Bill Text: TX SB11 | 2017 | 85th Legislature 1st Special Session | Enrolled
Bill Title: Relating to general procedures and requirements for certain do-not-resuscitate orders; creating a criminal offense.
Spectrum: 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 | ||
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| 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 | ||
