DIVISION 3
PUBLIC HEALTH PREPAREDNESS
Impending Public Health Crisis
333-003-0010
Definitions
For purposes of OAR 333-003-0020 to 333-003-0080, the following definitions apply:
(1) “Bioterrorism” has the meaning given that term in ORS 433.442.
(2) "Communicable disease" has the meaning given that term in ORS 431.260.
(3) "Condition of public health importance" has the meaning given that term in ORS 431.260.
(4) "Department" means the Department of Human Services.
(5) “Health care provider” has the meaning given that term in ORS 433.443.
(6) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996 and regulations adopted there under by the United States Department of Health and Human Services.
(7) “Individually identifiable health information” has the meaning given that term in ORS 433.443.
(8) "Local public health administrator" has the meaning given that term in ORS 431.260.
(9) "Local public health authority" has the meaning given that term in ORS 431.260.
(10) "Public health emergency" has the meaning given that term in ORS 433.442.
(11) "Public health law" has the meaning given that term in ORS 431.260.
(12) "Reportable disease" has the meaning given that term in ORS 431.260.
(13) "State Public Health Director" is the person appointed by the Director of Human Services under ORS 431.035(3) or his or her designee.
(14) "Strategic National Stockpile (SNS)" means the national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, and medical/surgical items, designed to supplement and re-supply state and local public health agencies in the event of a national emergency anywhere and at anytime within the U.S. or its territories.
Stat. Auth.:
ORS 409.050
Stats. Implemented:
ORS 431.264 & 433.441 - 433.452
Hist.: PH
25-2004, f. & cert. ef. 7-16-04; PH 8-2008, f. & cert. ef. 5-5-08
333-003-0020
Authority of the Public Health Director During a Public Health Emergency
(1) If the Governor declares a Public Health Emergency under ORS 433.441 the Public Health Director may take any action authorized in 433.443 or 431.264.
(2) If the Governor has not declared a public health emergency but the Public Health Director determines that public health actions in addition to those routinely taken by the Department, the Public Health Director, the local public health authority or local public health administrator are necessary to respond to a public health threat, the Public Health Director may, with approval from the Governor, take any action authorized in ORS 431.264
Stat. Auth.:
ORS 409.050
Stats. Implemented:
ORS 431.262, 431.264 & 433.441 - 433.452
Hist.: PH
25-2004, f. & cert. ef. 7-16-04; PH 8-2008, f. & cert. ef. 5-5-08
333-003-0040
Diagnostic and Treatment Protocols
(1) If the Public Health Director creates diagnostic and treatment guidelines or protocols in response to an emergency under ORS 431.264 or a declared public health emergency under 433.441, the Director shall consult with appropriate medical experts.
(2) Appropriate medical experts may include but are not limited to staff at the Centers for Disease Control and Prevention, a medical advisory group, and Public Health Division staff.
(3) To the extent feasible the Public Health Director shall make every effort to consult with local practicing health care providers regarding the development of diagnostic and treatment guidelines or protocols.
(4) Required diagnostic and treatment guidelines or protocols issued by the Public Health Director shall be in writing, and shall be provided to health care providers, institutions and facilities by one or more of the following means:
(a) Releases through print, radio or television media outlets;
(b) Releases in health care provider publications when timely; or
(c) Mailings, faxes, and/or e-mail or other electronic notification to affected health care providers, facilities and institutions.
(5) If the Governor or Public Health Director requests Strategic National Stockpile (SNS) materials and such a request has been approved, the State Public Health Director may:
(a) Distribute SNS materials to any local health department, hospital, point of dispensing, medical care point, or other health care facility; and
(b) Provide the local public health administrator with permission to dispense SNS materials as needed.
Stat. Auth.:
ORS 409.050
Stats. Implemented:
ORS 431.264 & 433.44 1- 433.452
Hist.: PH
25-2004, f. & cert. ef. 7-16-04; PH 8-2008, f. & cert. ef. 5-5-08
333-003-0050
Access to Individually Identifiable Health Information
(1) During a declared public health emergency the Public Health Director and local public health administrators shall be given immediate access to individually identifiable health information.
(2) If the Public Health Director has been authorized to take a public health action under ORS 431.264, the Public Health Director may adopt reporting requirements for health care providers, institutions and facilities for the purpose of obtaining information directly related to the public health threat presented, including the reporting of individually identifiable health information for individuals with or exposed to:
(a) A communicable disease;
(b) A reportable disease; or
(c) A condition of public health importance.
(3) To the extent possible, whenever access to individually identifiable health information is needed under subsections (1) or (2) of this rule the Public Health Director or local public health administrator will provide the request for information in writing.
(4) A written request for information, when provided, shall include, but is not limited to:
(a) The legal authority for requiring the information;
(b) An explanation of why the access to individually identifiable health information is necessary;
(c) A description of the information needed; and
(d) An explanation of how the information must be provided or made available to public health officials.
(5) To the extent possible, the Public Health Director and local public health authority will coordinate requests for information to avoid duplicate requests to the same facility or provider.
Stat. Auth.:
ORS 409.050
Stats. Implemented:
ORS 431.264 & 433.441 - 433.452
Hist.: PH
25-2004, f. & cert. ef. 7-16-04; PH 8-2008, f. & cert. ef. 5-5-08
333-003-0065
Civil Penalties
(1) Any person or entity that fails to comply with a protocol, order, other requirement imposed by the Public Health Director under ORS 431.262, 431.264, or 433.443 or these rules is subject to the imposition of civil penalties not to exceed $500 per day per violation.
(2) In determining the amount of a civil penalty the Department shall consider whether:
(a) The department made repeated attempts to obtain compliance;
(b) The person or entity has a history of noncompliance with public health laws; and
(c) The violation poses a serious risk to the public's health.
(3) Each day a violation continues will be considered an additional violation.
(4) A notice of imposition of civil penalties shall comply with ORS 183.745.
Stat. Auth.:
ORS 433.441 - 433.452 & 409.050
Stats. Implemented:
ORS 433.441 - 433.452
Hist.: PH
8-2008, f. & cert. ef. 5-5-08
333-003-0070
Temporary Restriction of Movement
(1) If the Public Health Director or the local public health administrator reasonably believes a person within his or her jurisdiction may have been exposed to a communicable reportable disease or a condition that is the basis for a declaration of a Public Health Emergency under ORS 433.441, the person may be detained for as long as necessary in order to obtain personal contact information and to convey information about the disease or condition.
(2) An individual subject to temporary restriction of movement will be provided with information including but is not limited to:
(a) Information on the disease or other hazard that the person may have been exposed to;
(b) Symptoms of the disease or resulting from exposure to the hazard and what to do in the event such symptoms occur; and
(c) How the person will be notified if it is determined that the individual was exposed to the disease or hazard.
(3) Restriction of movement shall be limited to the shortest duration of time reasonably required to provide health information to the individual and for the individual to provide contact information.
(4) The Department or the local health public health administrator restricting movement shall use reasonable resources to deliver and collect information in a timely manner.
(5) Any individual failing to comply with the provisions of this section may be subject to the imposition of a public health measure as described in ORS 433.121 or 433.123.
(6) Individually identifiable contact information shall be held in a secure location and destroyed in accordance with applicable record retention schedules when no longer needed.
Stat. Auth.:
ORS 409.050
Stats. Implemented:
ORS 433.441 - 433.452
Hist.: PH
25-2004, f. & cert. ef. 7-16-04; PH 8-2008, f. & cert. ef. 5-5-08
333-003-0080
Effect of Crisis Ending
Immediately upon termination of the declaration of the public health emergency, all actions taken pursuant to these rules are terminated unless an emergency related to the declaration has been proclaimed under ORS 401.055 or continuation of the actions is otherwise authorized by law.
Stat. Auth.:
ORS 409.050
Stats. Implemented:
ORS 433.441 - 433.452
Hist.: PH
25-2004, f. & cert. ef. 7-16-04; PH 8-2008, f. & cert. ef. 5-5-08
333-003-0100
Scope
The rules in OAR 333-003-0100 to 333-003-0140 pertain to emergency health care services under ORS 401.651 to 401.670.
Stat. Auth.: ORS 401.651 - 401.670
Stats. Implemented: ORS 401.651 - 401.670
Hist.: PH 26-2004, f. & cert. ef. 7-30-04
333-003-0105
Definitions
For purposes of OAR 333-003-0100 to 333-003-0140, the following definitions apply:
(1) "Compensation" means salary or other wages or benefits, including without limitation life, health or workers' compensation insurance coverage, whether the compensation is provided as an employee or under a contract or other agreement. "Compensation" does not include the provision of meals, clothing, or equipment to a health care provider who is a registrant or a volunteer when the registrant or volunteer is providing health care services under ORS 401.651 to 401.670, or any workers' compensation insurance or other coverages that are available to an "emergency service worker" as that term is defined in ORS 401.025(9)(a).
(2) "Cooperative Agreement" means an agreement between the Department and a local public health authority under ORS 401.657.
(3) "Credentialing" means granting privileges or permission, including any limitations or limits on the privileges or permission, authorizing a health care provider to provide health care services at a health care facility.
(4) "Credentialing plan" means the procedures established by an emergency health care center for credentialing emergency health care providers. At a minimum, the credentialing plan describes the verification procedure used to ensure that a registrant or volunteer is a licensed health care provider in this state.
(5) "Declaration" means the Governor has declared a state of emergency to exist under ORS 401.055 or 433.441
(6) "Department" means the Department of Human Services.
(7) "Emergency health care center" means a health care facility, or any portion thereof or any other location designated by the Department, or by a local public health authority under a cooperative agreement, to provide emergency health care services under ORS 401.651 to 401.670.
(8) "Emergency health care provider" means a health care provider who is a registrant or volunteer providing health care services under ORS 401.651 to 401.670.
(9) "Emergency health care services" means health care services rendered by an emergency health care provider.
(10) "Emergency operations plan" means procedures used by an emergency health care center that, at a minimum, meets the requirements of 333-003-0130(4).
(11) "Health care facility" has the meaning provided in ORS 401.651.
(12) "Health care provider" has the meaning provided in ORS 401.651.
(13) "Local public health authority" has the meaning provided in ORS 431.260.
(14) "Registrant" means a health care provider listed on the registry.
(15) "Registry" means the Health Care Provider Registry.
(16) "State Support Function 8" or "SSF 8" means the coordination of state assistance for health and medical care needs in the event of a disaster, as described in the Oregon Emergency Management Plan administered by the Department of State Police, Office of Emergency Management.
(17) "Volunteer" means a health care provider who is not a registrant who provides emergency health care services at an emergency health care center.
Stat. Auth.:
ORS 401.651 - 401.670
Stats. Implemented:
ORS 401.651 - 401.670
Hist.: PH
26-2004, f. & cert. ef. 7-30-04; PH 8-2008, f. & cert. ef. 5-5-08
333-003-0110
The Health Care Provider Registry
(1) The registry is a database of health care providers who choose to register to provide emergency health care services. The Department shall maintain the registry in electronic or paper form, or any combination thereof.
(a) For each registrant, the registry shall contain the registrant's name and license or other certification and any information provided to the Department describing any limits on the registrant's authority to provide health care services. The registry shall not contain any information regarding the reason for any limits on the registrant's authority to provide health care services, whether as a result of any disciplinary action imposed by the agency licensing the registrant or for any other reason.
(b) For each registrant, the registry may contain information about the registrant's usual practice or specialty, if that information is available and the Department determines it is appropriate to include in the registry.
(2) The Department shall issue to each registrant an identification card as provided in ORS 401.654.
(3) Information in the registry may be used for purposes of maintaining the registry and as needed in the event of a declaration, including without limitation that the information may be shared with emergency health care centers for purposes of facilitating granting privileges to registrants.
(4) Information in the registry may be used by local public health authorities in the manner provided in 333-003-0125(4).
Stat. Auth.:
ORS 401.651 - 401.670
Stats. Implemented:
ORS 401.651 - 401.670
Hist.: PH
26-2004, f. & cert. ef. 7-30-04; PH 8-2008, f. & cert. ef. 5-5-08
333-003-0115
Registration with the Department
(1) A health care provider may register in any manner made available by the Department including, without limitation, by filing an electronic, paper, fax or other form with the Department or, when available from the health care provider's licensing agency, by registering through that licensing agency.
(2) The Department may obtain verification of the license status of any health care provider who chooses to register from health care licensing agencies or other persons by electronic or other means.
(3) To be included in the registry, a health care provider must provide at least the following information to the Department:
(a) The information described in 333-003-0110(1)(a).
(b) The provider's license or certification number and other information that may be required by statute or rule.
(c) Disclosure of any restrictions on the health care provider's license imposed by a court or by a licensing or other agency.
(d) Information to enable the Department to identify the registrant, verify the registrant's license, and to contact the registrant in the event of a declaration.
(e) The Department may request additional information that may be required to identify the health care provider or to verify information about the health care provider.
(4) A health care provider may notify the Department at the time of registration if the provider authorizes release of the provider's information contained in the registry to local public health authorities for the purposes provided in 333-003-0125(4). A local public health authority accessing the registry for the purposes of 333-003-0125(4) may contact a registrant only if the registrant has provided this authorization.
(5) A registrant may request removal from the registry at any time by notifying the Department of the request. Upon receipt of such request and verification that it came from the registrant, the Department will remove the registrant from the registry. The registrant must return the identification card described in ORS 401.654 to the Department at the time of the request.
Stat. Auth.:
ORS 401.651 - 401.670
Stats. Implemented:
ORS 401.651 - 401.670
Hist.: PH
26-2004, f. & cert. ef. 7-30-04; PH 8-2008, f. & cert. ef. 5-5-08
333-003-0120
Health Care Providers Not Included in the Registry
(1) A health care provider who is not a registrant may provide health care services at an emergency health care center if authorized to do so pursuant to the emergency health care center's emergency operations plan and credentialing plan.
(2) A volunteer providing health care services within the course and scope of subsection (1) of this rule is an emergency health care provider if the services are provided without compensation.
Stat. Auth.: ORS 401.651 - 401.670
Stats. Implemented: ORS 401.651 - 401.670
Hist.: PH 26-2004, f. & cert. ef. 7-30-04
333-003-0125
Activation of Registrants
(1) The Department may activate the registry in the event of a declaration. The Department may support the state Emergency Coordination Center and the State Emergency Management Plan by activating the Registry, including by implementing SSF 8 plans, protocols, and procedures to integrate the Registry and registrants into the local emergency response.
(2) In the absence of a declaration, the Department may activate the registry only for training purposes.
(3) Upon activation under subsections (1) or (2) of this rule, a registrant acting without compensation and within the course and scope of the activation is an emergency health care provider.
(4) A local public health authority may activate registrants for use within the jurisdiction of the public health authority if the local public health administrator is acting under ORS 431.530 or if the county governing body in which the local public health authority is located has declared an emergency under ORS 401.309, if:
(a) The registrant has authorized local public health authorities to request that the registrant be activated for local purposes as provided in 333-003-0115(4);
(b) The local jurisdiction informs the registrant that the registrant is not an agent of the state under ORS 401.667; and
(c) The request to activate the registrant is made through the Department, and there has not been a declaration.
(5) A registrant may decline to respond to an activation at the time the registrant is notified of the activation. Unless a registrant requests otherwise, a registrant will remain on the registry whether or not the registrant responds to an activation.
Stat. Auth.:
ORS 401.651 - 401.670
Stats. Implemented:
ORS 401.651 - 401.670
Hist.: PH
26-2004, f. & cert. ef. 7-30-04; PH 8-2008, f. & cert. ef. 5-5-08
333-003-0130
Emergency Health Care Centers; Emergency Operations Plan
(1) In the event of a declaration, the Department or, when authorized by a cooperative agreement, a local public health authority, may designate one or more emergency health care centers.
(2) Emergency health care centers will be supervised by the Department or local public health authority that designates the emergency health care center, except:
(a) If an emergency health care center is a health care facility or is located within a health care facility, the Department or local public health authority designating the center may authorize supervision of the emergency health care center according to the health care facility's emergency operations plan, if it has one.
(b) If an emergency health care center is a health care facility or is located within a health care facility, the Department or local public health authority designating the center shall authorize supervision of the emergency health care center according to the health care facility's emergency operations plan if, prior to a declaration, the Department has determined that the health care facility's emergency operations plan meets the requirements of these rules. That determination may be made in the process of licensing the health care facility or upon a request to the Department by a health care facility.
(c) If an emergency health care center is not a health care facility or does not have an emergency operations plan, the emergency health care center shall operate under the emergency operations plan and credentialing plan developed by the Department under 333-003-0130(4) or by the local public health authority as provided in 333-003-0135. Pursuant to the emergency operations plan described in this paragraph, the Department or local public health authority that designated the emergency health care center may designate one or more persons to supervise the emergency health care center.
(3) The duties of the site supervisor, or that person's designee, includes providing to emergency health care providers a general orientation to the facility, a briefing on the situation at the emergency health care facility and written expectations of the emergency health care providers, all to be provided as soon as reasonably possible under the emergency
(4) An emergency operations plan shall include a chain of management and procedures for increasing staff during an emergency. For any emergency health care center that is a health care facility, this should include procedures for granting privileges, permission or other authority for health care providers who are not employed by, or otherwise associated with the health care facility, in the normal course of business, to provide emergency health care services. An emergency operations plan should include the following:
(a) The individual(s) responsible for granting emergency privileges and that decisions whether to grant privileges to registrants or volunteers are to be made on a case-by-case basis and at the discretion of the individual(s) responsible for granting emergency privileges;
(b) A mechanism to readily identify the emergency-privileged individuals;
(c) A process, to begin as soon as the situation that gave rise to the declaration allows, for verifying the license and any other information relevant to a registrant or volunteer who is granted emergency privileges under the credentialing plan;
(d) The credentialing plan may provide for emergency privileges to be granted upon presentation of any of the following:
(A) A current picture hospital ID card;
(B) A current license to practice and a valid picture ID; issued by a state, federal or regulatory agency;
(C) Identification indicating that the individual is a member of a Disaster Medical Assistance Team (DMAT);
(D) Identification indicating that the individual has been granted authority to render patient care in emergency circumstances, such authority having been granted by federal, state, or municipal entity, including without limitation the identification card described in ORS 401.654; or
(E) Presentation by current hospital or medical staff members(s) with personal knowledge regarding practitioner's identity.
Stat. Auth.:
ORS 401.651 - 401.670
Stats. Implemented:
ORS 401.651 - 401.670
Hist.: PH
26-2004, f. & cert. ef. 7-30-04; PH 8-2008, f. & cert. ef. 5-5-08
333-003-0135
Cooperative Agreements Between the Department and Local Public Health Authorities to Designate Emergency Health Care Centers
(1) The Department may enter into cooperative agreements with local public health authorities to authorize local public health authorities to identify and designate emergency health care centers within their respective jurisdictions as provided in 333-003-0130.
(2) A cooperative agreement may incorporate an emergency operations plan and credentialing plan developed by the local public health authority that is acceptable to the Department for emergency health care centers within the local jurisdiction. In the absence of an emergency operations plan and credentialing plan in the cooperative agreement, the emergency operations plan and credentialing plan established by Department under 333-003-0130(4) shall apply, unless the local public health authority authorizes an emergency health care center that is a health care facility to use its emergency operations plan as provided in OAR 333-003-0130(2)(a) or the health care facility's emergency operations plan has been approved as provided in OAR 333-003-0130(2)(b).
Stat. Auth.: ORS 401.651 - 401.670
Stats. Implemented: ORS 401.651 - 401.670
Hist.: PH 26-2004, f. & cert. ef. 7-30-04
333-003-0140
Training
The Department may require or otherwise make available to registrants training that the Department determines necessary or beneficial to the provision of health care services that may be rendered by registrants pursuant to ORS 401.651 to 401.670, including without limitation training in the emergency response system structure, operations, emergency preparedness and table top or other emergency response exercises. The Department shall not require training that is related to a registrant's professional license.
Stat. Auth.: ORS 401.651 - 401.670
Stats. Implemented: ORS 401.651 - 401.670
Hist.: PH 26-2004, f. & cert. ef. 7-30-04
333-003-0200
Public Health Emergency Plans
The Public Health Director and local public health authorities shall use an incident command system framework in their respective public health emergency plans.
Stat. Auth.:
ORS 431.266
Stats. Implemented:
ORS 431.266
Hist.: PH
8-2008, f. & cert. ef. 5-5-08
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