Texas Legislature Working to Fix Deadly 10-Day Rule That Puts Every Texan’s Life at Risk

Texas is one of the most dangerous states for hospital patients because of one law: the Texas Advance Directives Act, which includes the 10-Day Rule.

Under the Texas Advance Directives Act, if a doctor decides that the life-sustaining treatment a patient receives is “medically inappropriate” and an ethics committee at the hospital agrees, the patient and their family are given 10 calendar days to find a new health care provider that agrees with continuing the treatment. If they are unsuccessful in securing treatment elsewhere, the patient’s dialysis, blood pressure medication, or ventilator may be taken away against their will. There is no reporting or process for appeal — this hastens and often actually causes the patient’s death and violates the patient’s Right to Life and right to due process. 

Anyone could end up in the hospital after a car wreck, stroke, or accident. The deadly 10-Day Rule puts everyone’s life at risk. 

Texas Right to Life works closely with individuals and their families to protect patients from this lethal law and to help them find another facility that will care for them, but even this does not always stop the clock and save the vulnerable patient’s life.

Thankfully, we are working to pass a bill this session that would take significant steps in reforming this law. House Bill 3162 (HB 3162) by Representative Stephanie Klick (R-Fort Worth) modifies several aspects of the law by giving patients and their families more power and rights. 

One of the biggest ways HB 3162 would improve current law is to require the hospital to perform any procedures that are needed in order to facilitate a transfer before the countdown begins. For example, under the current 10-Day Rule, if a patient needs a tracheotomy to be transferred, the hospital can deny that procedure while still counting down the days that patient has left to live, effectively blocking a transfer from happening. This is what happened with baby Tinslee Lewis, who was given only 10 days to live at nine months old. She was only able to survive because Texas Right to Life stepped in and defended her. Thankfully she is now four years old and living at home with her family.

The bill also specifies that the process cannot be imposed on patients who are competent and capable of communication. As patient advocates, we have seen a number of cases where the 10-Day Rule was initiated against patients who were conscious and could actively speak for themselves. It should be obvious that no individual should be making life or death decisions for patients who can make decisions for themselves.

HB 3162 would require that the ethics committee must consider the patient’s well-being, and cannot make judgements based on the perceived “quality of life” of the patient. This includes a prohibition on discrimination against a patient for any unrelated disability they may have. Too often, the judgements made in these committee meetings are based on the idea that the patient’s life is “too hard” or is “not worth living.” A stranger’s personal feelings should not be the reason to bring about the death of another individual.

HB 3162 also makes several changes to the ethics committee meeting process. Notice of the meeting would be required to be given in writing seven days before the meeting happens. Currently, notice is only given 48 hours prior to the meeting. Families are often NOT made aware of the significance of the meeting, and are given very little time to plan. The proposed bill would improve this problem, making families more aware and involved. This extension would also allow family members of the patient to attend and participate in the hospital meeting where the fate of their loved one is decided. 

Another important change is the increase in the number of days the patient and family are provided before life-sustaining treatment is removed. Currently, only 10 calendar days are given for the patient and family to find and secure a transfer. This is one of the most harmful aspects of the law, and it is where we derive the “10-Day Rule” name.

Finally, HB 3162 requires hospitals to report non-identifying information whenever they use this process. Texas Right to Life maintains internal data on the patients and families we assist, but there is no state reporting required, so there is no way of knowing how often this law is used against fragile patients across Texas. Knowing how frequently hospitals use this rule on patients will help us as patient advocates and allow more clarity in what future adjustments may be needed to improve this law.

HB 3162 is scheduled to be debated on the House Floor on Saturday, May 6. This is the furthest that a bill significantly reforming the 10-Day Rule has gone in many years. Please join us in supporting the passage of this bill so that Texas patients are better protected!

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