Texas is about to face another crisis in its healthcare


Reprinted from the blog Abysmum Invocat Abysmum/Deep is Calling to Deep – April 8, 1013.

The Legislature of the State of Texas meets every two years and 2013 is going to see the Legislature wrestle with a lot of issues that concern different groups.  In the months when the Legislature is not in session the various committees of the Legislature prepare bills for consideration in the session.

Some of the bills being worked up by the Committees affect everyone in the State and one of these bills is Senate Bill 303 Advance Directive Law reform, which deals with the end-of-life issues.  Everyone in the State, regardless of their present state of health could be affected by this Bill in the event of a serious illness or an accident.

It sometimes happens that a patient in a hospital is declared by the attending physician to be “terminal” and the withdrawal of treatment is suggested.  Current Texas law allows for doctors and hospitals to withdraw treatment from any patient for any reason after providing ten days notice.  Doctors and hospitals can withdraw and deny medical treatment (after the required ten days) even against an advance directive, against patient’s expressed wishes, and against the surrogate’s decision.

SB 303 seeks to lay down more precise procedures that would be followed before treatment could be withdrawn but it really does not improve the current law, but rather specifically spells out that treatment can  be withdrawn from the disabled and terminal.  However, even under the criteria used to withdraw treatment from the  ”terminal” and the “irreversible” in SB 303, patients are all still at risk.

Current TX law is silent on DNR (Do Not Resuscitate) orders.  SB 303 takes away all confusion by removing ANY right of the patient to consent to a DNR for him.  SB 303 puts all power—power unspecified under current law—into the hands of the physician and medical facility, leaving no recourse to the patient, or the patient’s family, whose life is at stake.

Contrary to the claims of its proponents SB 303 does not make the process better.   For example, if the patient or the patient’s family should wish to have the patient transferred to another hospital, the most recent version of SB 303 changes the transfer time to 21 days from the law’s present stipulation of ten days, but that is still hardly enough time to for the patient’s surrogate or family to clear the red tape involved in the transfer of the patient from one medical facility to another.

Here are some of the highlights of SB 303:

1-The DNR section at the beginning in no way requires patient/surrogate consent prior to a doctor issuing a DNR for a patient.

2-Notice of the futility review is moved to 7 days, but only after two subcommittee meetings or a pre-meetings are held with the family.  The subcommittees or pre-meetings are not subject to any of the rules for the full futility review meeting.

3-Treatment may be withdrawn after 21 days.

4-SB 303 adds criteria for “terminal” and “irreversible” so as to limit application of the statute.  However, the criteria are subjective and cannot be based in medicine, instead rely on value judgments.

5-SB 303 uses the term “medically ineffective” in regard to treatment throughout the bill, but all the criteria for “medically ineffective” decisions are value judgments.

6-Limiting the number of people who can accompany the family to the futility review meeting is manipulative.

7-The reporting requirements in SB 303 will yield no insightful data to the State as to frequency, outcomes, transfer attempts, patients who died and the time frame, etc.

The Senate Committee for SB 303 will meet again tomorrow morning, Tuesday, April 9, at 9:00 PM.  Hopefully some of the readers of this post will contact a member of the Committee to express reservations about the provisions of SB 303.

Here are the members of the Senate Health and Human Services Committee working on SB 303:

Chair: Jane Nelson (R-Grapevine)
            Senate District 12


Vice Chair: Bob Deuell (R-Greenville)
                     Senate District 2



Joan Huffman (R-Houston)
Senate District 17

Robert Nichols (R-Jacksonville)
Senate District 3

Dr. Charles Schwertner (R-Georgetown)
Senate District 5

Larry Taylor (R-Friendswood)
Senate District 11

Carlos Uresti (D-San Antonio)
Senate District 19

Royce West (D-Dallas)
Senate District 23

Judith Zaffirini (D-Laredo)
Senate District 21


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