Cal. Code Regs. Tit. 9, § 10270 - Criteria for Patient Selection
(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 that includes the applicant's history of illicit drug use;
(2) An optional laboratory test for the
determination of human immunodeficiency virus (HIV) in accordance with Division
105, Part 4, Chapter 7 of Health and Safety Code; and laboratory tests for
determination of narcotic drug use, hepatitis C virus (HCV), 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 that 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
and lungs), abdomen, extremities, skin, and general appearance;
(D) An assessment of the applicant's
neurological system; and
(E) A
record of an overall impression that 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
subsections (d)(4)(A) and (d)(4)(B) of this section) and addiction to opioids ;
and
(2) Document his or her final
determination concerning physical dependence (except as specified in
subsections (d)(4)(A) and (d)(4)(B) of this section) and addiction to
opioids .
(c)
Detoxification Treatment .
The program shall determine which applicants with an
(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 opioids. 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) The applicant is not in the last
trimester of pregnancy.
(d) Maintenance Treatment .
The program shall determine which applicants with an
(1) Confirmed documented
history of at least one year of addiction to opioids . 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
outcomes, that are used to confirm one year of addiction to opioids . 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) For patients under the age of 18 years, a
documented history of two unsuccessful attempts at short-term detoxification or
drug-free treatment within a 12-month period. The methods to confirm this
history and the types of documentation to be maintained in the patient's record
shall be stated in the protocol . Patients under the age of 18 years shall also
have the written consent of their parent(s) or guardian prior to the admission
into maintenance treatment .
(3)
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,
including linkages to care and treatment , where needed, for patients who test
positive for HIV, HCV, tuberculosis or syphilis.
(4) 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 six months 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 two years 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.
(5) Pregnant patients who are currently
physically dependent on opioids and have had a documented history of addiction
to opioids in the past may be admitted to maintenance treatment without
documentation of a one-year addiction history, 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 subsection (d)(5) 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.
Notes
2.
3.
4.
5.
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.
8. Certificate of Compliance as to 4-15-97 order, including
9. New subsections (a)-(b)(2), subsection relettering,
10. Editorial correction of subsections (c), (c)(4), (d), (d)(1) and (d)(5)(B) and HISTORY 9 (Register 98, No. 1).
11. Reinstatement of section as it existed prior to 6-23-97 emergency
12. New subsections (a)-(b)(2), subsection relettering,
13. New subsections (a)-(b)(2), subsection relettering,
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 amending NOTE filed 4-19-2006 pursuant to section 100, title 1, California Code of Regulations (Register 2006, No. 16).
16.
Note: Authority cited: Sections 11750, 11755, 11835, 11839.3 and 11839.20, Health and Safety Code. Reference: Sections 11839.2, 11839.3 and 11839.20, Health and Safety Code.
2.
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.
5.
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.
8. Certificate of Compliance as to 4-15-97 order, including
9. New subsections (a)-(b)(2), subsection relettering,
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
12. New subsections (a)-(b)(2), subsection relettering,
13. New subsections (a)-(b)(2), subsection relettering,
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).
16.
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