§ 10270. Criteria for Patient Selection.  


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  • (a) Before admitting an applicant to detoxification or maintenance treatment, the medical director shall either conduct a medical evaluation or document his or her review and concurrence of a medical evaluation conducted by the physician extender. At a minimum this evaluation shall consist of:
    (1) A medical history which includes the applicant's history of illicit drug use;
    (2) Laboratory tests for determination of narcotic drug use, tuberculosis, and syphilis (unless the medical director has determined the applicant's subcutaneous veins are severely damaged to the extent that a blood specimen cannot be obtained); and
    (3) A physical examination which includes:
    (A) An evaluation of the applicant's organ systems for possibility of infectious diseases; pulmonary, liver, or cardiac abnormalities; and dermatologic sequelae of addiction;
    (B) A record of the applicant's vital signs (temperature, pulse, blood pressure, and respiratory rate);
    (C) An examination of the applicant's head, ears, eyes, nose, throat (thyroid), chest (including heart, lungs, and breasts), abdomen, extremities, skin, and general appearance;
    (D) An assessment of the applicant's neurological system; and
    (E) A record of an overall impression which identifies any medical condition or health problem for which treatment is warranted.
    (b) Before admitting an applicant to either detoxification or maintenance treatment, the medical director shall:
    (1) Document the evidence, or review and concur with the physician extender's documentation of evidence, used from the medical evaluation to determine physical dependence (except as specified in paragraphs (d)(5)(A) and (d)(5)(B) of this section) and addiction to opiates; and
    (2) Document his or her final determination concerning physical dependence (except as specified in paragraphs (d)(5)(A) and (d)(5)(B) of this section) and addiction to opiates.
    (c) Detoxification Treatment.
    The program shall determine which applicants with an addiction to opiates are accepted as patients for detoxification treatment subject to the following minimum criteria which shall be documented in the patient records:
    (1) Certification of fitness for replacement narcotic therapy by a physician.
    (2) Determination by a program physician that the patient is currently physically dependent on opiates. Evidence of current physical dependence shall include:
    (A) Observed signs of physical dependence, which shall be clearly and specifically noted in the patient's record.
    (B) Results of an initial test or analysis for illicit drug use shall be used to aid in determining current physical dependence, and shall be noted in the patient's record. Results of the initial test or analysis may be obtained after commencement of detoxification treatment.
    (3) Patients under the age of 18 years shall have the written consent of their parent(s) or guardian prior to the administration of the first medication dose.
    (4) At least seven days shall have elapsed since termination of the immediately preceding episode of detoxification treatment. A program may not knowingly admit a patient who does not satisfy this requirement.
    (5) The patient's signed statement that at least seven days have elapsed since termination of the immediately preceding episode of detoxification treatment may, if reliable, be acceptable evidence of compliance with the requirements of subsection (c)(4) above.
    (6) The applicant is not in the last trimester of pregnancy.
    (d) Maintenance Treatment.
    The program shall determine which applicants with an addiction to opiates are accepted as patients for maintenance treatment subject to the following minimum criteria which shall be entered in the patient records:
    (1) Confirmed documented history of at least two years of addiction to opiates. The method to be used to make confirmations shall be stated in the protocol. The program shall maintain in the patient record documents, such as records of arrest or treatment failures, which are used to confirm two years of addiction to opiates. Statements of personal friends or family shall not be sufficient to establish a history of addiction. With prior Department approval, the program may make an exception to this requirement only if the program physician determines, based on his or her medical training and expertise, that withholding treatment constitutes a life- or health-endangering situation. The program physician shall document the reason for this determination in the patient record.
    (2) Confirmed history of two or more unsuccessful attempts in withdrawal treatment with subsequent relapse to illicit opiate use. The methods used to make confirmations and the types of documentation to be maintained in the patient's record shall be stated in the protocol. At least seven days shall have elapsed since completion of the immediately preceding episode of withdrawal treatment if it is to be used to satisfy this subsection.
    (3) A minimum age of 18 years.
    (4) Certification by a physician of fitness for replacement narcotic therapy based upon physical examination, medical history, and indicated laboratory findings. Plans for correction of existing medical problems should be indicated.
    (5) Evidence of observed signs of physical dependence.
    (A) An applicant who has resided in a penal or chronic care institution for one month or longer may be admitted to maintenance treatment within one month of release without documented evidence to support findings of physical dependence, provided the person would have been eligible for admission before he or she was incarcerated or institutionalized and, in the clinical judgment of the medical director or program physician, treatment is medically justified.
    (B) Previously treated patients who voluntarily detoxified from maintenance treatment may be admitted to maintenance treatment without documentation of current physical dependence within six months after discharge, if the program is able to document prior maintenance treatment of six months or more and, in the clinical judgment of the medical director or program physician, treatment is medically justified. Patients admitted pursuant to this subsection may, at the discretion of the medical director or program physician, be granted the same take-home step level they were on at the time of discharge.
    (6) Pregnant patients who are currently physically dependent on opiates and have had a documented history of addition to opiates in the past may be admitted to maintenance treatment without documentation of a two-year addiction history or two prior treatment failures, provided the medical director or program physician, in his or her clinical judgment, finds treatment to be medically justified.
    (e) Pregnant patients admitted pursuant to (d)(6) immediately above shall be reevaluated by the program physician not later than 60 days following termination of the pregnancy in order to determine whether continued maintenance treatment is appropriate.
    (f) All information used in patient selections shall be documented in the patients' records.
    (g) The protocol for each program shall set forth all procedures and criteria used to satisfy the requirements of this section.
HISTORY
1. Change without regulatory effect renumbering and amending parts of former section 10176 to 10270 filed 6-3-91 pursuant to section 100, title 1, California Code of Regulations (Register 91, No. 34).
2. Amendment of section and Note filed 3-15-96 as an emergency; operative 3-15-96 (Register 96, No. 11). A Certificate of Compliance must be transmitted to OAL by 7-13-96 or emergency language will be repealed by operation of law on the following day.
3. Amendmentof section and Note refiled 7-8-96 as an emergency; operative 7-12-96 (Register 96, No. 28). A Certificate of Compliance must be transmitted to OAL by 11-12-96 or emergency language will be repealed by operation of law on the following day.
4. Amendment of section and Note refiled 10-23-96 as an emergency; operative 10-29-96 (Register 96, No. 43). A Certificate of Compliance must be transmitted to OAL by 2-26-97 or emergency language will be repealed by operation of law on the following day.
5. Amendment of section and Note refiled 2-11-97 as an emergency; operative 2-24-97 (Register 97, No. 7). A Certificate of Compliance must be transmitted to OAL by 6-24-97 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 2-11-97 order transmitted to OAL 3-4-97; disapproved by OAL and order of repeal as to 2-11-97 order filed 4-15-97 (Register 97, No. 16).
7. Amendment of section and Note filed 4-15-97 as an emergency; operative 4-15-97 (Register 97, No. 16). A Certificate of Compliance must be transmitted to OAL by 8-13-97 or emergency language will be repealed by operation of law on the following day.
8. Certificate of Compliance as to 4-15-97 order, including amendment of subsections (a)(4) and (b)(5)(A)-(b)(6), transmitted to OAL 6-2-97 and filed 6-13-97 (Register 97, No. 24).
9. New subsections (a)-(b)(2), subsection relettering, amendment of newly designated subsections (c)(5) and (e) and amendment of Note filed 6-23-97 as an emergency; operative 7-1-97 (Register 97, No. 26). Pursuant to Health and Safety Code section 11758.42, a Certificate of Compliance must be transmitted to OAL by 12-28-97 or emergency language will be repealed by operation of law on the following day.
10. Editorial correction of subsections (c), (c)(4), (d), (d)(1) and (d)(5)(B) and History9 (Register 98, No. 1).
11. Reinstatement of section as it existed prior to 6-23-97 emergency amendment by operation of Government Code section 11346.1(f) (Register 98, No. 1).
12. New subsections (a)-(b)(2), subsection relettering, amendment of newly designated subsections (c)(5) and (e) and amendment of Note filed 12-31-97 as an emergency; operative 12-31-97 (Register 98, No. 1). A Certificate of Compliance must be transmitted to OAL by 4-30-98 or emergency language will be repealed by operation of law on the following day.
13. New subsections (a)-(b)(2), subsection relettering, amendment of newly designated subsections (c)(5) and (e) and amendment of Note refiled 4-27-98 as an emergency; operative 4-30-98 (Register 98, No. 18). A Certificate of Compliance must be transmitted to OAL by 8-28-98 or emergency language will be repealed by operation of law on the following day.
14. Certificate of Compliance as to 4-27-98 order transmitted to OAL 6-1-98 and filed 6-29-98 (Register 98, No. 27).
15. Change without regulatory effect amendingNote filed 4-19-2006 pursuant to section 100, title 1, California Code of Regulations (Register 2006, No. 16).

Note

Note: Authority cited: Sections 11755, 11835, 11839.3 and 11839.20, Health and Safety Code. Reference: Sections 11835, 11839.2, 11839.3, 11839.20 and 11875, Health and Safety Code.