416-345-0030 Levels of Medical Care and Treatment (1) Youth in custody medical care and treatment is authorized and provided according to priorities established by the OYA medical director. Medical care and treatment is generally prioritized into four levels. (2) Level 1 – medically mandatory care and treatment (a) Level 1 care and treatment is medical care and treatment that is essential to life and health, without which rapid deterioration may be an expected outcome and where medical surgical intervention makes a very significant difference, or has a very high cost effectiveness. Examples of conditions that may allow for Level 1 care and treatment include: (A) Acute problems, potentially fatal, where treatment prevents death and allows full recovery, (e.g., appendectomy for appendicitis); (B) Acute problems, potentially fatal, where treatment prevents death but does not necessarily allow for full recovery (e.g., burn treatment, treatment for severe head injuries, status asthmaticus); and (C) Maternity care (e.g., monitoring, delivery, gestational hypertension). (b) Any OYA medical practitioner may authorize Level 1 care and treatment for a youth in custody. OYA nursing staff may authorize Level 1 care and treatment for a youth in custody in an emergency situation. (3) Level 2 – presently medically necessary care and treatment (a) Level 2 care and treatment is medical care and treatment that is medically necessary, without which a youth in custody cannot be maintained without significant risk of further serious deterioration of the condition, significant pain or discomfort, or significant reduction of the chance of possible repair after release from OYA custody. Examples of conditions that may allow for Level 2 care and treatment, or types of Level 2 care and treatment, include: (A) Chronic, usually fatal, conditions where treatment improves lifespan and quality of life (e.g., insulin-dependent diabetes mellitus, asthma, hypertension); (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 youth (e.g., preventive dental care, pap smears, blood pressure screenings, sexually transmitted disease screenings); (E) Acute nonfatal conditions where treatment causes a return to a previous state of health (e.g., fillings for dental cavities, medical treatment of various infectious disorders); (F) Acute nonfatal conditions where treatment allows the best approximation of return to previous health (e.g., reduction of dislocated elbow or shoulder, repair of corneal laceration, treatment of displaced fractures of the extremities); and (G) Medical treatment to ameliorate symptoms of gender dysphoria. (b) Any OYA medical practitioner may authorize Level 2 care and treatment for a youth in custody. The decisions of practitioners are subject to periodic review by the OYA medical director. (4) Level 3 – medically acceptable, but not medically necessary care and treatment (a) Level 3 care and treatment is medical care and treatment for nonfatal conditions where treatment may improve the youth in custody’s quality of life (e.g., routine hernia repair, treatment of non-cancerous skin lesions, surgery for certain chronic knee conditions, routine MRI for orthopedic injury, elective procedures). (b) Level 3 care and treatment may be authorized on an individual or problem-by-problem basis as follows: (A) Medical and surgical procedures and therapies that can be appropriately completed onsite in a routine clinic, and that are within the skills of the OYA medical practitioner, may be offered at the medical practitioner’s discretion. Any case may be referred by a medical practitioner to the OYA medical director for review pursuant to OAR 416-345-0040(2). (B) Offsite procedures and therapies deemed appropriate by an OYA medical practitioner for chronic Level 3 diseases must be referred to the OYA medical director for clinical review pursuant to OAR 416-345-0040(2). (i) The OYA medical director may form a clinical review committee to review requests for Level 3 offsite procedures and therapies on a case-by-case basis. (ii) The OYA medical director may approve or disapprove the Level 3 offsite procedure or therapy at the medical director’s discretion. (5) Level 4 – limited medical value care and treatment. (a) Level 4 care and treatment is medical care and treatment that is valuable to certain individuals but significantly less likely to be cost effective or to produce substantial long-term gain. This includes treatment of minor conditions where treatment merely speeds recovery, gives little improvement in quality of life, offers minimal palliation of symptoms, or is exclusively for the convenience of the individual (e.g., nasal reconstruction for cosmetic reasons, elective circumcision, surgery for gynecomastia). (b) OYA does not provide youth in custody Level 4 care or treatment. Statutory/Other Authority: ORS 420A.025 Statutes/Other Implemented: ORS 420A.010, ORS 420A.014 & ORS 420A.015 History: OYA 2-2023, amend filed 01/10/2023, effective 01/10/2023 OYA 7-2018, adopt filed 06/05/2018, effective 06/05/2018