OAR 291-124-0041
Healthcare and Treatment

(1) Health care procedures will be conducted in a clinically appropriate manner by appropriately credentialed personnel in an appropriate setting.
(2) Health care and treatment is authorized and provided according to priorities established by the Health Services Chief of Medicine and is subject to peer review. Medical care and treatment is generally prioritized into four levels.
(3) Level 1 Care and Treatment:
(a) Level 1 care and treatment (or medically mandatory care and treatment) is defined as care and treatment that is essential to life and health, without which rapid deterioration may be an expected outcome and where medical or surgical intervention makes a very significant difference or has a very high cost-effectiveness. Level 1 care and treatment may include, but is not limited to:
(A) Acute problems, potentially fatal, where treatment prevents death and allows full recovery, (for example, appendectomy for appendicitis, repair of deep open wound in neck, myocarditis, myocardial infarction);
(B) Acute problems, potentially fatal, where treatment prevents death but does not necessarily allow for full recovery (for example, burn treatment, treatment for severe head injuries, myocardial infarction); or
(C) Maternity care (for example, monitoring, delivery, hypertension in pregnancy)
(b) Level 1 care and treatment is generally provided to all AICs by the department. A treating provider may authorize Level 1 care and treatment. In emergency situations, any qualified licensed DOC health professional may authorize Level 1 care and treatment.
(4) Level 2 Care and Treatment:
(a) Level 2 care and treatment (or presently medically necessary care and treatment) is defined as care and treatment without which an AIC 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 include, but is not limited to:
(A) Chronic, usually fatal conditions where treatment improves life span and quality of life, (for example, medical management of insulin dependent diabetes mellitus, surgical treatment for treatable cancer of the uterus, medical management of asthma, hyper tension, etc.);
(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 adults, e.g., preventive dental care, mammograms, pap smears, blood pressure screenings;
(E) Acute but non-fatal conditions where treatment causes a return to previous state of health, (for example, fillings for dental cavities, medical treatment of various infectious disorders); or
(F) Acute non-fatal conditions where treatment allows the best approximation of return to previous health (for example, reduction of dislocated elbow, repair of corneal laceration).
(b) Level 2 care and treatment may be provided to AICs and, when not of an emergency nature, subject to periodic utilization review and appropriateness by the Health Services Chief of Medicine. A treating practitioner may authorize Level 2 care or treatment.
(5) Level 3 Care and Treatment:
(a) Level 3 care and treatment (or medically acceptable but not medically necessary care and treatment) is defined as care and treatment for non-fatal conditions where treatment or intervention may improve the quality of life for the AIC. Level 3 care and treatment may include but is not limited to routine hernia repair, treatment of non-cancerous skin lesions, corneal transplant for cataract, hip replacement, etc.
(b) Level 3 care and treatment may be authorized on an individual-by-individual basis or on a problem-by-problem basis as follows:
(A) Medical or surgical care and treatment that can be appropriately done on premises in a routine clinic and that is within the skills of the attending provider may be offered at the discretion of the treating provider. Any such care and treatment may be referred by an attending provider to the Health Services Chief of Medicine for clinical review as provided in OAR 291-124-0041 (Healthcare and Treatment)(9) to determine whether to authorize the medical or surgical care and treatment.
(B) Other medical or surgical care and treatment, including offsite procedures and therapies for chronic diseases may be referred to the Health Services Chief of Medicine for clinical review as provided in OAR 291-124-0041 (Healthcare and Treatment)(9) to determine whether to authorize the medical or surgical care and treatment.
(6) Level 4 Care and Treatment (Of Limited Medical Value):
(a) Level 4 care and treatment (or care and treatment of limited medical value) is defined as care and treatment that may be valuable to a certain individual but is significantly less likely to be cost-effective or to produce substantial long-term gain or improvement.
(A) Level 4 care and treatment includes care and treatment of minor conditions where treatment merely speeds recovery, where treatment gives little improvement in quality of life, offers minimal palliation of symptoms, or is exclusively for the convenience of the individual.
(B) Level 4 care and treatment may include but is not limited to tattoo removal, minor nasal reconstruction, oral aphthous ulcers, elective circumcision, common cold, infectious mononucleosis, surgery for gynecomastia.
(b) Level 4 care and treatment will not be routinely provided. AICs may obtain Level 4 care and treatment as provided in OAR 291-124-0085 (Charges for Elective Care or Treatment).
(7) The department is not obligated to carry out any recommendations or treatment plans formulated by any outside providers if ongoing care is required.
(8) Exceptions:
(a) The four defined levels of care are general categories of diagnoses, therapies, or procedures. Depending on the individual circumstances, the department may consider additional factors in deciding whether to provide particular care and treatment.
(b) Also, there may be an occasion when the level of care of a certain condition or disorder is unclear, or when it is not appropriate to apply the levels of care to an individual AIC, for example (when it may not seem appropriate to provide Level 2 care and treatment, or when it may seem appropriate to provide Level 4 care and treatment).
(c) Any individual case may be referred to the Health Services Chief of Medicine for clinical review as provided in OAR 291-124-0041 (Healthcare and Treatment)(9) to determine whether to authorize or not authorize medical or surgical care and treatment.
(9) Clinical Review
(a) Under appropriate circumstances, individual cases may be referred to the Health Services Chief of Medicine for clinical review. The Health Services Chief of Medicine may form a review committee comprised of one or more department providers and the Medical Services manager to review care and treatment requests on a case-by-case basis. The final authority in any review is the Health Services Chief of Medicine or designee.
(b) Factors that the Health Services Chief of Medicine and a review committee may consider, either singularly or in combination, when deciding whether specified care and treatment should be provided, may include, but are not limited to:
(A) The urgency of the care and treatment, and the length of the AIC’s remaining sentenced stay. Whether the care and treatment could be or could not be reasonably delayed without causing a significant progression, complication, or deterioration of the condition and would not otherwise be in clear violation of sound medical principles.
(B) The necessity of the care or treatment, including:
(i) Any relevant functional disability and the degree of functional improvement to be gained;
(ii) Medical necessity, or the overall morbidity and mortality of the condition if left untreated;
(iii) Pre-existing conditions, whether the condition existed prior to the AIC’s incarceration and, if treatment was not obtained previously, the reasons for not obtaining earlier treatment;
(iv) The probability the procedure or therapy will have a successful outcome along with relevant risks;
(v) Alternative therapy or procedures that may be appropriate;
(vi) The AIC’s desire for the procedure and the likelihood of the AIC’s cooperation in the treatment efforts;
(vii) Any known risks or benefits relative to those risks;
(viii) Any known costs or benefits relative to those costs;
(ix) Pain complaints or pain behaviors; and
(x) Any other factors that are relevant or pertinent in light of the circumstances presented.
(10) Therapeutic diets may be ordered by a treating provider for an AIC with a medical condition requiring nutritional adjustment that is not obtainable from the regular food services menu. Diets to achieve weight loss are the responsibility of the individual AIC.
(11) Health Services will screen AICs for work limitations at the assignment supervisor’s request. Ongoing daily review of AIC workers for symptoms of illness that would interfere with the work assignment is the responsibility of the on-site work supervisor.

Source: Rule 291-124-0041 — Healthcare and Treatment, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=291-124-0041.

Last Updated

Jun. 8, 2021

Rule 291-124-0041’s source at or​.us