Summary — HB 4419 (2025): “Probate: designation of a patient surrogate for health care decisions; allow”
Status: Passed House (9/18/2025); referred to Senate Committee on Civil Rights, Judiciary, and Public Safety (9/22/2025). Tie-bar: enactment contingent on enactment of HB 4418 or Senate companion (request no. S01584'25 / SB 502).
Purpose
- Adds a new Part 6, “Surrogate Decisionmakers for Health Care,” to the Estates and Protected Individuals Code (EPIC) to authorize designated or default “surrogates” to make health care decisions for patients who lack capacity under specified conditions.
Key definitions
- Surrogate: an individual (not a patient advocate or guardian) authorized under EPIC to make health care decisions for a patient.
- Health care decision: selection/discharge of providers or facilities, approval/denial of diagnostic tests, and directions to provide or withhold forms of health care except where a clear-and-convincing patient expression (per EPIC §5509) is required or when governed by Public Health Code patient-surrogate rules.
- Health care: any care, treatment, service, or procedure affecting physical or mental health.
Main provisions
- Designation: An adult or emancipated minor who is competent and admitted to a health facility may designate in writing a surrogate; the designation must be placed in the medical record. If the patient cannot sign, a verbal designation to an attending professional may be accepted if witnessed and documented.
- Priority/default surrogates: If no designation or patient advocate/guardian is available, the bill establishes an ordered, prioritized list of people who may serve (examples: existing guardian, durable power of attorney for health, spouse unless divorcing/absent >1 year, adult child, domestic partner of 12+ months, parent, long-term co-resident, adult sibling, caregiver nominee, close adult familiar with patient’s values). “Reasonably available” is defined (in person, phone, video, etc.).
- Authority conditions: A surrogate may act only when (1) the patient is determined incapable under EPIC §5508 standards, and (2) no patient advocate/guardian is available after documented attempts. The surrogate’s authority is suspended if the patient regains capacity.
- Acceptance and duties: Surrogates must sign a written acceptance placed in the medical record that:
- Affirms fiduciary standards and acting in the patient’s best interest (with known wishes presumptive).
- Prohibits making decisions to withhold/withdraw treatment that would cause the patient’s death.
- Prohibits compensation (but allows reimbursement for necessary expenses).
- Allows revocation by the surrogate; revocations are recorded.
- Requires visitation/access and timely family notification once assuming authority.
- Documentation: Changes in surrogate or revocations must be recorded in the medical record.
Liability and penalties
- Good-faith protections: Health care providers/facilities acting in good faith consistent with accepted standards are protected from civil/criminal liability and professional discipline for complying with or declining to follow asserted surrogate decisions when acting reasonably. Individuals acting as patient advocate, guardian, or surrogate are likewise protected for good‑faith decisions.
- Remedies/penalties:
- Providers/facilities that intentionally violate the part: liable to the aggrieved individual for $1,000 or actual damages (whichever is greater) plus reasonable attorney fees.
- Persons who intentionally falsify/forge/conceal an individual’s patient advocate designation or fraudulently induce action on advance directives: liable for $2,500 or actual damages (whichever is greater) plus attorney fees.
Who is affected
- Patients (adults and emancipated minors in health facilities) without an available patient advocate or guardian.
- Family members, designated surrogates, guardians, and people with durable powers of attorney.
- Health care providers and facilities, which gain statutory liability protections but also new compliance duties and potential damages exposure for intentional violations or fraud.
Procedural/timing notes
- Introduced May 1, 2025 (filed Mar 11, 2025); committee hearings and substitute considered in spring 2025; passed the House with immediate effect (9/18/2025). Enactment is contingent on passage of HB 4418 or the Senate companion listed in the tie-bar. Companion: SB 502.
