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  81R14608 T
 
  By: Coleman H.B. No. 2964
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to advance directives and health care and treatment
  decisions.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Sections 166.046(a), (b) and (e), Health and
  Safety Code, are amended to read as follows: 
         Sec. 166.046.  PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR
  TREATMENT DECISION.  (a) If an attending physician refuses to
  honor a patient's advance directive or a health care or treatment
  decision made by or on behalf of a patient, the physician's refusal
  shall be reviewed by an ethics or medical committee. The attending
  physician may not be a member of that committee. The patient shall
  be given life-sustaining treatment during the review. If
  artificial nutrition and hydration are the only life-sustaining
  treatment being provided to a patient with a terminal condition,
  the process established under this section may not be invoked
  unless reasonable medical evidence indicates the provision of
  artificial nutrition and hydration may hasten the patient's death
  or exacerbate other medical problems and the risk of serious
  medical pain or discomfort that cannot be alleviated based on
  reasonable medical judgment outweighs the benefit of continued
  artificial nutrition and hydration.
         (b)  The patient or the person responsible for the 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 of the committee review process
  not less than 48 hours before the meeting called to discuss the
  patient's directive, unless the time period is waived by mutual
  agreement;
               (3)  at the time of being so informed, 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 [Texas Health Care Information Council] under
  Section 166.053[.] and
                     (C)  a patient liaison, appointed by the ethics of
  medical committee, familiar with end-of-life issues and hospice
  care options to assist the person responsible for the health care
  decisions of the individual throughout the process described by
  this section.
               (4)  is entitled to:
                     (A)  attend the meeting; and
                     (B)  receive a written explanation of the decision
  reached during the review process.
         (e)  If the patient or the person responsible for the health
  care decisions of the patient is requesting life-sustaining
  treatment that the attending physician has decided and the review
  process has affirmed is inappropriate treatment, the patient shall
  be given available life-sustaining treatment pending transfer
  under Subsection (d). The patient is responsible for any costs
  incurred in transferring the patient to another facility. The
  physician and the health care facility are not obligated to provide
  life-sustaining treatment, except for the provision of artificial
  nutrition and hydration, unless providing the artificial nutrition
  and hydration would hasten death or seriously exacerbate other
  major medical conditions and the risk of serious medical pain or
  discomfort that cannot be alleviated based on reasonable medical
  judgment outweighs the benefit of continued artificial nutrition
  and hydration, after the 14th calendar [10th] day after the written
  decision required under Subsection (b) is provided to the patient
  or the person responsible for the health care decisions of the
  patient.
         SECTION 2.  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
  treatment decision requesting the provision of life-sustaining
  treatment, the statement required by 166.046(b)(2)(A) shall be in
  substantially the following form:
  You have been given this information because you have requested
  life-sustaining treatment,* which the attending physician believes
  is not 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 of the Texas Health and
  Safety Code
  When There Is A Disagreement About Medical Treatment: The
  Physician Recommends Against Life-Sustaining Treatment That You
  Wish To Continue
         When an attending physician refuses to comply with an advance
  directive or other request for life-sustaining treatment because of
  the physician's judgment that the treatment would be 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 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 48 hours, if possible. The committee
  will appoint a patient liaison to assist you through this process.
         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 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 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 [Texas]
  Health Services [Care Information Council]. You may wish to
  contact providers 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, including artificial nutrition and hydration unless
  reasonable medical evidence indicates the provision of artificial
  nutrition and hydration may hasten the patient's death or
  exacerbate other medical problems and the risk of serious medical
  pain or discomfort that cannot be alleviated based on reasonable
  medical judgment outweighs the benefit of continued artificial
  nutrition and hydration, until he or she can be transferred to a
  willing provider for up to 14 calendar [10] days from the time you
  were given the committee's written decision that life-sustaining
  treatment is not appropriate.
         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 14 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 14-day [10-day] period if the court finds that there is a
  reasonable expectation that a physician or health care facility
  willing to provide life-sustaining treatment will be found if the
  extension is granted.
         *"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
  artificial 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 treatment decision requesting
  the withholding or withdrawal of life-sustaining treatment, the
  statement required by Section 166.046(b)(3)(A) shall be in
  substantially the following form:
         You have been given this information because you have
  requested the withdrawal or withholding of life-sustaining
  treatment* and the attending physician 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 of the Texas Health and Safety Code.
  When There Is A Disagreement About Medical Treatment: The
  Physician Recommends Life-Sustaining Treatment That You Wish To
  Stop
         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 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 48 hours, if possible. The
  committee will appoint a patient liaison to assist you through this
  process.
         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 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 [Texas]
  Health Services [Care Information Council]. You may wish to
  contact providers 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
  artificial 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 3.  An advance directive form executed under Chapter
  166, Health and Safety Code, before the effective date of this Act
  is valid and shall be honored as if the form were executed on or
  after the effective date of this Act.
         SECTION 4.  This Act takes effect September 1, 2009.