Amends TCA Title 8; Title 29; Title 33; Title 34; Title 56; Title 63; Title 68 and Title 71.

RIGHT TO ADMINISTRATION OF TREATMENTS<br /> <br /> This bill authorizes a healthcare practitioner ("practitioner") to exercise good medical judgment in administering a treatment to a patient for illness recovery or injury based on the practitioner’s independent medical opinion, subject to the patient’s right to refuse treatment. If the practitioner treats a patient and the treatment does not constitute willful misconduct, then the practitioner is not subject to a cause of action by the patient, an advocate, or the patient’s estate; an adverse action by the practitioner’s employer; or adverse action by the entity responsible for licensing the practitioner for administration of the treatment. However, administering a treatment that is not approved by the federal food and drug administration, or not approved for the diagnosis, does not constitute willful misconduct. <br /> <br /> This bill prohibits a practitioner from denying a request for a second opinion by another practitioner within 24 hours of a request being made if the request is made by the patient and in the format solely determined by the patient; or the advocate, if the patient is incapacitated, in the format solely determined by the advocate. <br /> <br /> RIGHT TO ALTERNATIVE TREATMENT AVAILABLE UNDER EMERGENCY USE AUTHORIZATION<br /> <br /> This bill requires a healthcare facility ("facility") to provide a patient or their advocate with the risks and benefits of all alternative treatment plans available under emergency use authorizations before providing treatment to the patient. <br /> <br /> RIGHT TO TRANSFER OR RELEASE FROM CARE<br /> <br /> This bill prohibits a practitioner or facility from preventing the transfers or release from care of a patient within 12 hours of a written request being made if the request is made by the patient, if not incapacitated, or the advocate, if the patient is incapacitated, which includes such a physical or mental state that results from drugs or medical treatment. If a practitioner or facility complies with the appropriate rules over transfer, then the practitioner or facility is not subject to a cause of action by the patient, advocate, or the patient’s estate nor an adverse action by the entity responsible for licensing the practitioner or facility for the transfer or release from care. <br /> <br /> RIGHT TO ACCESS AN ADVOCATE<br /> <br /> This bill grants a patient the right to designate an advocate, and for the advocate to exercise all powers, as provided in the Tennessee Health Care Decisions Act. A facility must not restrict a patient from having at least one advocate with 24-hour physical access to the patient at any place in the facility where the patient is placed during the patient’s stay at the facility. This, however, does not apply when the patient is located in an operating room for a surgical procedure. <br /> <br /> In order to have physical access pursuant to this bill, the advocate must not be exhibiting symptoms of a virus or communicable disease. However, an advocate is only subject to non-invasive onsite facility protocols before entry to prove the absence of symptoms of a virus or communicable disease. <br /> <br /> RIGHT TO FREEDOM FROM UNREASONABLE RESTRAINT OR SEDATION<br /> <br /> This bill prohibits a facility from subjecting a patient to restraint or sedation for more than four hours and, if a facility seeks to do so, then the facility must receive permission from the patient to continue restraint or sedation as long as the patient is not incapacitated. If the patient declines the request, then the patient must be released from care or, if the patient is incapacitated, then the facility must receive permission in writing from the advocate to continue restraint or sedation. <br /> <br /> RIGHT TO BEING ROOMED WITH FAMILY MEMBERS<br /> <br /> This bill authorizes a facility to allow two patients who are family members to share a room, if a shareable room is available, unless medically contraindicated and documented by their practitioners in the medical records. <br /> <br /> RIGHT TO TRANSPLANT<br /> <br /> This bill prohibits a covered entity from doing the following solely based on vaccination status, meaning whether a person has received one or more doses of a vaccine, of a qualified donor or recipient:<br /> <br /> (1) Considering a qualified donor or recipient ineligible for transplantation or receipt of an anatomical gift;<br /> <br /> (2) Denying medical or other services related to transplantation, including evaluation, surgery, and counseling and treatment following transplantation; <br /> <br /> (3) Refusing to refer a qualified donor or recipient to a transplant center or specialist;<br /> <br /> (4) Refusing to place a qualified donor or recipient on an organ or tissue waiting list; or <br /> <br /> (5) Placing a qualified donor or recipient at a position on an organ or tissue waiting list that is lower than the position at which the qualified donor or recipient would have been placed if not for the qualified donor or recipient’s vaccination status. <br /> <br /> As used above, a "covered entity" includes a practitioner; a hospital; an ambulatory surgical treatment center; a home care organization; or another entity responsible for matching anatomical gifts or organ donors to potential recipients. <br /> <br /> RIGHT TO AVOID DISCRIMINATION IN ADMISSION OR TREATMENT<br /> <br /> This bill prohibits a facility from discriminating against a patient in admission or treatment based on sex, economic status, educational background, race, religion, ancestry, disability, medical condition, language, or marital status.<br /> <br /> RIGHT TO PRIVACY WITH REGARD TO MEDICAL RECORDS<br /> <br /> This bill prohibits a facility, practitioner, or governmental entity from making the medical records of a patient available to the public. This bill provides that a patient, or a patient's estate, has a cause of action against a facility, practitioner, or entity that violates this prohibition.<br /> <br /> RIGHT TO BE GIVEN NOTICE OF RIGHTS<br /> <br /> This bill requires a facility to post notice of a patient's rights, as applicable, in a prominent location at eye level in each waiting room and patient room. Additionally, a facility must provide written notice of a patient's rights, as applicable, at the time of admission to the patient, if the patient is not incapacitated; or to the advocate, if the patient is incapacitated.<br /> <br /> STATE OF EMERGENCY<br /> <br /> This bill provides that the rights described above continue to apply during a state of emergency declared by an official in state or federal government.<br /> <br /> ENFORCEMENT<br /> <br /> In addition to other remedies provided in this bill and otherwise in law, if a practitioner or facility violates the rights above, then the entity responsible for licensing the practitioner or facility must assess against that practitioner or facility a fine of $500 per day of the violation until the practitioner or facility complies with this bill or otherwise remedies the violation to the satisfaction of the licensing entity. <br /> <br /> TENNESSEE HEALTH CARE DECISIONS ACT<br /> <br /> This bill revises the Tennessee Health Care Decisions Act (the "Act"), as follows:<br /> <br /> (1) Present law provides that an adult or emancipated minor may execute an advance directive for health care, which may authorize the agent to make any health care decision the principal could have made while having capacity, as long as the advance directive is in writing and signed by the principal, and is either notarized or witnessed by two witnesses. This bill requires a health care provider ("provider") or health care institution ("institution") to provide the patient with two witnesses if needed;<br /> <br /> (2) Present law provides that a living will, durable power of attorney for health care, or other instrument signed by the individual, complying with the law relative to living wills, and a durable power of attorney for health care, must be given effect. However, an advance directive that does not evidence an intent to be given effect, but that complies with the Act may be treated as an advance directive under the Act. This bill revises the prior sentence to require such an advance directive to be treated as an advance directive under the Act;<br /> <br /> (3) Present law requires the board for licensing health care facilities to develop and issue appropriate model forms for advance directives that are consistent with the Act. This bill requires an institution to provide a patient, or the patient's agent, guardian, or surrogate, as applicable, with the form upon admission to the institution;<br /> <br /> (4) Present law provides that a designated physician who makes or is informed of a determination that a patient lacks or has recovered capacity, or that another condition exists that affects an individual instruction or the authority of an agent, guardian, or surrogate, must promptly record the determination in the patient's current clinical record and communicate the determination to the patient, if possible, and to any person then authorized to make health care decisions for the patient. This bill clarifies that the "record" means the entire record maintained by an individual provider or institution relating to the medical history, care, diagnosis, surgery, and treatment of a patient;<br /> <br /> (5) Present law provides that a provider or institution providing care to a patient generally must comply with an individual instruction of the patient and with a reasonable interpretation of that instruction made by a person then authorized to make health care decisions for the patient; and with a health care decision for the patient made by a person then authorized to make such decisions for the patient to the same extent as if the decision had been made by the patient while having capacity, unless the provider declines due to reasons of conscience, the institution declines due to the instruction or decision being contrary to an institutional policy, or a provider or institution declines due to the instruction or health requiring medically inappropriate health care or health care contrary to generally accepted health care standards applicable to the provider or institution. This bill rewrites these provisions to provide, instead, the following:<br /> <br /> (A) That a provider or institution must comply unless the provider or institution declines due to the instruction or health requiring medically inappropriate health care or health care contrary to generally accepted health care standards applicable to the provider or institution;<br /> <br /> (B) That such exception in (5)(A) does not apply when a provider, in the provider's sole medical judgment, decides to administer a treatment to a patient that is not approved by the federal food and drug administration, or not approved for the diagnosis, but is deemed appropriate by the provider; and<br /> <br /> (C) That such exception in (5)(A) does not authorize a provider or institution to infringe upon a patient's right to refuse or discontinue treatment. If a patient, or a patient's agent, guardian, or surrogate, refuses treatment or requests to discontinue treatment, then the provider or institution must comply;<br /> <br /> (6) Present law provides that a provider or institution that declines to comply with an individual instruction or health care decision must provide continuing care to the patient until a transfer can be effected or until the determination has been made that transfer cannot be effected, and that, if a transfer cannot be effected, the provider or institution must not be compelled to comply. This bill rewrites these provisions to provide, instead, that a provider or institution that declines to comply with an individual instruction or health care decision must provide continuing care to the patient until a transfer can be effected;<br /> <br /> (7) Present law provides that, unless otherwise specified in an advance directive, a person then authorized to make health care decisions for a patient has the same rights as the patient to request, receive, examine, copy, and consent to the disclosure of medical or any other health care information. This bill adds that a provider or institution must make available the full medical record of the patient to the requesting person within two business operating hours of the request;<br /> <br /> (8) Present law provides that a provider or institution that intentionally violates the Act is subject to liability to the aggrieved individual for damages of $2,500, or actual damages resulting from the violation, whichever is greater, plus reasonable attorney's fees and costs. This bill revises this provision by also holding the provider or institution subject to liability to the individual's estate. This bill also adds that an institution that intentionally violates the Act is also deemed a facility detrimental to the health, safety, and welfare of the patient, and the entity responsible for licensing the institution shall suspend the admission of new patients; and<br /> <br /> (9) Present law provides that a person who intentionally falsifies, forges, conceals, defaces, or obliterates an individual's advance directive or a revocation of an advance directive without the individual's consent, or who coerces or fraudulently induces an individual to give, revoke, or not to give an advance directive, is subject to liability to that individual for damages of $2,500, or actual damages resulting from the action, whichever is greater, plus reasonable attorney's fees and costs. This bill removes this provision.<br /> <br /> RULEMAKING<br /> <br /> This bill authorizes the department of health and all health licensing boards affected by this bill to promulgate rules, including emergency rules, to effectuate this bill.<br />