SECTION 340:75-14-3. Medical services for the child in Oklahoma Department of Human Services (DHS) custody

(a)   Definitions. The following words and terms, when used in this Subchapter, shall have the following meaning, unless the context clearly indicates otherwise:

(1)   "Consent" means obtaining approval from a person for the procedure after providing an explanation of the necessity for the procedure involved, any known risks involved and, when appropriate, any alternative course of care.

(A)   "Informed consent" means voluntary written consent from a person who received full, accurate, and sufficient information and explanation about a child's medical condition, medication, and treatment to enable the person to make a knowledgeable decision without being subjected to any deceit or coercion.

(B)   "Separate and specific consent" means a licensed physician, psychiatrist, or other medical professional recommended a treatment or medication and requires an additional consent form provided by the professional be signed to authorize the treatment to occur or medication to be administered.

(C)   "Sufficient explanation" means information provided and explained in plain language by the prescribing physician or physician's representative to the consent-giver including, but not limited to, the:

(i)   medical care and treatment or the medication;

(ii)   reason for prescribing the treatment or medication and the medication's purpose or intended results;

(iii)   side effects, risks, and contraindications including the effects of stopping the medication;

(iv)   method for administering the treatment or medication and dosage range, when applicable;

(v)   potential drug interactions;

(vi)   alternative treatments;

(vii)   behavioral health or other services used to complement the use of the psychotropic medication, when applicable; and

(viii)   other treatment interventions considered by the physician that may include, but are not limited to, medical, mental health, behavioral, counseling, or other services.

(2)   "DHS custody" means a child is in the voluntary, emergency, temporary, or permanent custody of DHS.

(3)   "Medical" care or "treatment" means, per Section 1-3-102 of Title 10A of the Oklahoma Statutes (10A O.S. § 1-3-102) medical care or treatment that is either extraordinary or routine and ordinary.

(A)   Extraordinary medical care and treatment includes, but is not limited to:

(i)   surgery;

(ii)   general anesthesia;

(iii)   blood transfusions; or

(iv)   invasive or experimental procedures.

(B)   Routine and ordinary medical care and treatment does not include any type of extraordinary care or treatment and includes, but is not limited to:

(i)   any necessary medical and dental examinations and treatments;

(ii)   medical screenings;

(iii)   clinical laboratory tests;

(iv)   blood testing;

(v)   preventative care;

(vi)   health assessments;

(vii)   physical examinations;

(viii)   immunizations;

(ix)   contagious or infectious disease screenings;

(x)   tests and care required for treatment of illness and injury including x-rays, stitches, and casts; or

(xi)   the provision of psychotropic medication.

(4)   "Placement provider" means the person, foster parent, or administrator of a facility providing out-of-home care for a child in DHS custody.

(5)   "Psychotropic medications" means medications with well-demonstrated efficacy in the treatment of mental disorders through the modification of behavior, mood, and emotions.

(b)   Medical services for the child in DHS custody in out-of-home care. DHS is required to provide medical care necessary to preserve the child's health, per Oklahoma Children's Code provisions, 10A O.S. § 1-7-103. The child in DHS custody receives:

(1)   Early Periodic, Screening, Diagnosis, and Treatment (EPSDT) screening according to the schedule of frequency or at a minimum, an annual physical exam. In addition, DHS provides, within 21-calendar days of entering custody, a standardized assessment for each child placed in DHS emergency custody, to evaluate the physical, developmental, medical, mental health, and educational needs, including health problems requiring immediate treatment, diagnosis of infections and communicable diseases, and an evaluation of injuries or other signs of abuse or neglect.

(2)   a yearly behavioral health or developmental screening, and when recommended a behavioral health or developmental assessment, within 60-calendar days of the screening;

(3)   a yearly dental exam when the child is over 3 years of age. A child under 3 years of age receives dental services as needed;

(4)   an initiation of immunizations that are kept current;

(5)   a visual and hearing evaluation exam and corrective lenses or hearing aids, when indicated;

(6)   outpatient or inpatient behavioral mental health treatment, when appropriate;

(7)   physician's services when the child is sick. This service is not considered a physical exam;

(8)   contagious or infectious disease screenings, including Human Immunodeficiency Virus (HIV) exams or testing, are provided as needed or upon request by a placement provider in a manner consistent with the Centers for Disease Control guidelines for time and testing frequency, per Oklahoma Administrative Code 340:75-1-113; and

(9)   follow-up and referral services as recommended by a qualified professional.

(c)   Consent for medical services.

(1)   DHS authority to consent to routine and ordinary medical care and treatment.

(A)   DHS may consent to routine and ordinary medical care and treatment when the child is in DHS custody. DHS makes reasonable attempts, per 10A O.S. § 1-3-102, when the child is in voluntary, emergency, or temporary custody to:

(i)   notify the child's parent or legal guardian of the provision of routine and ordinary medical care and treatment; and

(ii)   keep the parent or legal guardian involved in the care.

(B)   DHS may authorize the placement provider, in writing, through the placement provider agreement, to consent to routine and ordinary medical care and treatment needed for the child upon the advice of a licensed physician, including psychotropic medication.

(2)   Consent for extraordinary medical care.

(A)   DHS employees are not authorized to consent to extraordinary medical care and treatment for any child in DHS voluntary, emergency, temporary, or permanent custody.

(B)   When the child is in DHS voluntary, emergency, or temporary custody, consent for the child's extraordinary medical care and treatment is obtained from the parent or legal guardian, unless the:

(i)   parent is unavailable to provide consent;

(ii)   parent refuses to consent; or

(iii)   care and treatment is related to the suspected abuse or neglect.

(C)   Court authority is required for extraordinary medical care and treatment when the:

(i)   child is in DHS permanent custody;

(ii)   parent is unavailable to provide consent;

(iii)   parent refuses to provide consent; or

(iv)   care and treatment is related to the suspected abuse or neglect.

(D)   When the recommended extraordinary medical care and treatment is not the result of a life-threatening emergency requiring immediate medical intervention, the court, per 10A O.S. § 1-3-102:

(i)   holds a hearing, upon the application of the district attorney and notice to all parties; and

(ii)   may authorize the recommended extraordinary care and treatment.

(E)   DHS does not, in any circumstance, consent to a child's abortion, sterilization, termination of life support, or to a Do Not Resuscitate order. The court may authorize the withdrawal of life-sustaining medical treatment or the denial of the administration of cardiopulmonary resuscitation on behalf of the child in DHS custody, upon the written recommendation of a licensed physician, after notice to the parties, and a hearing.

(3)   Medical consent for child in protective custody.

(A)   Per 10A O.S. § 1-3-102, when the child taken into protective custody without a court order, requires emergency medical care prior to the emergency custody hearing, a peace officer, court employee, or the court may authorize treatment as necessary to safeguard the health and life of the child when the:

(i)   treatment is related to the suspected abuse and neglect;

(ii)   parent or guardian is unavailable to consent to the treatment recommended by a physician; or

(iii)   parent or guardian refuses to consent to the treatment recommended by a physician.

(B)   Before a peace officer, court employee, or the court authorizes treatment based on the unavailability of the parent or legal guardian, law enforcement exercises diligence in locating the parent or guardian, when known.

(4)   Consent for medical care for the child in his or her own home. The parent of the child in DHS custody placed in his or her own home consents to routine and ordinary medical care and treatment and extraordinary medical care and treatment needed by the child. In the event of parental refusal, DHS may consent to routine and ordinary medical care and treatment needed by a child in DHS custody, per OAC 340:75-14-3(c)(1). In the event of parental refusal to consent to extraordinary medical care and treatment needed by a child in DHS custody, DHS complies with procedures, per OAC 340:75-14-3(c)(2).

(5)   Consent for extraordinary medical care for the child who traveled out-of-state. When the child is out-of-state and requires extraordinary medical care and treatment, the judge may authorize the physician or medical facility to provide the extraordinary medical care via a verbal or written order.

(6)   Experimental medical procedures. Medical procedures that are experimental may not be compensable through SoonerCare (Medicaid) and are considered to be extraordinary medical care and treatment that must be authorized by the parent or court order.

[Source: Added at 36 Ok Reg 1856, eff 9-16-19; Amended at 37 Ok Reg 1850, eff 9-15-20]