Texas SB 303 bad law!

[wiredgeorge]

http://www.wnd.com/2013/04/surprise-loo ... -kill-you/" onclick="window.open(this.href);return false;

Read the above article. Contract your Texas state senator if you think this is a real bad piece of law, like I do. You can find your state senator here:

http://www.senate.state.tx.us/75r/senate/members.htm" onclick="window.open(this.href);return false;

To think the Republicans are responsible for this legislation! The Med Biz lobby must have a couple in their pocket. wg

[baldeagle]

Might I suggest that you read the bill before passing judgment? Because, just as politicians may advance bills supported by certain lobbyists, other lobbyists who don't want the bill will misrepresent it in an effort to build a consensus against the bill. IANAL, but from my reading of the bill, the family is in control, not the doctor except when, in the doctor's judgment, resuscitation would be ineffective. If that is the doctor's judgment, then the patient is already in serious distress, so the characterization in the article of forcing a DNAR on a patient projected to die in six months to a year appears to be inaccurate. Perhaps someone with a law degree could chime in?

(c) Before placing a do-not-attempt-resuscitation (DNAR)
order in a patient's medical record, the physician or the facility's
personnel shall inform the patient or, if the patient is
incompetent, make a reasonably diligent effort to contact or cause
to be contacted the surrogate. The facility shall establish a
policy regarding the notification required under this section. The
policy must authorize the notification to be given verbally by a
physician or facility personnel.
(d) The DNAR order takes effect at the time it is written in
the patient's chart or otherwise placed in the patient's medical
record.
(e) If the patient or surrogate disagrees with the DNAR
order being placed in or removed from the medical record, the
patient or surrogate may request in writing and is entitled to a
consultation or a review of the disagreement by the ethics or
medical committee in the manner described by Section 166.046, with
the patient or surrogate afforded all rights provided to the
surrogate under that section, and with the physician afforded all
protections from liability provided under Section 166.045(d). The
patient or surrogate may discontinue the process initiated under
Section 166.046 by providing written notice to the ethics or
medical committee.
(f) A DNAR order in the patient's medical record at the time
a consultation or review is requested under Subsection (e) must be
removed from the patient's medical record at that time. A DNAR
order may not be placed in the patient's medical record until the
process initiated under Section 166.046 is concluded or
discontinued at the request of the patient or surrogate.
(g) Subsection (c) does not apply to a DNAR order placed in
the medical record of a patient:
(1) whose death, based on reasonable medical judgment,
is imminent despite attempted resuscitation;
(2) for whom, based on reasonable medical judgment,
resuscitation would be medically ineffective and there is
insufficient time to contact the surrogate; or
(3) for whom the DNAR order is consistent with a
patient's or surrogate's request or a patient's advance directive to
not attempt resuscitation.
(h) Subsection (e) does not apply to a DNAR order placed in
the medical record of a patient with respect to whom, based on
reasonable medical judgment, death is imminent and resuscitation
would be medically ineffective.

[DocV]

To me, section C seems to imply a DNAR can be placed into the medical record without any regard to patient medical condition. Further, would not section B:

(b) Upon admission, a health care facility shall provide a
patient or surrogate written notice of the facility's policies
regarding the rights of the patient or surrogate under this
section.

allow any health facility to add a DNAR when you are admitted?

I don't like this bill.

[baldeagle]

To me, section C seems to imply a DNAR can be placed into the medical record without any regard to patient medical condition. Further, would not section B:

(b) Upon admission, a health care facility shall provide a
patient or surrogate written notice of the facility's policies
regarding the rights of the patient or surrogate under this
section.

allow any health facility to add a DNAR when you are admitted?

I don't like this bill.

The DNAR must be removed as soon as the patient or the patient's surrogate protests. The only exception is when, in the physician's judgment, life saving measures would be "medically ineffective". So, if the hospital informs the patient of their policies and the physician says I'm placing a DNAR on this patient, as soon as the surrogate protests, the DNAR is rescinded until the appeals process if finished. At least that's how I read it. Again, IANAL, and I really think we need a lawyer's take on this bill.

[n5wd]

To me, section C seems to imply a DNAR can be placed into the medical record without any regard to patient medical condition. Further, would not section B:

(b) Upon admission, a health care facility shall provide a
patient or surrogate written notice of the facility's policies
regarding the rights of the patient or surrogate under this
section.

allow any health facility to add a DNAR when you are admitted?

I don't like this bill.

Just a couple of things:
1. DNR orders are written by a doctor. You won't see a doctor at admissions. You'll see a doc once you're in your room, or in the ER, and after exam, the doc would write the DNR orders along with his other paperwork on you. An admissions clerk wouldn't be the one to do it. Giving you a copy of their policies,though, is something that IS routinely done at admissions.

2. What do you think would happen if it becomes known that Hospital-A writes DNR orders on non-terminal patients? Just because state law allowed it, don't you think that the bad publicity would force the facility to change that aspect of their routine OR wouldn't you expect them to go out of business pretty quickly. Would you take a loved one to a hospital that routinely writes DNR orders on people that walked in looking for, say, stiches for a cut, or treatment for appendicitis, etc.?

[JP171]

I can also tell you that as soon as the patient requests help the DNR is considered void! it doesn't matter what the MD says

[SewTexas]

why is the state getting involved in this? why? and why the heck do I have a feeling this bill will come up for a vote when our pro-gun bills and pro-life bills won't?

[baldeagle]

why is the state getting involved in this? why? and why the heck do I have a feeling this bill will come up for a vote when our pro-gun bills and pro-life bills won't?

I'm just guessing, but I think it's probably because some sort of problem arose with DNARs and hospitals, and so their lobby forwarded this bill.

[nmusgrove]

Read here for a list of all the National and State Pro-life leaders opposed to SB 303
http://www.texasrighttolife.com/a/1038/ ... e-Bill-303" onclick="window.open(this.href);return false;

Their website also has a comparison chart of why this is bad public policy.

[nyj]

I can also tell you that as soon as the patient requests help the DNR is considered void! it doesn't matter what the MD says

If the patient is alive, then they will receive palliative care. A DNR only goes into effect once the patient is in cardiac arrest.

About the only people you will see with a DNR that ever has a shot at being utilized, are those in a hospice, or those whom are literally in their death bed. A DNR has to be present/with the patient to be valid.

[SewTexas]

do you remember that case in CA a few months ago? some nurse calls 911 then says she won't be doing CPR because the nursing home has a "policy" wanna bet this is stemming from that case?

if they want a DNAR so badly it's shouldn't be 'hidden' in a stack of admin papers, but I don't feel like the state should be getting involved in it. when we were looking into the possibility of a home for my father-in-law after his stroke, you can be that nothing would have been signed without several sets of eyes reading every page. You have to be vigilant when signing things...it's a sad fact.