HBA-MPM H.B. 3527 76(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 3527
By: Coleman
Public Health
4/19/1999
Introduced



BACKGROUND AND PURPOSE 

Currently, a person may execute an out-of-hospital do not resuscitate (DNR)
order, or advance directive.  The regulations governing the execution of a
DNR order are spread across Chapters 672 and 674, Health and Safety Code,
and Chapter 135, Civil Practice and Remedies Code.  Although these three
chapters use the same terminology and have repetitive provisions, they
maintain inconsistences that confuse individuals who want to develop
advance directives and confuse providers who must carry out the directives.
Consolidating the chapters would reduce the confusion while setting forth
uniform provisions governing the execution of an advance directive.  S.B.
1260 amends law regarding an advance directive for medical treatment and
provides for administrative penalties.  

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that this bill does
not expressly delegate any additional rulemaking authority to a state
officer, department, agency, or institution. 

SECTION BY SECTION ANALYSIS

ARTICLE I.  ADVANCE DIRECTIVES

SECTION 1.01.  Amends Subtitle H, Title 2, Health and Safety Code, by
adding Chapter 166, as follows: 

CHAPTER 166.  ADVANCE DIRECTIVES

SECTION 1.02.  Amends Subtitle H, Title 2, Health and Safety Code, by
adding Subchapter A, Chapter 166, as follows: 

SUBCHAPTER A.  GENERAL PROVISIONS

Sec. 166.001.  SHORT TITLE.  Cites this chapter as the Advance Directives
Act. 

Sec. 166.002.  DEFINITIONS.  Defines for the purpose of this chapter the
following terms: "advance directive," "attending physician," "competent,"
"declarant," "durable power of attorney for health care," "incompetent,"
"life-sustaining procedure," "physician," and "terminal condition." 

Sec. 166.003.  WITNESSES.  Provides that in any circumstances in which this
chapter requires the execution of an advance directive or the issuance of a
nonwritten advance directive to be witnessed, at least one of the witnesses
must be a person who falls within certain categories with respect to the
person's relationship to the declarant. 

Sec. 166.004.  STATEMENT RELATING TO ADVANCE DIRECTIVE.  (a)  Sets for the
definition of "health care provider" (provider) for purposes of this
section. 

(b)  Requires a provider to maintain written policies regarding the
implementation of advance directives.  Provides that the policies must
include a clear and precise statement  of any procedure the provider is
unwilling or unable to withhold in accordance with an advance directive. 

(c)  Requires the provider to provide written notice to an individual of
the provider's written policies, except as provided by Subsection (g).
Provides that the notice must be provided before certain deadlines.   

(d)  Requires the provider to provide the required written notice, if at
the time notice is to be provided under Subsection (c), the individual is
incompetent or otherwise incapacitated and unable to receive notice as
required by this section, to certain individuals.  Sets forth the list of
individuals in the order of preference. 

(e)  Provides that if Subsection (b) applies and except as provided by
Subsection (f), if a provider is unable, after diligent search, to locate
an individual listed by Subsection (d), the provider is not required to
provide the notice. 

(f)  Requires the provider to provide the written notice at the time an
individual becomes able to receive it, if the individual who was
incompetent or otherwise incapacitated and unable to receive the notice at
the time it was to be provided under Subsection (c) later becomes able to
receive the notice. 

(g)  Makes this section inapplicable to outpatient hospital services,
including emergency services. 

Sec. 166.005.  ENFORCEABILITY OF ADVANCE DIRECTIVES EXECUTED IN ANOTHER
JURISDICTION.  Requires an advance directive or similar instrument validly
executed in another state or jurisdiction to be given the same effect as an
advance directive validly executed under the laws of this state.  Provides
that this section does not authorize the administration, withholding, or
withdrawal of health care otherwise prohibited by the laws of this state. 

Sec. 166.006.  EFFECT OF ADVANCE DIRECTIVE ON INSURANCE POLICY AND
PREMIUMS.  (a)  Provides that the fact that a person has executed or issued
an advance directive does not restrict, inhibit, or impair in any manner
the sale, procurement, or issuance of a life insurance policy to that
person or modify the terms of an existing life insurance policy. 

(b)  Provides that the fact that life-sustaining procedures are withheld or
withdrawn from an insured qualified patient under this chapter does not
legally impair or invalidate that person's life insurance policy,
notwithstanding the terms of any life insurance policy. 

(c)  Prohibits the fact that a person has executed or issued or failed to
execute or issue an advance directive from being considered in any way in
establishing insurance premiums. 

Sec. 166.007.  EXECUTION OF ADVANCE DIRECTIVE MAY NOT BE REQUIRED.
Prohibits a physician, health facility, provider, insurer, or health care
service plan from requiring a person to execute or issue an advance
directive as a condition for obtaining insurance for or receiving health
care services. 

Sec. 166.008.  CONFLICT BETWEEN ADVANCE DIRECTIVES.  Provides that to the
extent that a treatment decision or advance directive validly executed or
issued under this chapter conflicts with another treatment decision or
advance directive executed or issued, the treatment decision made or
instrument executed later in time controls. 

SECTION 1.03.  Transfers Chapter 672, Health and Safety Code, to Subtitle
H, Title 2, Health and Safety Code and redesignates it as Subchapter B,
Chapter 166, Health and Safety Code, as follows: 

SUBCHAPTER B.  DIRECTIVE TO PHYSICIANS.  
Deletes old title:  "CHAPTER 672.  NATURAL DEATH ACT"
 
Deletes existing title and text of Section 672.001, referring to this
chapter as the Natural Death Act. 

Sec. 166.031.  DEFINITIONS.  Redesignated from Sec. 672.002, Health and
Safety Code. Redefines "directive" as an instruction made under Sections
166.032, 166.034, or 166.035, Health and Safety Code, rather than Sections
672.003, 672.005, or 672.006, Health and Safety Code, to administer, in
addition to withhold, or withdraw life-sustaining procedures in the event
of a terminal condition.  Redefines "qualified patient" as a patient with a
terminal condition diagnosed and certified in writing by the attending
physician.  Deletes the provision that one other physician who has
personally examined the patient must diagnose and certify the patient's
condition.  Makes conforming and nonsubstantive changes.   

Sec. 166.032.  WRITTEN DIRECTIVE BY COMPETENT ADULT; NOTICE TO PHYSICIAN.
Redesignated from Section 672.003, Health and Safety Code.  Provides that
the declarant must sign the directive in the presence of at least two
witnesses, one of whom must be a witness who qualifies under Section
166.003, Health and Safety Code.  Deletes text authorizing another person
to notify the attending physician of the existence of the written directive
in the event the declarant is comatose.  Redesignates Subsection (c) to
Subsection (d).  Makes conforming and nonsubstantive changes.  

Sec. 166.033.  FORM OF WRITTEN DIRECTIVE.  Redesignated from Section
672.004, Health and Safety Code.  Modifies the language in the written
directive as follows:  "If an any time I should have an incurable or
irreversible condition caused by injury, disease, or illness certified to
be a terminal condition by a physician, rather than two physicians, and if
the application of life-sustaining procedures would serve only to
artificially postpone the moment of my death, and if my attending physician
determines that my death is imminent or will result within a relatively
short time without the application of life-sustaining procedures, I direct
that those procedures be withheld or withdrawn, and that I be permitted to
die naturally." 

Sec. 166.034.  ISSUANCE OF NONWRITTEN DIRECTIVE BY COMPETENT ADULT
QUALIFIED PATIENT.  Redesignated from Section 672.005, Health and Safety
Code. Stipulates that a declarant must issue the nonwritten directive in
the presence of the attending physician and two witnesses, at least one of
whom must be a witness who qualifies under Section 166.003, Health and
Safety Code.  Deletes the requirement that the witnesses must possess the
same qualifications as those required by Section 672.003(c).  Requires the
physician to enter the names of the witnesses to the nonwritten directive
in the declarant's medical records, rather than requiring the witnesses to
sign the entry. 

Sec. 166.035.  EXECUTION OF DIRECTIVE ON BEHALF OF PATIENT YOUNGER THAN 18
YEARS OF AGE.  Redesignated from Section 672.006, Health and Safety Code. 

Sec. 166.036.  NOTARIZED DOCUMENT NOT REQUIRED; REQUIREMENT OF SPECIFIC
FORM PROHIBITED.  (a)  Provides that a written directive executed under
Section 166.033 or 166.035, Health and Safety Code, is effective without
regard to whether the document has been notarized. 

(b)  Prohibits a physician, health care facility, or health care
professional from requiring that the directive be notarized or that a
person use a form provided by the physician, facility, or professional. 

Sec. 166.037.  PATIENT DESIRE SUPERSEDES DIRECTIVE.  Redesignated from
Section 672.007, Health and Safety Code. 

Sec. 166.038.  PROCEDURE WHEN DECLARANT IS INCOMPETENT OR INCAPABLE OF
COMMUNICATION.  Redesignated from Section 672.008, Health and Safety Code.
Makes conforming changes. 

 Sec. 166.039.  PROCEDURE WHEN PERSON HAS NOT EXECUTED OR ISSUED A
DIRECTIVE AND IS INCOMPETENT OR INCAPABLE OF COMMUNICATION. Redesignated
from Section 672.009, Health and Safety Code.  Adds an agent under a
durable power of attorney for health care to a list of those persons
authorized to make a treatment decision that may include a decision to
withhold or withdraw life-sustaining procedures from an adult patient who
has not executed or issued a directive and is incompetent or otherwise
mentally or physically incapable or communication.  Provides that if the
patient does not have a legal guardian or such an agent, the attending
physician and one person, rather than two people, from one of certain
categories may make the treatment decision.  Includes the patient's
reasonably available adult children, rather than a majority of the
patient's adult children, under this provision.  Specifies that if the
patient does not have a legal guardian and a person among those listed is
unavailable, a treatment decision must be concurred in, rather than
witnessed, by another physician not involved in the treatment of the
patient or who is an authorized representative of the ethics committee of
the health care facility in which the person is a patient.  Provides that a
person listed among those authorized to make a decision regarding the
patient's treatment who wishes to challenge a treatment decision made under
this section must apply for temporary guardianship under Section 875
(Temporary Guardian-Procedure), Texas Probate Code.  Authorizes the court
to waive applicable fees in that proceeding.  Makes conforming changes. 

Sec. 166.040.  PATIENT CERTIFICATION AND PREREQUISITES FOR COMPLYING WITH
DIRECTIVE.  Redesignated from Section 672.010, Health and Safety Code.
Deletes the requirements that an attending physician, before withholding or
withdrawing lifesustaining procedures from a qualified patient under this
subchapter, must determine that the patient's death is imminent or will
result within a relatively short time without application of
life-sustaining procedures and note that determination in the patient's
medical records. Makes a conforming change. 

Sec. 166.041.  DURATION OF DIRECTIVE.  Redesignated from Section 672.011,
Health and Safety Code.  Makes a conforming change. 

Sec. 166.042.  REVOCATION OF DIRECTIVE.  Redesignated from Section 672.012,
Health and Safety Code.  Makes a conforming change. 

Sec. 166.043.  REEXECUTION OF DIRECTIVE.  Redesignated from Section
672.013, Health and Safety Code.  Makes a conforming change. 

Deletes existing Section 672.014 (Effect of Directive on Insurance Policy
and Premiums), Health and Safety Code, to make conforming changes. 

Sec. 166.044.  LIMITATION OF LIABILITY FOR WITHHOLDING OR WITHDRAWING
LIFE-SUSTAINING PROCEDURES.  Redesignated from Section 672.015, Health and
Safety Code.  Provides that a physician or facility that causes
life-sustaining procedures to be withheld or withdrawn from a qualified
patient in accordance with this chapter is not civilly liable for that
action unless the physician or facility fails to exercise reasonable care
when applying the patient's advance directive, rather than unless the
physician or facility are negligent.  Requires the standard of care that a
physician, facility or health care professional exercises under this
chapter to be a degree of care that these individuals or entities, as
applicable, of ordinary prudence and skill would have exercised under the
same or similar circumstances.  Makes nonsubstantive and conforming
changes. 

Sec. 166.045.  LIMITATION OF LIABILITY FOR FAILURE TO EFFECTUATE DIRECTIVE.
Redesignated from Section 672.016, Health and Safety Code.  Provides that a
physician or health care professional acting under the direction of a
physician is subject to review and disciplinary action by the appropriate
licensing board, rather than is not civilly or criminally liable, for
failing to effectuate a qualified patient's directive in violation of this
subchapter or other laws of this state.  Provides that this subsection does
not limit remedies available under other state laws. 

 Sec. 166.046.  HONORING DIRECTIVE DOES NOT CONSTITUTE OFFENSE OF AIDING
SUICIDE.  Redesignated from Section 672.017, Health and Safety Code.  Makes
a conforming change. 

Sec. 166.047.  CRIMINAL PENALTY; PROSECUTION.  Redesignated from Section
672.018, Health and Safety Code.  

Sec. 166.048.  PREGNANT PATIENTS.  Redesignated from Section 672.019,
Health and Safety Code.  Makes a conforming change. 

Sec. 166.049.  MERCY KILLING NOT CONDONED.  Redesignated from Section
672.020, Health and Safety Code.  Makes conforming changes. 

Sec. 166.050.  LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.  Redesignated
from Section 672.021, Health and Safety Code.  Makes a conforming change. 

SECTION 1.04.  Transfers Chapter 674, Health and Safety Code, to Subtitle
H, Title 2, Health and Safety Code, and redesignates it as Subchapter C,
Chapter 166, Health and Safety Code, as follows: 

New title:  SUBCHAPTER C.  OUT-OF-HOSPITAL DO-NOT-RESUSCITATE 
ORDERS. Redesignated from Chapter 674, Health and Safety Code.

Sec. 166.081.  DEFINITIONS.  Redesignated from Section 674.001, Health and
Safety Code. Deletes the definitions of "attending physician," "board,"
"competent," "declarant," "department," "durable power of attorney for
health care," "incompetent," "life-sustaining procedure," "physician," and
"terminal condition" for purposes of this subchapter.  Redefines
"out-of-hospital DNR order" (DNR order) as a legally-binding
out-of-hospital do-notresuscitate order, in the form specified by the board
under Section 166.083, Health and Safety Code, and signed by the attending
physician of a person, rather than a person who has been diagnosed as
having a terminal condition.  Deletes endotrachacheal intubation, but not
advanced airway management, a one of the life-sustaining procedures which
a person or the person's legally authorized representative may direct a
health care professional in an out-ofhospital setting not to initiate.
Deletes the administration of cardiac resuscitation medications from the
list of these life-sustaining procedures.  Makes conforming changes. 

Sec. 166.082.  OUT-OF-HOSPITAL DNR ORDER; DIRECTIVE TO PHYSICIANS.
Redesignated from Section 674.002, Health and Safety Code.  Deletes the
requirement that a witness must have the same qualifications as those
provided by Section 672.003(c), Health and Safety Code.  Makes conforming
changes. 

Sec. 166.083.  FORM OF OUT-OF-HOSPITAL DNR ORDER.  Redesignated from
Section 674.003, Health and Safety Code.  Provides that the standard form
of a DNR order specified by the board must include a separate section for
execution of the document by at least one qualified relative, rather than
two.  Authorizes a photocopy or other complete facsimile of the original
written DNR order executed under this subchapter to be used for any purpose
for which the original written order may be used under this subchapter.
Makes conforming changes. 

Sec. 166.084.  ISSUANCE OF OUT-OF-HOSPITAL DNR ORDER BY NONWRITTEN
COMMUNICATION.  Redesignated from Section 674.004, Health and Safety Code.
Makes conforming changes. 

Sec. 166.085.  EXECUTION OF OUT-OF-HOSPITAL DNR ORDER ON BEHALF OF A MINOR.
Redesignated from Section 674.005, Health and Safety Code. 

Sec. 166.086.  DESIRE OF PERSON SUPERSEDES OUT-OF-HOSPITAL DNR ORDER.
Redesignated from Section 674.006, Health and Safety Code.  Makes a
conforming change. 

Sec. 166.087.  PROCEDURE WHEN DECLARANT IS INCOMPETENT OR INCAPABLE  OF
COMMUNICATION.  Redesignated from Section 674.007, Health and Safety Code.
Makes conforming changes. 

Sec. 166.088.  PROCEDURE WHEN PERSON HAS NOT EXECUTED OR ISSUED
OUTOF-HOSPITAL DNR ORDER AND IS INCOMPETENT OR INCAPABLE OF COMMUNICATION.
Redesignated from Section 674.008, Health and Safety Code. Authorizes a
physician and at least one qualified relative, rather than two, from a
category listed by Section 166.039(b), subject to the priority established
under that subsection, to execute a DNR order in the same manner as a
treatment decision made under Section 166.039(b), rather than Section
672.009(b), Health and Safety Code, if the person does not have a legal
guardian, proxy, or agent under a durable power of attorney for health
care. Provides that a DNR order must be made in the presence of at least
two witnesses, at least one of whom must be a witness qualifying under
Section 161.003, Health and Safety Code, rather than two witnesses who
possess the same qualifications required by Section 672.003(c), Health and
Safety Code.  Provides that a person listed in Section 166.039(b), Health
and Safety Code, who wishes to challenge a decision under this section is
required to apply for temporary guardianship under Section 875 (Temporary
Guardian--Procedure), Texas Probate Court.  Authorizes the court to waive
the applicable fees in that proceeding. Makes conforming changes. 

Sec. 166.089.  COMPLIANCE WITH OUT-OF-HOSPITAL DNR ORDER.  Redesignated
from Section 674.009, Health and Safety Code.  Provides that a DNR order
form or a copy of the form, when available, must accompany a person during
transport.  Makes conforming changes. 

Sec. 166.090.  DNR IDENTIFICATION DEVICE.  Redesignated from Section
674.010, Health and Safety Code.  Makes conforming changes.   

Sec. 166.091.  DURATION OF OUT-OF-HOSPITAL DNR ORDER.  Redesignated from
Section 674.011, Health and Safety Code.  Makes a conforming change. 

Sec. 166.092.  REVOCATION OF OUT-OF-HOSPITAL DNR ORDER. Redesignated from
Section 674.012, Health and Safety Code.  Makes a conforming change. 

Sec. 166.093.  REEXECUTION OF OUT-OF-HOSPITAL DNR ORDER.  Redesignated from
Section 674.013, Health and Safety Code.  Deletes existing Section 674.014
(Conflict with Natural Death Act or Durable Power of Attorney for Health
Care) and text stating that to the extend that a DNR order conflicts with a
directive or treatment decision executed or issued under Chapter 672
(Natural Death act), Health and Safety Code, or a durable power of attorney
for health care executed or issued in accordance with Chapter 135 (Durable
Power of Attorney for Health Care), Civil Practice and Remedies Code, the
instrument executed later in time controls. Deletes existing Section
674.015 (Effect of Out-of-Hospital DNR Order on Insurance Policy and
Premiums) and text regarding the effects of a DNR order on a person's
insurance policy and premiums and providing certain prohibitions. Makes
conforming changes. 

Sec. 166.094.  LIMITATION ON LIABILITY FOR WITHHOLDING CARDIOPULMONARY
RESUSCITATION AND CERTAIN OTHER LIFE-SUSTAINING PROCEDURES.  Redesignated
from Section 674.016, Health and Safety Code.  Makes conforming changes.   

Sec. 166.095.  LIMITATION ON LIABILITY FOR FAILURE TO EFFECTUATE
OUTOF-HOSPITAL DNR ORDER.  Redesignated from Section 674.017, Health and
Safety Code.  Provides that a health care professional or health care
facility or entity is subject to review and disciplinary action by the
appropriate licensing board, rather than not civilly or criminally liable,
for failing to effectuate a DNR order.  Provides that this subsection does
not limit remedies available under other laws of this state. 

Sec. 166.096. HONORING OUT-OF-HOSPITAL DNR ORDER DOES NOT  CONSTITUTE
OFFENSE OF AIDING SUICIDE.  Redesignated from Section 674.018, Health and
Safety Code.  Makes a conforming change. 

Sec. 166.097.  CRIMINAL PENALTY; PROSECUTION.  Redesignated from Section
674.019, Health and Safety Code.  Makes a conforming change. 

Sec. 166.098.  PREGNANT PERSONS.  Redesignated from Section 674.020, Health
and Safety Code.  Makes a conforming change. 

Sec. 166.099.  MERCY KILLING NOT CONDONED.  Redesignated from Section
674.021, Health and Safety Code.  Makes conforming changes. 

Sec. 166.100.  LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.  Redesignated
from Section 674.022, Health and Safety Code.  Makes a conforming change. 

Sec. 166.101.  DUTIES OF DEPARTMENT AND BOARD.  Redesignated from Section
674.023, Health and Safety Code.  Makes conforming changes. Deletes
existing Section 674.024 (Recognition of Out-of-Hospital DNR Executed or
Issued in Other State).  Deletes text stating that a DNR order executed,
issued, or authorized in another state or a territory or possession of the
United States in compliance with the law of that jurisdiction is effective
for purposes of this chapter. 

SECTION 1.05.  Transfers Chapter 135, Civil Practice and Remedies Code, to
Subtitle H, Title 2, Health and Safety Code, and redesignates it as
Subchapter D, Chapter 166, Health and Safety Code, as follows: 

SUBCHAPTER D.  DURABLE POWER OF ATTORNEY FOR HEALTH CARE.  

Sec. 166.151.  DEFINITIONS.  Redesignated from Section 135.001, Civil
Practice and Remedies Code.  Deletes from the definitions listed for
purposes of this chapter the following terms:  "attending physician,"
"capacity to make health care decisions," "durable power of attorney for
health care", "health care decision," and "physician."  

Sec. 166.152.  SCOPE AND DURATION OF AUTHORITY.  Redesignated from Section
135.002, Civil Practices and Remedies Code.  Authorizes an agent contained
in the durable power of attorney for health care to make any health care
decision on a principal's behalf that the principal could make if the
principal were competent, rather than but for the principal's lack of
capacity to make health care decisions, subject to this subchapter or any
express limitation on the authority of the agent.  Makes conforming
changes. 

Sec. 166.153.  PERSONS WHO MAY NOT EXERCISE AUTHORITY OF AGENT.
Redesignated from Section 135.003, Civil Practices and Remedies Code.   

Sec. 166.154.  EXECUTION AND WITNESS.  Redesignated from Section 135.004,
Civil Practices and Remedies Code.  Provides that the durable power of
attorney for health care must be signed by the principal in the presence of
two, rather than at least two, witnesses, rather than subscribing
witnesses, at least one of whom must be a witness qualifying under Section
166.003, Health and Safety Code.  Provides that the witnesses must sign the
document.  Deletes text prohibiting a witness, at the time of the
execution, from falling into certain categories of persons.  Deletes text
requiring the witnesses to affirm that, at the time the durable power of
attorney for health care was signed, the principal appeared to be of sound
mind to make a health care decision, stated in the witness's presence that
the principal was aware of the nature of the durable power of attorney for
health care and that the principal was signing the document voluntarily and
free of duress; and requested that the witness serve at a witness to the
principal's execution of the document. Redesignates Subsection (d) to
Subsection (b). 

Sec. 166.155.  REVOCATION.  Redesignated from Section 135.005, Civil
Practices and Remedies Code.  Provides that a durable power of attorney is
revoked by oral or written  notification at any time by the principal to
the agent or a licensed or certified health or residential care provider or
by any other act evidencing a specific intent to revoke the power, without
regard to whether the principal is competent or the principal's mental
state, rather that the principal's competency, or capacity to make health
care decisions.  Additionally provides that the durable power of attorney
is revoked by the divorce of the principal and spouse, if the spouse is the
principal's agent, unless the durable power of attorney provides otherwise. 

Sec. 166.156.  APPOINTMENT OF GUARDIAN.  Redesignated from Section 135.006,
Civil Practices and Remedies Code.   

Sec. 166.157.  DISCLOSURE OF MEDICAL INFORMATION.  Redesignated from
Section 135.007, Civil Practices and Remedies Code. 

Sec. 166.158. DUTY OF HEALTH OR RESIDENTIAL CARE PROVIDER.  Redesignated
from Section 135.008, Civil Practices and Remedies Code.  Makes conforming
changes. 

Sec. 166.159.  DISCRIMINATION RELATING TO EXECUTION OF DURABLE POWER OF
ATTORNEY FOR HEALTH CARE.  Redesignated from Section 135.009, Civil
Practices and Remedies Code. 

Sec. 166.160.  LIMITATION ON LIABILITY.  Redesignated from Section 135.010,
Civil Practices and Remedies Code.  Provides that an attending physician,
health or residential care provider, or a person acting as an agent for or
under the physician's or provider's control is not subject to criminal or
civil liability and has not engaged in unprofessional conduct for an act or
omission if the act or omission does not constitute a failure to exercise
reasonable, rather than due, care in the provision of health care services.
Provides that  the standard of care that the physician, provider, or agent
is required to exercise under this section is that degree of care that the
physician, provider, or agent, as applicable, of ordinary prudence and
skill would have exercised under the same or similar circumstance.
Redesignates Subsection (c) to Subsection (d).  Makes conforming changes. 

Sec. 166.161.  LIABILITY FOR HEALTH CARE COSTS.  Redesignated from
Section135.011, Civil Practices and Remedies Code. Deletes existing Section
135.012 (Natural Death Act).  Deletes existing text stating that to the
extent that a durable power of attorney for health care conflicts with a
directive or treatment decision executed under the Natural Death Act
(Chapter 672, Health and Safety Code), the instrument executed later in
time controls.  Further states that a physician who withholds or withdraws
life-sustaining procedures from a principal with a terminal condition as
required by an agent's directive is not required to comply with this Act.
Deletes existing Section 135.013 (Enforceability of Durable Power of
Attorney Executed in Another Jurisdiction).  Deletes text stating that this
chapter does not limit the enforceability of a durable power of a attorney
for health care or similar instrument executed in another state or
jurisdiction if the instrument complies with the law of the state or
jurisdiction. 

Sec. 166.162.  DISCLOSURE STATEMENT.  Redesignated from Section 135.014,
Civil Practices and Remedies Code. 

Sec. 166.163.  FORM OF DISCLOSURE STATEMENT.  Redesignated from Section
135.015, Civil Practices and Remedies Code.  Modifies substantive language
in a disclosure statement to delete the following persons prohibited to act
as potential qualified witnesses: 

_a principal's health or residential health care provider or an employee of
the provider;  
_a principal's spouse;
_a principal's lawful heirs or beneficiaries named in the principal's will
or a deed; or 
_creditors or persons who have a claim against the principal.

 Modifies substantive language in a disclosure form to add to a list of
persons prohibited to be potential qualified witnesses:   

_a person related to the principal by blood or marriage;
_a person entitled to any part of the principal's estate after the
principal's death under a will executed by the principal or by operation of
law; 
_the principal's attending physician or an employee of the principal's
attending physician; 
_an employee of a health care facility in which the principal is a patient,
or if the employee is providing direct patient care to the principal or is
an officer, director, partner, or business office employee of the facility
or of any parent organization of the facility; or 
_a person, who at the time the power of attorney is executed, has a claim
against any part of the principal's estate after death. 

Sec. 166.164.  FORM OF DURABLE POWER OF ATTORNEY.  Redesignated from
Section 135.016, Civil Practices and Remedies Code.  Sets forth the
substantive form of the durable power of attorney.   

Sec.  166.165. CIVIL ACTION.  Redesignated from Section 135.017, Civil
Practices and Remedies Code.  Makes a conforming change.   

Sec. 166.166.  OTHER RIGHTS OR RESPONSIBILITIES NOT AFFECTED.  Redesignated
from Section 135.018, Civil Practices and Remedies Code.  Makes a
conforming change. 

ARTICLE 2.  CONFORMING AMENDMENTS

SECTION 2.01.  Amends Subsection (a), Section 313.003, Health and Safety
Code, to make conforming changes.   

SECTION 2.02.  Amends Subchapter A, Chapter 142, Health and Safety Code, by
adding Section 142.0145, as follows: 

Sec. 142.0145.  VIOLATION OF LAWS RELATING TO ADVANCE DIRECTIVES.  (a)
Requires the Texas Department of Health (department) to assess an
administrative penalty of $500 against a home and community support
services agency that violates Section 166.004, Health and Safety Code.
Requires the penalty to be assessed according to department rules.
Requires the rules to provide for notice an opportunity for hearing. 

SECTION 2.03.  Amends Subsections (a) and (c), Section 241.059, Health and
Safety Code, to require the commissioner of public health (commissioner) to
assess an administrative penalty against a hospital that violates Section
166.004, Health and Safety Code.  Prohibits the penalty from exceeding
$1,000 for each violation, except that a penalty for a violation of Section
166.004, Health and Safety Code, is required to be $500.  Authorizes each
day of a continuing violation, other than a violation under Section
166.004, Health and Safety Code, to be considered a separate violation. 

SECTION 2.04.  Amends Subchapter C, Chapter 242, Health and Safety Code, by
adding Section 242.0663, as follows: 

Sec. 242.0663.  VIOLATION OF LAW RELATING TO ADVANCE DIRECTIVES.  (a)
Requires the department to assess an administrative penalty under this
subchapter against an institution that violates Section 166.004, Health and
Safety Code.  Provides that notwithstanding Sections 244.066(b) and (c), a
penalty assessed in accordance with this section is required to be $500 and
prohibits a separate penalty from being assessed for a separate day of a
continuing violation.  Makes Section 242.0665, Health and Safety Code,
inapplicable to a penalty assessed according to this section. 

SECTION 2.05.  Amends Subchapter C, Chapter 247, Health and Safety Code, by
adding Section 247.0445, as follows: 
 
Sec. 247.0455.  VIOLATION OF LAW RELATING TO ADVANCE DIRECTIVES.  (a)
Requires the department to assess an administrative penalty of $500 against
a personal care facility that violates Section 166.004, Health and Safety
Code.  Requires the penalty to be assessed according to department rules.
Requires the rules to provide for notice and an opportunity for a hearing. 

SECTION 2.06.  Amends Subchapter C, Chapter 248, Health and Safety Code, by
adding Section 248.0545, Health and Safety Code, as follows: 

Sec. 248.0545.  VIOLATION OF LAW RELATING TO ADVANCE DIRECTIVES.  (a)
Requires the department to assess an administrative penalty of $500 against
a special care facility that violates Section 166.004, Health and Safety
Code.  Requires the penalty to be assessed according to department rules.
Requires the rules to provide for notice and an opportunity for a hearing. 

ARTICLE 3.  TRANSITION AND EMERGENCY CLAUSE

SECTION 3.01.  Effective date:  January 1, 2000.

SECTION 3.02.  Makes the change in law made by this Act prospective with
respect to the validity of a document executed under Chapter 672 or 674,
Health and Safety Code, or Chapter 135, Civil Practice and Remedies Code. 

SECTION 3.03.  Makes the change in law made by this Act prospective with
respect to the punishment for an offense. 

SECTION 3.04.  Emergency clause.