85S12705 JG-F
 
  By: Perry, et al. S.B. No. 11
 
  (Bonnen of Galveston, Cook, Geren, Oliveira)
 
  Substitute the following for S.B. No. 11:  No.
 
 
 
A BILL TO BE ENTITLED
 
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.