Legislature weighs in on when stopping CPR on a patient is OK for doctors Medical groups express reservations about legislation

In this Monday, Jan. 14, 2013 photo, Dr. Steve Sun looks over a heart monitor display in the emergency room at St. Mary's Medical Center in San Francisco. (AP Photo/Eric Risberg) In this Monday, Jan. 14, 2013 photo, Dr. Steve Sun looks over a heart monitor display in the emergency room at St. Mary's Medical Center in San Francisco. (AP Photo/Eric Risberg) Photo: Eric Risberg, STF Photo: Eric Risberg, STF Image 1 of / 1 Caption Close Legislature weighs in on when stopping CPR on a patient is OK for doctors 1 / 1 Back to Gallery

AUSTIN -- Responding to fears that doctors and hospitals could allow patients to die without a patient's consent, the Texas Legislature is preparing to send Gov. Greg Abbott a bill to clarify how do-not-resuscitate orders are carried out.

"Right now under Texas law, a doctor can slip a DNR order into a patient's file without their knowledge," State Sen. Charles Perry, R-Lubbock, said. "It defies all logic."

Perry said it is not happening a lot, but it does occur enough that the Legislature needs to clarify what is required before a patient has a DNR order put into their file. Under his bill, if doctors issue an order instructing that no one attempt cardiopulmonary resuscitation -- or CPR -- on a dying patient, the patient or the patient's power of attorney must be notified of the order.

The issue has become important enough for some conservative groups like Texas Right to Life, that Abbott made the topic one of 20 must-pass priorities during a special session of the Legislature, which ends on Wednesday.

"As leaders of this state, we have a responsibility to protect life at all stages," Abbott said in June after calling the special session.

But medical professionals have pushed back that the idea that they are "slipping DNR" orders in on patients without their consent.

"I don't believe that is happening on a wide scale," said Dr. Arlo Weltge, a Houston emergency physician and a member of the Texas Medical Association. "This is not something that is slipped in."

Weltge said doctors are trying to meet the needs of patients in often very difficult circumstance and have to make a call on whether performing CPR on a patient -- especially a dying patient who may be unconscious -- will benefit them more than hurt them.

The TMA has warned the legislation has the potential of interfering with a doctor's attempt to do what is best for a patient and could open them up to lawsuits.

The group has sought provisions to protect physicians who act in good faith. State Rep. Greg Bonnen, R-League City, responded during a debate on the bill on Saturday that the House has included language in the bill to assure doctors would have some protections from lawsuits.

"So if they're acting in good faith to the best of their knowledge, then they have protection from liability under this statute," Bonnen said.

About two-thirds of all adult Americans do not have legal advance directive documents for end of life medical care, including medical power of attorney or DNR orders, according to the TMA.

Perry said TMA and Texas Right to Life have been part of on-going discussions on the bill to get it into a position to pass over the final days. Under his Senate Bill 11, doctors would have to notify a patient when a DNR order has been placed on them because of their condition. If the patient is unconscious, the doctor or medical facility has to make a diligent effort to contact the patient's power of attorney or a family member.

"A patient or a patient's representative would have to have knowledge of that DNR," Perry said. "If I'm in bed and I say I don't want the DNR anymore, it immediately gets pulled."

If the decision goes the other way, and someone changes their mind and wants a DNR, there have to be witnesses who are not affiliated with the hospital.

Texas Right to Life officials say all they want to assure is that patients can stop a DNR from being placed on them if they don't want it.

"You've got to get the patient's consent or their surrogate," said John Seago, legislative director for Texas Right to Life.

The Texas Hospital Association has said such notifications about DNR already take place and that such a law could result in a patient's request to be reversed by a family member or guardian.

"Texas hospitals and our providers have an obligation to honor the wishes of patients who have taken steps to articulate decisions related to end of life care," THA President Ted Shaw said in a statement. "SB 11, if enacted, will work to undermine patients' choices and adds unnecessary confusion and ambiguity within a process that should be a sacred and personal one."

The Texas House voted 122-20 on Sunday in support of Perry's bill. The Senate was expected to give final passage to the bill as early as Monday night.

Todd Ackerman contributed to this report.