth
111	111	in Section 166.052; and
112	112	(B) a copy of the registry list of health care
113	113	providers and referral groups that have volunteered their readiness
114	114	to consider accepting transfer or to assist in locating a provider
115	115	willing to accept transfer that is posted on the website maintained
116	116	by the department under Section 166.053; and
117	117	(3) [(4)] is entitled to:
118	118	(A) attend and participate in the meeting;
119	119	(B) receive before or during the meeting a
120	120	written statement of the full name and title of each committee
121	121	member who will participate in the meeting;
122	122	(C) subject to Subsection (b-2):
123	123	(i) be accompanied at the meeting by up to
124	124	10 individuals selected by the patient or surrogate, including
125	125	legal counsel, physicians, health care professionals, or patient
126	126	advocates; and
127	127	(ii) have an opportunity during the meeting
128	128	to either directly or through another individual:
129	129	(a) explain the justification for the
130	130	health care or treatment request made by or on behalf of the
131	131	patient;
132	132	(b) respond to information relating
133	133	to the patient that is submitted or presented during the meeting;
134	134	and
135	135	(c) state any concerns the patient or
136	136	surrogate has regarding compliance with this section or Section
137	137	166.0465;
138	138	(D) receive a written notice [explanation] of:
139	139	(i) the decision reached during the review
140	140	process;
141	141	(ii) an explanation of the decision,
142	142	including, if applicable, the committee's reasoning for affirming
143	143	that life-sustaining treatment requested in the patient's advance
144	144	directive or by the person responsible for the patient's health
145	145	care decisions is medically inappropriate;
146	146	(iii) a statement that the committee has
147	147	complied with Subsection (a-2) and Section 166.0465; and
148	148	(iv) a list of the health care facilities
149	149	contacted before the meeting as part of the transfer efforts made
150	150	under Subsection (d) and, for each facility on the list that denied
151	151	the request to transfer the patient, any reason provided by the
152	152	facility for denying the request;
153	153	(E) [(C)] receive a copy of the portion of the
154	154	patient's medical record related to the treatment received by the
155	155	patient in the facility for the lesser of:
156	156	(i) the period of the patient's current
157	157	admission to the facility; or
158	158	(ii) the preceding 30 calendar days; and
159	159	(F) [(D)] receive a copy of all of the patient's
160	160	reasonably available diagnostic results and reports related to the
161	161	medical record provided under Paragraph (E) [(C)].
162	162	(b-1) A health care facility may adopt and implement a
163	163	written attendance and confidentiality policy for meetings held
164	164	under this section that is reasonable and necessary to:
165	165	(1) facilitate information sharing and discussion of
166	166	the patient's medical status and treatment requirements; and
167	167	(2) preserve the effectiveness of the meeting.
168	168	(b-2) Notwithstanding Subsection (b)(3), the following
169	169	individuals may not participate in the deliberations of an ethics
170	170	or medical committee under this section:
171	171	(1) the physicians or health care professionals
172	172	providing treatment and care to the patient; or
173	173	(2) the patient, the person entitled to written notice
174	174	of the meeting under Subsection (b)(1), or any person attending
175	175	under Subsection (b)(3)(C).
176	176	(c) The written notices [explanation] required by
177	177	Subsections (b)(3)(D)(i) and (ii) [Subsection (b)(4)(B)] must be
178	178	included in the patient's medical record.
179	179	(d) After written notice is provided under Subsection
180	180	(b)(1), [If] the patient's attending physician [, the patient, or
181	181	the person responsible for the health care decisions of the
182	182	individual does not agree with the decision reached during the
183	183	review process under Subsection (b), the physician] shall make a
184	184	reasonable effort to transfer the patient to a physician who is
185	185	willing to comply with the directive. If the patient is a patient
186	186	in a health care facility, the facility's personnel shall assist
187	187	the physician in arranging the patient's transfer to:
188	188	(1) another physician;
189	189	(2) an alternative care setting within that facility;
190	190	or
191	191	(3) another facility.
192	192	(d-1) In this subsection, "medical procedure" means only a
193	193	tracheostomy or a percutaneous endoscopic gastrostomy. If the
194	194	person responsible for a patient's health care decisions does not
195	195	agree with the decision reached during the review process under
196	196	Subsection (b), the attending physician or another physician
197	197	responsible for the care of the patient shall perform on the patient
198	198	each medical procedure that satisfies the following conditions:
199	199	(1) in the physician's judgment, the medical procedure
200	200	is reasonable and necessary to help effect the patient's transfer
201	201	under Subsection (d);
202	202	(2) based on the physician's discussion with the
203	203	facility, performing the medical procedure will increase the
204	204	likelihood of effecting the patient's transfer under Subsection (d)
205	205	to a health care facility that is willing to consider accepting or
206	206	able to accept the patient;
207	207	(3) in the physician's medical judgment, performing
208	208	the medical procedure is:
209	209	(A) within the prevailing standard of medical
210	210	care; and
211	211	(B) not medically contraindicated or medically
212	212	inappropriate under the circumstances;
213	213	(4) the physician has the training and experience to
214	214	perform the medical procedure;
215	215	(5) if the patient is receiving care in a health care
216	216	facility, the physician has been granted privileges by the facility
217	217	that authorize the physician to perform the medical procedure at
218	218	the facility;
219	219	(6) the health care facility at which the medical
220	220	procedure will be performed has the resources for the performance
221	221	of the procedure; and
222	222	(7) the person responsible for the health care
223	223	decisions of the patient provides consent on behalf of the patient
224	224	for the medical procedure.
225	225	(e) If the patient's advance directive [patient] or the
226	226	person responsible for the health care decisions of the patient is
227	227	requesting life-sustaining treatment that the attending physician
228	228	has decided and the ethics or medical committee has affirmed is
229	229	medically inappropriate treatment, the patient shall be given
230	230	available life-sustaining treatment pending transfer under
231	231	Subsection (d). This subsection does not authorize withholding or
232	232	withdrawing pain management medication, medical procedures
233	233	necessary to provide comfort, or any other health care provided to
234	234	alleviate a patient's pain. The patient is responsible for any
235	235	costs incurred in transferring the patient to another
236	236	facility. The attending physician, any other physician
237	237	responsible for the care of the patient, and the health care
238	238	facility are not obligated to provide life-sustaining treatment
239	239	after the 45th business [10th] day after both the written decision
240	240	and the patient's medical record required under Subsection (b) are
241	241	provided to [the patient or] the person responsible for the health
242	242	care decisions of the patient unless ordered to extend the time [do
243	243	so] under Subsection (g), except that artificially administered
244	244	nutrition and hydration must be provided unless, based on
245	245	reasonable medical judgment, providing artificially administered
246	246	nutrition and hydration would:
247	247	(1) hasten the patient's death;
248	248	(2) be medically contraindicated such that the
249	249	provision of the treatment seriously exacerbates life-threatening
250	250	medical problems not outweighed by the benefit of the provision of
251	251	the treatment;
252	252	(3) result in substantial irremediable physical pain
253	253	not outweighed by the benefit of the provision of the treatment;
254	254	(4) be medically ineffective in prolonging life; or
255	255	(5) be contrary to the patient's or surrogate's
256	256	clearly documented desire not to receive artificially administered
257	257	nutrition or hydration.
258	258	(g) At the request of [the patient or] the person
259	259	responsible for the health care decisions of the patient, the
260	260	appropriate district or county court shall extend the time period
261	261	provided under Subsection (e) only if the court finds, by a
262	262	preponderance of the evidence, that there is a reasonable
263	263	expectation that a physician or health care facility that will
264	264	honor the patient's directive will be found if the time extension is
265	265	granted.
266	266	SECTION 3. Subchapter B, Chapter 166, Health and Safety
267	267	Code, is amended by adding Section 166.0465 to read as follows:
268	268	Sec. 166.0465. ETHICS OR MEDICAL COMMITTEE DECISION RELATED
269	269	TO PATIENT DISABILITY. (a) In this section, "disability" has the
270	270	meaning assigned by the Americans with Disabilities Act of 1990 (42
271	271	U.S.C. Section 12101 et seq.).
272	272	(b) During the review process under Section 166.046(b), the
273	273	ethics or medical committee may not consider a patient's disability
274	274	that existed before the patient's current admission unless the
275	275	disability is relevant in determining whether life-sustaining
276	276	treatment is medically appropriate.
277	277	SECTION 4. Sections 166.052(a) and (b), Health and Safety
278	278	Code, are amended to read as follows:
279	279	(a) In cases in which the attending physician refuses to
280	280	honor an advance directive or health care or treatment decision
281	281	requesting the provision of life-sustaining treatment, the
282	282	statement required by Section 166.046(b)(2)(A) [166.046(b)(3)(A)]
283	283	shall be in substantially the following form:
284	284	When There Is A Disagreement About Medical Treatment: The
285	285	Physician Recommends Against Certain Life-Sustaining Treatment
286	286	That You Wish To Continue
287	287	You have been given this information because you have
288	288	requested life-sustaining treatment* for yourself as the patient or
289	289	on behalf of the patient, as applicable, which the attending
290	290	physician believes is not medically appropriate. This information
291	291	is being provided to help you understand state law, your rights, and
292	292	the resources available to you in such circumstances. It outlines
293	293	the process for resolving disagreements about treatment among
294	294	patients, families, and physicians. It is based upon Section
295	295	166.046 of the Texas Advance Directives Act, codified in Chapter
296	296	166, Texas Health and Safety Code.
297	297	When an attending physician refuses to comply with an advance
298	298	directive or other request for life-sustaining treatment because of
299	299	the physician's judgment that the treatment would be medically
300	300	inappropriate, the case will be reviewed by an ethics or medical
301	301	committee. Life-sustaining treatment will be provided through the
302	302	review.
303	303	You will receive notification of this review at least seven
304	304	calendar days [48 hours] before a meeting of the committee related
305	305	to your case. You are entitled to attend the meeting. With your
306	306	agreement, the meeting may be held sooner than seven calendar days
307	307	[48 hours], if possible.
308	308	You are entitled to receive a written explanation of the
309	309	decision reached during the review process.
310	310	If after this review process both the attending physician and
311	311	the ethics or medical committee conclude that life-sustaining
312	312	treatment is medically inappropriate and yet you continue to
313	313	request such treatment, then the following procedure will occur:
314	314	1. The physician, with the help of the health care facility,
315	315	will assist you in trying to find a physician and facility willing
316	316	to provide the requested treatment.
317	317	2. You are being given a list of health care providers,
318	318	licensed physicians, health care facilities, and referral groups
319	319	that have volunteered their readiness to consider accepting
320	320	transfer, or to assist in locating a provider willing to accept
321	321	transfer, maintained by the Department of State Health
322	322	Services. You may wish to contact providers, facilities, or
323	323	referral groups on the list or others of your choice to get help in
324	324	arranging a transfer.
325	325	3. The patient will continue to be given life-sustaining
326	326	treatment until the patient can be transferred to a willing
327	327	provider for up to 45 business [10] days from the time you were
328	328	given both the committee's written decision that life-sustaining
329	329	treatment is not appropriate and the patient's medical record. The
330	330	patient will continue to be given after that [the 10-day] period
331	331	treatment to enhance pain management and reduce suffering,
332	332	including artificially administered nutrition and hydration,
333	333	unless, based on reasonable medical judgment, providing
334	334	artificially administered nutrition and hydration would hasten the
335	335	patient's death, be medically contraindicated such that the
336	336	provision of the treatment seriously exacerbates life-threatening
337	337	medical problems not outweighed by the benefit of the provision of
338	338	the treatment, result in substantial irremediable physical pain not
339	339	outweighed by the benefit of the provision of the treatment, be
340	340	medically ineffective in prolonging life, or be contrary to the
341	341	patient's or surrogate's clearly documented desires.
342	342	4. If a transfer can be arranged, the patient will be
343	343	responsible for the costs of the transfer.
344	344	5. If a provider cannot be found willing to give the
345	345	requested treatment within 45 business [10] days, life-sustaining
346	346	treatment may be withdrawn unless a court of law has granted an
347	347	extension.
348	348	6. You may ask the appropriate district or county court to
349	349	extend that [the 10-day] period if the court finds that there is a
350	350	reasonable expectation that you may find a physician or health care
351	351	facility willing to provide life-sustaining treatment if the
352	352	extension is granted. Patient medical records will be provided to
353	353	the patient or surrogate in accordance with Section 241.154, Texas
354	354	Health and Safety Code.
355	355	*"Life-sustaining treatment" means treatment that, based on
356	356	reasonable medical judgment, sustains the life of a patient and
357	357	without which the patient will die. The term includes both
358	358	life-sustaining medications and artificial life support, such as
359	359	mechanical breathing machines, kidney dialysis treatment, and
360	360	artificially administered nutrition and hydration. The term does
361	361	not include the administration of pain management medication or the
362	362	performance of a medical procedure considered to be necessary to
363	363	provide comfort care, or any other medical care provided to
364	364	alleviate a patient's pain.
365	365	(b) In cases in which the attending physician refuses to
366	366	comply with an advance directive or treatment decision requesting
367	367	the withholding or withdrawal of life-sustaining treatment, the
368	368	statement required by Section 166.046(b)(2)(A) [166.046(b)(3)(A)]
369	369	shall be in substantially the following form:
370	370	When There Is A Disagreement About Medical Treatment: The
371	371	Physician Recommends Life-Sustaining Treatment That You Wish To
372	372	Stop
373	373	You have been given this information because you have
374	374	requested the withdrawal or withholding of life-sustaining
375	375	treatment* for yourself as the patient or on behalf of the patient,
376	376	as applicable, and the attending physician disagrees with and
377	377	refuses to comply with that request. The information is being
378	378	provided to help you understand state law, your rights, and the
379	379	resources available to you in such circumstances. It outlines the
380	380	process for resolving disagreements about treatment among
381	381	patients, families, and physicians. It is based upon Section
382	382	166.046 of the Texas Advance Directives Act, codified in Chapter
383	383	166, Texas Health and Safety Code.
384	384	When an attending physician refuses to comply with an advance
385	385	directive or other request for withdrawal or withholding of
386	386	life-sustaining treatment for any reason, the case will be reviewed
387	387	by an ethics or medical committee. Life-sustaining treatment will
388	388	be provided through the review.
389	389	You will receive notification of this review at least seven
390	390	calendar days [48 hours] before a meeting of the committee related
391	391	to your case. You are entitled to attend the meeting. With your
392	392	agreement, the meeting may be held sooner than seven calendar days
393	393	[48 hours], if possible.
394	394	You are entitled to receive a written explanation of the
395	395	decision reached during the review process.
396	396	If you or the attending physician do not agree with the
397	397	decision reached during the review process, and the attending
398	398	physician still refuses to comply with your request to withhold or
399	399	withdraw life-sustaining treatment, then the following procedure
400	400	will occur:
401	401	1. The physician, with the help of the health care facility,
402	402	will assist you in trying to find a physician and facility willing
403	403	to withdraw or withhold the life-sustaining treatment.
404	404	2. You are being given a list of health care providers,
405	405	licensed physicians, health care facilities, and referral groups
406	406	that have volunteered their readiness to consider accepting
407	407	transfer, or to assist in locating a provider willing to accept
408	408	transfer, maintained by the Department of State Health
409	409	Services. You may wish to contact providers, facilities, or
410	410	referral groups on the list or others of your choice to get help in
411	411	arranging a transfer.
412	412	*"Life-sustaining treatment" means treatment that, based on
413	413	reasonable medical judgment, sustains the life of a patient and
414	414	without which the patient will die. The term includes both
415	415	life-sustaining medications and artificial life support, such as
416	416	mechanical breathing machines, kidney dialysis treatment, and
417	417	artificially administered nutrition and hydration. The term does
418	418	not include the administration of pain management medication or the
419	419	performance of a medical procedure considered to be necessary to
420	420	provide comfort care, or any other medical care provided to
421	421	alleviate a patient's pain.
422	422	SECTION 5. Subchapter B, Chapter 166, Health and Safety
423	423	Code, is amended by adding Section 166.054 to read as follows:
424	424	Sec. 166.054. REPORTING REQUIREMENTS REGARDING ETHICS OR
425	425	MEDICAL COMMITTEE PROCESSES. (a) Not later than the 180th day
426	426	after the date written notice is provided under Section
427	427	166.046(b)(1), a health care facility shall prepare and submit to
428	428	the department a report that contains information on:
429	429	(1) the number of days that elapsed from the patient's
430	430	admission to the facility to the date notice was provided under
431	431	Section 166.046(b)(1);
432	432	(2) whether the ethics or medical committee met to
433	433	review the case under Section 166.046 and, if the committee did
434	434	meet, the number of days that elapsed from the date notice was
435	435	provided under Section 166.046(b)(1) to the date the meeting was
436	436	held;
437	437	(3) whether the patient was:
438	438	(A) transferred to a physician within the same
439	439	facility who was willing to comply with the patient's advance
440	440	directive or a health care or treatment decision made by or on
441	441	behalf of a patient;
442	442	(B) transferred to a different facility; or
443	443	(C) discharged from the facility to a private
444	444	residence or other setting that is not a health care facility;
445	445	(4) whether the patient died while receiving
446	446	life-sustaining treatment;
447	447	(5) whether life-sustaining treatment was withheld or
448	448	withdrawn from the patient after expiration of the time described
449	449	by Section 166.046(e);
450	450	(6) the age group of the patient selected from the
451	451	following categories:
452	452	(A) 17 years of age or younger;
453	453	(B) 18 years of age or older and younger than 66
454	454	years of age; or
455	455	(C) 66 years of age or older;
456	456	(7) the health insurance coverage status of the
457	457	patient selected from the following categories:
458	458	(A) private health insurance coverage;
459	459	(B) public health plan coverage; or
460	460	(C) uninsured;
461	461	(8) the patient's sex; and
462	462	(9) the patient's race.
463	463	(b) The department shall ensure information provided in
464	464	each report submitted by a health care facility under Subsection
465	465	(a) is kept confidential and not disclosed in any manner, except as
466	466	provided by this section.
467	467	(c) Not later than April 1 of each year, the department
468	468	shall prepare and publish on the department's Internet website a
469	469	report that contains:
470	470	(1) aggregate information compiled from the reports
471	471	submitted to the department under Subsection (a) during the
472	472	preceding year on:
473	473	(A) the total number of written notices provided
474	474	under Section 166.046(b)(1);
475	475	(B) the average number of days described by
476	476	Subsection (a)(1);
477	477	(C) the total number of meetings held by ethics
478	478	or medical committees to review cases under Section 166.046;
479	479	(D) the average number of days described by
480	480	Subsection (a)(2);
481	481	(E) the total number of patients described by
482	482	Subsections (a)(3)(A), (B), and (C);
483	483	(F) the total number of patients described by
484	484	Subsection (a)(4); and
485	485	(G) the total number of patients for whom
486	486	life-sustaining treatment was withheld or withdrawn after
487	487	expiration of the time described by Section 166.046(e); and
488	488	(2) if the total number of reports submitted under
489	489	Subsection (a) for the preceding year is 10 or more, aggregate
490	490	information compiled from those reports on the total number of
491	491	patients categorized by:
492	492	(A) sex;
493	493	(B) race;
494	494	(C) age group, based on the categories described
495	495	by Subsection (a)(6); and
496	496	(D) health insurance coverage status, based on
497	497	the categories described by Subsection (a)(7).
498	498	(d) If the department receives fewer than 10 reports under
499	499	Subsection (a) for inclusion in an annual report required under
500	500	Subsection (c), the department shall include in the next annual
501	501	report prepared after the department receives 10 or more reports
502	502	the aggregate information for all years for which the information
503	503	was not included in a preceding annual report. The department shall
504	504	include in the next annual report a statement that identifies each
505	505	year during which an underlying report was submitted to the
506	506	department under Subsection (a).
507	507	(e) The annual report required by Subsection (c) or (d) may
508	508	not include any information that could be used alone or in
509	509	combination with other reasonably available information to
510	510	identify any individual, entity, or facility.
511	511	(f) The executive commissioner shall adopt rules to:
512	512	(1) establish a standard form for the reporting
513	513	requirements of this section; and
514	514	(2) protect and aggregate any information the
515	515	department receives under this section.
516	516	(g) Information submitted to the department under this
517	517	section:
518	518	(1) is not admissible in a civil or criminal
519	519	proceeding in which a physician, health care professional acting
520	520	under the direction of a physician, or health care facility is a
521	521	defendant;
522	522	(2) may not be used in relation to any disciplinary
523	523	action by a licensing or regulatory agency with oversight over a
524	524	physician, health care professional acting under the direction of a
525	525	physician, or health care facility; and
526	526	(3) is not public information or subject to disclosure
527	527	under Chapter 552, Government Code.
528	528	SECTION 6. Section 166.202(a), Health and Safety Code, is
529	529	amended to read as follows:
530	530	(a) This subchapter applies to a DNR order issued for a
531	531	patient admitted to [in] a health care facility or hospital.
532	532	SECTION 7. Sections 166.203(a), (b), and (c), Health and
533	533	Safety Code, are amended to read as follows:
534	534	(a) A DNR order issued for a patient is valid only if [the
535	535	patient's attending physician issues the order,] the order is
536	536	dated[,] and [the order]:
537	537	(1) is issued by a physician providing direct care to
538	538	the patient in compliance with:
539	539	(A) the written and dated directions of a patient
540	540	who was competent at the time the patient wrote the directions;
541	541	(B) the oral directions of a competent patient
542	542	delivered to or observed by two competent adult witnesses, at least
543	543	one of whom must be a person not listed under Section 166.003(2)(E)
544	544	or (F);
545	545	(C) the directions in an advance directive
546	546	enforceable under Section 166.005 or executed in accordance with
547	547	Section 166.032, 166.034, [or] 166.035, 166.082, 166.084, or
548	548	166.085;
549	549	(D) the directions of a patient's:
550	550	(i) legal guardian;
551	551	(ii) [or] agent under a medical power of
552	552	attorney acting in accordance with Subchapter D; or
553	553	(iii) proxy as designated and authorized by
554	554	a directive executed in accordance with Subchapter B to make a
555	555	treatment decision for the patient if the patient becomes
556	556	incompetent or otherwise mentally or physically incapable of
557	557	communication; or
558	558	(E) a treatment decision made in accordance with
559	559	Section 166.039; or
560	560	(2) is issued by the patient's attending physician
561	561	and:
562	562	(A) the order is not contrary to the directions
563	563	of a patient who was competent at the time the patient conveyed the
564	564	directions; and
565	565	(B) [,] in the reasonable medical judgment of the
566	566	patient's attending physician:
567	567	(i) [(A)] the patient's death is imminent,
568	568	regardless of the provision of cardiopulmonary resuscitation; and
569	569	(ii) [(B)] the DNR order is medically
570	570	appropriate.
571	571	(b) The DNR order takes effect at the time the order is
572	572	issued, provided the order is placed in the patient's medical
573	573	record as soon as practicable and may be issued in a format
574	574	acceptable under the policies of the health care facility or
575	575	hospital.
576	576	(c) Unless notice is provided in accordance with Section
577	577	166.204(a-1), before [Before] placing in a patient's medical record
578	578	a DNR order issued under Subsection (a)(2), a [the] physician,
579	579	physician assistant, nurse, or other person acting on behalf of a
580	580	health care facility or hospital shall:
581	581	(1) inform the patient of the order's issuance; or
582	582	(2) if the patient is incompetent, make a reasonably
583	583	diligent effort to contact or cause to be contacted and inform of
584	584	the order's issuance:
585	585	(A) the patient's known agent under a medical
586	586	power of attorney or legal guardian; or
587	587	(B) for a patient who does not have a known agent
588	588	under a medical power of attorney or legal guardian, a person
589	589	described by Section 166.039(b)(1), (2), or (3).
590	590	SECTION 8. Section 166.204, Health and Safety Code, is
591	591	amended by amending Subsection (a) and adding Subsection (a-1) to
592	592	read as follows:
593	593	(a) If a physician issues a DNR order under Section
594	594	166.203(a)(2), a physician, a physician assistant, a nurse, or
595	595	another person acting on behalf of a health care facility or
596	596	hospital shall provide notice of the order to the appropriate
597	597	persons in accordance with Subsection (a-1) or Section 166.203(c).
598	598	(a-1) If an individual arrives at a health care facility or
599	599	hospital that is treating a patient for whom a DNR order is issued
600	600	under Section 166.203(a)(2) and the individual notifies a
601	601	physician, physician assistant, or nurse providing direct care to
602	602	the patient of the individual's arrival, the physician, physician
603	603	assistant, or nurse who has actual knowledge of the order shall,
604	604	unless notice has been provided in accordance with Section
605	605	166.203(c), disclose the order to the individual, provided the
606	606	individual is:
607	607	(1) the patient's known agent under a medical power of
608	608	attorney or legal guardian; or
609	609	(2) for a patient who does not have a known agent under
610	610	a medical power of attorney or legal guardian, a person described by
611	611	Section 166.039(b)(1), (2), or (3).
612	612	SECTION 9. Sections 166.205(a) and (b), Health and Safety
613	613	Code, are amended to read as follows:
614	614	(a) A physician providing direct care to a patient for whom
615	615	a DNR order is issued shall revoke the patient's DNR order if [the
616	616	patient or, as applicable, the patient's agent under a medical
617	617	power of attorney or the patient's legal guardian if the patient is
618	618	incompetent]:
619	619	(1) the advance directive that serves as the basis of
620	620	the DNR order is properly revoked in accordance with this
621	621	chapter; [effectively revokes an advance directive, in accordance
622	622	with Section 166.042, for which a DNR order is issued under Section
623	623	166.203(a); or]
624	624	(2) the patient expresses to any person providing
625	625	direct care to the patient a revocation of consent to or intent to
626	626	revoke a DNR order issued under Section 166.203(a); or
627	627	(3) the DNR order was issued under Section
628	628	166.203(a)(1)(D) or (E) or Section 166.203(a)(2), and the person
629	629	responsible for making health care or treatment decisions on behalf
630	630	of the patient expresses to any person providing direct care to the
631	631	patient a revocation of consent to or intent to revoke the DNR
632	632	order.
633	633	(b) A person providing direct care to a patient under the
634	634	supervision of a physician shall notify the physician of the
635	635	request to revoke a DNR order or of the revocation of an advance
636	636	directive under Subsection (a).
637	637	SECTION 10. Sections 166.206(a) and (b), Health and Safety
638	638	Code, are amended to read as follows:
639	639	(a) If a [an attending] physician, health care facility, or
640	640	hospital does not wish to execute or comply with a DNR order or the
641	641	patient's instructions concerning the provision of cardiopulmonary
642	642	resuscitation, the physician, facility, or hospital shall inform
643	643	the patient, the legal guardian or qualified relatives of the
644	644	patient, or the agent of the patient under a medical power of
645	645	attorney of the benefits and burdens of cardiopulmonary
646	646	resuscitation.
647	647	(b) If, after receiving notice under Subsection (a), the
648	648	patient or another person authorized to act on behalf of the patient
649	649	and the [attending] physician, health care facility, or hospital
650	650	remain in disagreement, the physician, facility, or hospital shall
651	651	make a reasonable effort to transfer the patient to another
652	652	physician, facility, or hospital willing to execute or comply with
653	653	a DNR order or the patient's instructions concerning the provision
654	654	of cardiopulmonary resuscitation.
655	655	SECTION 11. Section 166.209, Health and Safety Code, is
656	656	amended to read as follows:
657	657	Sec. 166.209. ENFORCEMENT. (a) Subject to Sections
658	658	166.205(d), 166.207, and 166.208 and Subsection (c), a [A]
659	659	physician, physician assistant, nurse, or other person commits an
660	660	offense if, with the specific intent to violate this subchapter,
661	661	the person:
662	662	(1) [intentionally] conceals, cancels, effectuates,
663	663	or falsifies another person's DNR order in violation of this
664	664	subchapter; or
665	665	(2) [if the person intentionally] conceals or
666	666	withholds personal knowledge of another person's revocation of a
667	667	DNR order in violation of this subchapter.
668	668	(a-1) An offense under Subsection (a) [this subsection] is a
669	669	Class A misdemeanor. This section [subsection] does not preclude
670	670	prosecution for any other applicable offense.
671	671	(b) Subject to Sections 166.205(d), 166.207, and 166.208, a
672	672	[A] physician, health care professional, health care facility,
673	673	hospital, or entity is subject to review and disciplinary action by
674	674	the appropriate licensing authority for intentionally:
675	675	(1) failing to effectuate a DNR order in violation of
676	676	this subchapter; or
677	677	(2) issuing a DNR order in violation of this
678	678	subchapter.
679	679	(c) A person does not commit an offense under Subsection (a)
680	680	if the person's act or omission was based on a reasonable belief
681	681	that the act or omission was in compliance with the wishes of the
682	682	patient or the person having authority to make health care
683	683	treatment decisions on behalf of the patient.
684	684	SECTION 12. Section 313.004, Health and Safety Code, is
685	685	amended by amending Subsections (a) and (c) and adding Subsection
686	686	(a-1) to read as follows:
687	687	(a) If an adult patient of a home and community support
688	688	services agency or in a hospital or nursing home, or an adult inmate
689	689	of a county or municipal jail, is comatose, incapacitated, or
690	690	otherwise mentally or physically incapable of communication and
691	691	does not have a legal guardian or an agent under a medical power of
692	692	attorney who is reasonably available, an adult surrogate from the
693	693	following list, in order of priority, who has decision-making
694	694	capacity, is reasonably available after a reasonably diligent
695	695	inquiry, and is willing to consent to medical treatment on behalf of
696	696	the patient may consent to medical treatment on behalf of the
697	697	patient:
698	698	(1) the patient's spouse;
699	699	(2) the patient's [an adult child of the patient who
700	700	has the waiver and consent of all other qualified] adult children
701	701	[of the patient to act as the sole decision-maker];
702	702	(3) [a majority of] the patient's parents [reasonably
703	703	available adult children]; or
704	704	(4) the patient's nearest living relative [parents; or
705	705	[(5) the individual clearly identified to act for the
706	706	patient by the patient before the patient became incapacitated, the
707	707	patient's nearest living relative, or a member of the clergy].
708	708	(a-1) If the patient does not have a legal guardian, an
709	709	agent under a medical power of attorney, or a person listed in
710	710	Subsection (a) who is reasonably available, a treatment decision
711	711	may be concurred by another physician who is not involved in the
712	712	treatment of the patient.
713	713	(c) Any medical treatment consented to under Subsection (a)
714	714	or (a-1) must be based on knowledge of what the patient would
715	715	desire, if known.
716	716	SECTION 13. Chapter 166, Health and Safety Code, as amended
717	717	by this Act, applies only to a review, consultation, disagreement,
718	718	or other action relating to a health care or treatment decision made
719	719	on or after the effective date of this Act. A review, consultation,
720	720	disagreement, or other action relating to a health care or
721	721	treatment decision made before the effective date of this Act is
722	722	governed by the law in effect immediately before the effective date
723	723	of this Act, and the former law is continued in effect for that
724	724	purpose.
725	725	SECTION 14. Section 166.209, Health and Safety Code, as
726	726	amended by this Act, applies only to conduct that occurs on or after
727	727	the effective date of this Act. Conduct that occurs before the
728	728	effective date of this Act is governed by the law in effect on the
729	729	date the conduct occurred, and the former law is continued in effect
730	730	for that purpose.
731	731	SECTION 15. This Act takes effect September 1, 2023.