89R2473 KKR-D
By: Hall S.B. No. 124
A BILL TO BE ENTITLED
AN ACT
relating to hospital patients' rights and hospital policies and
procedures; providing an administrative penalty.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 241, Health and Safety Code, is amended
by adding Subchapter N to read as follows:
SUBCHAPTER N. HOSPITAL PATIENTS' RIGHTS; HOSPITAL POLICIES AND
PROCEDURES RELATED TO PATIENTS' RIGHTS
Sec. 241.451. DEFINITION. In this subchapter, "hospital"
includes a hospital providing comprehensive medical rehabilitation
services, chemical dependency services, and mental health
services.
Sec. 241.452. PATIENTS' RIGHTS POLICY. (a) Each hospital
shall adopt, implement, and enforce a written policy to ensure the
rights of the hospital's patients. The policy must provide that
each patient has a right to:
(1) the hospital's reasonable response to the
patient's requests and needs for treatment or service, to the
extent the request or need is within the hospital's capacity and
stated mission and is allowed by law;
(2) considerate and respectful care that accounts for
the psychosocial, spiritual, and cultural variables influencing
the perceptions of illness without any bullying or shaming by
hospital or medical staff;
(3) to the extent feasible, treatment by the patient's
choice of physician;
(4) unrestricted visitation by at least one individual
at any given time, including during a qualifying period of disaster
as defined by Section 241.012;
(5) use as prescribed by the patient's physician of
choice of:
(A) a prescription drug the United States Food
and Drug Administration has approved for use but prescribed for a
use other than the approved use; or
(B) a complementary or alternative medical
treatment, regardless of the United States Food and Drug
Administration's approval of the treatment;
(6) for terminally ill patients, access and use
certain investigational drugs, biological products, and devices
that are in clinical trials in accordance with this state's Right to
Try Act under Chapter 489, including to the extent allowed by
federal law during a qualifying period of disaster as defined by
Section 241.012;
(7) care that optimizes the comfort and dignity of a
patient who is dying through:
(A) treating primary and secondary symptoms that
are responsive to treatment as the patient or the patient's
surrogate decision-maker determines;
(B) effectively managing pain; and
(C) acknowledging the psychosocial and spiritual
concerns of the patient and the patient's family regarding dying
and the expression of grief by the patient and the patient's family;
(8) in collaboration with the patient's physician,
make decisions involving the patient's health care, including the
right to:
(A) accept or refuse treatment to the extent
permitted by law and be informed of the medical consequence of
refusing treatment;
(B) execute an advanced directive and
periodically review the directive as provided by Section 241.457;
(C) appoint a surrogate to make health care
decisions on the patient's behalf; and
(D) receive care that is not conditioned on the
existence of the directive;
(9) be provided information necessary for the patient
to make informed treatment decisions that reflect the patient's
wishes;
(10) be provided at the time of admission information
about the hospital's:
(A) patients' rights policy; and
(B) process for initiating, reviewing, and
resolving as feasible patient complaints about quality of care;
(11) participate or have the patient's designated
surrogate decision-maker participate in the consideration of
ethical issues arising in the patient's care;
(12) be informed of any human experimentation or other
research or educational project that affects the patient's care or
treatment;
(13) personal privacy and confidentiality of the
patient's information to the extent permitted by law; and
(14) access the information contained in the patient's
medical records.
(b) To the extent allowed by law, a patient's guardian, next
of kin, or other legally authorized surrogate decision-maker has
the right to exercise the patient's rights under Subsection (a) if
the patient:
(1) has been found to be incompetent by a court of law;
(2) is found by the patient's physician to be medically
incapable of understanding the proposed procedure or treatment;
(3) is unable to communicate the patient's wishes
regarding treatment; or
(4) is a minor.
Sec. 241.453. PATIENTS' RIGHTS POLICY FOR HOSPITALS
PROVIDING COMPREHENSIVE MEDICAL REHABILITATION SERVICES. A
hospital providing comprehensive medical rehabilitation services
must include in the hospital's patients' rights policy adopted
under Section 241.452 that each minor patient has the right to:
(1) appropriate treatment in the least restrictive
setting available;
(2) decline unnecessary or excessive medication;
(3) an individualized treatment plan that is developed
with the patient's participation;
(4) a humane treatment environment that provides
reasonable protection from harm and appropriate privacy for
personal needs;
(5) accommodations separated from adult patient
accommodations; and
(6) regular communication with the patient's family.
Sec. 241.454. EFFECT ON OTHER REQUIREMENTS FOR CERTAIN
HOSPITALS. A hospital patients' rights policy adopted under this
subchapter by a hospital providing chemical dependency services or
mental health services is in addition to any other patients' rights
policy required by law or commission rules.
Sec. 241.455. REQUIRED DISPLAY OF PATIENTS' RIGHTS POLICY.
(a) A hospital shall prominently and conspicuously display the
hospital's patients' rights policy in a public area readily
accessible to hospital patients, residents, visitors, and
employees.
(b) A hospital that provides comprehensive medical
rehabilitation services, chemical dependency services, or mental
health services must display the patients' rights policy in English
and in a language other than English that is appropriate to the
demographic composition of the community the hospital serves.
Sec. 241.456. NOTICE OF PATIENTS' RIGHTS BY HOSPITAL
PROVIDING COMPREHENSIVE MEDICAL REHABILITATION SERVICES. (a) This
section applies only to a hospital that provides comprehensive
medical rehabilitation services.
(b) Before admitting or accepting for evaluation any
patient, a hospital to which this section applies shall provide to
the patient and, if applicable, to the patient's parent, managing
conservator, or guardian, a written copy of the hospital's
patients' rights policy and as feasible provide the copy in the
patient's primary language.
(c) The hospital shall ensure that within two hours, or as
soon as reasonably possible within eight hours, after the time a
patient is admitted to the hospital, the hospital's patients'
rights policy is orally explained to the patient or, if
appropriate, the patient's parent, managing conservator, or
guardian. The explanation must be given in simple nontechnical
terms and as feasible in the individual's primary language. The
hospital may use other reasonable means to explain the policy to an
individual with a vision or hearing impairment.
(d) Except as provided by Subsection (e), the hospital shall
obtain a copy of the hospital's patients' rights policy signed by
the patient or, if appropriate, the patient's parent, managing
conservator, or guardian. The signed copy must:
(1) include a statement by the patient or other
individual acknowledging the patient or individual read the policy
and understands the specified rights; and
(2) be placed in the patient's medical record.
(e) If a patient is unable to comprehend the information
contained in the hospital's patients' rights policy because of
illness, age, or other factors, an emergency precludes a timely
explanation of the policy, or the patient refuses to sign the policy
as required under Subsection (d), the hospital may satisfy the
requirements of Subsections (c) and (d) by:
(1) explaining the policy to the patient with two
hospital staff members serving as witnesses; and
(2) placing the unsigned copy in the patient's medical
record with a written notation signed by the witnesses explaining
the reason the patient did not sign the policy.
Sec. 241.457. ADVANCED DIRECTIVE PROCEDURES. A hospital
shall:
(1) establish procedures for:
(A) determining at the time a patient is admitted
to the hospital whether the patient has executed an advanced
directive; and
(B) if appropriate, assisting in the development
of an advanced directive for the patient;
(2) include any executed advanced directive in the
patient's medical record; and
(3) periodically review the patient's advanced
directive with the patient or the patient's surrogate
decision-maker, as appropriate.
Sec. 241.458. POLICY ON INFORMED TREATMENT DECISIONS. A
hospital shall adopt, implement, and enforce a written policy for
ensuring a patient makes informed treatment decisions. The policy
must be consistent with state and federal law and any other
applicable legal requirements.
Sec. 241.459. ETHICAL ISSUES FOR PATIENT CARE. A hospital
shall establish procedures for considering ethical issues that
arise in a patient's care and provide education on health care
ethical issues to patients and their caregivers.
Sec. 241.460. ADMINISTRATIVE PENALTY. (a) The commission
shall assess an administrative penalty in the amount of $1,000
against a hospital for each violation of this subchapter or rules
adopted under this subchapter. Each day a violation continues or
occurs may be considered a separate violation for purposes of
imposing a penalty.
(b) The enforcement of the penalty may be stayed during the
time the order is under judicial review if the hospital pays the
penalty to the clerk of the court or files a supersedeas bond with
the court in the amount of the penalty.
(c) The attorney general may sue to collect the penalty.
(d) A proceeding to impose the penalty is considered to be a
contested case under Chapter 2001, Government Code.
Sec. 241.461. RULES. The executive commissioner shall
adopt rules to implement this subchapter.
SECTION 2. Section 164.009(a), Health and Safety Code, is
amended to read as follows:
(a) A treatment facility may not admit a patient to its
facilities without fully disclosing to the patient or, if the
patient is a minor, the patient's parent, managing conservator, or
guardian, in, if possible, the primary language of the patient,
managing conservator, or guardian, as the case may be, the
following information in writing before admission:
(1) the treatment facility's estimated average daily
charge for inpatient treatment with an explanation that the patient
may be billed separately for services provided by mental health
professionals;
(2) the name of the attending physician, if the
treatment facility is a mental health facility, or the name of the
attending mental health professional, if the facility is a chemical
dependency facility; and
(3) the current patients' rights policy as required
under Subchapter N, Chapter 241, and any ["patient's bill of
rights" as adopted by the executive commissioner that sets out]
restrictions to the patient's freedom that may be imposed on the
patient during the patient's stay in a treatment facility.
SECTION 3. Section 241.004, Health and Safety Code, is
amended to read as follows:
Sec. 241.004. EXEMPTIONS. Except as otherwise provided by
Subchapter N, this [This] chapter does not apply to a facility:
(1) licensed under Chapter 242 or 577;
(2) maintained or operated by the federal government
or an agency of the federal government; or
(3) maintained or operated by this state or an agency
of this state.
SECTION 4. Sections 321.002(a) and (b), Health and Safety
Code, are amended to read as follows:
(a) The executive commissioner by rule shall adopt a
"patient's bill of rights" that includes the applicable rights
included in this chapter, the rights described by Subchapter N,
Chapter 241, and other rights provided by Subtitle C of Title 7,
Chapters 241, 462, 464, and 466, and any other provisions the
executive commissioner considers necessary to protect the health,
safety, and rights of a patient receiving voluntary or involuntary
mental health, chemical dependency, or comprehensive medical
rehabilitation services in an inpatient facility. In addition,
the executive commissioner shall adopt rules that[:
[(1)] provide standards to prevent the admission of a
minor to a facility for treatment of a condition that is not
generally recognized as responsive to treatment in an inpatient
treatment setting[; and
[(2) prescribe the procedure for presenting the
applicable bill of rights and obtaining each necessary signature
if:
[(A) the patient cannot comprehend the
information because of illness, age, or other factors; or
[(B) an emergency exists that precludes
immediate presentation of the information].
(b) The executive commissioner by rule shall adopt a
"children's bill of rights" for a minor receiving treatment in a
child-care facility for an emotional, mental health, or chemical
dependency problem that includes the rights described by Subchapter
N, Chapter 241.
SECTION 5. Sections 321.002(c), (d), and (f), Health and
Safety Code, are repealed.
SECTION 6. (a) Notwithstanding Subchapter N, Chapter 241,
Health and Safety Code, as added by this Act, a hospital is not
required to comply with that subchapter until January 1, 2026.
(b) As soon as practicable after the effective date of this
Act, the executive commissioner of the Health and Human Services
Commission shall adopt the rules necessary to implement Subchapter
N, Chapter 241, Health and Safety Code, as added by this Act.
SECTION 7. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2025.