(a) Each community center shall develop and implement procedures consistent with this subchapter for the timely reporting and review of deaths.
(b) Deaths subject to a clinical death review will be reviewed by a medical review committee pursuant to the statutes that authorize peer review activities in the State of Texas, consisting of the previously appointed investigating officer and at least two other medical/nursing professionals (M.D., D.O., or R.N.), one of which should be a medical professional whom is neither an employee of the community center nor was the deceased's attending physician (if such medical professional is not available, then the effort to obtain external membership must be documented in the information sent to the administrative death review committee). Of these three committee members, all must be either medical doctors or registered nurses. The community center CEO shall appoint one of the three medical/nursing professionals as chair of the clinical death review committee. For the purposes of this subchapter the term employee does not refer to consultants or contractors. Additionally, the membership of the clinical death review committee may include the community center CEO and/or the director of clinical quality assurance, designee, or the person who is responsible for clinical quality assurance functions.
  (1) Upon determination of the need for a clinical death review, the investigating officer shall provide to the clinical death review committee:
    (A) the individual's medical record;
    (B) a copy of the death certificate, bearing a valid diagnosis, if available;
    (C) a copy of the preliminary or full autopsy report, if available;
    (D) the probable final diagnosis, including contributory causes, and reasons for variance from the death certificate, if any; and
    (E) a briefing of possible issues involving clinically related community center operational policies and procedures and quality of medical care.
  (2) Within 14 calendar days (or 45 days in which an autopsy is performed, or for deaths occurring at medical facilities to which the individual was transferred before death) of the determination of the need for a clinical death review, the clinical death review committee shall meet to review the information the investigating officer has provided as described in subsection (b)(1) of this subsection. On the basis of the review, the committee shall evaluate the quality of medical and nursing care given before death and shall formulate written recommendations, if appropriate, for changes in policy and procedures, professional education, operations, or patient care. Suspected abuse or neglect must be reported in accordance with the rules of the Texas Department of Family and Protective Services.
(c) Within 21 calendar days of the determination of the need for a clinical death review (or 52 days in cases in which an autopsy is performed, or for deaths occurring at medical facilities to which the individual was transferred before death), the clinical death review committee shall submit to the administrative death review committee the following:
  (1) the clinical death review committee's recommendations;
  (2) a copy of the death/discharge summary, if available;
  (3) a copy of the death certificate, bearing a valid diagnosis, if available;
  (4) the probable final diagnosis, including contributory causes, and reasons for variance from the death certificate, if any; and
  (5) documentation of the effort to obtain an external medical professional, if no such person was available.
(d) To maintain the effectiveness of the death review process, HHSC may conduct reviews of the community center's clinical death review process.
(e) The community center CEO is authorized to grant variances from the timelines by this section on a case-by-case basis. Reasons for timeline variances must be justified and documented.

Source Note: The provisions of this §405.274 adopted to be effective June 1, 1993, 18 TexReg 2133; amended to be effective May 26, 2022, 47 TexReg 3056