NEW STATE LAW GOVERNING INPATIENT DO-NOT-ATTEMPT RESUSCITATION ORDERS (SENATE BILL 11) UPDATED September 2018
On April 1, 2018, a new Texas state law governing inpatient do-not-attempt-resuscitation orders took effect. For the first time, Texas statute sets parameters for a specific physician’s medical order.
The changes are the result of Senate Bill 11, 85th Legislature, special session. Prior to SB 11, three related instruments governed end-of-life decision making for Texas patients:
- Directives to Physicians and Family or Surrogates (living wills).
- Medical Powers of Attorney.
- Out-of-Hospital Do-Not-Resuscitate Orders.
SB 11 adds inpatient DNAR Orders to this list. SB 11 is not intended to alter the current practice for Out-of-Hospital Do-Not-Resuscitate Orders, Directives (including oral directives) or MPOAs.
The Texas Department of State Health Services issued final rules to effect the new law on Sept. 14, 2018. The final rules require a hospital’s governing body to adopt, implement and enforce policies and procedures regarding DNAR orders issued in the hospital by the attending physician – to ensure compliance with SB 11’s provisions, including policies and procedures regarding the rights of a patient and person authorized to make treatment decisions regarding the patient’s DNAR status; notice and medical record requirements for DNAR orders and revocations; and actions the attending physician and hospital must take pursuant when the attending physician or hospital and the patient or person authorized to make treatment decisions regarding the patient’s DNAR status are in disagreement about the execution of, or compliance with, a DNAR order.
This hospital must provide notice of applicable policies and procedures to the patient or person authorized to make treatment decisions regarding the patient’s DNR status upon admission.
Additionally, a hospital’s medical staff must adopt, implement, and enforce bylaws, rules, and regulations to carry out its responsibilities under SB 11’s provisions.
The Texas House of Representatives State Affairs Committee covered several of these issues in its interim report to the 86th Legislature, which focused entirely on SB 11.
The Texas Hospital Association has developed the following summary, guidance and sample hospital policies so that hospitals are prepared to implement the law’s requirements. This summary and sample policies were developed in collaboration with clinicians, ethicists and hospital attorneys from THA member hospitals. The guidance should not be considered legal advice, and all Texas hospitals are strongly encouraged to note where the law is unclear and where hospitals might consider discussing particular implementation issues internally. All hospitals should review the statute and final rules to ensure complete compliance.