Amendments to the Texas Advance Directives Act -
2003
(a.k.a. SB 1320)
Robert L. Fine, MD. FACP
is the Director of the Office of Clinical Ethics at the Baylor Health System in
Dallas. As a member of the Texas Advance Directives Task Force, he was
instrumental in helping fine tune the Texas Advance Directives Act (TADA).
While already one of the model statutes in the country, some amendments were
passed in Senate Bill 1320 of the 78th Texas Legislature during its 2003 Regular
Session. Special thanks are given to Dr. Fine for his efforts with these
amendments and with helping to disseminate this information to our members.
One of the major additions is the
Registry of
Health Care Providers and Referral Groups maintained by the
Texas Health Care Information Council.
This registry will include health care providers and referral groups who are
available to either provide or to withhold/withdraw life-sustaining treatment in
accord with the TADA. There is also a link for such providers to request
addition to the registry. The TADA also provides the actual written
statements to be given to the parties when the due process procedure is invoked.
This information posted on this website at:
Physician Requests
Withdrawal of Treatment and Family
Requests Withdrawal of Treatment.
It may be helpful to view the entire updated statute, which
can be found on this website at
Texas
Advance Directives Act. What
follows is Dr. Fine's summary of these amendments:
1. We made it unequivocally clear that the
statute applies equally to both advance directives and health care treatment
decisions, Section 166.046:
"a patient's advance directive or a health care or treatment decision made by or
on behalf of a patient " and...
2. We made it unequivocally clear that the law applies to minors, Section
166.002:
"Health care or treatment decision" means consent, refusal to consent, or
withdrawal of consent to health care, treatment, service, or a procedure to
maintain, diagnose, or treat an individual's physical or mental condition,
including such a decision on behalf of a minor.
3. Various procedural guidelines were further enhanced in terms of the
information that must be given when invoking the dispute resolution process.
Section 166.052
4. A voluntary registry of providers willing to serve as alternative willing
providers was added with a requirement that this registry information be
available as part of the dispute resolution process. Section 166.053
5. A procedure was added to streamline the dispute resolution process for what
might be called "revolving door" futility cases. For example, an attending
physician and ethics committee following the full dispute resolution process at
Hospital A both agree that further life-sustaining treatment is inappropriate or
futile for a critically ill patient, however an alternative willing provider at
Nursing Home B is located. The patient is transferred to that alternative
provider, only to rapidly deteriorate and be returned to Hospital A. The new law
makes it possible to rapidly declare further life sustaining treatment
inappropriate without going back through a full 2 + 10 day process again, while
still maintaining the legal safe harbor provisions. Section 166.053 e 1.
(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 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.
6. Finally, we added clarification to out of hospital DNR directives to indicate
that they are the only order for DNR that EMS
personnel will follow, while other health care personnel may follow a routing
physician order for DNR in the out of hospital setting.
Sec. 166.102. PHYSICIAN'S DNR ORDER MAY BE HONORED BY HEALTH CARE PERSONNEL
OTHER THAN EMERGENCY MEDICAL SERVICES PERSONNEL. (a) Except as provided by
Subsection (b), a licensed nurse or person providing health care services in an
out-of-hospital setting may honor a physician's do-not-resuscitate order.
(b) When responding to a call for assistance, emergency medical services
personnel shall honor only a properly executed or issued out-of-hospital DNR
order or prescribed DNR identification device in accordance with this
subchapter.
