Behind the Scenes at Texas HHSC Surrogate Program

In the 1990s, Texas implemented a program to assist in decision making for individuals with intellectual disabilities known as the Surrogate Decision Making Program.   Whether you have liked the system, disliked it, or had little to do with it, the fact is the program has helped thousands of people make decisions with support for health, medical procedures, and psychotropic medications.

Over the years, the staff has come and gone in the Austin office for the Surrogate Program.  The program is currently overseen by two individuals.  Dennis Tomlinson and Marti Granger receive the request for Surrogate service from the entire state of Texas.

Dennis and Marti are responsible for the implementation of the program, according to Texas law.  This means they must gather the initial information, which includes paperwork like Certifications of Need, Data forms, notification forms, etc.  In addition to a list of standard forms from Texas, the two must also gather information about specific procedures or medications.  The information needed can include medical histories, family histories, social and psychological histories, nursing notes, psychiatric notes, or dental and medical notes.  It ultimately depends on what procedure or request is being made to the program as to what documentation will be required.

The program currently only addresses needs in an ICF/IID setting.  The areas covered are major medical treatment, major dental treatment, administration of psychoactive medications,  and the use of highly restrictive behavior procedures.  Also, the program may include the release of records to assist in obtaining consent and decisions the IDT indicates may pose a risk to individual protection and rights.

Outside of Dennis and Marti, the program depends entirely on a network of volunteers.  Volunteers attend a training - usually with Dennis or Marti - and learn the limitations under the law, the rules, and how to conduct hearings for a person from an ICF/IID program.

Perhaps the most crucial aspect of the entire program is the gathering and reviewing of the information for each person served.  Dennis and Marti must ensure that all information possible is gathered, reviewed, compiled, and distributed for a hearing.  The information, should it ever be needed, must show that the program administrators gathered all possible answers, avenues, and potential outcomes for the volunteer to use in making a decision.   The process and responsibility fall entirely to Marti and Dennis in the background.

Often providers and volunteers alike forget there is a considerable amount of work that goes on before a hearing.  Some hearings can last forty-five minutes or an hour or so, but the work that has gone into the preparation sometimes takes weeks and months to come together.  In the diligence required to ensure all aspects of a case are presented for review, Dennis and Marti have the sole responsibility.  It should be remembered that the work they do impacts the ability to make informed decisions for people.  In the area of making informed decisions, there can be no higher calling that requires so much care as ensuring the people we serve have a fair and knowledgeable hearing.  In the shadows of each hearing held, two people can be seen.  From time-to-time, those two people deserve a spotlight, and a thank you for the service they provide to the people living in ICF/IID programs.