Bill Text: TX SB11 | 2017 | 85th Legislature 1st Special Session | Enrolled

Texas Senate Bill 11 (Prior Session Legislation)

Bill Title: Relating to general procedures and requirements for certain do-not-resuscitate orders; creating a criminal offense.

Sponsorship: Strong Partisan Bill (Republican 11-1)

Status: (Passed) 2017-08-16 - Effective on . . . . . . . . . . . . . . . [SB11 Detail]

Download: Texas-2017-SB11-Enrolled.html



	S.B. No. 11




	AN ACT
	relating to general procedures and requirements for certain
	do-not-resuscitate orders; creating a criminal offense.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1. Chapter 166, Health and Safety Code, is amended
	by adding Subchapter E to read as follows:
	SUBCHAPTER E. HEALTH CARE FACILITY DO-NOT-RESUSCITATE ORDERS
	Sec. 166.201. DEFINITION. In this subchapter, "DNR order"
	means an order instructing a health care professional not to
	attempt cardiopulmonary resuscitation on a patient whose
	circulatory or respiratory function ceases.
	Sec. 166.202. APPLICABILITY OF SUBCHAPTER. (a) This
	subchapter applies to a DNR order issued in a health care facility
	or hospital.
	(b) This subchapter does not apply to an out-of-hospital DNR
	order as defined by Section 166.081.
	Sec. 166.203. GENERAL PROCEDURES AND REQUIREMENTS FOR
	DO-NOT-RESUSCITATE ORDERS. (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 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;
	(D) the directions of a patient's legal guardian
	or agent under a medical power of attorney acting in accordance with
	Subchapter D; or
	(E) a treatment decision made in accordance with
	Section 166.039; or
	(2) is not contrary to the directions of a patient who
	was competent at the time the patient conveyed the directions and,
	in the reasonable medical judgment of the patient's attending
	physician:
	(A) the patient's death is imminent, regardless
	of the provision of cardiopulmonary resuscitation; and
	(B) the DNR order is medically appropriate.
	(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.
	(c) Before placing in a patient's medical record a DNR order
	issued under Subsection (a)(2), 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).
	(d) To the extent a DNR order described by Subsection (a)(1)
	conflicts with a treatment decision or advance directive validly
	executed or issued under this chapter, the treatment decision made
	in compliance with this subchapter, advance directive validly
	executed or issued as described by this subchapter, or DNR order
	dated and validly executed or issued in compliance with this
	subchapter later in time controls.
	Sec. 166.204. NOTICE REQUIREMENTS FOR DO-NOT-RESUSCITATE
	ORDERS. (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
	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).
	(b) Failure to comply with Subsection (a) 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) of this section or
	Section 166.203(c).
	(d) A physician, physician assistant, or nurse may satisfy
	the notice requirement under Subsection (a) by notifying the
	patient's known agent under a medical power of attorney or legal
	guardian or, for a patient who does not have a known agent or
	guardian, one person in accordance with the priority established
	under Section 166.039(b). The physician, physician assistant, or
	nurse is not required to notify additional persons beyond the first
	person notified.
	(e) On admission to a health care facility or hospital, the
	facility or hospital shall provide to the patient or person
	authorized to make treatment decisions on behalf of the patient
	notice of the policies of the facility or hospital regarding the
	rights of the patient and person authorized to make treatment
	decisions on behalf of the patient under this subchapter.
	Sec. 166.205. REVOCATION OF DO-NOT-RESUSCITATE ORDER;
	LIMITATION OF LIABILITY. (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) 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) 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).
	(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 under Subsection (a).
	(c) A patient's attending physician may at any time revoke a
	DNR order issued under Section 166.203(a)(2).
	(d) Except as otherwise provided by this subchapter, a
	person is not civilly or criminally liable for failure to act on a
	revocation described by or made under this section unless the
	person has actual knowledge of the revocation.
	Sec. 166.206. PROCEDURE FOR FAILURE TO EXECUTE
	DO-NOT-RESUSCITATE ORDER OR PATIENT INSTRUCTIONS. (a) If 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.
	(c) The procedures required by this section may not be
	construed to control or supersede Section 166.203(a).
	Sec. 166.207. LIMITATION ON LIABILITY FOR ISSUING DNR ORDER
	OR WITHHOLDING CARDIOPULMONARY RESUSCITATION. A physician, health
	care professional, health care facility, hospital, or entity that
	in good faith issues a DNR order under this subchapter or that, in
	accordance with this subchapter, causes cardiopulmonary
	resuscitation to be withheld or withdrawn from a patient in
	accordance with a DNR order issued under this subchapter is not
	civilly or criminally liable or subject to review or disciplinary
	action by the appropriate licensing authority for that action.
	Sec. 166.208. LIMITATION ON LIABILITY FOR FAILURE TO
	EFFECTUATE DNR ORDER. A physician, health care professional,
	health care facility, hospital, or entity that has no actual
	knowledge of a DNR order is not civilly or criminally liable or
	subject to review or disciplinary action by the appropriate
	licensing authority for failing to act in accordance with the
	order.
	Sec. 166.209. ENFORCEMENT. (a) A physician, physician
	assistant, nurse, or other person commits an offense if the person
	intentionally conceals, cancels, effectuates, or falsifies another
	person's DNR order or if the person intentionally conceals or
	withholds personal knowledge of another person's revocation of a
	DNR order in violation of this subchapter. An offense under this
	subsection is a Class A misdemeanor. This subsection does not
	preclude prosecution for any other applicable offense.
	(b) 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.
	SECTION 2. The executive commissioner of the Health and
	Human Services Commission shall adopt rules necessary to implement
	Subchapter E, Chapter 166, Health and Safety Code, as added by this
	Act, as soon as practicable after the effective date of this Act.
	SECTION 3. Subchapter E, Chapter 166, Health and Safety
	Code, as added by this Act, applies only to a do-not-resuscitate
	order issued on or after the effective date of this Act.
	SECTION 4. This Act takes effect April 1, 2018.





	______________________________	______________________________
	President of the Senate	Speaker of the House

	I hereby certify that S.B. No. 11 passed the Senate on
	July 26, 2017, by the following vote: Yeas 21, Nays 10; and that
	the Senate concurred in House amendment on August 15, 2017, by the
	following vote: Yeas 21, Nays 10.


	______________________________
	Secretary of the Senate

	I hereby certify that S.B. No. 11 passed the House, with
	amendment, on August 13, 2017, by the following vote: Yeas 122,
	Nays 20, one present not voting.


	______________________________
	Chief Clerk of the House



	Approved:

	______________________________
	Date


	______________________________
	Governor