Pronouncement of death articles published in the RN Update
"Legislation Allows RNs to Pronounce Death," in RN Update, February, 1992.
Senate Bill 823 passed in the last legislative session gives RNs the legal authority to assess a patient/client and make a determination of death, unless the pronouncement is clearly prohibited under the Health and Safety Code (such as when an inquest is required). The bill specifically requires the RNs employing agency/facility to have written policies jointly developed and approved by the nursing and medical staff to direct the practice.
The bill amended Section 671.001 of the Health and Safety Code. The legislation directed "the board" to adopt rules to govern policies for facilities, institutions or entities that do not have organized nursing staffs and organized medical staffs or medical consultants. Since this legislation amended the Health and Safety Code generally enforced by the Texas Department of Health, it was assumed that "the board" referred to the Board of Health. Legal Counsel at TDH, however, plans to seek an Attorney General's opinion to assure they have authority to adopt rules. This delay only affects those who do not have an organized medical or nursing staff or medical consultant. All other employers of registered nurses may develop policies and once approved by the nursing and medical staffs, RNs may pronounce death.
In RN Update, September, 1994.
Q: I work in the critical care unit of a hospital. I am aware that there was legislation some time ago that allowed nurses to pronounce death in long-term care and hospice facilities, but the nurses on my unit are being asked to pronounce death. Is this allowed, or am I jeopardizing my license?
A: During the 1991 Legislative Session, registered nurses were given the legal authority to determine and pronounce a person dead in situations not involving artificial life support, if permitted by written policies of a licensed health care facility, institution, or entity providing services to that person. The statutory authority is set forth in Chapter 671 of the Health and safety Code. The bill specifically states that if the RN's employing health care facility has an organized nursing staff and an organized medical staff or medical consultant, the nursing staff and medical staff or consultant shall jointly develop and approve those policies. Facilities that do not have an organized nursing or medical staff should contact the Texas Department of Health, who is charged with adopting rules regarding nurse determination of death policies.
12/96
Copr. West 1996 No claim to orig. U.S. govt. works
TX HEALTH & S s 671.001
V.T.C.A., Health & Safety Code § 671.001
VERNON'S TEXAS STATUTES AND CODES ANNOTATED
HEALTH AND SAFETY CODE
TITLE 8. DEATH AND DISPOSITION OF THE BODY
SUBTITLE A. DEATH
CHAPTER 671. DETERMINATION OF DEATH AND AUTOPSY REPORTS
SUBCHAPTER A. DETERMINATION OF DEATH
Copr. West 1996. All rights reserved.
Current through End of 1995 Reg. Sess.
§ 671.001. Standard Used in Determining Death
- (a) A person is dead when, according to ordinary standards of medical practice, there is irreversible cessation of the person's spontaneous respiratory and circulatory functions.
- (b) If artificial means of support preclude a determination that a person's spontaneous respiratory and circulatory functions have ceased, the person is dead when, in the announced opinion of a physician, according to ordinary standards of medical practice, there is irreversible cessation of all spontaneous brain function. Death occurs when the relevant functions cease.
- (c) Death must be pronounced before artificial means of supporting a person's respiratory and circuatory functions are terminated.
- (d) A registered nurse or physician assistant may determine and pronounce
a person dead in situations other than those described by Subsection (b) if
permitted by written policies of a licensed health care facility, institution,
or entity providing services to that person. Those policies must include physician
assistants who are credentialed or otherwise permitted to practice at the
facility, institution, or entity. If the facility, institution, or entity
has an organized nursing staff and an organized medical staff or medical consultant,
the nursing staff and medical staff or consultant shall jointly develop and
approve those policies. The board shall adopt rules to govern policies for
facilities, institutions, or entities that do not have organized nursing staffs
and organized medical staffs or medical consultants.
§ 671.002. Limitation of Liability
- (a) A physician who determines death in accordance with Section 671.001(b) or a registered nurse or physician assistant who determines death in accordance with Section 671.001(d) is not liable for civil damages or subject to criminal prosecution for the physician's, registered nurse's, or physician assistant's actions or the actions of others based on the determination of death.
- (b) A person who acts in good faith in reliance on a physician's, registered
nurse's, or physician assistant's determination of death is not liable for
civil damages or subject to criminal prosecution for the person's actions.
§ 671.011. Filing Autopsy Report
A designated physician who performs an autopsy provided for by state law shall file an autopsy report with the office designated by the autopsy order not later than the 30th day after the date of request for the autopsy unless:
- (1) a required test cannot be completed within that time; and
- (2) the physician certifies when the autopsy report is filed that a required
test could not be completed within the 30-day limit.
§ 671.012. Copies of Reports
A copy of an autopsy report shall be furnished to a duly authorized person on payment of a $5 fee.
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Copr. (C) West 1996 No claim to orig. U.S. govt. works
Tex. Atty. Gen. Op. LO-93-28
1993 WL 360843 (Tex.A.G.)
Office of the Attorney General State of Texas
Letter Opinion No. 93-28
April 13, 1993
Re: Authority to pronounce death and the requisites of a death certificate (ID# 17647)
Honorable Eddie G. Shell
Burnet County Attorney
220 South Pierce
Burnet, Texas 78611
Dear Mr. Shell:
You have requested our opinion regarding the authority to pronounce a person dead and the requisites of a death certificate. You indicate that an individual confined in a nursing home was pronounced dead by a registered nurse, and then transferred to a crematorium. The crematorium requested a death certificate signed by a justice of the peace.
Chapter 671 of the Health and Safety Code describes the standards used in determining death.
Subsection (d) of section 671.001, provides that
- [a] registered nurse may determine and pronounce a person dead in situations other than those described by Subsection (b) [relating to persons on life support systems] if permitted by written policies of a licensed health care facility, institution, or entity providing services to that person.
[Emphasis added.]
Thus, a registered nurse may pronounce a person dead, so long as the health care facility wherein he or she is employed has written policies authorizing a registered nurse to do so. Unless the county clerk and justice of the peace have, with the approval of the county commissioners court, transferred local registrar duties to the county clerk, the "justice of the peace is the local registrar of births and deaths in a justice of the peace precinct." Health & Safety Code s 191.022(a). Sections 193.002 and 193.003 of the Health and Safety Code instruct "the person in charge of interment" to obtain the death certificate and file it in the office of the local registrar within ten days of the date of death. The person who is required to file the death certificate must obtain "the required personal information from a competent person with knowledge of the facts" and "the required medical certification from the physician who was last in attendance on the decedent if the death occurred with medical attendance." [FN1] Id. s 193.004(a).
On its face, section 193.004(a) authorizes only that physician last in attendance on the decedent to provide the required medical certification if the death occurred with medical attendance. See Attorney General Opinion C-124 (1963) at 3 (stating that to sign death certificate as physician person must be licensed by State Board of Medical Examiners). Thus, section 193.004(a) precludes the registered nurse who was in attendance at the death from providing the required medical certification. Section 193.004(a) also precludes the justice of the peace from providing the required medical certification.
Our conclusion that the registered nurse who pronounced a patient dead pursuant to section 671.001(d) of the Health and Safety Code may not provide the medical certification section 193.004(a) requires is consistent with the legislative history of section 671.001(d). The legislature enacted that section as Senate Bill 823 in 1991. See Acts 1991, 72d Leg., ch. 201, s 1. Senate Bill 823 and its companion bill, House Bill 983, initially were introduced essentially in the form that the legislature ultimately enacted. Notably, in public hearings before the House Committee on Public Health, Representative Madla, the sponsor of House Bill 983, affirmed a witness's testimony that the bill, if enacted, would not authorize a registered nurse to sign a death certificate. Hearings on H.B.983 Before the House Comm. on Public Health, 72d Leg. (Mar. 18, 1991) (statement of Representative Madla, sponsor) (affirming statement of Ann Calvert, Texas Hospice Organization) (tape on file with House Committee Coordinator); see also id. (statement of Susan Pascoe, Texas Nurses Ass'n). Instead, according to Representative Madla, a physician would continue to be necessary to sign death certificates. Hearings on H.B.983 Before the House Comm. on Public Health, 72d Leg. (Mar. 18, 1991) (statement of Representative Madla, sponsor).
Representative Park subsequently proposed to amend section 193.004(c) of the Health and Safety Code to authorize a registered nurse to certify the death certificate if the physician who last attended the patient could not certify the death certificate and if the same registered nurse had pronounced the patient dead. Committee Amendment No. 1 to H.B.983, 72d Leg. (1991). In the end, however, the legislature did not adopt Representative Park's amendment. In our opinion, therefore, the legislature explicitly chose not to authorize a registered nurse to provide the medical certification section 193.004(a) of the Health and Safety Code requires the person who must file a death certificate to obtain.
Summary
Section 671.001(d) of the Health and Safety Code authorizes a registered nurse to pronounce a patient dead if the licensed health care facility that employs the nurse has enacted written policies permitting a registered nurse to do so. However, section 193.004(a) of the Health and Safety Code authorizes only that physician last in attendance on the decedent to provide the required medical certification if the death occurred with medical attendance. Neither a registered nurse nor a justice of the peace is authorized to provide the required medical certification.
Yours very truly,
Kymberly K. Oltrogge
Assistant Attorney General
Opinion Committee
FN1 Subsection (a) of section 193.005 of the Health and Safety Code provides that, "[i]f a death or fetal death occurs without medical attendance, the funeral director or the person acting as funeral director shall notify the local registrar of the death." (Emphasis added.) The local registrar is directed to "refer the case to the local health authority for immediate investigation and certification." Health & Safety Code s 193.005(b). In the absence of a local health authority, the local registrar "may complete the death certificate or fetal death certificate and return from the statement of relatives or other persons having adequate knowledge of the facts." Id. Under certain circumstances, the local registrar may require that an inquest be performed. Id. s 193.005(c) - (e).
Tex. Atty. Gen. Op. LO-93-28, 1993 WL 360843 (Tex.A.G.)