Rules For ‘Do Not Resuscitate’ Orders Rewritten in Texas

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Beatrice Marie recalls feeling stressed when she learned a “do not resuscitate” order was in her daughter’s file without her consent.

“I was horrified,” she said. “It was just a parent’s worst nightmare.”

Her daughter, Sabrina Martin, was 14 years old and was dealing with a brain abscess. Marie says her family learned after Martin came out of a coma that she would have around 80 percent brain damage.

“We were just scrambling around trying to find other options,” Marie said, “looking for second opinions.”
Stories like this are what motivated Texas lawmakers to pass a bill requiring additional steps for a patient to obtain a “do not resuscitate” order to stop a physician’s care while inside a health care facility setting.

“What that means is that families have greater rights in terms of their family members and how end of life care is dealt with,” Christopher Cagle, a personal injury attorney, said.

Under Texas’ new law surrounding DNR orders inside a health care facility, only the attending physician can order that CPR will not be performed on a patient who is about to die — and only if the DNR order is valid. One of the requirements for a verbal order by a patient is that it must be observed by two adult witnesses, one of whom isn’t a family member or a hospital employee.

“It does have implications for potentially creating a few more barriers from the time the person or the family member decides [a DNR] is what they would like for themselves or their family member and making sure that does get in their medical record in a way that is legal and able to be enforced,” said

Dr. Liam Fry, division chief of geriatrics and palliative medicine at Dell Medical School at UT Austin.
Fry says this law still respects and leaves the decision-making process up to the patient.

“If they are no longer competent and no longer at capacity, then it would go to their designated surrogate or medical power of attorney or health care proxy that’s been done in writing,” she said.

However, there’s been some delay already in the less than two weeks the law’s been in effect, according to Fry.

“As an example, we had someone whose family, as part of a discussion with a palliative care physician, wanted to pursue hospice and be a ‘do not resuscitate,'” she said. “But to actually get the DNR, it took up to 12 hours because, again, the attending physician was not involved in that discussion.”

Any physician, physician assistant or nurse who intentionally falsifies or cancels a patient’s DNR order will face a Class A misdemeanor charge. They would also be subject to review and disciplinary action by the Texas Medical Board.

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