309-033-0270 Provision of Care, Custody and Treatment of Persons under Civil Commitment (1) Persons under civil commitment have the rights provided under ORS 426.385, ORS 430.205 through 430.210, and this rule, including: (a) A person under civil commitment’s right to fresh air. (b) If a person under civil commitment requests access to fresh air and the outdoors or the person under civil commitment’s treating health care provider determines that fresh air or the outdoors would be beneficial to the person under civil commitment, the facility in which the person under civil commitment is receiving services shall provide daily access to fresh air and the outdoors unless this access would create a significant risk of harm to the person under civil commitment or others; (c) The determination whether a significant risk of harm to the person under civil commitment or others exists shall be made by the person under civil commitment’s treating health care provider. The treating health care provider may find that a significant risk of harm to the person under civil commitment or others exists if: (A) The person under civil commitment’s circumstances and conditions indicate an unreasonable risk of harm to the person under civil commitment or others which cannot be reasonably accommodated within existing programming should the person under civil commitment be allowed access to fresh air and the outdoors; or (B) The facility’s existing physical plant or existing staffing prevent the provision of access to fresh air and the outdoors in a manner than maintains the safety of the person under civil commitment or others. (d) If a facility determines that its existing physical plant prevents the provision of access to fresh air and the outdoors in a safe manner, the facility shall make a good faith effort at the time of any significant renovation to the physical plant that involves renovation of the unit or relocation of where persons under civil commitment are treated to include changes to the physical plan or location that allow access to fresh air and the outdoors, so long as such changes do not add an unreasonable amount to the cost of the renovation. (2) Provision of care at a state hospital. The superintendent of the state hospital shall be responsible for all admissions to the state hospital pursuant to OAR 309-091-0015. The superintendent shall implement policies and procedures which afford a person under civil commitment placed in a state hospital the rights provided by ORS 426.385, 430.205 through 430.210 and this rule. (3) Provision of care at a community hospital. The director shall place a person under civil commitment at a community hospital only if it is approved under OAR 309-033-0530: (a) The Licensed Independent Practitioner (LIP), in consultation with the director, shall determine whether the best interests of a person under civil commitment are served by an admission to a community hospital; (b) The administrator shall implement policies and procedures which afford a person under civil commitment placed in a community hospital the rights provided by ORS 426.385, 430.205 through 430.210 and this rule. (4) Provision of care at a nonhospital facility or an outpatient program. The director shall only place a person under civil commitment in a nonhospital facility that is licensed or certified by the Division: (a) The administrator, in consultation with the director, shall determine whether the best interests of a person under civil commitment are served by an admission to a nonhospital facility or an outpatient program; (b) The administrator shall implement policies and procedures which afford a person under civil commitment placed in a nonhospital facility or an outpatient program the rights provided by ORS 426.385, 430.205 through 430.210 and this rule; (c) The director may place the person under civil commitment on a trial visit when the person is discharged from Oregon State Hospital, a community hospital, or a level one facility to a lower level of care in accordance with OAR 309-033-0290 and 309-033-0300 . A lower level of care may include treatment in another facility, outpatient care, or case management services; (d) The director may place a person under civil commitment on outpatient commitment, who , at the time of the civil commitment hearing and immediately following it, is not initially placed in a level one facility or hospital setting . This may include treatment or services whereby the person resides in a residential behavioral health facility or their personal residence with outpatient or medication management services (5) Provision of medical services for a person under civil commitment. The superintendent of the state hospital, the treating LIP at a community hospital or the director may transfer a person under civil commitment to a community hospital, or transfer a person under civil commitment from a psychiatric unit to a medical unit for medical care: (a) The treating LIP shall only provide medical care with the consent of the person under civil commitment in accordance with OAR 309-033-0600 through 309-033-0650; (b) The superintendent or treating LIP shall transfer a person under civil commitment to a community hospital for medical services on a pass or discharge the person from the state hospital when it is determined that the person will not return to the state hospital within a reasonable length of time, or that discharge is clinically appropriate and is required for the person to have access to third-party insurance benefits; (c) The treating LIP shall immediately notify the director that a person was transferred to another hospital for medical care under this subsection. Statutory/Other Authority: ORS 413.042, 426.060, 426.385 & 430.205 - 430.210 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 BHS 17-2022, temporary amend filed 10/14/2022, effective 10/14/2022 through 04/11/2023 MHS 5-2009, f. & cert. ef. 12-17-09 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0080