By: Hughes, et al.  S.B. No. 917          (In the Senate - Filed March 2, 2021; March 11, 2021, read   first time and referred to Committee on Health & Human Services;   May 13, 2021, reported adversely, with favorable Committee   Substitute by the following vote:  Yeas 5, Nays 4; May 13, 2021,   sent to printer.)Click here to see the committee vote     COMMITTEE SUBSTITUTE FOR S.B. No. 917 By:  Perry     A BILL TO BE ENTITLED   AN ACT     relating to advance directives or health care or treatment   decisions made by or on behalf of patients.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  This Act may be cited as the Respecting Texas   Patients' Right to Life Act of 2021.          SECTION 2.  The purpose of this Act is to protect the right   of patients and their families to decide whether and under what   circumstances to choose or reject life-sustaining treatment. This   Act amends the applicable provisions of the Advance Directives Act   (Chapter 166, Health and Safety Code) to ensure that, when an   attending physician is unwilling to respect a patient's advance   directive or a patient's or family's decision to choose the   treatment necessary to prevent the patient's death,   life-sustaining medical treatment will be provided for 90 days   after an ethics or medical committee's review so that the patient   can be transferred to a health care provider willing to honor the   directive or treatment decision.          SECTION 3.  Section 166.045(c), Health and Safety Code, is   amended to read as follows:          (c)  If an attending physician refuses to comply with a   directive or treatment decision to provide life-sustaining   treatment to a patient [and does not wish to follow the procedure   established under Section 166.046], life-sustaining treatment   shall be provided to the patient for 90 days under the procedures   prescribed by Section 166.046 so that[, but only until a reasonable   opportunity has been afforded for the transfer of] the patient can   be transferred to another physician or health care facility willing   to comply with the directive or treatment decision.          SECTION 4.  Sections 166.046(a), (b), (d), (e), and (e-1),   Health and Safety Code, are amended to read as follows:          (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, other than a directive or decision to   provide artificial nutrition and hydration to the 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.          (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 under Section 166.053; and                (4)  is entitled to:                      (A)  attend the meeting;                      (B)  receive a written explanation of the   recommendations made [decision reached] during the review process;                      (C)  receive a copy of 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                      (D)  receive a copy of all of the patient's   reasonably available diagnostic results and reports related to the   medical record provided under Paragraph (C).          (d)  If the attending physician, the patient, or the person   responsible for the health care decisions of the individual does   not agree with the recommendations made [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. 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.          (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 ethics   or medical committee consider [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 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 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 90th [10th] day after both the   written recommendation [decision] and the patient's medical record   required under Subsection (b) are provided to the patient or the   person responsible for the health care decisions of the patient   unless ordered to 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 the provision of   the treatment;                (3)  result in substantial irremediable physical pain   not outweighed by the benefit of 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.          (e-1)  If during a previous admission to a facility a   patient's attending physician and the review process under   Subsection (b) have determined that life-sustaining treatment is   inappropriate, and the patient is readmitted to the same facility   within six months from the date of the recommendations made   [decision reached] during the review process conducted upon the   previous admission, Subsections (b) through (e) need not be   followed if the patient's attending physician and a consulting   physician who is a member of the ethics or medical committee of the   facility document on the patient's readmission that the patient's   condition either has not improved or has deteriorated since the   review process was conducted.          SECTION 5.  Section 166.051, Health and Safety Code, is   amended to read as follows:          Sec. 166.051.  LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.     This subchapter does not impair or supersede any legal right or   responsibility a person may have to effect the withholding or   withdrawal of life-sustaining treatment in a lawful manner,   provided that if an attending physician or health care facility is   unwilling to honor a patient's advance directive or a treatment   decision to provide life-sustaining treatment, life-sustaining   treatment must [is required to] be provided to the patient in   accordance with this chapter[, but only until a reasonable   opportunity has been afforded for transfer of the patient to   another physician or health care facility willing to comply with   the advance directive or treatment decision].          SECTION 6.  Section 166.052(a), Health and Safety Code, is   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, the   statement required by Section 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 you have   requested life-sustaining treatment* 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 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 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.          You are entitled to receive a written explanation of the   recommendations made [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 90 [10] days from the time you were given 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 90-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 90 [10] days, life-sustaining treatment   may be withdrawn unless a court of law has granted an extension.          5. [6.]  You may ask the appropriate district or county court   to extend the 90-day [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.          SECTION 7.  The changes in law made by this Act apply only to   a health care or treatment decision made on or after the effective   date of this Act.          SECTION 8.  This Act takes effect immediately if it receives   a vote of two-thirds of all the members elected to each house, as   provided by Section 39, Article III, Texas Constitution.  If this   Act does not receive the vote necessary for immediate effect, this   Act takes effect September 1, 2021.     * * * * *