Oregon Administrative Rules
Chapter 416 - OREGON YOUTH AUTHORITY
Division 345 - YOUTH IN CUSTODY MEDICAL CARE AND TREATMENT IN YOUTH CORRECTION FACILITIES
Section 416-345-0030 - Levels of Medical Care and Treatment
Universal Citation: OR Admin Rules 416-345-0030
Current through Register Vol. 63, No. 3, March 1, 2024
(1) Youth in custody medical care and treatment is authorized and provided according to priorities established by the OYA medical director. Medical care and treatment is generally prioritized into four levels.
(2) Level 1 - medically mandatory care and treatment
(a)
Level 1 care and treatment is medical care and treatment that is essential to
life and health, without which rapid deterioration may be an expected outcome
and where medical surgical intervention makes a very significant difference, or
has a very high cost effectiveness. Examples of conditions that may allow for
Level 1 care and treatment include:
(A) Acute
problems, potentially fatal, where treatment prevents death and allows full
recovery, (e.g., appendectomy for appendicitis);
(B) Acute problems, potentially fatal, where
treatment prevents death but does not necessarily allow for full recovery
(e.g., burn treatment, treatment for severe head injuries, status asthmaticus);
and
(C) Maternity care (e.g.,
monitoring, delivery, gestational hypertension).
(b) Any OYA medical practitioner may
authorize Level 1 care and treatment for a youth in custody. OYA nursing staff
may authorize Level 1 care and treatment for a youth in custody in an emergency
situation.
(3) Level 2 - presently medically necessary care and treatment
(a) Level 2 care and treatment is medical
care and treatment that is medically necessary, without which a youth in
custody cannot be maintained without significant risk of further serious
deterioration of the condition, significant pain or discomfort, or significant
reduction of the chance of possible repair after release from OYA custody.
Examples of conditions that may allow for Level 2 care and treatment, or types
of Level 2 care and treatment, include:
(A)
Chronic, usually fatal, conditions where treatment improves lifespan and
quality of life (e.g., insulin-dependent diabetes mellitus, asthma,
hypertension);
(B)
Immunizations;
(C) Comfort care
such as pain management and hospice-type care for the end stages of diseases
such as cancer and AIDS;
(D) Proven
effective preventive care for youth (e.g., preventive dental care, pap smears,
blood pressure screenings, sexually transmitted disease screenings);
(E) Acute nonfatal conditions where treatment
causes a return to a previous state of health (e.g., fillings for dental
cavities, medical treatment of various infectious disorders);
(F) Acute nonfatal conditions where treatment
allows the best approximation of return to previous health (e.g., reduction of
dislocated elbow or shoulder, repair of corneal laceration, treatment of
displaced fractures of the extremities); and
(G) Medical treatment to ameliorate symptoms
of gender dysphoria.
(b)
Any OYA medical practitioner may authorize Level 2 care and treatment for a
youth in custody. The decisions of practitioners are subject to periodic review
by the OYA medical director.
(4) Level 3 - medically acceptable, but not medically necessary care and treatment
(a)
Level 3 care and treatment is medical care and treatment for nonfatal
conditions where treatment may improve the youth in custody's quality of life
(e.g., routine hernia repair, treatment of non-cancerous skin lesions, surgery
for certain chronic knee conditions, routine MRI for orthopedic injury,
elective procedures).
(b) Level 3
care and treatment may be authorized on an individual or problem-by-problem
basis as follows:
(A) Medical and surgical
procedures and therapies that can be appropriately completed onsite in a
routine clinic, and that are within the skills of the OYA medical practitioner,
may be offered at the medical practitioner's discretion. Any case may be
referred by a medical practitioner to the OYA medical director for review
pursuant to OAR 416-345-0040(2).
(B) Offsite procedures and therapies deemed
appropriate by an OYA medical practitioner for chronic Level 3 diseases must be
referred to the OYA medical director for clinical review pursuant to OAR
416-345-0040(2).
(i) The OYA medical director
may form a clinical review committee to review requests for Level 3 offsite
procedures and therapies on a case-by-case basis.
(ii) The OYA medical director may approve or
disapprove the Level 3 offsite procedure or therapy at the medical director's
discretion.
(5) Level 4 - limited medical value care and treatment.
(a) Level 4 care and treatment is
medical care and treatment that is valuable to certain individuals but
significantly less likely to be cost effective or to produce substantial
long-term gain. This includes treatment of minor conditions where treatment
merely speeds recovery, gives little improvement in quality of life, offers
minimal palliation of symptoms, or is exclusively for the convenience of the
individual (e.g., nasal reconstruction for cosmetic reasons, elective
circumcision, surgery for gynecomastia).
(b) OYA does not provide youth in custody
Level 4 care or treatment.
Statutory/Other Authority: ORS 420A.025
Statutes/Other Implemented: ORS 420A.010, ORS 420A.014 & ORS 420A.015
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