When the Texas Legislature debated hospital visitation restrictions in this year’s regular session, it was a microcosm of what society has been wrangling with for a year and a half now.
People – including and perhaps especially hospitalized patients – need human contact, and that contact may need to come from an outside caregiver. Institutions like hospitals need latitude to guard against an outbreak of a contagious, potentially deadly virus like COVID-19.
Balancing those often-conflicting interests became the center of discussions around House Bill 2211 by Rep. Will Metcalf (R-Conroe).
The bill ultimately became law after Texas Medical Association influence made sure it included significant nods to public health and infection control needs. It takes effect on Sept. 1.
Dallas public health specialist John Carlo, MD, chair of TMA’s Council on Legislation, said the final bill navigated “a very tricky situation.” He says the way to think about the law is in relation not just to the current pandemic but also to potential future infectious disease scenarios such as an Ebola outbreak.
“The intention was to be flexible enough so that we could really address [those situations] effectively,” he said.
The new law lays out hospitals’ latitude to restrict visitations during times and in locations of officially declared disasters. For instance, hospitals can’t prohibit in-person visitation with a patient during the disaster period unless federal law or a federal agency requires it. Otherwise, during such a disaster, hospitals can restrict visitors to as few as one person. They can also require visitors to complete a health screening before entering the hospital and to wear personal protective equipment (PPE) at all times.
“[Hospitals] can definitely require [visitors] to have specific kinds of PPE and follow related protocols,” TMA lobbyist Troy Alexander said. “If they don’t comply with what the hospital’s asking, they can be asked to leave.”
Importantly for doctors, hospitals aren’t required to allow in-person visitation with a patient if an attending physician determines that it “may lead to the transmission of an infectious agent that poses a serious community health risk.” An attending physician’s determination along those lines is good for five days and can be renewed after that.
If the attending physician’s decision denies visitation to someone who’s authorized to receive the patient’s health information, such as under a medical power of attorney, the hospital must provide either an oral or written daily update of the patient’s condition. If a patient is seriously ill or dying, the hospital may not prohibit in-person visitation by a religious counselor unless the counselor fails to comply with the health screening or PPE requirements.
Some hospitals may already be well on their way to complying with the new law because of everything that’s occurred since March 2020.
Edinburg gastroenterologist Carlos Cardenas, MD, a TMA past president and chair of the board of Doctors Hospital at Renaissance (DHR), says his facility already had installed a separate unit to isolate patients who required it. In many cases DHR has been setting up video conference visits between patients and their would-be visitors. He says he doesn’t see any issues with HB 2211, and DHR is in the process of formulating its policy to comply with the law.
“Given the circumstance, [legislators] tried to balance all the factors,” Dr. Cardenas said. “I think that it’s reasonable and that we still have the safeguards in place to be able to protect our patients and protect the public.”
HB 2211 also protects hospitals and physicians from civil or criminal penalties if, during a disaster period, a visitor “contracts an infectious disease while on the hospital’s premises … or, in connection with a visit to the hospital, spreads an infectious disease,” except in cases of intentional misconduct or gross negligence.
Mr. Alexander says thanks to Representative Metcalf, chair of the House Administration Committee, TMA was involved in talks on HB 2211 before the 2021 session began and fought to make it mutually palatable both for lonely patients and public health interests.
The new law does still create “many situations like the one we’re in currently, where you could continue to have a spreader because you’re forcing [entry for] these other folks into the facility. But physicians also recognized people need emotional support and patients have suffered from isolation,” Mr. Alexander said.
Two of the House of Representatives’ physician-legislators, Rep. Greg Bonnen, MD (R-Friendswood), and Rep. Tom Oliverson, MD (R-Cypress), cosponsored HB 2211.