H.B. No. 3162

	AN ACT
	relating to advance directives, do-not-resuscitate orders, and
	health care treatment decisions made by or on behalf of certain
	patients, including a review of directives and decisions.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Subchapter B, Chapter 166, Health and Safety
	Code, is amended by adding Section 166.0445 to read as follows:
	Sec. 166.0445.  LIMITATION ON LIABILITY FOR PERFORMING
	CERTAIN MEDICAL PROCEDURES. (a) A physician or a health care
	professional acting under the direction of a physician is not
	subject to civil liability for participating in a medical procedure
	performed under Section 166.046(d-2).
	(b)  A physician or a health care professional acting under
	the direction of a physician is not subject to criminal liability
	for participating in a medical procedure performed under Section
	166.046(d-2) unless:
	(1)  the physician or health care professional in
	participating in the medical procedure acted with a specific
	malicious intent to cause the death of the patient and that conduct
	significantly hastened the patient's death; and
	(2)  the hastening of the patient's death is not
	attributable to the risks associated with the medical procedure.
	(c)  A physician or a health care professional acting under
	the direction of a physician has not engaged in unprofessional
	conduct by participating in a medical procedure performed under
	Section 166.046(d-2) unless the physician or health care
	professional in participating in the medical procedure acted with a
	specific malicious intent to harm the patient.
	SECTION 2.  The heading to Section 166.046, Health and
	Safety Code, is amended to read as follows:
	Sec. 166.046.  PROCEDURE IF NOT EFFECTUATING [A] DIRECTIVE
	OR TREATMENT DECISION FOR CERTAIN PATIENTS.
	SECTION 3.  Section 166.046, Health and Safety Code, is
	amended by amending Subsections (a), (b), (c), (d), (e), and (g) and
	adding Subsections (a-1), (a-2), (b-1), (b-2), (b-3), (d-1), (d-2),
	(d-3), and (i) to read as follows:
	(a)  This section applies only to health care and treatment
	for a patient who is determined to be incompetent or is otherwise
	mentally or physically incapable of communication.
	(a-1)  If an attending physician refuses to honor an [a
	patient's] advance directive of or [a] health care or treatment
	decision made by or on behalf of a patient to whom this section
	applies, the physician's refusal shall be reviewed by an ethics or
	medical committee. The attending physician may not be a member of
	that committee during the review. The patient shall be given
	life-sustaining treatment during the review.
	(a-2)  An ethics or medical committee that reviews a
	physician's refusal to honor an advance directive or health care or
	treatment decision under Subsection (a-1) shall consider the
	patient's well-being in conducting the review but may not make any
	judgment on the patient's quality of life. For purposes of this
	section, a decision by the committee based on any of the
	considerations described by Subdivisions (1) through (5) is not a
	judgment on the patient's quality of life. If the review requires
	the committee to determine whether life-sustaining treatment
	requested in the patient's advance directive or by the person
	responsible for the patient's health care decisions is medically
	inappropriate, the committee shall consider whether provision of
	the life-sustaining treatment:
	(1)  will prolong the natural process of dying or
	hasten the patient's death;
	(2)  will result in substantial, irremediable, and
	objectively measurable physical pain that is not outweighed by the
	benefit of providing the treatment;
	(3)  is medically contraindicated such that the
	provision of the treatment seriously exacerbates life-threatening
	medical problems not outweighed by the benefit of providing the
	treatment;
	(4)  is consistent with the prevailing standard of
	care; or
	(5)  is contrary to the patient's clearly documented
	desires.
	(b)  The [patient or the] person responsible for the
	patient's health care decisions [of the individual who has made the
	decision regarding the directive or treatment decision]:
	(1)  [may be given a written description of the ethics
	or medical committee review process and any other policies and
	procedures related to this section adopted by the health care
	facility;
	[(2)]  shall be informed in writing [of the committee
	review process] not less than seven calendar days [48 hours] before
	the meeting called to discuss the patient's directive, unless the
	[time] period is waived by written mutual agreement, of:
	(A)  the ethics or medical committee review
	process and any other related policies and procedures adopted by
	the health care facility, including any policy described by
	Subsection (b-1);
	(B)  the rights described in Subdivisions
	(3)(A)-(D);
	(C)  the date, time, and location of the meeting;
	(D)  the work contact information of the
	facility's personnel who, in the event of a disagreement, will be
	responsible for overseeing the reasonable effort to transfer the
	patient to another physician or facility willing to comply with the
	directive;
	(E)  the factors the committee is required to
	consider under Subsection (a-2); and
	(F)  the language in Section 166.0465;
	(2) [(3)]  at the time of being [so] informed under
	Subdivision (1), shall be provided:
	(A)  a copy of the appropriate statement set forth
	in Section 166.052; and
	(B)  a copy of the registry list of health care
	providers and referral groups that have volunteered their readiness
	to consider accepting transfer or to assist in locating a provider
	willing to accept transfer that is posted on the website maintained
	by the department under Section 166.053; and
	(3) [(4)]  is entitled to:
	(A)  attend and participate in the meeting as
	scheduled by the committee;
	(B)  receive during the meeting a written
	statement of the first name, first initial of the last name, and
	title of each committee member who will participate in the meeting;
	(C)  subject to Subsection (b-1):
	(i)  be accompanied at the meeting by the
	patient's spouse, parents, adult children, and not more than four
	additional individuals, including legal counsel, a physician, a
	health care professional, or a patient advocate, selected by the
	person responsible for the patient's health care decisions; and
	(ii)  have an opportunity during the open
	portion of the meeting to either directly or through another
	individual attending the meeting:
	(a)  explain the justification for the
	health care or treatment request made by or on behalf of the
	patient;
	(b)  respond to information relating
	to the patient that is submitted or presented during the open
	portion of the meeting; and
	(c)  state any concerns of the person
	responsible for the patient's health care decisions regarding
	compliance with this section or Section 166.0465, including stating
	an opinion that one or more of the patient's disabilities are not
	relevant to the committee's determination of whether the medical or
	surgical intervention is medically appropriate;
	(D)  receive a written notice [explanation] of:
	(i)  the decision reached during the review
	process accompanied by an explanation of the decision, including,
	if applicable, the committee's reasoning for affirming that
	requested life-sustaining treatment is medically inappropriate;
	(ii)  the patient's major medical conditions
	as identified by the committee, including any disability of the
	patient considered by the committee in reaching the decision,
	except the notice is not required to specify whether any medical
	condition qualifies as a disability;
	(iii)  a statement that the committee has
	complied with Subsection (a-2) and Section 166.0465; and
	(iv)  the health care facilities contacted
	before the meeting as part of the transfer efforts under Subsection
	(d) and, for each listed facility that denied the request to
	transfer the patient and provided a reason for the denial, the
	provided reason;
	(E) [(C)]  receive a copy of or electronic access
	to the portion of the patient's medical record related to the
	treatment received by the patient in the facility for [the lesser
	of:
	[(i)]  the period of the patient's current
	admission to the facility; [or
	[(ii)  the preceding 30 calendar days;] and
	(F) [(D)]  receive a copy of or electronic access
	to all of the patient's reasonably available diagnostic results and
	reports related to the medical record provided under Paragraph (E)
	[(C)].
	(b-1)  A health care facility may adopt and implement a
	written policy for meetings held under this section that is
	reasonable and necessary to:
	(1)  facilitate information sharing and discussion of
	the patient's medical status and treatment requirements, including
	provisions related to attendance, confidentiality, and timing
	regarding any agenda item; and
	(2)  preserve the effectiveness of the meeting,
	including provisions disclosing that the meeting is not a legal
	proceeding and the committee will enter into an executive session
	for deliberations.
	(b-2)  Notwithstanding Subsection (b)(3), the following
	individuals may not attend or participate in the executive session
	of an ethics or medical committee under this section:
	(1)  the physicians or health care professionals
	providing health care and treatment to the patient; or
	(2)  the person responsible for the patient's health
	care decisions or any person attending the meeting under Subsection
	(b)(3)(C)(i).
	(b-3)  If the health care facility or person responsible for
	the patient's health care decisions intends to have legal counsel
	attend the meeting of the ethics or medical committee, the facility
	or person, as applicable, shall make a good faith effort to provide
	written notice of that intention not less than 48 hours before the
	meeting begins.
	(c)  The written notice [explanation] required by Subsection
	(b)(3)(D)(i) [Subsection (b)(4)(B)] must be included in the
	patient's medical record.
	(d)  After written notice is provided under Subsection
	(b)(1), [If] the patient's attending physician [, the patient, or
	the person responsible for the health care decisions of the
	individual does not agree with the decision reached during the
	review process under Subsection (b), the physician] shall make a
	reasonable effort to transfer the patient to a physician who is
	willing to comply with the directive. The health care [If the
	patient is a patient in a health care facility, the] facility's
	personnel shall assist the physician in arranging the patient's
	transfer to:
	(1)  another physician;
	(2)  an alternative care setting within that facility;
	or
	(3)  another facility.
	(d-1)  If another health care facility denies the patient's
	transfer request, the personnel of the health care facility
	assisting with the patient's transfer efforts under Subsection (d)
	shall make a good faith effort to inquire whether the facility that
	denied the patient's transfer request would be more likely to
	approve the transfer request if a medical procedure, as that term is
	defined in this section, is performed on the patient.
	(d-2)  If the patient's advance directive or the person
	responsible for the patient's health care decisions is requesting
	life-sustaining treatment that the attending physician has decided
	and the ethics or medical committee has affirmed is medically
	inappropriate:
	(1)  the attending physician or another physician
	responsible for the care of the patient shall perform on the patient
	each medical procedure that satisfies all of the following
	conditions:
	(A)  in the attending physician's judgment, the
	medical procedure is reasonable and necessary to help effect the
	patient's transfer under Subsection (d);
	(B)  an authorized representative for another
	health care facility with the ability to comply with the patient's
	advance directive or the health care or treatment decision made by
	or on behalf of the patient has expressed to the personnel described
	by Subsection (b)(1)(D) or the attending physician that the
	facility is more likely to accept the patient's transfer to the
	other facility if the medical procedure is performed on the
	patient;
	(C)  in the medical judgment of the physician who
	would perform the medical procedure, performing the medical
	procedure is:
	(i)  within the prevailing standard of
	medical care; and
	(ii)  not medically contraindicated or
	medically inappropriate under the circumstances;
	(D)  in the medical judgment of the physician who
	would perform the medical procedure, the physician has the training
	and experience to perform the medical procedure;
	(E)  the physician who would perform the medical
	procedure has medical privileges at the facility where the patient
	is receiving care authorizing the physician to perform the medical
	procedure at the facility;
	(F)  the facility where the patient is receiving
	care has determined the facility has the resources for the
	performance of the medical procedure at the facility; and
	(G)  the person responsible for the patient's
	health care decisions provides consent on behalf of the patient for
	the medical procedure; and
	(2)  the person responsible for the patient's health
	care decisions is entitled to receive:
	(A)  a delay notice:
	(i)  if, at the time the written decision is
	provided as required by Subsection (b)(3)(D)(i), a medical
	procedure satisfies all of the conditions described by Subdivision
	(1); or
	(ii)  if:
	(a)  at the time the written decision
	is provided as required by Subsection (b)(3)(D)(i), a medical
	procedure satisfies all of the conditions described by Subdivision
	(1) except Subdivision (1)(G); and
	(b)  the person responsible for the
	patient's health care decisions provides to the attending physician
	or another physician or health care professional providing direct
	care to the patient consent on behalf of the patient for the medical
	procedure within 24 hours of the request for consent;
	(B)  a start notice:
	(i)  if, at the time the written decision is
	provided as required by Subsection (b)(3)(D)(i), no medical
	procedure satisfies all of the conditions described by Subdivisions
	(1)(A) through (F); or
	(ii)  if:
	(a)  at the time the written decision
	is provided as required by Subsection (b)(3)(D)(i), a medical
	procedure satisfies all of the conditions described by Subdivision
	(1) except Subdivision (1)(G); and
	(b)  the person responsible for the
	patient's health care decisions does not provide to the attending
	physician or another physician or health care professional
	providing direct care to the patient consent on behalf of the
	patient for the medical procedure within 24 hours of the request for
	consent; and
	(C)  a start notice accompanied by a statement
	that one or more of the conditions described by Subdivisions (1)(A)
	through (G) are no longer satisfied if, after a delay notice is
	provided in accordance with Subdivision (2)(A) and before the
	medical procedure on which the delay notice is based is performed on
	the patient, one or more of those conditions are no longer
	satisfied.
	(d-3)  After the 25-day period described by Subsection (e)
	begins, the period may not be suspended or stopped for any reason.
	This subsection does not limit or affect a court's ability to order
	an extension of the period in accordance with Subsection (g).
	Subsection (d-2) does not require a medical procedure to be
	performed on the patient after the expiration of the 25-day period.
	(e)  If the patient's advance directive [patient] or the
	person responsible for the patient's health care decisions [of the
	patient] is requesting life-sustaining treatment that the
	attending physician has decided and the ethics or medical committee
	has affirmed is medically inappropriate treatment, the patient
	shall be given available life-sustaining treatment pending
	transfer under Subsection (d).  This subsection does not authorize
	withholding or withdrawing pain management medication, medical
	interventions [procedures] necessary to provide comfort, or any
	other health care provided to alleviate a patient's pain.  The
	patient is responsible for any costs incurred in transferring the
	patient to another health care facility.  The attending physician,
	any other physician responsible for the care of the patient, and the
	health care facility are not obligated to provide life-sustaining
	treatment after the 25th calendar [10th] day after a start notice is
	[both the written decision and the patient's medical record
	required under Subsection (b) are] provided in accordance with
	Subsection (d-2)(2)(B) or (C) to [the patient or] the person
	responsible for the patient's health care decisions or a medical
	procedure for which a delay notice was provided in accordance with
	Subsection (d-2)(2)(A) is performed, whichever occurs first, [of
	the patient] unless ordered to extend the 25-day period [do so]
	under Subsection (g), except that artificially administered
	nutrition and hydration must be provided unless, based on
	reasonable medical judgment, providing artificially administered
	nutrition and hydration would:
	(1)  hasten the patient's death;
	(2)  be medically contraindicated such that the
	provision of the treatment seriously exacerbates life-threatening
	medical problems not outweighed by the benefit of providing [the
	provision of] the treatment;
	(3)  result in substantial, irremediable, and
	objectively measurable physical pain not outweighed by the benefit
	of providing [the provision of] the treatment;
	(4)  be medically ineffective in prolonging life; or
	(5)  be contrary to the patient's or surrogate's
	clearly documented desire not to receive artificially administered
	nutrition or hydration.
	(g)  At the request of [the patient or] the person
	responsible for the patient's health care decisions [of the
	patient], the appropriate district or county court shall extend the
	[time] period provided under Subsection (e) only if the court
	finds, by a preponderance of the evidence, that there is a
	reasonable expectation that a physician or health care facility
	that will honor the patient's directive will be found if the time
	extension is granted.
	(i)  In this section:
	(1)  "Delay notice" means a written notice that the
	first day of the 25-day period provided under Subsection (e), after
	which life-sustaining treatment may be withheld or withdrawn unless
	a court has granted an extension under Subsection (g), will be
	delayed until the calendar day after a medical procedure required
	by Subsection (d-2)(1) is performed unless, before the medical
	procedure is performed, the person receives written notice of an
	earlier first day because one or more conditions described by that
	subdivision are no longer satisfied.
	(2)  "Medical procedure" means only a tracheostomy or a
	percutaneous endoscopic gastrostomy.
	(3)  "Start notice" means a written notice that the
	25-day period provided under Subsection (e), after which
	life-sustaining treatment may be withheld or withdrawn unless a
	court has granted an extension under Subsection (g), will begin on
	the first calendar day after the date the notice is provided.
	SECTION 4.  Subchapter B, Chapter 166, Health and Safety
	Code, is amended by adding Section 166.0465 to read as follows:
	Sec. 166.0465.  ETHICS OR MEDICAL COMMITTEE DECISION RELATED
	TO PATIENT DISABILITY. (a) In this section, "disability" has the
	meaning assigned by the Americans with Disabilities Act of 1990 in
	42 U.S.C. Section 12102.
	(b)  During the review process under Section 166.046(b), the
	ethics or medical committee may not consider a patient's disability
	that existed before the patient's current admission unless the
	disability is relevant in determining whether the medical or
	surgical intervention is medically appropriate.
	SECTION 5.  Sections 166.052(a) and (b), Health and Safety
	Code, are amended to read as follows:
	(a)  In cases in which the attending physician refuses to
	honor an advance directive or health care or treatment decision
	requesting the provision of life-sustaining treatment for a patient
	who is determined to be incompetent or is otherwise mentally or
	physically incapable of communication, the statement required by
	Section 166.046(b)(2)(A) [166.046(b)(3)(A)] shall be in
	substantially the following form:
	When There Is A Disagreement About Medical Treatment:  The
	Physician Recommends Against Certain Life-Sustaining Treatment
	That You Wish To Continue
	You have been given this information because the patient has
	requested through an advance directive or you have requested on
	behalf of the patient that life-sustaining treatment* be provided
	to [for yourself as the patient or on behalf of] the patient, [as
	applicable,] which the attending physician believes is not
	medically appropriate.  This information is being provided to help
	you understand state law, your rights, and the resources available
	to you in such circumstances.  It outlines the process for resolving
	disagreements about treatment among patients, families, and
	physicians.  It is based upon Section 166.046 of the Texas Advance
	Directives Act, codified in Chapter 166, Texas Health and Safety
	Code.
	When an attending physician refuses to comply with an advance
	directive or other request for life-sustaining treatment for a
	patient who is determined to be incompetent or is otherwise
	mentally or physically incapable of communication because of the
	physician's judgment that the treatment would be medically
	inappropriate, the case will be reviewed by an ethics or medical
	committee.  Life-sustaining treatment will be provided through the
	review.
	You will receive notification of this review at least seven
	calendar days [48 hours] before a meeting of the committee related
	to your case.  You are entitled to attend the meeting.  With your
	agreement, the meeting may be held sooner than seven calendar days
	[48 hours], if possible.
	You are entitled to receive a written explanation of the
	decision reached during the review process.
	If after this review process both the attending physician and
	the ethics or medical committee conclude that life-sustaining
	treatment is medically inappropriate and yet you continue to
	request such treatment, then the following procedure will occur:
	1.  The physician, with the help of the health care facility,
	will assist you in trying to find a physician and facility willing
	to provide the requested treatment.
	2.  You are being given a list of health care providers,
	licensed physicians, health care facilities, and referral groups
	that have volunteered their readiness to consider accepting
	transfer, or to assist in locating a provider willing to accept
	transfer, maintained by the Department of State Health Services.
	You may wish to contact providers, facilities, or referral groups
	on the list or others of your choice to get help in arranging a
	transfer.
	3.  The patient will continue to be given life-sustaining
	treatment until the patient can be transferred to a willing
	provider for up to 25 calendar [10] days from the time you were
	given a written notice of the first day of the 25-day period or a
	medical procedure is performed that delayed the 25-day period and
	for which you received notice, whichever occurs first [both the
	committee's written decision that life-sustaining treatment is not
	appropriate and the patient's medical record].  The patient will
	continue to be given after the 25-day [10-day] period treatment to
	enhance pain management and reduce suffering, including
	artificially administered nutrition and hydration, unless, based
	on reasonable medical judgment, providing artificially
	administered nutrition and hydration would hasten the patient's
	death, be medically contraindicated such that the provision of the
	treatment seriously exacerbates life-threatening medical problems
	not outweighed by the benefit of the provision of the treatment,
	result in substantial irremediable physical pain not outweighed by
	the benefit of the provision of the treatment, be medically
	ineffective in prolonging life, or be contrary to the patient's or
	surrogate's clearly documented desires.
	4.  If a transfer can be arranged, the patient will be
	responsible for the costs of the transfer.
	5.  If a provider cannot be found willing to give the
	requested treatment within 25 calendar [10] days, life-sustaining
	treatment may be withdrawn unless a court of law has granted an
	extension.
	6.  You may ask the appropriate district or county court to
	extend the 25-day [the 10-day] period if the court finds that there
	is a reasonable expectation that you may find a physician or health
	care facility willing to provide life-sustaining treatment if the
	extension is granted.  Patient medical records will be provided to
	the patient or surrogate in accordance with Section 241.154, Texas
	Health and Safety Code.
	*"Life-sustaining treatment" means treatment that, based on
	reasonable medical judgment, sustains the life of a patient and
	without which the patient will die.  The term includes both
	life-sustaining medications and artificial life support, such as
	mechanical breathing machines, kidney dialysis treatment, and
	artificially administered nutrition and hydration.  The term does
	not include the administration of pain management medication or the
	performance of a medical procedure considered to be necessary to
	provide comfort care, or any other medical care provided to
	alleviate a patient's pain.
	(b)  In cases in which the attending physician refuses to
	comply with an advance directive or a health care or treatment
	decision requesting the withholding or withdrawal of
	life-sustaining treatment for a patient who is determined to be
	incompetent or is otherwise mentally or physically incapable of
	communication, the statement required by Section 166.046(b)(2)(A)
	[166.046(b)(3)(A)] shall be in substantially the following form:
	When There Is A Disagreement About Medical Treatment:  The
	Physician Recommends Life-Sustaining Treatment That You Wish To
	Stop
	You have been given this information because the patient has
	requested through an advance directive or you have requested on
	behalf of the patient that [the withdrawal or withholding of]
	life-sustaining treatment* be withdrawn or withheld from [for
	yourself as the patient or on behalf of] the patient, [as
	applicable,] and the attending physician disagrees with and refuses
	to comply with that request.  The information is being provided to
	help you understand state law, your rights, and the resources
	available to you in such circumstances.  It outlines the process for
	resolving disagreements about treatment among patients, families,
	and physicians.  It is based upon Section 166.046 of the Texas
	Advance Directives Act, codified in Chapter 166, Texas Health and
	Safety Code.
	When an attending physician refuses to comply with an advance
	directive or other request for withdrawal or withholding of
	life-sustaining treatment for any reason, the case will be reviewed
	by an ethics or medical committee. Life-sustaining treatment will
	be provided through the review.
	You will receive notification of this review at least seven
	calendar days [48 hours] before a meeting of the committee related
	to your case. You are entitled to attend the meeting. With your
	agreement, the meeting may be held sooner than seven calendar days
	[48 hours], if possible.
	You are entitled to receive a written explanation of the
	decision reached during the review process.
	If you or the attending physician do not agree with the
	decision reached during the review process, and the attending
	physician still refuses to comply with your request to withhold or
	withdraw life-sustaining treatment, then the following procedure
	will occur:
	1.  The physician, with the help of the health care facility,
	will assist you in trying to find a physician and facility willing
	to withdraw or withhold the life-sustaining treatment.
	2.  You are being given a list of health care providers,
	licensed physicians, health care facilities, and referral groups
	that have volunteered their readiness to consider accepting
	transfer, or to assist in locating a provider willing to accept
	transfer, maintained by the Department of State Health Services.
	You may wish to contact providers, facilities, or referral groups
	on the list or others of your choice to get help in arranging a
	transfer.
	*"Life-sustaining treatment" means treatment that, based on
	reasonable medical judgment, sustains the life of a patient and
	without which the patient will die. The term includes both
	life-sustaining medications and artificial life support, such as
	mechanical breathing machines, kidney dialysis treatment, and
	artificially administered nutrition and hydration. The term does
	not include the administration of pain management medication or the
	performance of a medical procedure considered to be necessary to
	provide comfort care, or any other medical care provided to
	alleviate a patient's pain.
	SECTION 6.  Subchapter B, Chapter 166, Health and Safety
	Code, is amended by adding Section 166.054 to read as follows:
	Sec. 166.054.  REPORTING REQUIREMENTS REGARDING ETHICS OR
	MEDICAL COMMITTEE PROCESSES. (a) Not later than the 180th day
	after the date written notice is provided under Section
	166.046(b)(1), a health care facility shall prepare and submit to
	the commission a report that contains the following information:
	(1)  the number of days that elapsed from the patient's
	admission to the facility to the date notice was provided under
	Section 166.046(b)(1);
	(2)  whether the ethics or medical committee met to
	review the case under Section 166.046 and, if the committee did
	meet, the number of days that elapsed from the date notice was
	provided under Section 166.046(b)(1) to the date the meeting was
	held;
	(3)  whether the patient was:
	(A)  transferred to a physician within the same
	facility who was willing to comply with the patient's advance
	directive or a health care or treatment decision made by or on
	behalf of the patient;
	(B)  transferred to a different health care
	facility; or
	(C)  discharged from the facility to a private
	residence or other setting that is not a health care facility;
	(4)  whether the patient died while receiving
	life-sustaining treatment at the facility;
	(5)  whether life-sustaining treatment was withheld or
	withdrawn from the patient at the facility after expiration of the
	time period described by Section 166.046(e) and, if so, the
	disposition of the patient after the withholding or withdrawal of
	life-sustaining treatment at the facility, as selected from the
	following categories:
	(A)  the patient died at the facility;
	(B)  the patient is currently a patient at the
	facility;
	(C)  the patient was transferred to a different
	health care facility; or
	(D)  the patient was discharged from the facility
	to a private residence or other setting that is not a health care
	facility;
	(6)  the age group of the patient selected from the
	following categories:
	(A)  17 years of age or younger;
	(B)  18 years of age or older and younger than 66
	years of age; or
	(C)  66 years of age or older;
	(7)  the health insurance coverage status of the
	patient selected from the following categories:
	(A)  private health insurance coverage;
	(B)  public health plan coverage; or
	(C)  uninsured;
	(8)  the patient's sex;
	(9)  the patient's race;
	(10)  whether the facility was notified of and able to
	reasonably verify any public disclosure of the contact information
	for the facility's personnel, physicians or health care
	professionals who provide care at the facility, or members of the
	ethics or medical committee in connection with the patient's stay
	at the facility; and
	(11)  whether the facility was notified of and able to
	reasonably verify any public disclosure by facility personnel of
	the contact information for the patient's immediate family members
	or the person responsible for the patient's health care decisions
	in connection with the patient's stay at the facility.
	(b)  The commission shall ensure information provided in
	each report submitted by a health care facility under Subsection
	(a) is kept confidential and not disclosed in any manner, except as
	provided by this section.
	(c)  Not later than April 1 of each year, the commission
	shall prepare and publish on the commission's Internet website a
	report that contains:
	(1)  aggregate information compiled from the reports
	submitted to the commission under Subsection (a) during the
	preceding year on:
	(A)  the total number of written notices provided
	under Section 166.046(b)(1);
	(B)  the average number of days described by
	Subsection (a)(1);
	(C)  the total number of meetings held by ethics
	or medical committees to review cases under Section 166.046;
	(D)  the average number of days described by
	Subsection (a)(2);
	(E)  the total number of patients described by
	Subsections (a)(3)(A), (B), and (C);
	(F)  the total number of patients described by
	Subsection (a)(4);
	(G)  the total number of patients for whom
	life-sustaining treatment was withheld or withdrawn after
	expiration of the time period described by Section 166.046(e);
	(H)  the total number of cases for which the
	facility was notified of and able to reasonably verify the public
	disclosure of the contact information for the facility's personnel,
	physicians or health care professionals who provide care at the
	facility, or members of the ethics or medical committee in
	connection with the patient's stay at the facility; and
	(I)  the total number of cases for which the
	facility was notified of and able to reasonably verify the public
	disclosure by facility personnel of contact information for the
	patient's immediate family members or person responsible for the
	patient's health care decisions in connection with the patient's
	stay at the facility; and
	(2)  if the total number of reports submitted under
	Subsection (a) for the preceding year is 10 or more, aggregate
	information compiled from those reports on the total number of
	patients categorized by:
	(A)  sex;
	(B)  race;
	(C)  age group, based on the categories described
	by Subsection (a)(6);
	(D)  health insurance coverage status, based on
	the categories described by Subsection (a)(7); and
	(E)  for patients for whom life-sustaining
	treatment was withheld or withdrawn at the facility after
	expiration of the period described by Section 166.046(e), the total
	number of patients described by each of the following:
	(i)  Subsection (a)(5)(A);
	(ii)  Subsection (a)(5)(B);
	(iii)  Subsection (a)(5)(C); and
	(iv)  Subsection (a)(5)(D).
	(d)  If the commission receives fewer than 10 reports under
	Subsection (a) for inclusion in an annual report required under
	Subsection (c), the commission shall include in the next annual
	report prepared after the commission receives 10 or more reports
	the aggregate information for all years for which the information
	was not included in a preceding annual report. The commission shall
	include in the next annual report a statement that identifies each
	year during which an underlying report was submitted to the
	commission under Subsection (a).
	(e)  The annual report required by Subsection (c) or (d) may
	not include any information that could be used alone or in
	combination with other reasonably available information to
	identify any individual, entity, or facility.
	(f)  The executive commissioner shall adopt rules to:
	(1)  establish a standard form for the reporting
	requirements of this section; and
	(2)  protect and aggregate any information the
	commission receives under this section.
	(g)  Information collected as required by this section or
	submitted to the commission under this section:
	(1)  is not admissible in a civil or criminal
	proceeding in which a physician, health care professional acting
	under the direction of a physician, or health care facility is a
	defendant;
	(2)  may not be used in relation to any disciplinary
	action by a licensing or regulatory agency with oversight over a
	physician, health care professional acting under the direction of a
	physician, or health care facility; and
	(3)  is not public information or subject to disclosure
	under Chapter 552, Government Code, except as permitted by Section
	552.008, Government Code.
	SECTION 7.  Sections 166.203(a), (b), and (c), Health and
	Safety Code, are amended to read as follows:
	(a)  A DNR order issued for a patient is valid only if [the
	patient's attending physician issues the order,] the order is
	dated[,] and [the order]:
	(1)  is issued by a physician providing direct care to
	the patient in compliance with:
	(A)  the written and dated directions of a patient
	who was competent at the time the patient wrote the directions;
	(B)  the oral directions of a competent patient
	delivered to or observed by two competent adult witnesses, at least
	one of whom must be a person not listed under Section 166.003(2)(E)
	or (F);
	(C)  the directions in an advance directive
	enforceable under Section 166.005 or executed in accordance with
	Section 166.032, 166.034, [or] 166.035, 166.082, 166.084, or
	166.085;
	(D)  the directions of a patient's:
	(i)  legal guardian;
	(ii) [or] agent under a medical power of
	attorney acting in accordance with Subchapter D; or
	(iii)  proxy as designated and authorized by
	a directive executed in accordance with Subchapter B to make a
	treatment decision for the patient if the patient becomes
	incompetent or otherwise mentally or physically incapable of
	communication; or
	(E)  a treatment decision made in accordance with
	Section 166.039; [or]
	(2)  is issued by the patient's attending physician
	and:
	(A)  the order is not contrary to the directions
	of a patient who was competent at the time the patient conveyed the
	directions; and
	(B)  [,] in the reasonable medical judgment of the
	patient's attending physician:
	(i) [(A)]  the patient's death is imminent,
	within minutes to hours, regardless of the provision of
	cardiopulmonary resuscitation; and
	(ii) [(B)]  the DNR order is medically
	appropriate; or
	(3)  is issued by the patient's attending physician:
	(A)  for a patient who is incompetent or otherwise
	mentally or physically incapable of communication; and
	(B)  in compliance with a decision:
	(i)  agreed on by the attending physician
	and the person responsible for the patient's health care decisions;
	and
	(ii)  concurred in by another physician who
	is not involved in the direct treatment of the patient or who is a
	representative of an ethics or medical committee of the health care
	facility in which the person is a patient.
	(b)  The DNR order takes effect at the time the order is
	issued, provided the order is placed in the patient's medical
	record as soon as practicable and may be issued and entered in a
	format acceptable under the policies of the health care facility or
	hospital.
	(c)  Unless notice is provided in accordance with Section
	166.204(a), before [Before] placing in a patient's medical record a
	DNR order issued under Subsection (a)(2), a [the] physician,
	physician assistant, nurse, or other person acting on behalf of a
	health care facility or hospital shall:
	(1)  inform the patient of the order's issuance; or
	(2)  if the patient is incompetent, make a reasonably
	diligent effort to contact or cause to be contacted and inform of
	the order's issuance:
	(A)  the patient's known agent under a medical
	power of attorney or legal guardian; or
	(B)  for a patient who does not have a known agent
	under a medical power of attorney or legal guardian, a person
	described by Section 166.039(b)(1), (2), or (3).
	SECTION 8.  Section 166.204, Health and Safety Code, is
	amended by amending Subsections (a), (b), and (c) and adding
	Subsection (a-1) to read as follows:
	(a)  If an individual arrives at a health care facility or
	hospital that is treating a patient for whom a DNR order is issued
	under Section 166.203(a)(2) and the individual notifies a
	physician, physician assistant, or nurse providing direct care to
	the patient of the individual's arrival, the physician, physician
	assistant, or nurse who has actual knowledge of the order shall,
	unless notice has been provided in accordance with Section
	166.203(c), disclose the order to the individual, provided the
	individual is:
	(1)  the patient's known agent under a medical power of
	attorney or legal guardian; or
	(2)  for a patient who does not have a known agent under
	a medical power of attorney or legal guardian, a person described by
	Section 166.039(b)(1), (2), or (3).
	(a-1)  For a patient who was incompetent at the time notice
	otherwise would have been provided to the patient under Section
	166.203(c)(1) and if a physician providing direct care to the
	patient later determines that, based on the physician's reasonable
	medical judgment, the patient has become competent, a physician,
	physician assistant, or nurse providing direct care to the patient
	shall disclose the order to the patient, provided that the
	physician, physician assistant, or nurse has actual knowledge:
	(1)  of the order; and
	(2)  that a physician providing direct care to the
	patient has determined that the patient has become competent.
	(b)  Failure to comply with Subsection (a) or (a-1) or
	Section 166.203(c) does not affect the validity of a DNR order
	issued under this subchapter.
	(c)  Any person, including a health care facility or
	hospital, [who makes a good faith effort to comply with Subsection
	(a) of this section or Section 166.203(c) and contemporaneously
	records the person's effort to comply with Subsection (a) of this
	section or Section 166.203(c) in the patient's medical record] is
	not civilly or criminally liable or subject to disciplinary action
	from the appropriate licensing authority for any act or omission
	related to providing notice under Subsection (a) or (a-1) of this
	section or Section 166.203(c) if the person:
	(1)  makes a good faith effort to comply with
	Subsection (a) or (a-1) or Section 166.203(c) and contemporaneously
	records in the patient's medical record the person's effort to
	comply with those provisions; or
	(2)  makes a good faith determination that the
	circumstances that would require the person to perform an act under
	Subsection (a) or (a-1) or Section 166.203(c) are not met.
	SECTION 9.  Section 166.205, Health and Safety Code, is
	amended by amending Subsections (a), (b), and (c) and adding
	Subsection (c-1) to read as follows:
	(a)  A physician providing direct care to a patient for whom
	a DNR order is issued shall revoke the patient's DNR order if [the
	patient or, as applicable, the patient's agent under a medical
	power of attorney or the patient's legal guardian if the patient is
	incompetent]:
	(1)  an advance directive that serves as the basis of
	the DNR order is properly revoked in accordance with this
	chapter; [effectively revokes an advance directive, in accordance
	with Section 166.042, for which a DNR order is issued under Section
	166.203(a); or]
	(2)  the patient expresses to any person providing
	direct care to the patient a revocation of consent to or intent to
	revoke a DNR order issued under Section 166.203(a); or
	(3)  the DNR order was issued under Section
	166.203(a)(1)(D) or (E) or Section 166.203(a)(3), and the person
	responsible for the patient's health care decisions expresses to
	any person providing direct care to the patient a revocation of
	consent to or intent to revoke the DNR order.
	(b)  A person providing direct care to a patient under the
	supervision of a physician shall notify the physician of the
	request to revoke a DNR order or of the revocation of an advance
	directive under Subsection (a).
	(c)  A patient's attending physician may at any time revoke a
	DNR order issued under:
	(1)  Section 166.203(a)(1)(A), (B), or (C), provided
	that:
	(A)  the order is for a patient who is incompetent
	or otherwise mentally or physically incapable of communication; and
	(B)  the decision to revoke the order is:
	(i)  agreed on by the attending physician
	and the person responsible for the patient's health care decisions;
	and
	(ii)  concurred in by another physician who
	is not involved in the direct treatment of the patient or who is a
	representative of an ethics or medical committee of the health care
	facility in which the person is a patient;
	(2)  Section 166.203(a)(1)(E), provided that the
	order's issuance was based on a treatment decision made in
	accordance with Section 166.039(e);
	(3)  Section 166.203(a)(2); or
	(4)  Section 166.203(a)(3).
	(c-1)  A patient's attending physician shall revoke a DNR
	order issued for the patient under Section 166.203(a)(2) if, in the
	attending physician's reasonable medical judgment, the condition
	described by Section 166.203(a)(2)(B)(i) is no longer satisfied.
	SECTION 10.  Sections 166.206(a) and (b), Health and Safety
	Code, are amended to read as follows:
	(a)  If a [an attending] physician, health care facility, or
	hospital does not wish to execute or comply with a DNR order or the
	patient's instructions concerning the provision of cardiopulmonary
	resuscitation, the physician, facility, or hospital shall inform
	the patient, the legal guardian or qualified relatives of the
	patient, or the agent of the patient under a medical power of
	attorney of the benefits and burdens of cardiopulmonary
	resuscitation.
	(b)  If, after receiving notice under Subsection (a), the
	patient or another person authorized to act on behalf of the patient
	and the [attending] physician, health care facility, or hospital
	remain in disagreement, the physician, facility, or hospital shall
	make a reasonable effort to transfer the patient to another
	physician, facility, or hospital willing to execute or comply with
	a DNR order or the patient's instructions concerning the provision
	of cardiopulmonary resuscitation.
	SECTION 11.  Section 166.209, Health and Safety Code, is
	amended to read as follows:
	Sec. 166.209.  ENFORCEMENT. (a) Subject to Sections
	166.205(d), 166.207, and 166.208 and Subsection (c), a [A]
	physician, physician assistant, nurse, or other person commits an
	offense if, with the specific intent to violate this subchapter,
	the person intentionally:
	(1)  conceals, cancels, effectuates, or falsifies
	another person's DNR order in violation of this subchapter; or
	(2)  [if the person intentionally] conceals or
	withholds personal knowledge of another person's revocation of a
	DNR order in violation of this subchapter.
	(a-1)  An offense under Subsection (a) [this subsection] is a
	Class A misdemeanor.  This section [subsection] does not preclude
	prosecution for any other applicable offense.
	(b)  Subject to Sections 166.205(d), 166.207, and 166.208, a
	[A] physician, health care professional, health care facility,
	hospital, or entity is subject to review and disciplinary action by
	the appropriate licensing authority for intentionally:
	(1)  failing to effectuate a DNR order in violation of
	this subchapter; or
	(2)  issuing a DNR order in violation of this
	subchapter.
	(c)  Subsection (a) does not apply to a person whose act or
	omission was based on a reasonable belief that the act or omission
	was in compliance with the wishes of the patient or the person
	responsible for the patient's health care decisions.
	SECTION 12.  Section 313.004, Health and Safety Code, is
	amended by amending Subsections (a) and (c) and adding Subsection
	(a-1) to read as follows:
	(a)  If an adult patient of a home and community support
	services agency or in a hospital or nursing home, or an adult inmate
	of a county or municipal jail, is comatose, incapacitated, or
	otherwise mentally or physically incapable of communication and
	does not have a legal guardian or an agent under a medical power of
	attorney who is reasonably available after a reasonably diligent
	inquiry, an adult surrogate from the following list, in order of
	priority, who has decision-making capacity, is reasonably
	available after a reasonably diligent inquiry, and is willing to
	consent to medical treatment on behalf of the patient may consent to
	medical treatment on behalf of the patient:
	(1)  the patient's spouse;
	(2)  the patient's [an adult child of the patient who
	has the waiver and consent of all other qualified] adult children
	[of the patient to act as the sole decision-maker];
	(3)  [a majority of] the patient's parents [reasonably
	available adult children]; or
	(4)  the patient's nearest living relative [parents; or
	[(5)  the individual clearly identified to act for the
	patient by the patient before the patient became incapacitated, the
	patient's nearest living relative, or a member of the clergy].
	(a-1)  If the patient does not have a legal guardian, an
	agent under a medical power of attorney, or a person listed in
	Subsection (a) who is reasonably available after a reasonably
	diligent inquiry, another physician who is not involved in the
	medical treatment of the patient may concur with the treatment.
	(c)  Any medical treatment consented to under Subsection (a)
	or concurred with under Subsection (a-1) must be based on knowledge
	of what the patient would desire, if known.
	SECTION 13.  Chapter 166, Health and Safety Code, as amended
	by this Act, applies only to a review, consultation, disagreement,
	or other action relating to a health care or treatment decision made
	on or after the effective date of this Act. A review, consultation,
	disagreement, or other action relating to a health care or
	treatment decision made before the effective date of this Act is
	governed by the law in effect immediately before the effective date
	of this Act, and the former law is continued in effect for that
	purpose.
	SECTION 14.  Section 166.209, Health and Safety Code, as
	amended by this Act, applies only to conduct that occurs on or after
	the effective date of this Act. Conduct that occurs before the
	effective date of this Act is governed by the law in effect on the
	date the conduct occurred, and the former law is continued in effect
	for that purpose.
	SECTION 15.  This Act takes effect September 1, 2023.
	______________________________	______________________________
	President of the Senate	Speaker of the House
	I certify that H.B. No. 3162 was passed by the House on May 8,
	2023, by the following vote:  Yeas 136, Nays 1, 1 present, not
	voting.
	______________________________
	Chief Clerk of the House
	I certify that H.B. No. 3162 was passed by the Senate on May
	18, 2023, by the following vote:  Yeas 31, Nays 0.
	______________________________
	Secretary of the Senate
	APPROVED:  _____________________
	Date
	_____________________
	Governor