Dept. of Corrections_291

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The Oregon Administrative Rules contain OARs filed through January 15, 2010

DEPARTMENT OF CORRECTIONS

DIVISION 124

HEALTH SERVICES (INMATE)

291-124-0005

Authority, Purpose, and Policy

(1) Authority: The authority for this rule is granted to the Director of the Department of Corrections in accordance with ORS 179.040, 423.020, 423.030 and 423.075.

(2) Purpose: The purpose of this rule is to:

(a) Specify the level of health care services to be provided to inmates under the custody of the Department of Corrections; and

(b) Establish Department policies and procedures for reimbursement to hospitals providing inpatient and outpatient hospital services to inmates physically housed in Department of Corrections facilities.

(3) Policy: It is the policy of the Department of Corrections to:

(a) Provide those health care services that preserve and maintain the health status of inmates during incarceration. The level of service provided shall be consistent with the standard for such services in the community. Health care procedures shall be conducted in a clinically appropriate manner by appropriately credentialed personnel in an appropriate setting;

(b) Seek to provide quality health services for inmates committed to its custody and care at a reasonable cost.

Stat. Auth.: ORS 179.040, ORS 423.020, ORS 423.030 & ORS 423.075
Stats. Implemented: ORS 179.040, ORS 423.020, ORS 423.030 & ORS 423.075
Hist.: CD 3-1990, f. & cert. ef. 1-29-90; CD 18-1995, f. 9-25-95, cert. ef. 10-1-95; CD 6-1996(Temp), f. 6-28-96, cert. ef. 7-1-96; CD 19-1996, f. 11-20-96, cert. ef. 12-1-96

291-124-0010

Definitions

(1) Department of Corrections Facility: Any institution, facility or staff office, including the grounds, operated by the Department of Corrections.

(2) Employee: Any person employed full-time, part-time, or under temporary appointment by the Department of Corrections; any person employed under contractual arrangement to provide services to the Department; any person employed by private or public sector agencies who is serving under Department-sanctioned special assignment to provide services or support to Department programs within any Department of Corrections facility.

(3) Functional Unit: Any organizational component within the Department of Corrections responsible for the delivery of services or coordination of programs.

(4) Functional Unit Manager: Any person within the Department of Corrections who reports to the Director, an Assistant Director or an administrator and has responsibility for the delivery of services or coordination of programs.

(5) Health Care Provider: Any professional who is licensed or certified to provide health care services in Oregon, including physicians and hospitals (and the various entities/forms in which they do business), and public, quasi-public and private organizations and entities that contract with direct service providers to furnish health care services, such as insurance companies and managed care organizations.

(6) Inmate: Any person under the supervision of Department of Corrections who is not on parole, probation, or post-prison supervision status.

(7) Off-Site Health Care Services: Health care services delivered at locations other than those operated by the Department of Corrections. This include the range of health care services available in the community, including but not limited to inpatient and outpatient hospital services, diagnostic services, and specialty physician services.

(8) Treating Practitioner: Any Health Services employee who by licensure is authorized to prescribe treatment. This includes physicians, dentists, nurse practitioners, optometrists and physician assistants.

291-124-0015

Procedures

(1) Organization of the Health Services Division:

(a) The Health Services Division Administrator is designated as the Department of Corrections health authority responsible for arranging the provision of all levels of health care, assuring the quality of health care services provided, access of inmates to health care services and reasonable protection from disease. The Health Services Manager at each Department of Corrections facility is delegated authority for operational, fiscal and resource matters;

(b) All matters requiring a final medical or dental judgment are the authority of the Department of Corrections Clinical Director. In the absence of the Clinical Director, the facility Chief Medical Officer is delegated authority for medical/dental decisions;

(c) The functional unit manager shall provide operational support necessary to ensure inmate access to health care services;

(d) Medical/Dental Autonomy: Medical and dental matters requiring medical/dental judgment are the sole province of the treating practitioner; however, security regulations applicable to facility personnel also apply to the treating practitioner and all other health care personnel.

(2) Management of the Health Services Division:

(a) The Health Services Division Administrator is the functional unit manager responsible for planning, implementing, and directing health care services for the Department of Corrections including:

(A) Supervision of subordinate management personnel;

(B) Development, monitoring, and control of health services budget;

(C) Coordination of resources and service delivery between correctional facilities; development of health care resources in the community;

(D) Establishment of standards for delivery of health care services; and

(E) Maintenance of systems to monitor quality of health care services. The Health Services Division Administrator shall prepare a report of deaths occurring in the facilities for submission to the Senate President and Speaker of the House of Representatives each quarter.

(b) The Department of Corrections Clinical Director is responsible for:

(A) The selection and assignment of treating practitioners;

(B) Arranging for specialized health services in advance of need;

(D) Leading and directing the organization of treating practitioners in activities to assure the clinical quality of the health care program; and

(E) Providing clinical training for other Department of Corrections employees.

(c) The Pharmacy Manager is the clinical authority for the Department of Corrections pharmacy program. The Pharmacy Manager is responsible for:

(A) Selection and assignment of pharmacists, pharmacy technicians, and other pharmacy service employees;

(B) Establishing and managing a system for ordering, inventory, dispensing, and administering pharmaceuticals and medical supplies to all Department of Corrections facilities;

(D) Providing and/or coordinating in-service training for Department of Corrections employees;

(E) Assuring that service delivery is accomplished in compliance with state and federal statutes and administrative rules of the Department of Corrections and Board of Pharmacy; and

(F) Maintaining licensure of the Department pharmacies and maintaining a division formulary with the Pharmacy and Therapeutics Committee.

(d) The Health Services Manager is the delegated health authority at each Department of Corrections facility which houses inmates. The Health Services Manager is responsible for:

(A) The operation of the health care delivery system including selection and assignment of physicians, dentists, and other health care employees to provide continuous availability of health services, including specialty services;

(B) Evaluation and securing of equipment, supplies, and materials necessary to deliver health services;

(D) Providing or coordinating in-service training for Department of Corrections employees;

(E) Assuring that service delivery is provided according to the Department of Corrections rule on Health Services (Inmate); and

(F) Providing statistical and other information to the Health Services Division Administrator to monitor health care delivery. The Health Services Manager is accountable to the facility functional unit manager for the operation of the health care program within the facility and shall meet with the functional unit manager at least quarterly to discuss the health care program and health environment.

(e) The facility Chief Medical Officer is responsible for medical decision making and clinical direction of the facility health care delivery system including:

(A) Implementing clinical procedures consistent with the Department of Corrections rule on Health Services (Inmate);

(B) Providing input to the Health Services Manager on clinical management of the health care program;

(D) Assisting with arrangements for specialty services;

(E) Participating in the development of treatment protocols and prescriptive formulary;

(F) Clinical training of Department of Corrections employees; and

(G) Participating in quality review activities as directed by the Clinical Director.

(3) Professional Credentials:

(a) Treating practitioners providing medical or dental care to inmates shall be fully licensed to practice by the State of Oregon. Specialists providing medical or dental services shall be board certified in the specialty field or recognized as specialists in the medical community;

(b) All other employees of health services shall be licensed, registered, or certified to practice as stipulated by the regulatory agency of their respective discipline;

(c) Licensure, registration, or certification of employees providing on-site services shall be verified and copies maintained by the facility Health Services Manager, Pharmacy Manager or Health Services Central Office. Such verification shall occur prior to any work performed by the employee or contractor for the Department of Corrections. Any such licensure, registration or certification renewals shall be kept current;

(d) The practice of employees providing health services shall be within the scope of practice defined by statute and administrative rule of the respective regulatory professional licensing or certification board.

(4) Training:

(a) The Health Services/Pharmacy Manager shall ensure that each new employee hired into a permanent position completes new employee orientation and all other department required inservice training;

(b) All other persons employed by the health services program to provide services within a correctional facility shall be oriented to the security requirements of the facility, the methods for work to be performed, and applicable legal or administrative directives. The Health Services/Pharmacy Manager is responsible for completion and documentation of this orientation;

(c) It is the responsibility of individual health service employees to meet continuing education requirements for re-licensure when a license is required by the job classification;

(d) Any time arrangements are made for clinical placement of students or interns in the health care field with the Department of Corrections Health Services Division, a written agreement shall be completed with the academic institution and the Health Services Division Administrator to include the objectives of the placement, provision of appropriate clinical assignments, and on-site supervision by appropriate health service employees.

(5) Inmate Work Assignments:

(a) Inmates are prohibited from performing any health care duties. Inmates may be assigned to work in the health services area to perform janitorial, maintenance, or housekeeping duties. Inmates may be assigned to assist other inmates with activities of daily living;

(b) Inmates may participate in certified vocational training programs in the health care field; however, such training shall not be used as the primary means or supplement the health care delivery system;

(c) Health Service employees shall take reasonable steps to screen inmates for medical condition(s) which will prohibit specific types of work assignments at various correctional facilities. This will include screening for communicable diseases prior to work assignment in food service departments. Any inmate who exhibits symptoms of illness that interferes with the work assignment, including symptoms of a communicable disease when working in the food service department, shall be removed by the supervisor until the inmate has been re-examined by the health service program at the facility.

(6) Reporting and Evaluation:

(a) The Department of Corrections rule on inmate health care shall be reviewed every three years by the Health Services Division Policy and Procedure Committee and revised as necessary;

(b) Each Health Services/Pharmacy Manager shall submit a monthly statistical report to the Health Services Division Administrator on the type and volume of services provided;

(c) Each Health Services Manager shall submit a narrative report quarterly to the Health Services Division Administrator describing major activities, accomplishments, problems and continuous quality improvement;

(d) The Health Services Division Administrator shall prepare a report each quarter listing the deaths which have occurred in Department of Corrections facilities, including the age of the deceased, cause of death, and disposition of remains. This report shall be submitted to the President of the Senate and the Speaker of the House of Representatives according to ORS 179.509 by the 30th of the month following the end of the quarter.

Stat. Auth.: ORS 179.040, ORS 423.020, ORS 423.030 & ORS 423.075
Stats. Implemented: ORS 179.040, ORS 179.509, ORS 423.020, ORS 423.030 & ORS 423.075
Hist.: CD 3-1990, f. & cert. ef. 1-29-90; CD 18-1995, f. 9-25-95, cert. ef. 10-1-95

291-124-0020

Facilities and Equipment for Provision of Health Care

(1) Space, Equipment and Supplies:

(a) Sufficient space, equipment, and supplies will be available to provide the level of health care designated at each state operated correctional facility. The Health Services Division Administrator shall be responsible for evaluation of the adequacy of space allocated, review of major equipment purchases, and the system for distribution of health care supplies. The facility Health Services Manager is responsible for inventory and maintenance of equipment and the requisition of supplies sufficient for the operation of the facility health services program;

(b) The medical stores unit at the Department of Corrections Pharmacy shall be responsible for maintaining an adequate inventory of medical and dental supplies. A medical stores catalog shall be made available to all facility health services programs. The catalog shall be revised and updates distributed as changes or additions to the medical stores inventory are made;

(c) The medical stores unit shall be responsible for maintaining an inventory of all expendable supplies, commodities and products in accordance with Department of Corrections rule on Inventory and Property Control (OAR 291-023). Upon release of the property from the medical stores unit, the property is removed from the expendable inventory;

(d) Medical supplies shall be purchased by the medical stores unit in accordance with the Department of Corrections rule on Purchasing (OAR 291-164).

(2) Level of Service at Each Facility:

(a) The assigned Health Service Manager is responsible for providing inmate access to health care services either at the site, in the community, or at another correctional facility;

(b) Health care services at correctional facilities shall at a minimum include instruction and supervision of self care, ambulatory care, emergency care, and referrals for specialty services;

(c) Inpatient infirmary beds, on site dental clinics, optometry clinics and mental health treatment are not available at each correctional facility. Inmates needing these services will be transferred to the most appropriate correctional facility to receive the needed service;

(d) Inmates with complex medical conditions that cannot be referred to providers in the immediate community may be transported to a correctional facility in another geographic area to receive medically necessary care and treatment;

(e) At correctional facilities with patients occupying inpatient infirmary beds, health care staff shall be on duty 24 hours per day with a physician on call 24 hours per day. At correctional facilities without 24 hour on duty coverage, a nurse and a physician shall be designated and on call 24 hours per day;

(f) Each correctional facility, shall arrange in advance of need for the availability of hospital, emergency, emergency transport services with community facilities or agencies;

(g) Each health services program shall have a written plan and maintain readiness to provide emergency medical services to anyone injured in the event of fire, riot, local disaster, or other emergency situation. This plan shall be in accordance with the emergency response plan for the facility.

291-124-0025

Standards for the Provision of Health Care

(1) Employees of the health services program are expected to take reasonable steps to assure that delivery of health care is in compliance with the standards set forth in this section assuming normal staffing levels and assignments, and barring conflicting emergencies.

(2) Receiving Health Screening:

(a) Each inmate shall be screened by health service employees at the time of admission to an intake facility. The purpose of this screening shall be to identify any health conditions that require referral for evaluation and treatment and to determine if there are any special needs for housing based on a physical or mental condition;

(b) A brief health screening shall be completed on all inmates received on intra-department transfers by health care staff at the receiving facility. This shall include review of medical records information transferred with the inmate and verification of any care or treatment requirements prearranged by the sending facility Health Services Manager. This information will be used to determine disposition of the inmate;

(c) Dental screening shall be completed on all inmates within seven days of admission to include the inmate's dental history, whether the inmate is being treated for a dental problem, and written or verbal dental hygiene instructions;

(d) All inmates will be screened for the presence of mental disorder upon admission. Inmates who as a result of the screening are identified as at risk for mental illness will be referred within 14 days of admission for further evaluation by a qualified mental health professional. Inmates with mental illness will be housed in a facility with services appropriate for their treatment needs.

291-124-0030

Baseline Health Evaluation

(1) Each inmate shall receive a baseline health assessment within seven days of admission. On readmission if there is documented evidence that the inmate received a baseline health assessment within the previous 90 days, the prior assessment and health record is reviewed and assessment, examination and diagnostic procedures are updated as clinically necessary.

(2) A baseline dental examination shall be completed within one month of admission to include review of the dental history, examination of the oral cavity, and diagnostic X-rays, if necessary. If there is documented evidence of an examination of the inmate's dental condition within the previous six months, a dental exam is not required unless determined to be clinically necessary by the treating dentist. If treatment is recommended based upon the baseline dental examination, a treatment plan shall be written and the recommendations reviewed with the inmate.

(3) Inmates will be informed at the conclusion of the baseline health evaluation of the recommended schedule for preventive health care exams.

291-124-0035

Emergency Services

(1) Each functional unit manager or designee shall maintain adequate numbers of correctional and other employees trained to respond to life threatening situations within four minutes. Such training shall be according to the Department of Corrections training plan and include recognition of signs, symptoms, and action required in potential emergency situations; administration of first aid and cardiopulmonary resuscitation (CPR); methods of obtaining emergency medical assistance; signs and symptoms of mental illness, retardation, and chemical dependency; implementation of suicide prevention measures; and procedures for transfer to medical facilities.

(2) Each facility Health Services Manager shall assure that health care employees are trained and prepared to provide emergency medical assistance when notified by the facility that an emergency exists. Training content shall be as described above in section (1) of this rule but specific to the health services employee's clinical role in responding to requests for emergency medical assistance.

(3) Emergency medical care beyond the recognition of signs and symptoms of medical emergencies, first aid response, and cardiopulmonary resuscitation (CPR) shall be provided by emergency medical response agencies in the community.

291-124-0041

Health Care and Treatment

(1) The facility Health Services Manager shall establish, in consultation with the facility functional unit manager, the frequency, schedule, and procedures for health care attention appropriate for the facility population, including inmates in segregation.

(2) Each inmate shall be informed orally and in writing of methods for obtaining health care attention. The schedule for sick call shall be posted for the information of inmates at each Department of Corrections facility.

(3) Each inmate's request for health care attention will be evaluated and triaged by a licensed nurse who may:

(a) Instruct an inmate in self-care;

(b) Initiate treatment according to Oregon Department of Corrections standardized nursing protocol;

(d) Refer the inmate to be seen in the ambulatory care clinic that same day.

(4) Health care and treatment is authorized and provided according to priorities established by the Clinical Director:

(a) Level 1: Medically Mandatory is 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 and/or has a very high cost effectiveness. Level 1 care and treatment shall be routinely provided to all inmates by the Department. Any health service employee may authorize care and treatment of Level 1 conditions;

(b) Level 2: Presently Medically Necessary is care and treatment without which an inmate could not be maintained without significant risk of either further serious deterioration of the condition or significant reduction in the chance of possible repair after release or without significant pain or discomfort. Level 2 care and treatment may be provided to inmates subject to periodic utilization review by the Chief Medical Officer. Any treating practitioner may authorize care and treatment of Level 2 conditions;

(c) Level 3: Medically Acceptable but not Medically Necessary is care and treatment for non-fatal conditions where intervention may improve the quality of life for the inmate. Level 3 care and treatment may or may not be authorized based upon review of an individual case. Only the Clinical Director and as delegated, the Chief Medical Officer, may authorize or deny care and treatment of Level 3 conditions;

(d) Level 4: Of Limited Medical Value is care and treatment which may be valuable to a certain individual but is significantly less likely to be cost effective or to produce substantial long term improvement. Level 4 care and treatment will not be routinely provided to inmates by the Department;

(e) Inmates may elect to obtain services for conditions at any of these levels, at their own expense in accordance with OAR 291-124-0085(1). Treating practitioners employed by the Department are not obligated to carry out any recommendations or treatment plans formulated by another practitioner from whom the inmate elects to purchase care and treatment, if ongoing care is required.

(5) Infirmary care shall be made available to provide limited medical, dental, and nursing services for inmates with health problems whose care cannot be safely managed via ambulatory care services. Infirmary services consist of isolation, observation, first aid, postoperative care, short or long term nursing care, treatment of minor illnesses, sheltered living, and convalescence. Infirmary care shall not be used as an alternative to hospital level acute care. Infirmary beds are located at Oregon State Penitentiary, Eastern Oregon Correctional Institution and Snake River Correctional Institution. Only health service employees shall admit and discharge from infirmary care.

(6) Therapeutic diets may be ordered for an inmate with a medical condition requiring nutritional adjustment by a treating practitioner. The institution Food Service Manager shall be notified of the order for a therapeutic diet and the Health Services Manager will reverify the need for the therapeutic diet monthly thereafter. Diets to achieve weight loss are the responsibility of the individual inmate and shall not be ordered by treating practitioners.

(7) Chapter 486, 1987 Oregon Session Laws states persons who while an inmate of a correctional institution that were subjected to radiation as part of a study conducted by the Pacific Northwest Research Foundation between the dates of 1963 and 1973 shall:

(a) Receive an annual evaluation of the consequences of the radiation experiments, and care of treatment for any condition directly related to such experiments;

(b) These evaluations, care, or treatment shall be provided by qualified professionals not employed by the Department of Corrections.

Stat. Auth.: ORS 179.040, ORS 423.020, ORS 423.030 & ORS 423.075
Stats. Implemented: ORS 179.040, ORS 423.020, ORS 423.030, ORS 423.075; & 1987 OL, Ch. 486
Hist.: CD 18-1995, f. 9-25-95, cert. ef. 10-1-95

291-124-0055

Health Education

(1) Each facility health services program shall provide inmate health education, including instruction and supervision of self-care if appropriate.

(2) Inmates with chronic diseases will be provided with information designed to increase their ability to monitor and manage their health status:

(a) This may be accomplished by individualized or group instruction at the time of a health care contract, written pamphlets, posters, video or audio tapes, and prevention or self-care programs;

(b) The facility Health Services Manager is responsible for reviewing health education material used by the program and may consult with other correctional employees providing health education programs at the facility. Material provided by community health education groups, public health departments, or developed by other correctional facilities may be used.

291-124-0060

Transfer, Travel, or Release Arrangements

(1) Transfers Between Oregon Department of Corrections Facilities:

(a) Information about an inmate's health status shall be provided to Classification and Transfer to ensure that inmates are assigned only to those facilities able to provide health care appropriate to an individual's needs;

(b) Instructions shall be provided to the Transport Unit regarding any inmate who will require medication or medical care during transport or any special precautions which are recommended to reduce transmission of a communicable disease;

(c) The inmate's health care record shall be transferred in a confidential manner to the health services program responsible for health care at the receiving facility simultaneously with the inmate.

(2) Transfer to Community Facilities for Hospitalization or Ambulatory Care:

(a) Scheduling: The facility Health Services Manager or designee shall schedule inmates for hospitalization or ambulatory care appointments in the community. The Transport Unit and/or facility shall be notified by the health services program of transportation requirements. Transport shall be provided by correctional employees in a timely manner;

(b) Release: The facility Health Service Manager or designee shall make arrangements so the correctional facility is notified by the hospital when an inmate is to be released. The correctional employee assigned to transport the inmate shall hand carry all treatment orders/medical records from the hospital to the health services employee on duty;

(c) Upon completion of ambulatory care appointments in the community, the correctional employee providing transport will return the inmate to the facility in a timely manner and hand carry any treatment recommendations or information to health service staff on duty.

(3) Arrangements for Health Care Upon Release:

(a) Prior to release, the facility Health Services Manager shall notify a counselor if the inmate has a severe medical condition that will require ongoing treatment in the community. The counselor will assist the inmate to complete those applications for state or federal assistance the inmate may be eligible for;

(b) The facility Health Services Manager or designee shall assist with referrals to agencies or individual practitioners in the community for the ongoing treatment of inmates with severe medical conditions;

(c) Health care records information may be provided to referral agencies when written authorization for release of information is obtained from the inmate;

(d) Medical evaluations and diagnostic workups that are required for admission to treatment facilities in the community shall not be provided unless paid for by the provider, the inmate, or another source. Existing medical information may be made available to treatment facilities with written authorization from the inmate to release the information requested.

Stat. Auth.: ORS 179.040, ORS 423.020, ORS 423.030 & ORS 423.075
Stats. Implemented: OL 433, ORS 179.040, ORS 423.020, ORS 423.030 & ORS 423.075
Hist.: CD 3-1990, f. & cert. ef. 1-29-90; CD 18-1995, f. 9-25-95, cert. ef. 10-1-95

291-124-0065

Communicable Disease Control

(1) All inmates shall be screened for communicable diseases upon admission and as medically necessary thereafter.

(2) Management of communicable diseases shall be according to Oregon Chapter Law 433, the Oregon Health Division administrative rules, and Department of Corrections procedures.

(3) Measures, such as universal precautions, to prevent transmission of communicable diseases in the facility shall be made known and available to correctional employees working in Department of Corrections facilities. Health service employees shall provide specific instructions if additional precautions are necessary for a particular inmate during transport, hospital supervision, or in the infirmary.

(4) Communicable disease control precautions specific to health care workers as required by OSHA or recommended by the Oregon Health Division shall be followed by health service employees.

(5) Information about communicable disease prevention shall be provided to inmates during incarceration as part of the health education program. Individual inmates with diagnosed communicable diseases shall be provided information about transmission and methods to prevent future infection of self or others. Immunizations and preventive treatment shall be made available to those inmates whose medical condition would be severely compromised if infected with those communicable diseases for which these preventive therapies exist.

291-124-0070

Management of Pharmaceuticals

(1) Employees of the health services program are expected to take reasonable steps to assure that delivery of health care is in compliance with the standard set forth in this section assuming normal staffing levels and assignments, and barring conflicting emergencies.

(2) Department of Corrections pharmacy services shall be provided under the direction of a registered pharmacist(s).

(3) The Pharmacy Manager shall establish methods for the purchase, receipt, storage, inventory, and dispensing of pharmaceuticals, including controlled substances.

(4) Each facility shall maintain a controlled substances inventory according to methods established by the Pharmacy Manager.

(5) A pharmacist assigned by the Pharmacy Manager is responsible for conducting regularly scheduled inspections of medication rooms at Department of Corrections facilities. Deficiencies will be reported to the facility Health Services Manager. The facility Health Services Manger will be responsible for correcting the deficiency before the next scheduled inspection unless otherwise agreed to by the Health Services Manager and the Pharmacy Manager.

(6) The Health Services Pharmacy shall receive and properly dispose of outdated medications in accordance with OAR 855-041-0036 and 855-080-0105.

(7) During such times as pharmacy services are not available, arrangements shall be made in advance by the Pharmacy Manager for provision of drugs to the facility health services program by use of drug rooms in accordance with OAR 855-041-0120(2).

(8) Medication shall be prescribed according to a formulary approved by the Department of Corrections Clinical Director.

(9) The facility Health Services Manager shall establish methods for the timely distribution and administration of medication to inmates according to prescription.

(10) Psychotropic medications shall be prescribed only when clinically indicated and as one facet of a treatment program in accordance with the Department of Corrections rule on Informed Consent to Treatment with Psychotropic Medication.

(11) All medications shall be administered by appropriately trained health care personnel in accordance with the laws and regulations governing drug administration. Inmates may be allowed to administer their own medication when the medication is on the approved self-medication list and, in the opinion of the health services employee, the inmate is appropriately able to take his/her own medication.

(12) Medications shall be given only on the written order of a treating practitioner. Telephoned and verbal orders shall be put in writing immediately upon receiving the order, and the treating practitioner shall countersign these orders within 72 hours. Only a pharmacist or licensed nurse shall accept verbal or telephone orders.

(13) Prescription medications brought by inmates to the facility shall be confiscated and delivered to the health services program at the facility. The health service staff shall note what medications the inmate brought in and then send the medications to the Health Services Pharmacy. Such drugs shall not be administered unless they have been precisely identified by a physician in collaboration with a pharmacist pursuant to OAR 855-041-0130(4).

291-124-0075

Health and Dental Records

(2) Inmate health and dental records shall be maintained separately from the inmate's custody file.

(3) The contents of health and dental records, methods of recording entries, and the form and format of the record shall assure that the information necessary to manage inmate health care is available to health care staff.

(4) A medical/dental record shall be established for each inmate received at a Department of Corrections facility.

(5) Entries made in the health/dental records shall use the problem oriented method (or SOAP format) of charting.

(6) The health/dental record shall be transferred at the time an inmate is transferred to another Department of Corrections facility.

(7) Information contained in the health/dental record may be released to other parties only according to ORS 179.495 through 179.505 and other Oregon statutes.

(8) Inactive health/dental records are retained as permanent records as specified in the Department of Corrections rule on Release of Public Records (OAR 291-037).

Stat. Auth.: ORS 179.040, ORS 423.020, ORS 423.030 & ORS 423.075
Stats. Implemented: ORS 179.040, ORS 799.495 - ORS 179.505, ORS 423.020, ORS 423.030 & ORS 423.075
Hist.: CD 3-1990, f. & cert. ef. 1-29-90; CD 18-1995, f. 9-25-95, cert. ef. 10-1-95

291-124-0080

Patient Rights

Employees of the health services program are expected to take reasonable steps to assure that delivery of health care is in compliance with the standard set forth in this section assuming normal staffing levels and assignments, and barring conflicting emergencies.

(1) Medical Research: The use of inmates for medical, psychiatric, or psychological experimentation or research is prohibited as stipulated in ORS 421.085.

(2) Informed Consent:

(a) The inmate's informed consent or refusal shall be obtained in writing prior to administration of any invasive health care procedure with major adverse health risks. An inmate may withdraw consent any time prior to the procedure;

(b) Informed consent shall include providing the inmate with information about:

(A) The nature, purpose, and benefits of the procedure or treatment;

(B) The risks, if any, of the procedure or treatment; and

(c) Informed consent is not required in a medical emergency if the inmate is unable to give or to refuse consent and there is an immediate threat to the life or irreversible bodily harm to the inmate, in a psychiatric emergency if the inmate does not have the mental capacity to make an informed decision, and in certain public health matters.

(3) Confidentiality:

(a) The inmate's health record and medical, dental, or health related information obtained by health service employees is confidential and shall not be released except as provided for in ORS 179.495 through 179.509, and other Oregon statutes;

(b) Health service employees shall communicate to correctional employees pertinent information which has a direct impact on the safety and security of the facility or which reflects on the inmate's ability to function in programs.

291-124-0085

Charges for Care and Treatment

(1) Purchase of Care: Any inmate may purchase his/her own health care from a practitioner, provided:

(a) The inmate's trust account has sufficient funds and set up in a reserve account to pay for the purchase of care before the treatment is scheduled. Cost of care includes: expenses associated with providing the treatment, including follow-up care as well as the salary and other personal expenses of employees who may be assigned to escort or supervise; and

(b) The Chief Medical Officer of the facility must review and approve follow-up care and treatment recommended by community practitioners.

(2) Prosthetics and Self Care Items:

(a) Inmates shall be required to pay for prostheses and/or other devices which become the personal property of the inmate;

(b) To charge or indebt the inmate's account for the estimated or actual cost of an item, the Health Services Procedure for Purchase of Medical Necessary Items will be followed;

(c) Upon delivery of the item, any variance from the actual cost will be indebted or credited to the inmate's account accordingly;

(d) An inmate shall not be denied prostheses and/or other devices which are medically necessary because of lack of funds;

(e) Items for self care are contained on the institution canteen list, and an inmate may be advised to purchase a particular self care item by health services employees. Such advice is education in self care and not a directive that the item is considered medically necessary.

(3) Expenses for Medical Care for Inmates on Escape, Transitional Leave, Parole, Post-Prison Supervision, or Emergency Leave:

(a) Payment for health care treatment for inmates on transitional leave, parole, post-prison supervision or escape status will not be authorized by the Department of Corrections;

(b) Inmates experiencing health problems while on emergency leave shall contact the facility Health Services Manager who will give directions to the inmate on how health care is to be provided or obtained;

(c) Expenses incurred for health care of offenders on transitional leave, parole or post-prison supervision are the responsibility of the offender;

(d) Expenses incurred by inmates on escape status are not the responsibility of the Department of Corrections until such time as the inmate is in the physical custody of the Department of Corrections.

(4) Refusal of Medical Appointments:

(a) Any inmate who willfully refuses to keep a prearranged medical appointment in the community shall have his/her account charged or indebted. He/she may be charged for the reserved time at the community agency and/or for staff time utilized to arrange the appointment;

(b) A decision under this section to charge or indebt an inmate's account shall be treated as an order in a contested case for purposes of ORS Chapter 183.

(5) Destruction of Property:

(a) Any inmate who willfully destroys, or misuses, any health services equipment or supplies shall have his/her account charged or indebted for the cost of repair or replacement of the item;

(b) A decision under this section to charge or indebt an inmate's account shall be treated as an order in a contested case for purposes of ORS Chapter 183.

291-124-0095

Reimbursement for Off-Site Health Care Services

(1) The Department of Corrections may enter into agreements with health care providers to furnish off-site health care services to inmates, and/or reimbursement claims processing services.

(2) Unless otherwise provided for by a governing contract between the Department of Corrections and a health care provider, the department shall reimburse the health care provider for inpatient and outpatient hospital services furnished to inmates assigned to Department of Corrections facilities in accordance with the Hospital Fee Schedule -- Adjusted Cost/Charge Ratios for Oregon Hospitals published by the Department of Consumer and Business Services in BULLETIN NO. 290 (Revised), and issued September 18, 1998 (attached hereto as Exhibit 1). [Exhibit not included. See ED. NOTE.] Reimbursement to health care providers for inpatient and outpatient hospital services pursuant to this subsection will be paid at the time the claim is processed. All claims for inpatient and outpatient hospital services shall be presented to the department, or to the department's claims processing agent, on the applicable form UB-92 or HCFA 1500. To receive payment, health care providers entitled to reimbursement pursuant to this subsection shall transmit the UB-92 or HCFA 1500 form to the Health Services Manager of the referring Department of Corrections facility, or to the department's claims processing agent. (The UB-92 or HCFA 1500 form shall include the State Identification Number (SID#) for the inmate listed as patient.

(3) As used in this rule, "health care provider" means any professional who is licensed or certified to provide health care services in Oregon, including physicians and hospitals (and the various entities/forms in which they do business), and public, quasi-public and private organizations and entities that contract with direct service providers to furnish health care services, such as insurance companies and managed care organizations.

[ED. NOTE: Copies of the Exhibit referenced in this rule are available from the agency.]

Stat. Auth.: ORS 179.040, ORS 423.020, ORS 423.030 & ORS 423.075
Stats. Implemented: ORS 179.040, ORS 423.020, ORS 423.030 & ORS 423.075
Hist.: CD 6-1996(Temp), f. 6-28-96, cert. ef. 7-1-96, CD 12-1996(Temp), f. & cert. ef. 8-27-96; CD 19-1996, f. 11-20-96, cert. ef. 12-1-96; DOC 16-1998, f. & cert. ef. 7-1-98; DOC 24-1998(Temp), f. 12-30-98, cert. ef. 1-1-99 thru 6-29-99; DOC 7-1999, f. 3-26-99 cert. ef. 4-1-99

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