SECTION 133.42. Patient Rights

(a) Patient rights requirements for all hospitals.

(1) A hospital shall adopt, implement, and enforce a policy to ensure patients' rights. The written policy shall include:

(A) the right of the patient to the hospital's reasonable response to his or her requests and needs for treatment or service, within the hospital's capacity, its stated mission, and applicable law and regulation;

(B) the right of the patient to considerate and respectful care:

(i) the care of the patient includes consideration of the psychosocial, spiritual, and cultural variables that influence the perceptions of illness;

(ii) the care of the dying patient optimizes the comfort and dignity of the patient through:

(I) treating primary and secondary symptoms that respond to treatment as desired by the patient or surrogate decision maker;

(II) effectively managing pain; and

(III) acknowledging the psychosocial and spiritual concerns of the patient and the family regarding dying and the expression of grief by the patient and family;

(C) the right of the patient, in collaboration with his or her physician, to make decisions involving his or her health care, to include the following:

(i) the right of the patient to accept medical care or to refuse treatment to the extent permitted by law and to be informed of the medical consequences of such refusal; and

(ii) the right of the patient to formulate advance directives and to appoint a surrogate to make health care decisions on his or her behalf to the extent permitted by law. Advance directives are written instructions recognized under state law relating to the provision of health care when individuals are unable to communicate their wishes regarding medical treatment. The advance directive may be a written document authorizing an agent or surrogate to make decisions on an individual's behalf (a medical power of attorney for health care), a written or verbal statement (a living will), or some other form of instruction recognized under state law specifically addressing the provisions of health care;

(I) a hospital shall have in place a mechanism to ascertain the existence of, and, as appropriate, assist in the development of advance directives at the time of the patient's admission;

(II) the provision of care shall not be conditioned on the existence of an advance directive; and

(III) an advance directive(s) shall be in the patient's medical record and shall be reviewed periodically with the patient or surrogate decision maker if the patient has executed an advance directive;

(D) the right of the patient to the information necessary to enable him or her to make treatment decisions that reflect his or her wishes; a policy on informed decision making shall be adopted, implemented and enforced by the medical staff and governing body and shall be consistent with any legal requirements;

(E) the right of the patient to receive, at the time of admission, information about the hospital's patient rights policy(ies) and the mechanism for the initiation, review, and when possible, resolution of patient complaints concerning the quality of care;

(F) the right of the patient or the patient's designated representative to participate in the consideration of ethical issues that arise in the care of the patient. The hospital shall have a mechanism for the consideration of ethical issues arising in the care of patients and to provide education to care givers and patients on ethical issues in health care;

(G) the right of the patient to be informed of any human experimentation or other research or educational projects affecting his or her care or treatment;

(H) the right of the patient, within the limits of law, to personal privacy and confidentiality of information;

(I) the right of the patient or the patient's legally designated representative access to the information contained in the patient's medical record, within the limits of the law; and

(J) the right of the patient's guardian, next of kin, or legally authorized responsible person to exercise, to the extent permitted by law, the rights delineated on behalf of the patient if the patient:

(i) has been adjudicated incompetent in accordance with the law;

(ii) is found by his or her physician to be medically incapable of understanding the proposed treatment or procedure;

(iii) is unable to communicate his or her wishes regarding treatment; or

(iv) is a minor.

(2) The hospital patient's bill of rights shall be prominently and conspicuously posted for display in a public area of the facility that is readily available to patients, residents, employees, and visitors.

(b) Additional patient bill of rights requirements for hospitals providing comprehensive medical rehabilitation services. A hospital that provides comprehensive medical rehabilitation services shall comply with subsection (a) of this section and with the following additional provisions applicable to patients who receive such services.

(1) The patient's bill of rights shall address the rights of minors and provide that a minor is entitled to:

(A) appropriate treatment in the least restrictive setting available;

(B) not receive unnecessary or excessive medication;

(C) an individualized treatment plan and to participate in the development of the plan;

(D) a humane treatment environment that provides reasonable protection from harm and appropriate privacy for personal needs;

(E) separation from adult patients; and

(F) regular communication between the minor patient and the patient's family.

(2) Prior to admission or acceptance for evaluation, a written copy of the patient's bill of rights in the patient's primary language, if possible, shall be given to each patient, and, as appropriate, to the patient's parent, managing conservator, or guardian.

(3) The hospital shall ensure that within 24 hours after the patient is admitted to the hospital, the rights described in this subsection are explained to the patient and, if appropriate, to the patient's parent, managing conservator, or guardian in the following manner:

(A) orally, in simple, nontechnical terms in the person's primary language, if possible; or

(B) other reasonable means calculated to communicate with a person who has an impairment of vision or hearing, if applicable.

(4) If the patient cannot comprehend the information because of illness, age, or other factors, or an emergency exists that precludes immediate presentation of the information, or the patient refused to sign the written copy of the patient's bill of rights as provided for in paragraph (5) of this subsection, the presentation of the document shall be witnessed by two members of the hospital staff, and the unsigned patient's bill of rights shall be placed in the clinical record along with a note signed by the witnesses indicating the reasons for their signatures.

(5) The hospital shall obtain a signed copy of the patient's bill of rights from each patient, or, if appropriate, from the patient's parent, managing conservator, or guardian. The signed copy shall include a statement that the patient, patient's parent, managing conservator, or guardian has read the document and understands the rights specified in the document. The signed copy shall be made a part of the patient's medical record.

(c) Additional patient bill of rights requirements for hospitals providing chemical dependency services. A hospital that provides chemical dependency services shall comply with subsection (a) of this section and with §448.701 of this title (relating to Client Bill of Rights) applicable to patients who receive such services.

(d) Additional patient bill of rights requirements for hospitals providing mental health services. A hospital that provides mental health services shall comply with subsection (a) of this section and Chapter 404, Subchapter E of this title (relating to Rights of Persons Receiving Mental Health Services) applicable to patients who receive such services.

(e) Posting requirements for patient bill of rights for hospitals providing comprehensive medical rehabilitation services, chemical dependency services, or mental health services. The hospital shall prominently and conspicuously post for display a copy of the patient's bill of rights in a public area of the hospital that is readily visible to patients, residents, employees, and visitors. The patient bill of rights posted for display shall be in English and in a second language appropriate to the demographic makeup of the community served.

Source Note: The provisions of this §133.42 adopted to be effective June 21, 2007, 32 TexReg 3587