reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 404.159 - Rights of Persons Apprehended for Emergency Detention for Inpatient Chemical Dependency Services

Current through Reg. 49, No. 28; July 12, 2024
The rights of each person apprehended and presented for emergency
													 detention for inpatient chemical dependency services at a department facility, community center, or
													 psychiatric hospital are granted under the relevant sections of the Texas Alcohol and Drug Abuse Services Act
													 (Texas Civil Statutes, Article 5561c-2).
(1) Each person apprehended
											  or detained, but not yet admitted, for emergency detention has the following rights.
(A) The right to be advised of the location of detention, the reasons for
											  detention, and that detention could result in a longer period of involuntary commitment.
(B) The right to contact an attorney of the person's own choosing with
											  opportunities to contact that attorney.
(C) The right to be
											  transported back to the location of apprehension, or other suitable place, if not admitted for emergency
											  detention, unless the person is arrested or objects to the return.
(D) The right to be released if the head of the department facility,
											  community center, or psychiatric hospital determines that any one of the criteria for emergency detention, as
											  outlined in the Texas Health and Safety Code, §
											573.022, no longer
											  applies.
(E) The right to be informed that anything the person
											  says to the personnel of the department facility, community center, or psychiatric hospital may be used in
											  proceedings for further detention.
(F) The right to have a
											  preliminary examination by a physician conducted immediately upon arrival at the department facility,
											  community center, or psychiatric hospital following apprehension to determine whether the person meets the
											  criteria for admission for emergency detention. If a physician is not available to conduct the examination,
											  steps shall immediately be taken to arrange for the examination as soon as possible, but in no case more than
											  24 hours after apprehension.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 404.160 - Special Rights of Minors Receiving Inpatient Mental Health Services

Current through Reg. 49, No. 28; July 12, 2024
In addition to the applicable rights addressed in §
										404.154-404.159
													 of this title (relating to Rights of All Persons Receiving Mental Health Services; Rights of Persons
													 Receiving Residential Mental Health Services; Additional Rights of Persons Receiving Residential Mental
													 Health Services at Department; Rights of Persons Voluntarily Admitted to Inpatient Services; Rights of
													 Persons Apprehended for Emergency Detention for Inpatient Mental Health Services (Other Than for Chemical
													 Dependency); and Rights of Persons Apprehended for Emergency Detention for Inpatient Chemical Dependency
													 Services), minors admitted to inpatient mental health services shall have the following rights.
(1) The right to treatment by persons who have specialized education and
											  training in the emotional, mental health, and chemical dependency problems and treatment of minors.
(2) The right to receive inpatient services in an area separated from
											  adults receiving services.
(3) The right to regular communication
											  with the individual's family. Other than in keeping with the general rules of the facility, this right may
											  only be limited when the limitation is necessary to protect the individual's welfare in keeping with
											  procedures outlined in §
										404.155(a)(2)
											  of this title (relating to Rights of Persons Receiving Residential Mental Health Services).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 404.161 - Rights Handbooks for Persons Receiving Mental Health Services at Department Facilities, Community Centers, and Psychiatric Hospitals Operated by Community Centers

Current through Reg. 49, No. 28; July 12, 2024
(a) The department will publish a
											  rights handbook which will contain interpretations written in simple and nontechnical language of the various
											  rights afforded individuals receiving mental health services, an explanation of the circumstances under which
											  those rights may be limited, and an explanation of the appeals process. This handbook will be revised by the
											  Office of Consumer Services and Rights Protection as necessary.
(b) The department will publish a Teen's Bill of Rights and a Children's
											  Bill of Rights ("The Little Dinosaur Named Wilbur," with supplementary material) which are adopted by
											  reference as Exhibits B and C of this subchapter, respectively, with copies available from the Texas
											  Department of Mental Health and Mental Retardation, P.O. Box 12668, Austin, Texas 78711-2668. The Teen's Bill
											  of Rights and the Children's Bill of Rights will contain interpretations written in simple and nontechnical
											  language of the rights afforded minors receiving mental health services, an explanation of the circumstances
											  under which those rights may be limited, and organizations individuals may contact in the event of rights
											  violations. The Teen's Bill of Rights and the Children's Bill of Rights will be revised as necessary.
(1) The Teen's Bill of Rights is generally recommended for minors over the
											  age of eight.
(2) The Children's Bill of Rights is generally
											  recommended for minors under the age of eight.
(3)
											  Notwithstanding these guidelines, staff should consider the developmental level of the minor being admitted
											  in determining the appropriate document to be provided. Minors may also request and receive the rights
											  handbook.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 404.163 - Communication of Rights to Individuals Receiving Mental Health Services

Current through Reg. 49, No. 28; July 12, 2024
(a) In addition to receiving a
											  rights handbook, each newly admitted individual, the parent or conservator of a minor, and the guardian of
											  the person shall be informed orally of all rights in his or her primary language using plain and simple terms
											  within 24 hours of admission into services. Persons admitted for voluntary services shall be given this
											  information prior to admission to services. The notification will also include an explanation of the
											  circumstances under which those rights may be limited, and an explanation of how a complaint may be filed.
											  This notification also must occur at least annually and upon any changes to this information. The method used
											  to communicate the information should be designed for effective communication, tailored to meet each person's
											  ability to comprehend, and responsive to any visual or hearing impairment.
(b) Oral communication of rights shall be documented on a form bearing the
											  date and signatures of the individual and/or the parent, conservator, or guardian, and the staff member who
											  explained the rights. The form should be filed in the individual's chart. Psychiatric hospitals should use
											  the form provided on the Patient's Bill of Rights. Department facilities should use the Receipt of
											  Information Record (MHRS 9-1 Form). Community centers may use the MHRS 9-1 Form or a form of their own design
											  which contains all of the applicable elements, so long as the form is used only for the documentation of
											  communication of rights.
(c) When the individual receiving
											  services is unable or unwilling to sign the document which confirms that rights have been orally
											  communicated, a brief explanation of the reason should be entered onto that document along with the
											  signatures of the person who explained the rights and a third-party witness.
(d) If the individual does not appear to understand the rights explanation,
											  staff will attempt to provide another explanation periodically until understanding is reached or until
											  discharge. The necessity for repeating the rights communication process will be documented, signed, and dated
											  by staff.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 404.164 - Rights Protection Officer at Department Facilities and Community Centers

Current through Reg. 49, No. 28; July 12, 2024
(a) The head of each
											  department facility and each community center shall appoint a rights protection officer for the facility or
											  center. The rights protection officer must be able to perform the duties of this office without any conflicts
											  of interest.
(b) The name, telephone number, and mailing address
											  of the rights protection officer must be prominently posted in every program or residential area frequented
											  by service recipients, including community outreach or contract programs. Individuals desiring to contact the
											  rights protection officer must be allowed access to facility or center telephones to do so.
(c) Duties required of the rights protection officer are specified at the
											  discretion of the head of the facility or center, but must include the following:
(1) receiving complaints/allegations of violations of rights, allegations
											  of inadequate provision of services, and requests for advocacy from service recipients, their families, their
											  friends, service providers, other facility or center personnel, other agencies, the general public, and the
											  Office of Consumer Services and Rights Protection;
(2) thoroughly
											  investigating each such complaint received;
(3) representing the
											  expressed desires of the individuals served and advocating for the resolution of their grievances;
(4) reporting the results of investigations and advocacy to service
											  recipients and the complainants, consistent with the protection of the service recipients' right to have any
											  identifying information remain confidential;
(5) ensuring that
											  the rights of individuals receiving services have been thoroughly explained to facility and center personnel
											  through periodic training. The rights protection officer may provide the training directly or by consulting
											  with facility or center training personnel; and
(6) reviewing all
											  policies, procedures, behavior therapy programs, and rules which affect the rights of persons receiving
											  services.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 404.165 - Staff Training in Rights of Persons Receiving Mental Health Services

Current through Reg. 49, No. 28; July 12, 2024
This subchapter shall be thoroughly and periodically explained to
													 all employees of each department facility, community center, and psychiatric hospital as follows.
(1) All new employees shall receive the instruction on the content of this
											  subchapter during their orientation training and prior to beginning work.
(2) Within 60 days after the effective date of this subchapter, all current
											  employees shall be briefed on its contents by the head of the department facility, community center, or
											  psychiatric hospital or designee.
(3) All supervisory personnel
											  shall have a continuing responsibility to keep employees informed about rules governing rights of persons
											  receiving mental health services and shall ensure that each employee receives training on the subject not
											  less than once each calendar year. At department facilities and community centers, such training shall be
											  reported to the department facility or community center's office for staff development. Psychiatric hospitals
											  shall develop an appropriate means for maintaining training records.
(4) A record shall be kept by the psychiatric hospital or the department
											  facility or community center's office for staff development on each employee receiving orientation, annual
											  training, or additional instruction in compliance with this section, including the date training was provided
											  and the name of the individual conducting the training.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 404.166 - Restriction of Rights as Part of Non-Emergency Behavioral Interventions

Current through Reg. 49, No. 28; July 12, 2024
(a) Patients rights are
											  guaranteed under the provisions of this subchapter. Although under special circumstances set out in this
											  subchapter, certain rights can be limited without informed consent, it is usually mandatory and always
											  preferable to obtain informed consent when limitation of rights is contemplated.
(b) Except as otherwise noted in this subchapter, written informed consent
											  must be obtained when a right guaranteed by law or department rule is limited.
(1) The patient or legally authorized representative gives informed
											  consent. Written informed consent is obtained from the:
(A) adult
											  individual, if legally competent and deemed to be capable of understanding the required elements which
											  constitute informed consent;
(B) guardian of the person of the
											  adult individual if there has been a determination of mental incompetence by a court; or
(C) parent or managing conservator of a minor under the age of
											  16.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 404.167 - Restriction of Rights as Part of Emergency Behavioral Interventions: Restraint and Seclusion

Current through Reg. 49, No. 28; July 12, 2024
Restraint and seclusion shall be initiated, implemented, and
													 monitored in keeping with the provisions of Chapter 405, Subchapter F of this title (relating to Voluntary
													 and Involuntary Behavioral Interventions in Mental Health Programs).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 404.168 - References

Current through Reg. 49, No. 28; July 12, 2024
Reference is made to the following Texas laws, federal laws,
													 departmental rules, and other standards:
(1) Texas Department of
											  Mental Health and Mental Retardation (Texas Health and Safety Code, Chapters 531-535);
(2) Texas Mental Health Code (Texas Health and Safety Code, §§
										572.003,
											  573.022,
											  573.025,
											  576.001-.024,
											  611.002);
(3) Treatment of Chemically Dependent Persons (Texas
											  Health and Safety Code, Chapters 461 and 462);
(4) 42 Code of
											  Federal Regulations, Part 2;
(5) Public Law 99-319, The
											  Protection and Advocacy Act for Mentally Ill Individuals (42 USC §10802, et seq.);
(6) Chapter 403, Subchapter K of this title (relating to Client-Identifying
											  Information);
(7) Texas Administrative Code (TAC), Title 40,
											  Chapter 710, Subchapter A (Abuse and Neglect of Persons Served by TXMHMR Facilities);
(8) TAC, Title 40, Chapter 710, Subchapter B (Client Abuse and Neglect in
											  Community Mental Health and Mental Retardation Centers);
(9) TAC,
											  Title 40, Chapter 710, Subchapter C (Patient Abuse in Private Psychiatric Hospitals);
(10) Chapter 405, Subchapter F of this title (relating to Voluntary and
											  Involuntary Behavioral Interventions in Mental Health Programs);
(11) Chapter 405, Subchapter FF of this title (relating to Consent to
											  Treatment With Psychoactive Medication);
(12) Fair Labor
											  Standards Act;
(13) Joint Commission on the Accreditation of
											  Healthcare Organizations, Comprehensive Accreditation Manual for Hospitals (1996);
(14) TDMHMR Mental Health Community Services Standards (1995), Chapter 3;
											  and
(15) RAJ v. Jones settlement agreement.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 404.169 - Distribution

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter shall be distributed to members of the Texas Board of
											  Mental Health and Mental Retardation, commissioner, assistant commissioner, medical director, and management
											  and program staff of Central Office; superintendents and directors of all TDMHMR mental health facilities;
											  and executive directors and chairpersons of the boards of all Texas community mental health and mental
											  retardation centers; chief executive officers of all psychiatric hospitals in Texas; Advocacy Inc.; the Texas
											  Mental Health Consumers; the Texas Alliance for the Mentally Ill; the Mental Health Association in Texas; and
											  other interested advocacy organizations.
(b) The superintendent
											  or director of each facility and the executive director of each community center shall provide a copy of this
											  subchapter to the facility or center rights officer; the chair of the facility's or center's public
											  responsibility committee; all appropriate staff; each individual who provides direct services under contract;
											  and any other person who requests a copy.
(c) The chief executive
											  officers of psychiatric hospitals shall provide a copy of this subchapter to the rights officer; all
											  appropriate staff; each individual who provides direct services under contract; and any other person who
											  requests a copy.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 405.101 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is:
(1) to establish uniform procedures for informed consent to ECT;
(2) to establish statewide reporting requirements for the use of ECT and
											  other procedures;
(3) to establish statewide registration
											  requirements for ECT equipment;
(4) to prohibit the use of ECT in
											  persons under 16 years of age;
(5) to prohibit the administration
											  of ECT by any person not licensed to practice medicine in Texas; and
(6) to provide explicit safeguards for patients in all facilities of the
											  Texas Department of Mental Health and Mental Retardation, community mental health and mental retardation
											  centers, private inpatient psychiatric hospitals licensed by the Texas Department of Health under the Texas
											  Health and Safety Code, Chapter 577, and psychiatric units of hospitals licensed by the Texas Department of
											  Health under the Texas Health and Safety Code, Chapter 241, by:
(A)
											  establishing appropriate limits for the therapeutic utilization of electroconvulsive therapy;
(B) establishing current guidelines of the American Psychiatric Association
											  and the Food and Drug Administration as the references of choice in questions of practice related to ECT,
											  except to the extent that they conflict with the provisions of the Health and Safety Code, Title 7, Subtitle
											  C, Chapter 578; and
(C) prohibiting the use of chemical or
											  gaseous agents for convulsive therapy except as a research procedure conducted in accordance with Subchapter
											  Q of this chapter (relating to Departmental Procedures for the Protection of Human Subjects Involved in
											  Research).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 405.102 - Application

Current through Reg. 49, No. 28; July 12, 2024
(a) The provisions of this subchapter apply to all organizations and
											  individuals providing electroconvulsive therapy on an inpatient or outpatient basis, in or on a contractual
											  basis with:
(1) all facilities of the Texas Department of Mental Health and
											  Mental Retardation;
(2) community mental health and mental
											  retardation centers;
(3) psychiatric hospitals licensed by the
											  Texas Department of Health under the Health and Safety Code, Chapter 577; and
(4) psychiatric units of hospitals licensed by the Texas Department of
											  Health under the Health and Safety Code, Chapter 241.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 405.104 - General Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) Only a physician licensed to practice medicine in Texas may administer
											  ECT and a physician may not delegate the act of administering the therapy. A nonphysician who administers ECT
											  is considered to be practicing medicine in violation of the Medical Practice Act, Texas Civil Statutes,
											  Article 4495b.
(b) No person under the age of 16 shall receive
											  ECT.
(c) Prior to receiving ECT, every patient, voluntary or
											  involuntary, competent or incompetent, shall be given full explanation of ECT consistent with the definition
											  of ECT in §
										405.103 of this title (relating to Definitions) and
											  meeting the requirements of §
										405.108 of this title (relating to
											  Informed Consent to ECT).
(d) If any patient, without regard to
											  competency, objects to ECT and there is an alternative method of treatment (that is not contraindicated and
											  which has a reasonable potential for success) to which the patient does not object, the alternative method
											  shall be considered and, if mutually acceptable to the patient or the guardian of the person of the patient
											  and the treating physician, shall be used. It is not to be inferred, however, that ECT should be held as a
											  treatment of "last resort." Full documentation of the factors considered in arriving at the decision to use
											  ECT, the consent process, the treatment procedures, and patient response to treatment shall be entered into
											  the patient's permanent medical record.
(e) The use of ECT for
											  punishment, solely for control of behavior, for convenience of staff, in order to make patients more
											  compliant, and the use of ECT in a discriminatory or abusive manner are explicitly prohibited.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 405.105 - Indications and Contraindications for the Use of Electroconvulsive Therapy (ECT)

Current through Reg. 49, No. 28; July 12, 2024
(a) The major
											  indications for the therapeutic use of ECT are major mood disorders. ECT may be considered for some other
											  disorders, with appropriate consideration of the risk/benefit ratio.
(b) The major contraindications to the therapeutic use of ECT are as
											  follows:
(1) absolute space-occupying intracranial pathology;
(2) relative, requiring clinical consideration:
(A) cardiovascular disease, including arrhythmias, myocardial disease, or
											  coronary artery disease;
(B) diseases which render a patient
											  likely to suffer hemorrhage, including peptic ulcer, subdural hematoma, and aortic aneurysm;
(C) degenerative diseases of the central nervous system;
(D) glaucoma although it is recognized that intraocular pressure is not
											  increased by ECT, and is, in fact, reduced during the seizure period, medications used adjunctively to the
											  treatment may result in increased intraocular pressure. For patients with glaucoma, consideration should be
											  given to pretreatment with physostigmine;
(E) severe orthopedic
											  disability.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 404 - PROTECTION OF CLIENTS AND STAFF-MENTAL HEALTH SERVICES › Subchapter E - RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES › Section 405.106 - Medical Evaluation Required Prior to a Course of Electroconvulsive Therapy (ECT)

Current through Reg. 49, No. 28; July 12, 2024
(a) A thorough
											  evaluation of the patient's psychiatric and physical status with review of pertinent laboratory findings
											  shall be done within 30 days prior to the initiation of a course of ECT and shall be recorded in the
											  patient's permanent medical record. Physical evaluation shall include a neurological examination. Other
											  determinations shall include, but not be limited to, the following:
(1)
											  laboratory as appropriate to medical history and/or conditions, such as:
(A) complete blood count;
(B)
											  electrolytes; and
(C) serum pseudocholinesterase if there is no
											  documentation of successful use of muscle relaxant medication with general anesthesia, and if there is no
											  record of previous testing;
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter E - ELECTROCONVULSIVE THERAPY (ECT) › Section 405.107 - Consultation Required

Current through Reg. 49, No. 28; July 12, 2024
(a) Before initiating a course of ECT, it shall be the responsibility of
											  the attending physician who is not a fully qualified psychiatrist to obtain consultation from a fully
											  qualified psychiatrist, licensed to practice medicine in Texas.
(b) The consultant shall render a written report regarding the
											  appropriateness and probable benefits to be obtained by administration of ECT. That report will be
											  incorporated into the patient's permanent medical record.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter E - ELECTROCONVULSIVE THERAPY (ECT) › Section 405.108 - Informed Consent to ECT

Current through Reg. 49, No. 28; July 12, 2024
(a) Consent under this section is not valid unless the person giving
											  consent understands the information presented and consents voluntarily and without coercion or undue
											  influence.
(b) A person who gives consent may revoke consent for
											  any reason at any time, with revocation effective immediately.
(c) Prior to each individual ECT treatment, consent to electroconvulsive
											  therapy must be obtained. Unless the person consents in accordance with this subchapter, ECT may not be
											  administered to:
(1) a patient who is 16 years or older and voluntarily
											  receiving services;
(2) an involuntary patient who is 16 years or
											  older and who has not been adjudicated incompetent to manage his or her own personal affairs;
(3) an involuntary patient who is 16 years or older and who has been
											  adjudicated incompetent to manage his or her own personal affairs, unless:
(A) the patient has an appointed guardian of the person of the
											  patient;
(B) the guardian of the person consents to treatment in
											  accordance with this section; and
(C) the consent of the guardian
											  is based on knowledge of what the patient would desire, if known.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter E - ELECTROCONVULSIVE THERAPY (ECT) › Section 405.109 - Limitations on Use: Number per Year and Number per Series of Treatments

Current through Reg. 49, No. 28; July 12, 2024
(a) No more than 24
											  electroconvulsive therapy treatments may be administered to a given patient in any 12-month period, dated
											  from the date of the first treatment except as provided in this subsection.
(1) Exceptions to this limitation require, prior to the additional
											  treatments:
(A) for state facilities, the written approval of the
											  department's medical director, who shall consider the recommendations of an independent, fully qualified
											  psychiatrist who is not affiliated with the department except in a consultative capacity; or
(B) for all other providers, the written concurrence of a fully qualified
											  psychiatrist not involved in the patient's care.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter E - ELECTROCONVULSIVE THERAPY (ECT) › Section 405.110 - Personnel and Equipment Procedures

Current through Reg. 49, No. 28; July 12, 2024
(a) Personnel. ECT may be administered only by a
											  licensed physician credentialed by the facility providing the treatment to use ECT, or by a licensed
											  physician in training in an approved residency program under the direct supervision of a fully qualified
											  psychiatrist so trained and credentialed. In specific circumstances a licensed physician who is not a fully
											  qualified psychiatrist but who has demonstrated training and experience in the administration of ECT may
											  administer ECT providing authorization has been provided in writing to the chief executive officer by the
											  hospital or facility medical director. Assistants shall include a recovery nurse and an ECT treatment nurse
											  or assistant trained in ECT procedures.
(b) Equipment. Equipment
											  available in the ECT room shall receive a general inspection on a regular basis. Equipment shall include, but
											  not be limited to, the following:
(1) an ECT machine of contemporary model
											  which shall be calibrated at least semiannually;
(2) a
											  respiratory support system including oxygen, endotracheal intubation tray, suction apparatus, and equipment
											  for tracheotomy;
(3) a cardiac arrest tray with appropriate
											  drugs;
(4) a cardiac monitor and defibrillator.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter E - ELECTROCONVULSIVE THERAPY (ECT) › Section 405.111 - Prohibition of Induction of Seizure by Chemical or Gaseous Agent

Current through Reg. 49, No. 28; July 12, 2024
No chemical or gaseous agent may be used as a means to induce a
													 seizure for therapeutic purposes, in lieu of or as a substitute for electroconvulsive therapy, unless such
													 procedure is conducted as a research investigation and meets all the requirements of Subchapter Q of this
													 chapter (relating to Departmental Procedures for the Protection of Human Subjects Involved in
													 Research).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter E - ELECTROCONVULSIVE THERAPY (ECT) › Section 405.112 - Report of ECT

Current through Reg. 49, No. 28; July 12, 2024
(a) Reporting requirements for state facilities and community centers.
(1) A report of each individual ECT administered to a patient shall be
											  entered into the patient's medical record and shall include, but not be limited to, the following:
(A) diagnosis for which ECT given;
(B) date of treatment;
(C) type
											  of ECT machine used;
(D) duration and strength of electrical
											  stimulation;
(E) all medications administered; and
(F) any complications or adverse effects.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter E - ELECTROCONVULSIVE THERAPY (ECT) › Section 405.113 - ECT on Outpatient Basis

Current through Reg. 49, No. 28; July 12, 2024
If ECT is to be given to patients on an outpatient basis, all the
													 provisions of this subchapter apply.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter E - ELECTROCONVULSIVE THERAPY (ECT) › Section 405.114 - Registration of ECT Stimulus Apparatus

Current through Reg. 49, No. 28; July 12, 2024
(a) A person may not administer ECT unless the
											  equipment used to administer the therapy is registered annually with the department. All ECT stimulus
											  apparatus must be registered with the department by the mental hospital or other facility or by the private
											  physician administering ECT on an outpatient basis.
(1) The department
											  shall use the information to analyze, audit, and monitor the use of ECT.
(2) The department shall file annually a report summarizing the information
											  with the governor and the presiding officers of the legislature. The report shall not name or otherwise
											  identify individual physicians or patients.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter E - ELECTROCONVULSIVE THERAPY (ECT) › Section 405.115 - Enforcement and Penalties

Current through Reg. 49, No. 28; July 12, 2024
(a) For private psychiatric hospitals and psychiatric units of general
											  hospitals, the Texas Department of Health shall enforce the applicable rules and standards adopted by the
											  department to the same extent as it enforces rules adopted by the Texas Board of Health. A violation of this
											  subchapter is subject to the same consequences as a violation of a rule adopted by the Texas Board of
											  Health.
(b) A person who violates a provision of this subchapter
											  may be subject to injunction, civil penalties, and related costs pursuant to the provisions of the Health and
											  Safety Code, Chapter 571, §§571.022-.024, and Chapter 241, §241.055.
(c) A person licensed by the Texas Department of Health or regulated by the
											  department who violates a provision of this subchapter may be subject to administrative penalties and related
											  costs pursuant to the Health and Safety Code, Chapter 571, §§571.025-.026, and Chapter 241,
											  §241.058 and §241.0585.
(d) A treatment facility or
											  mental health facility that violates a provision of this subchapter is liable to a person receiving care or
											  treatment from the facility who is harmed as a result of the violation, consistent with the provisions of the
											  Health and Safety Code, Chapter 321, Subsections 321.003-.004.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter E - ELECTROCONVULSIVE THERAPY (ECT) › Section 405.116 - Distribution

Current through Reg. 49, No. 28; July 12, 2024
(a) The provisions of this subchapter shall be distributed to:
(1) members of the Texas Board of Mental Health and Mental
											  Retardation;
(2) deputy commissioners, associate deputy
											  commissioners, and assistant deputy commissioners of TXMHMR central office;
(3) superintendents and directors of all department facilities;
(4) the TXMHMR Medical Advisory Committee;
(5) chairpersons of the boards of trustees and executive directors of
											  community mental health and mental retardation centers;
(6) chief
											  executive officers and medical staff chiefs of all inpatient facilities licensed in Texas;
(7) chief executive officers and chief physicians at other state agencies
											  providing medical care, including, but not limited to, the Texas Department of Criminal Justice, the Texas
											  Department of Corrections, and the Texas Department of Health;
(8) all psychiatrists licensed to practice medicine in Texas;
(9) the executive director of the Texas Society of Psychiatric
											  Physicians;
(10) the executive director of the Texas Medical
											  Association;
(11) the executive director of the Texas Hospital
											  Association;
(12) psychiatry department chairs of universities in
											  Texas;
(13) psychiatry department heads of Veterans
											  Administration hospitals;
(14) psychiatry department heads of
											  large hospital departments of psychiatry; and
(15) the Texas
											  State Board of Medical Examiners.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter E - ELECTROCONVULSIVE THERAPY (ECT) › Section 405.117 - Exhibits

Current through Reg. 49, No. 28; July 12, 2024
The following exhibits referenced in this subchapter are available
													 by contacting TDMHMR, Policy Development, P.O. Box 12668, Austin, Texas 78711-2668:
(1) Exhibit A--"Disclosure and Consent for Electroconvulsive Therapy":
Attached Graphic
(2) Exhibit B--"Supplemental Statement"; and
Attached Graphic
(3) Exhibit C--"Report of ECT/Other Therapies."
Attached Graphic
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter K - DEATHS OF INDIVIDUALS SERVED BY COMMUNITY MENTAL HEALTH CENTERS › Section 405.261 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to provide clinical peer review
													 procedures and, separately, administrative review procedures to be followed upon the death of an individual
													 receiving services directly operated or contracted for by a community mental health center, and their
													 respective contract providers, in order to improve the quality of care.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter K - DEATHS OF INDIVIDUALS SERVED BY COMMUNITY MENTAL HEALTH CENTERS › Section 405.262 - Application

Current through Reg. 49, No. 28; July 12, 2024
The provisions of this subchapter apply to community mental health
													 centers and to their respective contract providers.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter K - DEATHS OF INDIVIDUALS SERVED BY COMMUNITY MENTAL HEALTH CENTERS › Section 405.263 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this subchapter, shall
													 have the following meanings, unless the context clearly indicates otherwise.
(1) Administrative death review--An administrative/quality assurance review
											  activity to identify non-clinically related problems requiring correction and opportunities to improve the
											  quality of care.
(2) Attending physician--A physician licensed to
											  practice medicine in the State of Texas who is responsible for the general medical care and/or psychiatric
											  care of the individual served.
(3) Chief executive officer or
											  CEO--The executive director of a community center.
(4) Clinical
											  death review--A clinical quality assurance/peer review activity conducted to identify clinically related
											  problems requiring correction and opportunities to improve the quality of care pursuant to the statutes that
											  authorize peer review activities in the State of Texas.
(5)
											  Community center--A community mental health center organized pursuant to the Texas Health and Safety Code,
											  Title 7, Chapter 534, §534.053 (formerly the Texas Mental Health and Mental Retardation Act, §3, as
											  amended, Texas Civil Statutes, Article 5547-201 et seq.).
(6)
											  Contract provider--An entity which, through written agreement or contract, is providing services to an
											  individual served by a community center, including entities regulated by other governmental
											  agencies.
(7) Deceased--An individual who, at death, is receiving
											  services directly operated or contracted for by a community center.
(8) HHSC--The Texas Health and Human Services Commission.
(9) Investigating officer--A physician or registered nurse who is neither
											  the attending physician nor anyone significantly involved as the primary provider of treatment to the
											  deceased immediately preceding the death.
(10) Registered
											  nurse--A nurse licensed by the Texas Board of Nurse Examiners to practice professional nursing in the State
											  of Texas.
(11) Unusual circumstances--A death which occurs under
											  circumstances including, but not limited to, the following: unnatural death; death by unlawful means or
											  suspicion of death by unlawful means; absence of witnesses; suicide or suspicion of suicide; or death within
											  24 hours of admission to the community center.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter K - DEATHS OF INDIVIDUALS SERVED BY COMMUNITY MENTAL HEALTH CENTERS › Section 405.266 - Community Centers: Actions Taken upon the Death of an Individual Served

Current through Reg. 49, No. 28; July 12, 2024
(a) Each community center shall develop separate
											  clinical peer review and administrative review procedures consistent with this subchapter to be implemented
											  at the time that a determination has been made to conduct a death review.
(b) When appropriate, the community center CEO or designee shall notify the
											  deceased's personal representative (primary or emergency correspondent(s)) of the death; provide an
											  explanation of the relevant facts related to the death; and inform them of their right to examine the
											  deceased's medical information relevant to the death, death certificate, and autopsy findings, if any. A
											  physician shall request consent to conduct an autopsy when appropriate.
(c) Immediately after determination of the need to conduct an
											  administrative death review, the community center CEO shall be responsible for ensuring that the completed
											  HHSC reporting form is submitted to HHSC.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter K - DEATHS OF INDIVIDUALS SERVED BY COMMUNITY MENTAL HEALTH CENTERS › Section 405.268 - Community Centers: General Guidelines upon Death of an Individual Served

Current through Reg. 49, No. 28; July 12, 2024
(a) When a death has been determined to
											  require an administrative death review, a copy of the certificate of death shall be made a part of the
											  deceased's record, when possible.
(b) When appropriate, the
											  property of the deceased will be disposed of under the provisions of the Texas Probate Code.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 405 - PATIENT CARE-MENTAL HEALTH SERVICES › Subchapter K - DEATHS OF INDIVIDUALS SERVED BY COMMUNITY MENTAL HEALTH CENTERS › Section 405.269 - Community Centers: Administrative Death Review Determination

Current through Reg. 49, No. 28; July 12, 2024
(a) Within one working day of the knowledge of
											  death of an individual receiving services in an HHSC-funded or HHSC-contracted program, the community center
											  CEO is responsible for conducting a preliminary review to determine whether:
(1) the death occurred on the premises of an HHSC-funded or HHSC-contracted
											  program (e.g., the individual dies in his/her sleep at an MHA/MRA funded group home);
(2) the death occurred while the individual was participating in
											  HHSC-funded or HHSC-contracted program activities (e.g., the individual dies in a community hospital after
											  being transferred from the community center; the individual drowns while on a psychosocial program
											  outing);
(3) other conditions indicate that the death may
											  reasonably have been related to the individual's care or activities as part of the community center program
											  (e.g., the individual overdoses on a psychoactive drug; the individual dies by suicide); or
(4) other conditions indicate that although the death is not reasonably
											  related to the individual's care or activities as part of the community center program, an evaluation of
											  policy is warranted (e.g., the individual dies of a chronic illness in a community
											  hospital).