justicedao/ipfs_state_laws huggingface dataset:
309-033-0630 Administration of Significant Procedures in Emergencies Without the Informed Consent of a Person under Civil Commitment (1) Hospitals or nonhospital facilities authorized. The following facilities that serve persons under civil commitment and which administer significant procedures in emergencies, without obtaining informed consent, shall be subject to the provisions of 309-033-0630: (a) A hospital or nonhospital facility approved under OAR 309-033-0700 through 309-033-0740. (b) A hospital or nonhospital facility approved under OAR 309-033-0530. (c) Secure residential facilities licensed by the Division or licensed by Aging and People with Disabilities (APD). (d) Intermediate care facilities or enhanced care facilities licensed by the APD. (2) Administering a significant procedure. If an emergency exists, the responsible physician or nurse may administer a significant procedure to a person under civil commitment without obtaining prior informed consent in the manner otherwise required by these rules, provided: (a) The physician or designee shall document in the person’s clinical record the specific nature of each emergency and the procedure which was used to deal with the emerge; (b) If the person is determined to be legally incapacitated or has a court-appointed guardian the physician or designee shall make reasonable effort to contact the legal guardian prior to the administration of the significant procedure. If contact is not possible, the physician or designee shall notify the legal guardian as soon as possible; (c) Within a reasonable period of time after an emergency procedure is administered, the treatment team shall review the treatment and, if practicable, implement treatment designed to correct the behavior creating the emergency; (d) The responsible physician or nurse shall not administer a significant procedure after the emergency situation has subsided, without obtaining informed consent. Statutory/Other Authority: ORS 413.042 & 426.236 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 9-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-215-0040
309-033-0700 Purpose and Scope (1) This section establishes rules pursuant to ORS 426.072, 426.236, 426.228, 426.232, 426.233 and 426.234, 426.385 for certification of hospitals and facilities which provide care, custody, and treatment to persons under civil commitment and to persons in custody or on diversion. (2) Seclusion or restraint may be used only for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or other individuals. Statutory/Other Authority: ORS 413.042, 426.236, 426.385 & 430.021 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 13-2014, f. & cert. ef. 9-29-14 MHD 10-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-220-0000
309-033-0725 Medical Services (1) A Licensed Independent Practitioner (LIP) must be available 24 hours per day, seven days per week to provide medical supervision of the services provided. (a) In accordance with state law, those LIPs authorized to order seclusion or restraint pursuant to the facility policy must at minimum have a working knowledge of the hospital policy regarding the use of seclusion and restraint; (b) A LIP must examine a person admitted to the facility within 24 hours of the person’s admission. (2) At least one registered nurse must be on duty at all times. (3) The facility must maintain a personnel file for each patient care staff which includes a written job description; the minimum level of education or training required for the position; copies of applicable licenses, certifications, or degrees granted; annual performance appraisals; a biennial, individualized staff development plan signed by the staff; documentation of CPR training; documentation of annual training and certification in managing aggressive behavior, including seclusion and restraint; and other staff development and/or skill training received. (4) Healthcare supervisor. The facility must appoint a Healthcare supervisor who shall review and approve policies and procedures relating to: (a) The reporting of indicators of medical problems to a LIP; and (b) Curriculum for the staff training, as identified in these rules; and (c) The Restraint/Seclusion Review Committee as described in OAR 309-033-0733, including review of its findings. The healthcare supervisor shall make these reviews available to the Authority upon request. Statutory/Other Authority: ORS 426.005, 426.060, 426.110(2), 426.232, 426.236 & 430.041 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 MHS 13-2014, f. & cert. ef. 9-29-14
309-033-0727 Structural and Physical Requirements (1) The hospital or other facility which provides care, custody, and treatment for persons with mental illness or persons alleged to have a mental illness have available at least one room which meets the following requirements: (a) The room must be of adequate size, not isolated from regular staff of the facility, and provided with an adequate locking device on all doors and windows; (b) The door must open outward and contain a port of shatterproof glass or plastic through which the entire room may be viewed from outside and before entering; (c) The room shall contain no protruding objects, such as doorknobs, towel or clothes bars, hooks, or racks. There shall be no exposed curtains, drapes, rods, or furniture, except a portable bed which can be removed, if necessary. In case of the removal of the bed frame, a fireproof mattress shall be placed on the floor. Beds which are securely fastened to the floor must have no protrusions such as bed posts or sharp corners; (d) Any windows shall be made of unbreakable or shatterproof glass, or plastic. Non-shatterproof glass shall be protected by adequate detention type screening, such as Chamberlain Detention Screen; (e) There shall be no exposed pipes or electrical wiring in the room. Electric outlets shall be permanently capped or covered with a metal shield which opens with a key. Ceiling and wall lights shall be recessed and covered with safety-type glass or unbreakable plastic. Any cover, cap or shield shall be secured by tamper-proof screws or other means approved by the Division; (f) The room shall contain no combustible material, such as matches, lighters, cigarettes, etc. Smoking shall not be allowed in the room, except under direct supervision of staff; (g) The room shall meet fire, safety, and health standards. If sprinklers are installed, they shall be recessed and covered with a fine mesh metal screening. If pop-down type, sprinklers must have breakaway strength of under 80 pounds. In lieu of sprinklers, a combined smoke and heat detector shall be used. Documentation of the breakaway strength of sprinklers must be on file at the facility. (2) Bathroom requirements include: (a) Adequate toilet and sanitary facilities; (b) The bathroom shall contain no shower rods, shower curtains, window curtain rods, curtains, or towel rods, unless used only with direct staff supervision; (c) The bathroom shall not lock from the inside and, if connected to the room, shall be locked when not in use. (3) No sharp objects, such as razor blades, scissors, knives, nail files, etc., shall be available to the patient, except under direct staff supervision. No poisons or cleaning materials shall be kept in the room or in the bathroom available for the room. Statutory/Other Authority: ORS 426.236, 426.385 & 430.041 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 13-2014, f. & cert. ef. 9-29-14
309-033-0730 Seclusion and Restraint Procedures (1) Certified facilities shall not use seclusion and restraint except in an emergency and only then subject to the conditions and limitations of these rules. (2) General procedures: (a) Only a Licensed Independent Practitioner (LIP), physician assistant, or registered nurse may initiate seclusion or restraint procedures; (b) Each use of seclusion or restraint shall be monitored and supervised by a LIP or a registered nurse; (c) A LIP responsible for the patient’s care must order the use of seclusion or restraint within one hour of the administration of the procedure. This approval must be documented in the person's medical record. The LIP's order may occur by the following methods: (A) Verbally, in person or via telephone; (B) By Electronic Medical Record; or (C) By a written order. (d) Within one hour after the initiation of the seclusion or restraint intervention, the patient must be seen face-to-face by a LIP, a registered nurse or physician assistant who has been trained in accordance with these rules; (e) If the face-to-face evaluation is performed by a registered nurse or physician assistant, the evaluator must consult with the attending LIP as soon as possible following the face-to-face evaluation; (f) The face-to-face evaluation must include the following: (A) An evaluation of the patient's immediate situation; (B) The patient's reaction to the intervention; (C) The patient's medical and behavioral condition; and (D) The need to continue or terminate the restraint or seclusion. Statutory/Other Authority: ORS 426.005, 426.060, 426.110(2), 426.232 & 426.236 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 13-2014, f. & cert. ef. 9-29-14 MHD 10-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-220-0040
309-033-0732 Time Limits (1) The maximum time limit for each restraint or seclusion order — before consideration of a renewal, and up to a maximum of 24 hours — is as follows: (a) 4 hours for adults 18 years of age or older; (b) 2 hours for children and adolescents 9 to 17 years of age; or (c) 1 hour for children under 9 years of age. (2) Orders may be renewed according to time limits for a maximum 24 hours verbally or in writing, or through an electronic medical record. After each 24 hours of continuous restraint or seclusion, and prior to further extension of the restraint or seclusion, an examination and second opinion must occur by a second Licensed Independent Practitioner (LIP). (3) The LIP responsible for the care of the patient shall examine a person within 24 hours of the administration of seclusion or restraint and the person must be examined by a registered nurse every two hours until such time as the LIP examines the person and either makes new orders for seclusion nor restraint or for releasing the patient from seclusion or restraint. The LIP must document reasons for the use of the seclusion or restraint over the LIP’s signature. (4) A LIP shall not order physical restraint on an as required basis, i.e. a LIP shall not make "P.R.N." orders for physical restraint. (5) No form of restraint shall be used as punishment, for the convenience of staff, or as a substitute for activities, treatment, or training. (6) Medication will not be used as a restraint but will be prescribed and administered according to acceptable medical, nursing, and pharmaceutical practices. (7) Patients shall not be permitted to use restraint on other patients. (8) Physical restraint must be used in accordance with sound medical practice to assure the least risk of physical injury and discomfort. Any patient placed in physical restraint shall be protected from self-injury and from injury by others. (9) 15 Minute Checks: (a) A patient in restraint or seclusion must be checked at least every 15 minutes; (b) Include circulation checks, during waking hours adequate range of motion, and partial release of restraint to permit motion and exercise without endangering the patient or staff; (c) Attention must be paid to the patient's basic personal needs (such as regular meals, personal hygiene, and sleep) as well as the person's need for good body alignment and circulation; (d) Staff must document that the patient was checked, and appropriate attention paid to the person's needs; (e) The patient must be released as soon as the patient is assessed by a registered nurse or LIP to not present imminent dangerousness to themselves or others. Statutory/Other Authority: ORS 426.005, 426.060, 426.110(2), 426.232, 426.236 & 430.041 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 13-2014, f. & cert. ef. 9-29-14
309-033-0733 Documentation (1) No later than the end of their work shifts, the persons who obtained authorization and carried out the use of restraint shall document in the person's chart including but not necessarily limited to the following: (a) The specific behavior(s) which required the intervention of seclusion or restraint; (b) Less restrictive alternatives used before deciding seclusion or restraint was necessary; (c) The methods of intervention used and the patient's responses to the interventions; and (d) Findings and recommendations from the face-to-face evaluation discussed in OAR 309-033-0730(d) through (f) above. (2) Within 24 hours after the incident resulting in the use of restraint, the treating Licensed Independent Practitioner (LIP) who ordered the intervention must review and sign the order. (3) Each use of restraint must be reported daily to the health care supervisor. (4) Any death that occurs while a patient is in seclusion or restraint must be reported to the Division within 24 hours of the death. (5) Restraint/Seclusion Review Committee. Each facility must have a Restraint/Seclusion Review Committee. The committee may be one formed specifically for the purposes set forth in this rule, or the duties prescribed in this rule may be assigned to an existing committee. The purpose and duty of the Restraint/Seclusion Review Committee is to review and evaluate, at least quarterly, the appropriateness of all such interventions and provide its findings to the healthcare supervisor in a written report: (a) The committee shall evaluate incidents of seclusion and restraint for alternative approaches and interventions where a resident required seclusion or restraint. (b) In Class 1 facilities, the committee shall evaluate all incidents wherein a resident requiring restraint or seclusion was transferred to another facility for the administration of seclusion and restraint. Statutory/Other Authority: ORS 426.236, 426.385 & 430.021 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 MHS 13-2014, f. & cert. ef. 9-29-14
309-033-0735 Quarterly Reports (1) Every facility certified under these rules must report to the Division and to the Council within 30 days of each quarter’s end, the following information: (a) The number of seclusion and the number of restraint incidents; and (b) The number of patient days in the quarter. (2) The Division must compile the information from all facilities approved under this rule and make available to the public statewide aggregate data. The information may be divided according to facility types. Statutory/Other Authority: ORS 426.236, 426.385 & 430.021 Statutes/Other Implemented: ORS 426.005 - 426.309 History: MHS 13-2014, f. & cert. ef. 9-29-14 MHS 5-2008, f. & cert. ef. 6-27-08 MHS 17-2007(Temp), f. 12-28-07, cert. ef. 1-1-08 thru 6-29-08
309-033-0900 Statement of Purpose and Statutory Authority (1) Purpose. These rules prescribe standards and procedures relating to the investigation and examination of a person alleged to be a person with mental illness during the involuntary civil commitment process, including training, education, and certification of mental health investigators and examiners. (2) Statutory authority. These rules are authorized by ORS 426.005–426.395 and carry out the provisions of 426.005–426.395. Statutory/Other Authority: ORS 413.042 & 426.060 - 426.500 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 MHD 12-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-230-0000
309-033-0950 Certification of Mental Health Examiners (1) Psychiatrists exempt from certification. A psychiatrist may serve as an examiner as provided by ORS 426.110. Division certification is not necessary for psychiatrists serving as mental health examiners. (2) Qualifications for certification of persons other than psychiatrists. The Division shall certify, as a qualified mental health examiner for three years or until such time as the Division terminates the certificate, a Qualified Mental Health Professional who meets all of the following: (a) Has at least three years clinical experience in the diagnosis and treatment of adults with severe and persistent mental illness who primarily live with a psychotic disorder; (b) Presents acceptable written references from two persons who have the above qualifications and can demonstrate direct knowledge of the person’s qualifications; (c) Is recommended by the CMHP director to be an examiner in the county; and (d) Has established individual competence through training provided by the Division in the following areas: (A) The role and duties of an examiner and the process of examination; (B) Oregon statutes and administrative rules relating to the civil commitment of persons with mental illness; (C) Establishing clear and convincing evidence for mental disorder; (D) The mental status examination; and (E) The assessment of suicidality, self-harm, risk of harm to self or others, and ability to care for basic needs. (3) Qualifications for recertification. The Division may recertify for three years, or until such time as the Division terminates the certificate of, any mental health examiner who meets the following: (a) The examiner has been an examiner certified by the Division after July 1, 1988; (b) The examiner has successfully maintained certification or licensure in accordance with credentials described in subsections (1) and (2) of this rule, and completed eight hours of training provided by the Division relating to the assessment and diagnosis of mental disorder and, changes in statutes and administrative rules relating to civil commitment; and (c) The director recommends the person to be an examiner in the county. (4) Examination. The examiner shall conduct an examination in a manner that elicits the data necessary for establishing a diagnosis and a plan for treatment. Only certified examiners shall conduct an examination of an alleged person with a mental illness. (5) Termination of certification. The Division may terminate the certification of any mental health examiner when, in the opinion of the Division: (a) The person no longer can competently perform the duties required by this rule; or (b) The person has exhibited a behavior or a pattern of behavior which violates the rights, afforded by statute, of persons being investigated. Statutory/Other Authority: ORS 413.042 & 426.060 - 426.500 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 MHD 12-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-230-0060
309-035-0100 Purpose and Scope (1) These rules prescribe standards by which the Behavioral Health Division (Division) of the Oregon Health Authority (Authority) licenses community based residential treatment facilities and community based residential treatment homes for adults with mental health conditions. The standards promote optimum health, mental and social well-being, and recovery for adults with mental health conditions through the availability of a wide range of home and community based residential settings and services. They prescribe how services will be provided in safe, secure, and homelike environments that recognize the dignity, individuality, and right to self-determination of each resident. (a) These rules incorporate and implement the requirements of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services for Home and Community-Based Services (HCBS) authorized under section 1915(i) of the Social Security Act. (b) These rules establish requirements to ensure individuals receive services in settings that are integrated in and support the same degree of access to the greater community as individuals not receiving HCBS, consistent with the standards set out in OAR chapter 410, division 173. (2) These rules apply to all Residential Treatment Facilities (RTF) and Residential Treatment Homes (RTH) providing services to adults with mental health conditions regardless of whether the program receives public funds. These rules prescribe distinct standards in some areas for Secure Residential Treatment Facilities (SRTF), and Crisis Respite Services, or are based on the number of residents receiving services in the program. (3) These rules recognize that some residents may have their rights limited through civil or forensic commitment processes as described in ORS chapters 161 and 426, guardianship proceedings as described in ORS chapter 125, or other legal mechanisms as described in ORS chapter 127. Statutory/Other Authority: ORS 413.042 & 443.450 Statutes/Other Implemented: ORS 443.400 - 443.465 & 443.991 History: BHS 4-2025, amend filed 02/28/2025, effective 03/01/2025 BHS 6-2024, amend filed 04/11/2024, effective 04/11/2024 BHS 41-2023, temporary amend filed 10/12/2023, effective 10/15/2023 through 04/11/2024 MHS 5-2017, f. & cert. ef. 6-8-17 MHS 2-2017(Temp), f. 3-3-17, cert. ef. 3-4-17 thru 8-30-17 MHS 13-2016(Temp), f. 9-6-16, cert. ef. 9-7-16 thru 3-3-17 MHS 5-2012, f. 5-3-12, cert. ef. 5-4-12 MHS 10-2011(Temp), f. & cert. ef. 12-5-11 thru 5-31-12 MHS 4-2008, f. & cert. ef. 6-12-08 MHD 4-2005, f. & cert. ef. 4-1-05 MHD 4-1998, f. 5-21-98, cert. ef. 6-1-98 MHD 9-1985, f. & ef. 6-7-85 MHD 9-1984(Temp), f. & ef. 12-10-84