Office of House Bill AnalysisS.B. 876
By: Moncrief
Public Health


Currently, there are federal standards relating to emergency behavioral
interventions in psychiatric and medical facilities and psychiatric
residential treatment centers. However, each health and human services
agency promulgates its own rules regarding the appropriate use of
restraints and seclusion. The lack of consistency among agencies raises
concerns related to possible injury or death associated with the use of
restraints and seclusion, particularly in cases involving children. Senate
Bill 876 provides for consistent standards for health care facilities in
the state. 


It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to health and human services agencies that
regulate the care or treatment of residents of certain facilities in
SECTION 1 (Sections 322.004, 322.006, and 322.007; Health and Safety Code)
and SECTION 2 and to the Health and Human Services Commission in SECTION 1
(Sections 322.010, Health and Safety Code) of this bill. 


Senate Bill 876 amends the Health and Safety Code to require a health and
human services agency (agency) that regulates the care or treatment of
residents of certain child-care institutions, intermediate care facilities,
mental hospitals or mental health facilities, nursing facilities, or
assisted living facilities (facilities) by rule to adopt procedures for
administering mechanical restraint, personal restraint,  seclusion,
emergency psychoactive medication, and supportive and protective devices.
The bill provides that the procedures must be consistent with the
provisions of this bill and with the right of a resident to be free from
physical or mental abuse, corporal punishment, and the use of restraints or
seclusion as punishment, as a substitute for treatment or habilitation, for
the convenience of facility staff, or to compensate for a lack of facility
staff. The bill requires a facility to provide to its staff, annually or
more frequently if necessary, competency-based training on the prevention
and de-escalation of a resident's aggressive behavior and the safe
administration of mechanical and personal restraints.  

The bill requires a facility to report to the appropriate law enforcement
or regulatory agencies for investigation each death of or serious injury to
a resident of the facility that occurs during the administration of, or
less than 48 hours after the termination of the administration of,
restraint, seclusion, or emergency psychoactive medication to the resident.
The bill requires an agency to collect information each quarter related to
the facility's administration to the facility's residents in emergencies of
restraint, seclusion, and psychoactive medication. The bill requires an
agency to submit annually an analysis of the information collected under
these provisions to the Health and Human Services Commission (HHSC), the
governor, and the presiding officer of each house of the legislature.  The
bill requires the agencies by rule to adopt methods and procedures for the
reports and analysis.   

The bill prohibits a person from administering a restraint to a resident of
a facility that maintains the resident in a face-down posture while
pressure is placed on the resident's back, obstructs the resident's airway,
impairs the resident's breathing, or restricts the resident's ability to
communicate. The bill requires the  commissioner of health and human
services and the agencies to execute a memorandum of understanding to
ensure that procedures and definitions of terms adopted by the agencies in
rules under these provisions are consistent.  The bill requires HHSC to
adopt the memorandum by rule.  The bill requires the commissioner of health
and human services and the agencies to review the memorandum annually and
revise the memorandum as necessary.  The bill requires an agency to
implement this bill no later than March 1, 2002.  In adopting rules that
affect a facility under the jurisdiction of the agency, an agency is
required to use the procedures provided by the Negotiated Rulemaking Act.   


March 1, 2002.