OAR 309-033-0640
Involuntary Administration of Significant Procedures to a Committed Person With Good Cause


(1)

Hospitals or nonhospital facilities authorized. Only the following facilities that serve committed persons shall involuntarily administer significant procedures with good cause under the provisions of 309-033-0640 (Involuntary Administration of Significant Procedures to a Committed Person With Good Cause):

(a)

A hospital or nonhospital facility approved under OAR 309-033-0700 (Purpose and Scope) through 309-033-0740 (Variances), Approval of Hospitals and Nonhospital Facilities To Provide Seclusion and Restraint to Committed Persons and to Persons in Custody or on Diversion.

(b)

A hospital or nonhospital facility approved under OAR 309-033-0530 (Approval of Hospitals and Nonhospital Facilities to Provide Services to Committed Persons and to Persons In Custody and On Diversion), Approval of Hospitals and Nonhospital Facilities To Provide Services to Committed Persons and to Persons in Custody or on Diversion.

(c)

Secure residential facilities licensed by the Division or licensed by the APD.

(d)

Intermediate care facilities or enhanced care facilities licensed by SPD which have a variance from SPD to provide involuntary medication.

(2)

Good cause. Good cause exists to administer a significant procedure to a person committed to the Division without informed consent if, in the opinion of the treating physician, after consultation with the treatment team:

(a)

The person is deemed unable pursuant to OAR 309-033-0620 (Obtaining Informed Consent to Treatment From a Person and the Administration of Significant Procedures Without the Informed Consent of a Committed Person) to consent to, refuse, withhold or withdraw consent to the significant procedure.

(b)

The proposed significant procedure will likely restore, or prevent deterioration of, the person’s mental or physical health, alleviate extreme suffering, or save or extend the person’s life.

(c)

The proposed significant procedure is the most appropriate treatment for the person’s condition according to current clinical practice, and all other less intrusive procedures have been considered and all criteria and information set forth in OAR 309-033-0620 (Obtaining Informed Consent to Treatment From a Person and the Administration of Significant Procedures Without the Informed Consent of a Committed Person), Procedures for Obtaining Informed Consent and Information to be Given, are considered.

(d)

The treating physician has made a conscientious effort to obtain informed consent to the significant procedure from the person.

(3)

Independent review. Prior to granting approval for the administration of a significant procedure for good cause to a person committed to the Division, the administrator shall obtain consultation and approval from an independent examining physician.

(a)

The administrator shall maintain a list of independent examining physicians and shall seek consultation and approval from independent examining physicians selected on a rotating basis from the list. The independent examining physician shall:

(A)

Be a psychiatrist;

(B)

Not be in a position to provide primary or on-call care or treatment to the person who is subject of the independent review;

(C)

Not be an employee of the facility;

(D)

Have been subjected to review by medical staff executive committee as to qualifications to make such an examination; and

(E)

Have read and received training from the medical staff regarding the meaning and the application of these rules.

(b)

Prior to seeking consultation and approval of an examining physician, the administrator shall provide written notice to the committed person who is subject to the proposed significant procedure without the person’s consent.

(4)

Independent physician activities. The physician selected to conduct the independent consultation shall:

(a)

Review the person’s clinical record, including the records of efforts made to obtain the person’s informed consent;

(b)

Personally examine the person;

(c)

Interview the person to determine the extent of the need for the procedure and the nature of the person’s refusal, withholding, or withdrawal or inability to consent to the significant procedure;

(d)

Consider additional information, if any, presented prior to or at the time of examination or interview as may be requested by the person; and

(e)

Make a determination whether the factors required under these rules exist for the particular person or that one or more factors are not present. If the physician determines that the person does not have capacity to give consent to treatment, the physician shall review the proposed significant procedure. The physician shall make his/her determination of capacity, approval or disapproval of the proposed significant procedure to:

(A)

The administrator; and

(B)

The person to whom a significant procedure is proposed to be administered, with a copy being made part of the person’s record.

(5)

Administrator determination. The administrator shall approve or disapprove of the administration of the significant procedure to a person committed to the Division based on good cause, provided:

(a)

The administrator shall not approve the significant procedure and it shall not be performed when the independent examining physician found that one or more of the factors required by OAR 309-033-0640 (Involuntary Administration of Significant Procedures to a Committed Person With Good Cause) were not present or otherwise disapproved of the procedure.

(b)

Approval of the significant procedure shall terminate if there is a substantial increase in risk, as determined by a physician, of administering the significant procedure or at any time the person regains capacity to give informed consent/refusal. Approval of the significant procedure shall terminate at the end of the person’s commitment but in no case longer than 180 days. Disapproval shall be only so long as no substantial change occurs in the person’s condition.

(c)

Written notice of the administrator’s determination shall be provided to the person and made part of the committed person’s clinical records.

(d)

A copy of the independent examining physician’s report shall be made part of the committed person’s clinical record.

(6)

Ninety-day right to review. The administrator shall adopt procedures which assure that the committed person may request independent review of the approval once every ninety days after the initial approval. Within 14 days of a verbal or written request from the committed person, the administrator shall initiate an independent review of the approval, as in OAR 309-033-0640 (Involuntary Administration of Significant Procedures to a Committed Person With Good Cause).

(7)

Transfer of approval. The administrator, or the superintendent of a State hospital, shall transfer the approval of the administration of a significant procedure when a committed person is transferred to another hospital or nonhospital facility described in OAR 309-033-0640 (Involuntary Administration of Significant Procedures to a Committed Person With Good Cause).

(a)

The administrator, or the superintendent, of the sending hospital or nonhospital facility shall transfer the approval by sending copies of all approval documents to the administrator of the receiving facility.

(b)

The administrator, or the superintendent, of the receiving hospital or nonhospital facility shall assure that the treating physician at that facility reexamines the committed person and verifies that the need for the approval continues to exist as described in OAR 309-033-0620 (Obtaining Informed Consent to Treatment From a Person and the Administration of Significant Procedures Without the Informed Consent of a Committed Person), Procedures for Obtaining Informed Consent and Information to be Given, and 309-033-0640 (Involuntary Administration of Significant Procedures to a Committed Person With Good Cause), Good Cause. The receiving hospital or nonhospital facility may administer the significant procedure if the need for the procedure continues in accordance with OAR 309-033-0640 (Involuntary Administration of Significant Procedures to a Committed Person With Good Cause), Involuntary Administration of Significant Procedures to a Committed Person with Good Cause.

(c)

In no event shall the approval of a significant procedure continue beyond 180 days from the date of the original approval without reestablishing the need for the approval by following the procedures prescribed in OAR 309-033-0640 (Involuntary Administration of Significant Procedures to a Committed Person With Good Cause), Involuntary Administration of Significant Procedures to Committed Persons with Good Cause.

(8)

Administrative procedures.

(a)

Utilization summary. Every four months the administrator shall make a summary of the use of OAR 309-033-0630 (Administration of Significant Procedures in Emergencies Without the Informed Consent of a Committed Person) and 309-033-0640 (Involuntary Administration of Significant Procedures to a Committed Person With Good Cause) that includes:

(A)

Each type of proposed significant procedure for which consultation with an independent examining physician was sought;

(B)

The number of times consultation was sought from a particular independent examining physician or disposition board for each type of proposed significant procedure;

(C)

The number of times each independent examining physician approved and disapproved each type of proposed significant procedure; and

(D)

The number of times the approved and disapproved each type of proposed significant procedure.

(b)

Outside reviewer’s access to summaries. The administrator shall provide a copy of a utilization summary to the federally-mandated advocacy and protection agency for Oregon, which is appointed by the Governor and which currently is the Oregon Advocacy Center, and the Division. The Division may only distribute the report to any other person or organization authorized by the Division which in the opinion of the Assistant Administrator:

(A)

Has substantial interest in the advocacy and protection of the rights of persons with mental illness; and

(B)

Whose access to the summaries will provide a substantial and material benefit to the citizens of Oregon.

Source: Rule 309-033-0640 — Involuntary Administration of Significant Procedures to a Committed Person With Good Cause, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=309-033-0640.

309‑033‑0200
Statement of Purpose and Statutory Authority
309‑033‑0210
Definitions
309‑033‑0220
General Standards
309‑033‑0230
Custody of Persons Alleged to Be Mentally Ill Prior to Filing a Notification of Mental Illness
309‑033‑0240
Initiation of the Civil Commitment Process
309‑033‑0250
Standards for Custody, Hospital and Nonhospital Holds, Emergency Commitment and Emergency Hospitalization of Persons Under Warrant of Detention
309‑033‑0260
Diversion from Commitment Hearing
309‑033‑0270
Provision of Care, Custody and Treatment of Persons Committed to the Division
309‑033‑0280
Procedures for Committed Persons on Outpatient Commitment or Trial Visit
309‑033‑0290
Assignment and Placement of Persons Committed to the Division
309‑033‑0300
Transfers Between Classes of Facilities
309‑033‑0310
Recertification for Continued Commitment
309‑033‑0320
Revocation of Conditional Release, Outpatient Commitment or Trial Visit
309‑033‑0330
Discharge of Committed Persons, Who Are Placed in the Community, from Commitment Status
309‑033‑0340
Variances
309‑033‑0400
Statement of Purpose and Statutory Authority
309‑033‑0410
Definitions
309‑033‑0420
Transportation and Transfer of Persons in Custody or On Diversion
309‑033‑0430
Transportation of a Committed Person to a State Hospital, Community Hospital or Nonhospital Facility
309‑033‑0432
Standards for the Approval of a Secure Transport Provider to Transport a Person in Custody or On Diversion to an Approved Holding Hospital or Nonhospital Facility
309‑033‑0435
Client Rights with Regards to a Secure Transport Provider
309‑033‑0437
Mechanical Restraint by a Secure Transport Provider
309‑033‑0440
Variance
309‑033‑0500
Statement of Purpose and Statutory Authority
309‑033‑0510
Definitions
309‑033‑0520
Classes of Facility that Provide Care, Custody or Treatment to Committed Persons or to Persons In Custody or On Diversion
309‑033‑0530
Approval of Hospitals and Nonhospital Facilities to Provide Services to Committed Persons and to Persons In Custody and On Diversion
309‑033‑0540
Administrative Requirements for Hospitals and Nonhospital Facilities Approved to Provide Services to Persons In Custody
309‑033‑0550
Standards for the Approval of Hospitals Detaining Persons In Custody Pending Transport to an Approved Holding Hospital or Nonhospital Facility
309‑033‑0560
Variances
309‑033‑0600
Statement of Purpose and Statutory Authority
309‑033‑0610
Definitions
309‑033‑0620
Obtaining Informed Consent to Treatment From a Person and the Administration of Significant Procedures Without the Informed Consent of a Committed Person
309‑033‑0625
Administration of Medication and Treatment without the Informed Consent of a Person in Custody
309‑033‑0630
Administration of Significant Procedures in Emergencies Without the Informed Consent of a Committed Person
309‑033‑0640
Involuntary Administration of Significant Procedures to a Committed Person With Good Cause
309‑033‑0650
Variances
309‑033‑0700
Purpose and Scope
309‑033‑0710
Definitions
309‑033‑0720
Application, Training and Minimum Staffing Requirements
309‑033‑0725
Medical Services
309‑033‑0727
Structural and Physical Requirements
309‑033‑0730
Seclusion and Restraint Procedures
309‑033‑0732
Time Limits
309‑033‑0733
Documentation
309‑033‑0735
Quarterly Reports
309‑033‑0740
Variances
309‑033‑0800
Statement of Purpose and Statutory Authority
309‑033‑0810
Definitions
309‑033‑0820
Denial of Payment for Services to Persons In Custody or On Diversion
309‑033‑0830
Variances
309‑033‑0900
Statement of Purpose and Statutory Authority
309‑033‑0910
Definitions
309‑033‑0920
Certification of Mental Health Investigators
309‑033‑0930
Investigation of Person Alleged to Be a Mentally Ill Person
309‑033‑0940
The Investigation Report
309‑033‑0950
Certification of Mental Health Examiners
309‑033‑0960
Mental Health Examiner’s Report to the Court
309‑033‑0970
Variances
Last Updated

Jun. 8, 2021

Rule 309-033-0640’s source at or​.us