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<p class="MsoNormal">03/26/2020<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">The <b>Oregon Health Authority (OHA</b>) has recently published the attached guidance and FAQs for elective and non-elective procedures referenced in the Executive Order 20-10 issued on 3/19/20. We have included the text of the guidance
below for ease in review. Please go to the following link to access the document online: <u><span style="color:#0563C1"><a href="https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le2284.pdf" target="_blank">https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le2284.pdf</a>.<o:p></o:p></span></u></p>
<p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p></p>
<p class="MsoNormal"> <o:p></o:p></p>
<p class="MsoNormal" align="right" style="margin-left:.25in;text-align:right"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#005494">Health Facility Licensing and<span style="letter-spacing:-1.05pt">
</span>Certification</span></b><o:p></o:p></p>
<p class="MsoNormal" align="right" style="margin-left:.25in;text-align:right"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#005494">800<span style="letter-spacing:-2.05pt">
</span>NE<span style="letter-spacing:-1.95pt"> </span>Oregon<span style="letter-spacing:-1.9pt">
</span>Street,<span style="letter-spacing:-1.9pt"> </span>Suite<span style="letter-spacing:-1.95pt">
</span>465</span><o:p></o:p></p>
<p class="MsoNormal" align="right" style="margin-left:.25in;text-align:right"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#005494">Portland, OR<span style="letter-spacing:-.65pt">
</span>97232</span><o:p></o:p></p>
<p class="MsoNormal" align="right" style="margin-left:.25in;text-align:right"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#005494">Voice: (971)<span style="letter-spacing:-.7pt">
</span>673-0540</span><o:p></o:p></p>
<p class="MsoNormal" align="right" style="margin-left:.25in;text-align:right"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#005494">Fax: (971)<span style="letter-spacing:-.8pt">
</span>673-0556</span><o:p></o:p></p>
<p class="MsoNormal" align="right" style="margin-left:.25in;text-align:right"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#005494">TTY:<span style="letter-spacing:-.2pt">
</span>711</span><o:p></o:p></p>
<p class="MsoNormal" align="right" style="margin-left:.25in;text-align:right"><span style="font-size:12.0pt;font-family:"Times New Roman",serif"><a href="http://www.healthoregon.org/hflc" target="_blank"><span style="font-family:"Arial",sans-serif;color:#005494;text-decoration:none">http://www.healthoregon.org/hflc</span></a></span><o:p></o:p></p>
<p class="MsoNormal" align="right" style="margin-left:.25in;text-align:right"><span style="font-size:12.0pt;font-family:"Arial",sans-serif"><a href="mailto:mailbox.hclc@state.or.us">mailbox.hclc@state.or.us</a></span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"> <o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify;line-height:120%">
<span style="font-size:12.0pt;line-height:120%;font-family:"Arial",sans-serif;color:#005494">PUBLIC HEALTH DIVISION, Center for Health Protection Health Care Regulation and Quality Improvement Section Health Facility Licensing and Certification Program</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#005494">Kate Brown, Governor</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#005494"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">March 23, 2020</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:14.0pt;font-family:"Arial",sans-serif">Interim COVID-19 Guidance for Elective and Non-Urgent Health Care Procedures</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:14.0pt;font-family:"Arial",sans-serif"> </span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Background:
</span></b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Health care facilities currently face an enormous challenge in providing safe care to patients during a pandemic. On March 19, 2020, Governor Brown issued
<a href="https://www.oregon.gov/gov/Documents/executive_orders/eo_20-10.pdf" target="_blank">
<span style="color:#0562C1">Executive Order No. 20-10</span><span style="color:#0562C1;text-decoration:none">
</span></a><span style="color:black">to cancel all elective and non-urgent health care procedures that require personal protective equipment (PPE) effective March 23, 2020. Elective and non-urgent procedures can be rescheduled for no earlier than June 15, 2020.
This decision was not made lightly, and the Governor recognizes the implications for the health care systems and the financial repercussions. However, this action is necessary given anticipated surges in health care need due to COVID-19, and the importance
of preserving scarce PPE and other health care resources such as hospital beds and ventilators for situations in which it is most needed.</span></span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Authority:
</span></b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Executive Order 20-10.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.25in"><o:p> </o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:14.0pt;font-family:"Arial",sans-serif">Guidance</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;line-height:13.75pt"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Which providers or facilities are covered?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">The Executive Order applies to hospitals, ambulatory surgery centers, outpatient clinics (including community health clinics and student health centers),
dental clinics, veterinary clinics and all clinics in which procedures requiring personal protective equipment are undertaken by any provider. The provider classification does not determine whether procedures are canceled; elective and non-urgent procedures
for which the standard of practice requires use of PPE should be canceled.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Which procedures are exempt from the cancellation requirements?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">A procedure is subject to cancellation if it is elective or non-urgent and the procedure requires the use of PPE. A procedure is exempt from the cancellation
requirement if delay would put the patient at risk of irreversible harm. Risks of irreversible harm include, but are not limited to:</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;line-height:13.75pt"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;letter-spacing:-.2pt">1.</span><span style="font-size:7.0pt;font-family:"Times New Roman",serif;letter-spacing:-.2pt">
</span><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Threat to the patient’s<span style="letter-spacing:.15pt">
</span>life;</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;line-height:13.75pt"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;letter-spacing:-.2pt">2.</span><span style="font-size:7.0pt;font-family:"Times New Roman",serif;letter-spacing:-.2pt">
</span><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Threat of irreversible harm to the patient’s physical or mental<span style="letter-spacing:.35pt">
</span>health;</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;line-height:13.75pt"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;letter-spacing:-.2pt">3.</span><span style="font-size:7.0pt;font-family:"Times New Roman",serif;letter-spacing:-.2pt">
</span><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Threat of permanent dysfunction of an extremity or<span style="letter-spacing:-.05pt">
</span>organ;</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;line-height:13.75pt"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;letter-spacing:-.2pt">4.</span><span style="font-size:7.0pt;font-family:"Times New Roman",serif;letter-spacing:-.2pt">
</span><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Risk of cancer metastasis or progression of staging;<span style="letter-spacing:-.2pt">
</span>and<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">5<span style="letter-spacing:-.2pt">.</span></span><span style="font-size:7.0pt;font-family:"Times New Roman",serif;letter-spacing:-.2pt">
</span><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Risk of rapidly worsening condition (i.e., need for the procedure is time-sensitive).</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><o:p> </o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">If you, as a health care provider, believe that a patient will suffer irreversible harm if a recommended procedure is delayed or foregone, then you
should provide that care, using as little PPE as is safe and consistent with applicable infection-control guidelines and laws.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><o:p> </o:p></p>
<p class="MsoNormal" style="margin-left:.25in;line-height:95%"><b><span style="font-size:12.0pt;line-height:95%;font-family:"Arial",sans-serif">Can I provide care to an individual in order to stop the spread of disease to other humans?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">If you, as a provider of health care believe that a patient or other humans will suffer irreversible harm if the procedure is delayed or foregone, then
you should provide that care, using as little PPE as is safe and consistent with applicable infection-control guidelines and laws.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:11.5pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Can I provide vaccinations?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;line-height:95%"><span style="font-size:12.0pt;line-height:95%;font-family:"Arial",sans-serif">Lack of vaccination poses a risk to the patient and to others; therefore, vaccinations are essential and should be provided.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Can I see patients for wellness visits?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;line-height:95%"><span style="font-size:12.0pt;line-height:95%;font-family:"Arial",sans-serif">Yes, if the visit does not require the use of PPE, and with appropriate screening for patients to prevent the spread
of disease.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><o:p> </o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Should a patient be referred elsewhere to have an elective and non-urgent procedure during the cancellation period?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">No. Patients should be rescheduled and not redirected to other providers, since the Executive Order applies to all care settings. Elective and non-urgent
procedures should not be performed while the Executive Order is in effect.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:11.5pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">What equipment falls within the meaning of PPE?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;line-height:13.75pt"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">PPE includes facemasks, N95 respirators, gowns and eye protection.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Should exam gloves or surgical gloves be in short supply, non-urgent and elective procedures requiring them would also be canceled.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:11.5pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Can providers continue to perform elective and non-urgent procedures using exclusive reusable PPE (non-disposable, available for donation or collection,
if needed) during the cancellation period?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">No. The Executive Order applies to all elective and non-urgent procedures during the cancellation period that require PPE, whether the PPE can be re-used
or not, except as otherwise indicated under this guidance.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:11.5pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Can providers perform elective and non-urgent procedures without PPE while preserving infection-control practices for both patients and providers
during the cancellation period?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Yes, if it is safe to perform the elective or non-urgent procedure without PPE, and not using PPE for the procedure is consistent
with applicable infection-control guidelines and laws.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Can I provide care to animals to stop the spread of disease to animals or humans?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">If you, as a veterinarian believe that an animal will suffer irreversible harm if the procedure is delayed or foregone, then you should provide that
care, using as little PPE as is safe and consistent with applicable infection-control guidelines and laws.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:11.5pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Can shelters provide care to their animal population?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Shelters are impacted by the economic downturn and people are no longer able to provide care to their animals. Shelters should continue their care activities
if re-usable PPE is available. OHA is putting out more specific guidance related to veterinarian care.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:11.5pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;line-height:13.75pt"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Can Veterinarians provide end-of-life care to prevent pain and suffering?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Yes. If you, as a veterinarian, believe that an animal is at the end-of-life, you should provide care to relieve pain and suffering. OHA is putting
specific guidance related to veterinarian care.</span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:11.5pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Where should surplus PPE be donated?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in;line-height:95%"><span style="font-size:12.0pt;line-height:95%;font-family:"Arial",sans-serif">You can go to the following website if you want to donate PPE:
<a href="https://survey123.arcgis.com/share/3e02947d6e4a46559997feeac473fba6" target="_blank">
<span style="color:#0562C1">https://survey123.arcgis.com/share/3e02947d6e4a46559997feeac473fba6</span></a></span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Does Executive Order 20-10 extend any liability protections to health care providers related to delays in care and diagnosis?</span></b><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">The
<span style="letter-spacing:-.15pt">Executive </span>Order <span style="letter-spacing:-.15pt">
allows </span>health care <span style="letter-spacing:-.15pt">providers </span>to use their<span style="letter-spacing:-.15pt"> judgment with
</span>regard <span style="letter-spacing:-.15pt">to</span> what <span style="letter-spacing:-.15pt">
procedures must </span>be <span style="letter-spacing:-.15pt">cancelled </span>or<span style="letter-spacing:-.15pt"> delayed,
</span>and what care must be <span style="letter-spacing:-.15pt">provided to</span> protect a
<span style="letter-spacing:-.1pt">patient’s </span><span style="letter-spacing:-.15pt">health
</span>and <span style="letter-spacing:-.15pt">life.</span><span style="letter-spacing:2.9pt">
</span>The <span style="letter-spacing:-.15pt">Executive Order </span>does not <span style="letter-spacing:-.15pt">
address liability issues.</span></span><o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:14.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-left:.25in"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">If you need this material in an alternate language or format, please call 971-673-0540 or TTY (711).<o:p></o:p></span></p>
<p class="MsoNormal"> <o:p></o:p></p>
<p class="MsoNormal"> <o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">__________________________________</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Cassandra C. McLeod-Skinner, J.D.</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Executive Director</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Oregon Board of Chiropractic Examiners</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">530 Center St NE, Suite 620</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">Salem, OR 97301</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">O: 503-373-1620</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">C: 503-779-9038</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif">E: <a href="mailto:cass.mcleod-skinner@oregon.gov" target="_blank">
cass.mcleod-skinner@oregon.gov</a></span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif"><a href="http://www.oregon.gov/obce" target="_blank">www.oregon.gov/obce</a></span><o:p></o:p></p>
<p class="MsoNormal"><img border="0" width="75" height="75" id="gmail-m_7329131977571782951Picture_x0020_1" src="cid:image001.jpg@01D60371.D7725370" alt="cid:image001.jpg@01D60371.D7725370"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;color:#333333;background:white"> </span><o:p></o:p></p>
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