Med question!

[Daniel]

Recently I was told by my school that they wouldn't accept my medication into their facilities.  The reason for this is the pharmacy where I get my meds doesn't put child proof lids on them, which I requested them too so I didn't have to get my mum to open them for me. and I was wondering if Cap medics have the same policy.

[Hawk200]

Not that I'm aware of. Your commander should be aware that you're taking medications, but I can't think of any issue because of it. We don't have anyone really functioning in a medical status.

[DC]

Not that I'm aware of. Your commander should be aware that you're taking medications, but I can't think of any issue because of it. We don't have anyone really functioning in a medical status.

I believe qualified personnel typically take control of medication and administer them per the prescription at most CAP events.

To the OP: That would be up to the individual medic, I've never heard of a policy like that in use at CAP activities. If the meds are stored properly then it shouldn't matter what kind of lid the bottle has...

[Cecil DP]

Suggestion: Take the med's back to the pharmacy and explain the problem. Ask them to fill the prescriptions 1/2 in the required cap for school and 1/2 in the non-child proof cap for home.

[Eclipse]

The only policy our encampment has is that the meds be in their original container with the cadet's name on them as is required by law.

Otherwise, a child-proof cap for a 12+year old is going to be pretty much irrelevant.

[LtCol Hooligan]

There is a National Board topic on this that will be discussed in September.  It was pretty interesting and gives us clearer instructions around this.  From what I can tell it essentially says that the medical officer can hold the perscriptions for the cadets, but they are required to take them at the correct times.

[Ned]

There is a National Board topic on this that will be discussed in September.  It was pretty interesting and gives us clearer instructions around this.  From what I can tell it essentially says that the medical officer can hold the perscriptions for the cadets, but they are required to take them at the correct times.

The NB agenda item is actually a little different.  It establishes a default policy that members (cadets and seniors) hold on to their own medications and self-medicate.  This is a sound policy that will provide overdue guidance to the field.

CAP personnel have no business taking and holding someone else's prescription medications.  In many states it is a crime to possess prescription medications without a prescriptions.

See the agenda item for additional details.

Ned Lee

[Eclipse]

The NB agenda item is actually a little different.  It establishes a default policy that members (cadets and seniors) hold on to their own medications and self-medicate.  This is a sound policy that will provide overdue guidance to the field.

CAP personnel have no business taking and holding someone else's prescription medications.  In many states it is a crime to possess prescription medications without a prescriptions.

Sorry, this is a very bad idea.

No one should take meds away from adults, that's silly.

Cadets are not adults, not even the 21 year olds (we've been here before).

If I, as the encampment commander, have personal loco-parentis-level responsibility for these cadets, I should certainly have the right to insure they are taking their required medication and no sharing it with their friends.

[Ned]

Sorry, this is a very bad idea.

No one should take meds away from adults, that's silly.

Cadets are not adults, not even the 21 year olds (we've been here before).

If I, as the encampment commander, have personal loco-parentis-level responsibility for these cadets, I should certainly have the right to insure they are taking their required medication and no sharing it with their friends.

For medical and state law purposes, anyone who has attained their 18th birthday is an adult.  With all the rights and responsibilities attached to that status.

IOW, you simply do not have loco parentis power over your adult cadets anymore than you do for your adult tactical officers.

The agenda item certainly allows you, if you choose, to help remind anyone to take their meds on time.


And you might want to check Ill. state law in this area, but in many states it is a crime for you to possess someone else's prescription mediications.  That's kinda the whole reason for a prescription in the first place.

And as we were researching this proposal, we were unable to confirm a single instance of improper prescription drug "sharing" in the history of CAP.  So it is hard to verify that this is a big issue.  OTOH we did find multiple instances where seniors lost or misplaced a cadet's medications, or simply had it in the wrong place when it was time for administration, leading to minor problems.

Remember, a person taking medication normally has a lot more experience in taking and storing that medication when compared to a well-inentioned but otherwise unqualified senior.

Let's see what our volunteer leaders do with the proposal.

Ned Lee

[arajca]

There is a National Board topic on this that will be discussed in September.  It was pretty interesting and gives us clearer instructions around this.  From what I can tell it essentially says that the medical officer can hold the perscriptions for the cadets, but they are required to take them at the correct times.

The NB agenda item is actually a little different.  It establishes a default policy that members (cadets and seniors) hold on to their own medications and self-medicate.  This is a sound policy that will provide overdue guidance to the field.

CAP personnel have no business taking and holding someone else's prescription medications.  In many states it is a crime to possess prescription medications without a prescriptions.

See the agenda item for additional details.

Ned Lee

Where can we see the agenda? It's not online.

[Eclipse]

For medical and state law purposes, anyone who has attained their 18th birthday is an adult.  With all the rights and responsibilities attached to that status.

IOW, you simply do not have loco parentis power over your adult cadets anymore than you do for your adult tactical officers.

Sorry, I disagree and so does CAP. They are not full adults in the eyes of the program, nor are they responsible for their own safety or actions in the eyes of the program.

It's be fine with me if they were, but they aren't.

A 20.999 year old cadet still has to be supervised by a senior member, even if that senior member is 18.1 years old.

[Ned]

Sorry, I disagree and so does CAP. They are not full adults in the eyes of the program, nor are they responsible for their own safety or actions in the eyes of the program.

It's be fine with me if they were, but they aren't.

A 20.999 year old cadet still has to be supervised by a senior member, even if that senior member is 18.1 years old.

Bob,

I'm not trying to pull a fast one here.  But 18 year old is an adult for these purposes in every state in the union.  I get the fact that they are also cadets and need to be supervised.  I really do.  As you know, I'm one of the biggest defenders of the 18-20.99 CP.

The status of being an "adult" and a "cadet" are not incompatible.  One can be both.  (And roughly a thousand CAP cadets are both.)

But this is a pretty simple area of black letter law.  Just like an 18 year old high school student is an adult for medical purposes.  Even though they are a high school student.  An 18 year old high school student can see a doctor on their own, get a prescription, and make life or death medical decisions for themselves.  To the exclusion of their parents or the school principal.

99% of adults working in the real world have supervisors who get to tell them what to do or not to do at work.  But that doesn't mean they are not legal adults 24/7.

(And the agenda should be posted on-line soon.  I just saw the final agenda yesterday through staff channels.0

[heliodoc]

Some senior members STILL need supervision....

CAP in its zeal to "do all things right" in the cadet program has lost its way when it comes to the individual needing and taking the prescription.

The "Volunteer Leadership" in CAP in the last 20 yrs or so has gotten so far off course with its "legal team" thinking they are protecting EVERY resource CAP has without a lot of common sense

Its time we treat some of the cadets as mature enough to take their own prescription(s)

With all of CAP's movement towards putting helmets on everything, senior members need supervision 'cuz they are all going into knipsitions (sp) over "SAFETY" at Maxwell.  I am sure it is driven by some 1AF stuff also.

Hopefully CAP DOES NOT get any more DHS/HLS missions, 'cuz they would try to MICROMANAGE everything as evidenced by something as simple as prescription medication  

[Eclipse]

Ned,

Its the same circular argument, one which would be negated if we just cut off cadets at 18 as many advocate.

The reality is that in a CAP context, which is all I care about, we're both basically correct, and those facts are somewhat opposed in their execution.

There is one thing, however, that can't be argued - if an HSO holds and tracks the meds, we will know where they are, and if a cadet has taken them (and conversely can react immediately if not).  Otherwise we have little control over that situation, and I'd prefer to explain to a judge why I felt the need to protect my cadets, than a parent why their son is in ICU because they decided this was the week to "show mom".

[Hawk200]

I believe qualified personnel typically take control of medication and administer them per the prescription at most CAP events.

So you're telling me that when the OP goes to his weekly meetings that he has to present his medications to someone at the meeting for them to give to him? Because that is going to be the majority of interaction he has when it comes to CAP.

[LtCol057]

From personal experience, I feel the meds need to be collected from cadets and they come to "sick bay" to get meds.  I was chief HSO at several encampments and 1 NCSA.  The last time I did it (Will NOT do that job ever again) I got a call a week after encampment ended. The parents of one of the cadets called the wing CC wanting to know why their son hadn't been given his meds during the week. He told them that we wouldn't give them to him. I pulled all the paperwork on this cadet.  First, the parents hadn't sent back any paperwork letting us know he was supposed to be on meds. Secondly, during the checkin, the cadet told us he was not on any meds.  He had kept them, and didn't take them.   

Because of that experience, I will NEVER work as an HSO at a CAP activity. That's a choice I've made, not someone else.  If meds are collected, and paperwork denotes meds, then the HSO staff can monitor administration.  If someone doesn't come get their meds, the HSO can track the cadet down.

[Cecil DP]

I think this whole discussion is situational and dependent on the cadet and medical situation. If a cadet has diabetes, he should be taking his medication with the encampment medical staff (only because of the needle involved), if he has a severe allergy, I wouldn't take their inhaler or epi pen away, because bees, wasps, and other allergens don't annouce their presence, and in severe allergies, seconds count.  As stated by Col Lee, holding a prescription for someone is illegal in most, if not all states. I would also be wary of trying to search down the medical officer and his key (you do keep the prescription drugs under lock and key), at odd hours of the day and night.

[isuhawkeye]

This discussion also leads into questions about the event HSO.  Depending on the Certification/Liscense level, and the rules of the particular state the HSO may not be legally allowed to maintain, or "administer" medications.  Again very case specific, but keep those things in mind when talking about how policies unfold.

[Ned]

This discussion also leads into questions about the event HSO.  Depending on the Certification/Liscense level, and the rules of the particular state the HSO may not be legally allowed to maintain, or "administer" medications.  Again very case specific, but keep those things in mind when talking about how policies unfold.

!.  Most encampments/NCSAs do not have any sort of HSO.  Qualifications and "scope of practice" aside, there are simply not enough HSOs in CAP who can make that sort of time commitment.  If we were to invent some requirement to have a CAP doctor or nurse at every encampment or NCSA, we would have to cancel almost all of our activities.  That can't be right.

2.  Since under our regulations, HSOs simply cannot provide routine medical care for our members, they cannot collect and store cadet medications.  Administering medications is pretty much, by definition, routine medical care.  Which CAP HSOs cannot do under any circumstnaces.

3.  Since HSOs cannot provide any non-emergency care, why on earth would we ever have "sick call" or anything remotely similar?  (Sure, if you have a Reservist doctor/nurse/medic etc., you might.  But not with CAP personnel.)  This is an extremely dangerous practice that threatens the very existence of our cadet program.

4.  Bob, you're right that by defaulting to a "self - medication model" we have, by definition, less control over the situation.  But that is as it should be.  Non-medical people are not remotely qualified to store, safeguard, and administer prescription medications. (Or to "react immediately" to any medication situation).  And CAP HSOs cannot and should not do it either.  So we should be leaving the responsibiity where it belongs -  on the individual member .

Ned Lee
Former CAP Legal Officer

[Eclipse]

In this case, the person storing the meds need not have any medical ability beyond using a watch and a spreadsheet - they are simply acting as the facilitator - they aren't administering, they are administrating.

By "react immediately", I mean - find the commander, and let the cadet know they have two choices - take their meds as prescribed and agreed to by their parents, or go home.  Period.

On the "sick call" nonsense, you and I have been in agreement since day 1 - thats just asking for trouble.

This is another troublesome area where NHQ has chosen to look the other way and grumble instead of taking a stand and directing the field.  The practice of storing meds is done at a lot of activities and encampments, and has years of precedent.  If NHQ chooses to direct the field to change things, I hope they will understand the full ramifications.

Further, if we're to take a "not my problem" approach to the meds, we might as well just delete the health information page on the 31, as it's really information no one at the activity has any use for.  If they get hurt, call 911, and then call mom.  That's all we're supposed to do now.  If they have a serious health condition, they should be wearing a med-alert anyway.  BTW - I'm not being sarcastic, I'd have no issue with this at all.

I would like to ask, though, who gets kicked when Johnny starts passing out his psychotics or concentration meds to other cadets who need a little "help".

[Ned]

In this case, the person storing the meds need not have any medical ability beyond using a watch and a spreadsheet - they are simply acting as the facilitator - they aren't administering, they are administrating.

And I thought I was the "recovering lawyer."    That's a mighty sharp razor you are using to parse words there, my friend.

Don't think too hard.  In this context, the definition of "administer' is simple: "to provide or give".  If you look at the definition at Dictionary.com they even use the example to administer medicine to describe the situation we have here.

This is another troublesome area where NHQ has chosen to look the other way and grumble instead of taking a stand and directing the field. 

Another way to look at it is that NHQ has observed a problem and is (finally?) taking action to provide clear guidance to the field.  Isn't that what we are supposed to do?

The practice of storing meds is done at a lot of activities and encampments, and has years of precedent.  If NHQ chooses to direct the field to change things, I hope they will understand the full ramifications.

I agree that it has certainly been done this way in the past, and that some activities continue to do so now.

But if it makes you feel better, the proposal was drafted by the National Legal Officer, who I hope "understands the full ramifications."

I would like to ask, though, who gets kicked [out] when Johnny starts passing out his psychotics or concentration meds to other cadets who need a little "help".

Umm, Johnny?

But remember, we have had thousands of encampments and similar activities in CAP, and it bears repeating that no one has been able to point to a single documented instance of cadets improperly sharing prescription medicaitons.

IOW, this is a theoretical issue, but not a practical one.

[Spike]

CAP personnel have no business taking and holding someone else's prescription medications.  In many states it is a crime to possess prescription medications without a prescriptions.

So Correct!!

Encampment Medical Officers and Staff seem to forget about that part.  It is also a crime in most states to dispense over the counter medication to minors without written permission from the Parent(s)/ Guardian(s).  This is a serious issue, and I am surprised no parent has filed a civil suit against CAP yet for this.

Honestly if little Johny or Nancy can not keep track of their meds or take them when they are supposed to take them, they should not be allowed away from home. 

The only issue I see with this agenda item is loss of meds or theft.  That is the only drawback to Cadets not being required to turn over their prescriptions.  It is sad, but true that there are dishonest Cadets in the CAP.   

[IceNine]

But remember, we have had thousands of encampments and similar activities in CAP, and it bears repeating that no one has been able to point to a single documented instance of cadets improperly sharing prescription medicaitons.

IOW, this is a theoretical issue, but not a practical one.

Dollars to doughnuts this is specifically related to the precautions that have been taken to prevent this exact situation.  Holding medication, administering only at the agreed upon times,

And I'm willing to put my life savings (however small it may be) on the number of these instances increasing exponentially once this is passed.

[Ned]

And I'm willing to put my life savings (however small it may be) on the number of these instances increasing exponentially once this is passed.

Really?

Why do you think so?

I assume that neither of us is referring to cadets passing around aspirin or Sudafed.

Why would you think that a cadet taking prescribed "heavy" medications would decide not to take it and pass it along to someone to abuse?

Granted, people are people and sometimes do strange things for no apparent reason, but you have to admit that it seems somewhat counter-intuitve.

I don't want to take your bet because I suppose I would not be flabbergasted if it happened once or twice a year out of the thousands of activity attendees.  But that sort of "voluntary misconduct" - people willingly trading medications- seems less damaging than some senior losing medications or mis-dosing a cadet because they didn't have their reading glasses or whatever.  In that situation the cadet is an innocent victim of our overzealous policies.

But let's see what our volunteer leaders choose to do.

Ned Lee
National Cadet Advisor
(Cool job, Crummy Job Title)

[IceNine]

Have you been in a high school lately?  From day 1 it was well know to everyone in mine that rittalin and other such "interesting" drugs were available for $5 to start.

1 dumb kid that "likes how it makes him feel" can easily influence others to try it out.

Twitter, myspace, text message and the rest make peer pressure an international business now.  And if you ask me the kids are responding accordingly.

The numbers don't lie.  Sexual activity is starting between 12-15 on average, smoking for the first time is in the range.  I have no reason to believe that sharing would not happen.

At the end of the day I'm with Bob.  I'll gladly stand in front of a judge and explain that my holding medication prevented others from being provided the experience  VS  I had a 13 yoa cadet that I was responsible for die because C/Amn Bojangles mom sent him a few extra pills.

[IceNine]

The second half of this is , And this is from recent personal experience.

If a cadet feels that their meds are unnecessary so they simply neglect them we can be in for a ride. 

I experienced a cadet at the pinnacle of his career that chose simply to not take his meds during the course of an activity.  And believe me his performance, attitude, and mood suffered.

There needs to be a line in the sand that protects us from this particular mental giant.  At the end of the day even though Johnny is being held responsible for his actions the end result is we wind up with a tainted reputation, potential lawsuit, and so on.

[Ned]

If a cadet feels that their meds are unnecessary so they simply neglect them we can be in for a ride.
I experienced a cadet at the pinnacle of his career that chose simply to not take his meds during the course of an activity.  And believe me his performance, attitude, and mood suffered.

So, what, you are telling me that you stand there with a flashlight and look under Junior's tounge to make sure he swallowed the pill you dispensed to him?

If the kid doesn't want to take it, she/he isn't going to take it and you will never know one way or another.

I also have a little personal experience in this area, including an investiagtion where a cadet arrived at encampment with a bottle of ADD/ADHD drugs to be taken "as needed."

Like your example, he decided that he would tough it out without his meds, and subsequenty crashed and burned.

But the difference is this cadet had given his meds to the encampment staff as ordered, but didn't want to have to go to his Tactical Officer and ask for his meds because he thought that that was a sign of weakness.

In that circumstance, the cadet would have taken his meds if they had been in his possession, but did not take his meds precisely because CAP had seized them from him and put the burden on the cadet to come forward and admit he needed his medications to control his behavior.

There needs to be a line in the sand that protects us from this particular mental giant.  At the end of the day even though Johnny is being held responsible for his actions the end result is we wind up with a tainted reputation, potential lawsuit, and so on.

I don't know your legal background, but I do know that the author of the proposal is the National Legal Officer, Col. Herron.  I'm willing to rely on his expertise when it comes to lawsuits against members and the corporation in this area.  His opinion is that the proposed policy reduces rather than increases liability for CAP and our members.

I take it you think he was simply wrong on the law.  Why do you think so?

[Daniel]

I'm too lazy to read most of the super long replies.

But I don't mind if you taking my meds for safekeeping

hell I prefer it. I'm on a controlled substance and I don't want my meds stolen. A pill bottle with a persons name and a generic name for a common yet powerful medication when stolen can end a cadets career or even his freedom.

At an age where some kids will huff glue to get high, whose to say they won't steal to get it.
Now we pray those aren't our cadets but we never know.

and when caught stole sounds a lot like sold.

So if you can understand what I'm saying is if anyones thinking of letting cadets keep meds there encampment might just become Shawshank prison

(Thats dramatic of course.. had to dust off my creative writing skill as school is starting soon.)

[NC Hokie]

I don't want to take your bet because I suppose I would not be flabbergasted if it happened once or twice a year out of the thousands of activity attendees.  But that sort of "voluntary misconduct" - people willingly trading medications- seems less damaging than some senior losing medications or mis-dosing a cadet because they didn't have their reading glasses or whatever.  In that situation the cadet is an innocent victim of our overzealous policies.

But let's see what our volunteer leaders choose to do.

This just leaves me speechless.  Lost medication is easily replaced and the idea that a senior member will misdose a cadet because he could not read a label is both insulting and absurd.  Does NHQ really believe that either scenario is a realistic threat to CAP?  Does either scenario justify a policy that allows any possibility for cadets to medicate other cadets?

What would the fallout be if a cadet DIES because he managed to take something he was allergic to?  What if a cadet takes his friend's pain medication to deal with a "sprained" ankle that turns out to be broken and further damaged from lack of timely treatment when he gets home?  This doesn't even address the issue of prescription drug abuse; has anyone thought to ask the DDR staff for their input on this?

I understand the legalities involved in administering medication to minors, but I really think someone is stretching this definition a bit too far.  IMHO, administering medicine involves writing a prescription or giving medication in response to an acute or immediate need (like a headache).  This is NOT what IceNine and Eclipse are addressing.  They're addressing the practice of securing prescribed medication to ensure that it does not "get out into the wild" as well as to give some sense of assurance to parents that a responsible adult is making sure that cadets are taking the medications prescribed for them.

Seems to me that this is a PERFECT opportunity for EMTs, doctors, and nurses to actually use the knowledge and skills CAP gives them advanced grade for.

[jimmydeanno]

So these cadets, in the normal world, are permitted to self medicate and somehow manage to not share their pills with their buddies.

Then, when they come to CAP, an organization that teaches leadership and personal responsibility, they somehow become drug dealers and swindlers and deviants? 

I don't think so.

One encampment I went to would require that emergency inhalers and epi-pens be turned in to the medical officer at the encampment every night.  In the morning, they'd get it back. Absurd.

Another would have the TAC hold inhalers and epi-pens for the cadets.

These people live with their medications on a daily basis.  It is part of their routine.  It is their medication.

I've never seen a cadet giving their medications to another one, selling it, etc.  I'd be more concerned about the adult swiping a few than I would the 12 year old.  Last I checked, we have more adults being booted from the program than we do the cadets...

Not to mention, with a medical staff, the possibility of them giving the wrong pill to the wrong cadet increases.

[NC Hokie]

So these cadets, in the normal world, are permitted to self medicate and somehow manage to not share their pills with their buddies.

Not really. They cannot medicate at school (drug-free zones) and they're at least being nominally supervised by their parents when they take their medicine at home.

Then, when they come to CAP, an organization that teaches leadership and personal responsibility, they somehow become drug dealers and swindlers and deviants? 

I don't think so.

Probably not, but I believe that a hands-off approach presents a far greater potential for legal exposure (not to mention the potential harm to our cadets) than the current practice.

One encampment I went to would require that emergency inhalers and epi-pens be turned in to the medical officer at the encampment every night.  In the morning, they'd get it back. Absurd.

Another would have the TAC hold inhalers and epi-pens for the cadets.

Emergency items such as these should be properly documented and kept with the affected member at all times.

These people live with their medications on a daily basis.  It is part of their routine.  It is their medication.

Agreed on all counts.  All I'm advocating is that their medication be secured whenever they're not actually taking it.  Staff members should only be responsible for securing it and reminding the cadet that they missed their dosage if they fail to take it at the agreed upon time.

I've never seen a cadet giving their medications to another one, selling it, etc.  I'd be more concerned about the adult swiping a few than I would the 12 year old.  Last I checked, we have more adults being booted from the program than we do the cadets...

I'll give you that, but consider this.  Parents grant permission for their cadets to participate in encampments and activities that are supervised (if not actually run) by adults.  Those adults are responsible for anything that happens under their watch, whether they see it or not.  Try telling a jury that a legally responsible adult didn't see one cadet give another a fatal medication and see how far that gets you.

Not to mention, with a medical staff, the possibility of them giving the wrong pill to the wrong cadet increases.

Using real medical personnel (CAP has those, remember) and requiring that the cadet handle his own medicine in a properly labeled bottle seems to be an adequate safeguard against this.

[arajca]

Seems to me that this is a PERFECT opportunity for EMTs, doctors, and nurses to actually use the knowledge and skills CAP gives them advanced grade for.

As an EMT-Basic, the ONLY medication I can administer without contact medical control is oxygen. I cannot assist someone taking their medications except for Epi-pens, baby asprin, and nitro. And then there are very specific rules I have to follow. I cannot, by law as I understand it, dispense medications, which is what is being suggested here.

I have, when I served on encampment staff, refused to participate in the medical section or the medical operations. I have seen practices that violate the not merely the letter of the regs, but also the intent of the regs.

[Ned]

This just leaves me speechless.  Lost medication is easily replaced and the idea that a senior member will misdose a cadet because he could not read a label is both insulting and absurd.  Does NHQ really believe that either scenario is a realistic threat to CAP? 

Yes, because we have seen the mishap reports.  Is misdosing really hard to imagine in an encampment scenario?

I've been to a little over 30 encampments.  Some required me to maintain meds for the cadets in my care, some did not.  I don't think it will surprise you to learn that there are a whole lot of young people out there taking medications for various conditions ranging from acne to diabetes to ADD/ADHD.  And many take multiple medications.

I have literally had to lug around 30 pill bottles for 25 cadets.  With something like 100 "pill administrations" a day (there are a lot of different dosing schedules - 2x, 3x, 4x a day; before/after meals; as needed; every four hours, etc.), I'd like to think I did a conscientious job and got it right 99% of the time.

Which means I was probably wrong in dose or timing at least once a day.

Is that really so hard to imagine?

Does either scenario justify a policy that allows any possibility for cadets to medicate other cadets?

The policy does not permit or encourage cadets to improperly trade or share medications.  Sure, cadets - like seniors- can deliberately violate our rules and the law.  But I'm not sure why that is any more likely in this arena that any other potential problem area.

What would the fallout be if a cadet DIES because he managed to take something he was allergic to? 

It would be a tragedy, of course.  But since the proposal requires that he have either a prescription for the medication, or explicit parental permission for the specific drug and dose, I'm not sure I see your point.

Are you suggesting that we have to do some sort of allergy screening for drugs prescribed by a physician?

How is this any different than the risk than anyone could have an allergic reaction to an insect bite or food in the chow hall?

What if a cadet takes his friend's pain medication to deal with a "sprained" ankle that turns out to be broken and further damaged from lack of timely treatment when he gets home? 

So your hypo is "what happens when two cadets conspire to violate rules designed for their protection, commit a crime by sharing a controlled substance, wrongfully and deliberately conceal an injury, and the injury is compounded by their own deliberate wrongful conduct?"

Hmmm.  My guess is that the cadet will get treatment for his compounded injury, but not too much beyond that.

Unless we learn that the cadets in question committed a serious crime at encampment.  Then I suspect there would be some serious disciplinary proceedings.

What do you think will happen?

This doesn't even address the issue of prescription drug abuse; has anyone thought to ask the DDR staff for their input on this?

Of course the proposal doesn't address prescription drug abuse; it addresses lawful prescription drug use.  And yes, the DDR Advisor reports to me.  We all had input to the NLO's proposal.

Seems to me that this is a PERFECT opportunity for EMTs, doctors, and nurses to actually use the knowledge and skills CAP gives them advanced grade for.

Except of course that CAP docs and nurses are specifically forbidden by our own regulations from doing what you suggest - using their special "knowledge and skills" to do anything other than emergency treatment.


Thank you for your work with our cadets.

Ned Lee
National Cadet Advisor
(Cool job, Crummy job title)

[Eclipse]

In this case, the person storing the meds need not have any medical ability beyond using a watch and a spreadsheet - they are simply acting as the facilitator - they aren't administering, they are administrating.

And I thought I was the "recovering lawyer."    That's a mighty sharp razor you are using to parse words there, my friend.

Yes, it is, however words have meaning, and in this case the meaning is important and more than an attempt at a fudge.

The rest went to a PM...

[LtCol057]

The times I worked as HSO at encampments, the cadets were allowed to keep epi-pens and inhalers with them at all times, with the understanding that if they used them, they were to notify someone on the HSO staff ASAP.  Those that turned in meds, did not have to ask their TAC to come to get meds. The TACs were given a list of who was to come get meds and when.  If they were going to be away from the compound, the HSO with them would have the meds.  The meds were kept in separate bags by cadet. The cadet was the one to take the med out of the bottle after the HSO gave them the bottle. 

As far as qualifications, I was EMT-P certified and had 12 years recent experience as a Pharmacy Specialist in the US Army. All my staff were also state certified EMT-Ps and AD USAF medics that were also CAP members.  One year, 3 of them were TDY from the local USAF base.  The clinic Medical Director said he had no problem signing off on a written set of protocols for us to work by.   

[Eclipse]

The times I worked as HSO at encampments, the cadets were allowed to keep epi-pens and inhalers with them at all times, with the understanding that if they used them, they were to notify someone on the HSO staff ASAP.  Those that turned in meds, did not have to ask their TAC to come to get meds. The TACs were given a list of who was to come get meds and when.  If they were going to be away from the compound, the HSO with them would have the meds.  The meds were kept in separate bags by cadet. The cadet was the one to take the med out of the bottle after the HSO gave them the bottle. 

That sounds about the way we do it...

[Ned]

As far as qualifications, I was EMT-P certified and had 12 years recent experience as a Pharmacy Specialist in the US Army. All my staff were also state certified EMT-Ps and AD USAF medics that were also CAP members.  One year, 3 of them were TDY from the local USAF base.  The clinic Medical Director said he had no problem signing off on a written set of protocols for us to work by.

Somehow I think that if every encampment had multiple certified paramedics and AD USAF medics working under the supervision of a USAF physician, we wouldn't have needed a policy in the first place.

But realistically, how often does that happen?

We have something like 70 week long+ encampments and NCSAs every year.  How many of them are likely to have such terrific USAF medical support?

[Spike]

We have something like 70 week long+ encampments and NCSAs every year.  How many of them are likely to have such terrific USAF medical support?

Wish more activities just had USAF support!  Seems like 10 years ago the USAF supported CAP with more personnel than today.  I do understand that our military is being pressed for other causes than "CAP support" though!

As far as meds go, let Cadets self medicate, with parents signature on a form and when caught selling or passing them out let the Juvenile Court system deal with those involved!

Can it be that simple...or am I just a simpleton? 

[Cecil DP]

Who is dosing these cadets when they're at home? Probably themselves. Why not let them keep doing it? The only time they should be turned in is if the medecine needs to be refrigerated. The only place I know of where people are not allowed to maintain their own prescriptions are prisons. As stated by an earlier poster, we' re training these cadets to be responsible for themselves. So let them. 

[Eclipse]

Who is dosing these cadets when they're at home? Probably themselves. Why not let them keep doing it? The only time they should be turned in is if the medecine needs to be refrigerated. The only place I know of where people are not allowed to maintain their own prescriptions are prisons. As stated by an earlier poster, we' re training these cadets to be responsible for themselves. So let them.

At home, it could be anyone, their parents, themselves, Weird "Uncle" Jimmy from down the street (you know the one with the freaky eye who likes to hug you?).  Bottom line, the person who is ultimately responsible for that cadet's health and safety decides how they insure the medicine is taken.

See, that was easy.

[heliodoc]

^^^
No it wasn't....2 "pages" of responses indicates it wasn't so easy

Like Cecil says "let them"  How much simpler does it get

CAP is like the government in some cases.....always knows what is better for it members

[RedFox24]

As an encampment commander and senior who has been a TAC, Commandant and on the command staff I see both sides of this discussion.

As a TAC, I didn't want to hold or be responsible to make sure that a cadet took their meds.  Didn't feel that I was "qualified" and didn't want the responsibly of it.

That being said I can tell you the "pain" and problems that a cadet can cause who doesn't take his meds just because he/she forgot, didn't think they needed them or doubled up because they didn't take them yesterday.  I speak from recent personal experience.  And this wasn't the first time either.  As a Commandant and Commander, I want someone to make sure that cadets are taking their meds in the right doses and at the right time. 

At a weekend activity you might never notice, but at a week long activity it happens and it is not pretty esp. with what some of these kids are on. 

Maybe we should just say if you're on certain meds, you can't participate?  Oh wait, cant do that...............maybe have their parents come and take care of them at the activity?  Nope, cant to that either. 

Wait for NHQ to develop a policy.............    Most likely it will be like the safety policy..................

[LtCol057]

Maybe start charging an extra fee to have a RN come administer the meds? Or make the cadets bring a private-duty nurse with them for the whole week?   

[Ned]

Maybe start charging an extra fee to have a RN come administer the meds? Or make the cadets bring a private-duty nurse with them for the whole week?   

I have actually done something like that as an encampment commander.

I "hired" a non-member nurse (actually a member's spouse) and purchased a "camp nurse policy" from an insurance broker.  It worked out to something like $ 2-3 a head IIRC.  Cleared it with wing and NHQ JAG types in advance.  The nurse then went to the local "doc in the box" urgent care center to coordinate protocols and supervision in exchange for our business.

She did a few meds, but mostly was instrumental on the triage end of the business - which "turned ankle" needed an x-ray, which tummy ache needed a doctor's review, etc.

Worked like a charm, but did add a not-insignificant cost to the encampment.

Didn't need to do it the following year since we had a USAF nurse working with us on mandays.

Ned Lee
Former Encampment Commander

[Nathan]

Jeezum crowe, this is an intense thread.

The reason, of course, is not because we have the usual hardliner worry-worts versus the freewheelin' hippies in terms of "how important the regs are in the real world" argument. Both sides carry liability.

One side is arguing that CAP holds liability if the cadet is self-medicating and does something wrong, whether that's accidental or intentional, to his/her self or to others.

The other side is arguing that CAP holds liability if the cadet is issued medication incorrectly by the mostly unqualified and untrained personnel who hold the medication for them.

Both sides are valid, but I think we need to look at this from a few standpoints.

As a CNA, I cannot even place medication in someone's hands. I can put it on the table, and they can take it themselves, but if I hand them the medication, I am liable because they received it from my person. On the other hand, I am fully allowed to move people using a gait belt, feed people, remove bandages, perform CPR, take and record vitals, reapply restraints, and so on. Even with this dinky certification, I am far more medically qualified than many in CAP (I would guess the VAST majority of most TAC's), and I am still going to get in a huge amount of trouble if I distribute medication. Hell, I can't even take a physician's order over the phone.

With that said, I think that, regardless of what age the cadet is, the idea that an adult will be protected by a court for distributing medications is almost laughable. Even the doctors are getting sued these days for things that seem so clearly not to be their fault, so what makes people think that they have a prayer in court against an angry parent when a SM screwed up the dosage?

I mean, this seems to be the EXACT reason why there is the "no senior member and cadet alone" rule. Even if the cadet manipulates the senior through lying or whatever in order to screw up the dosage, the senior is STILL LIABLE.

So what would I rather defend in a court of law? From a personal perspective, I would much rather say that I was following the law by NOT holding on to prescription medications, and by law NOT distributing prescription medications. Between the two arguments, there is NO gray area as to whether or not seniors are allowed to distribute prescriptions. But there IS gray area as to whether or not the leaders are responsible for cadets who choose to distribute their own medications, so I would much rather argue something that has an argument.

Now, that isn't to say that I would allow cadets to go completely free with their prescriptions. During this thread, I have not seen a single mention that CAP can still monitor the cadet and their prescription. Maybe it's there, and I didn't see it, but it seems to be an obvious point. For instance, I am not aware of any legal restriction from having the cadet report to the medical (or TAC) officer every time he/she needs to take a prescription, and having said SM witness and record that the cadet did, in fact, self medicate. Cadet remains legally in control of the medication, and CAP still covers their butt by doing everything it can legally do in order to ensure that the cadet is safely being medicated.

As Ned said, until I see enough documented evidence to prove that cadets distributing medication to others is a problem, I don't think it's something we practically need to worry about. After all, a cadet COULD stab another cadet, and COULD steal from another cadet. But in the end, it's not something we plan extensively for, and if said event does happen, it quickly tends to escalate beyond CAP control anyway (which is likely to be the case for our drug-dealing cadet).

[RiverAux]

CAP has no business holding and distributing medications for anybody.  If we had a real medical program of some kind within CAP maybe it would be worth considering, but given our lack of willingness to be serious about being able to provide emergency medical care to our own members or victims it just doesn't make any sense to me.

I know that I certainly would not accept responsibility for holding and distributing medications to cadets and quite frankly, I'm not sure I would want to be responsible for making sure they were doing it on their own either. 

[Spike]

I know that I certainly would not accept responsibility for holding and distributing medications to cadets and quite frankly, I'm not sure I would want to be responsible for making sure they were doing it on their own either.

You and me both.  I don't want that negligent death conviction over my head for the rest of my life is Cadet Dan overdoses because I gave him 2 blue bills and 1 red pill instead of 2 red pills and 1 blue pill by mistake one night, and he failed to follow his own guidelines and took them anyway. 

Jeez we have enough to worry about these days.  I have to keep track of my own meds (multivitamin and CoQ10) now add 30 Cadets (or more).  No thanks I did not sign up to be a pharmacy. 

The most minimum thing I will do for Cadets regarding medication is show them wear the paper cup and water fountain is to wash their pills down with.

Some of us here are acting like our Cadets are uneducated children when it comes to their own health.  If Mommy and Daddy has not shown the 14 or 15 year old child what pills they need to take, when to take them and how to store them and get them refilled, NOT our problem. 

[IceNine]

Some of us here are acting like our Cadets are uneducated children when it comes to their own health.  If Mommy and Daddy has not shown the 14 or 15 year old child what pills they need to take, when to take them and how to store them and get them refilled, NOT our problem.

This is exactly the argument.  We Cannot take a "not our problem" tact with our cadets because until Mom and Dad show up to take these cadets home it is without question OUR problem.

[Nathan]

This is exactly the argument.  We Cannot take a "not our problem" tact with our cadets because until Mom and Dad show up to take these cadets home it is without question OUR problem.

It is our problem to do all we can do in order to ensure that the cadets take their medication. Legally, it is NOT our problem to actually GIVE them the medication. Only the legal guardians can do that, and we are not their signed, legal guardians. We cannot make medical decisions for them, we cannot overrule the parents on any medical decision, and we cannot take legal possession of their medications.

As I said, there is nothing wrong with us having cadets report to the medical officer for each appointed time for medication. The medical officer or TAC officer can then witness the cadet taking medication and record when it occurred. After that, it cannot be our responsibility, legally. Sorry.

[Airrace]

Interesting inputs.

[Ned]

As I said, there is nothing wrong with us having cadets report to the medical officer for each appointed time for medication. The medical officer or TAC officer can then witness the cadet taking medication and record when it occurred. After that, it cannot be our responsibility, legally. Sorry.

Non-concur.

I see several things "wrong" with this kind of scenario.

(Well, not "wrong" so much as extremely problematic.)


1.  Most activities don't have a "medical officer."  There are simply not enough qualified HSOs to go around in the first place.  If we invent some sort of requirement for a "medical officer" to stand around just to watch cadets take pills, then we will wind up having to cancel a lot of activities.

2.  Nor should most activities have a resident medical officer, for reasons discussed extensively in other threads.  (Mostly because they can't do much at the actvity in the first place.  Except to passively watch cadets take pills, I guess.  Doesn't sound like a professionally rewarding situation.)

3.  Making a written record of personal medical information - even if it is as simple as "I saw C/Amn Jones take 2x 20mg Accutane tablets at 1400" - becomes a logistical and medical burden of significant dimensions.  Although we are not subject to HIPPA, we would need to secure this kind of data.  Who maintains it after encapment is over?  For how long?  Who has access?  How is it destroyed?  How do we document the destruction?  Maybe CAP should have some sort of comprehensive records retention and destruction policy, but until we do, this is gonna be a problem we don't need to add to our growing list.

And probably a few more problems I didn't think of.

Ned lee

[Eclipse]

3.  Making a written record of personal medical information - even if it is as simple as "I saw C/Amn Jones take 2x 20mg Accutane tablets at 1400" - becomes a logistical and medical burden of significant dimensions.  Although we are not subject to HIPPA, we would need to secure this kind of data.  Who maintains it after encapment is over?  For how long?  Who has access?  How is it destroyed?  How do we document the destruction?  Maybe CAP should have some sort of comprehensive records retention and destruction policy, but until we do, this is gonna be a problem we don't need to add to our growing list.

Detailed medical information is already required data on the Form 31's and collected routinely for every major activity in CAP and most ES operations.

[Ned]

3.  Making a written record of personal medical information - even if it is as simple as "I saw C/Amn Jones take 2x 20mg Accutane tablets at 1400" - becomes a logistical and medical burden of significant dimensions.  Although we are not subject to HIPPA, we would need to secure this kind of data.  Who maintains it after encapment is over?  For how long?  Who has access?  How is it destroyed?  How do we document the destruction?  Maybe CAP should have some sort of comprehensive records retention and destruction policy, but until we do, this is gonna be a problem we don't need to add to our growing list.

Detailed medical information is already required data on the Form 31's and collected routinely for every major activity in CAP and most ES operations.

Of course. 

(So, what is your storage and retention policy for that data?  For most encampments, the paper F31's gather dust  in the admin officer's garage for a couple of years until a spouse gets tired of it and throughs it into a dumpster.)

But there is a difference.  Medical history information is data that is freely available elsewhere.  Once the activity is over, you could shred it with no significant worries.  It simply isn't needed anymore.

But medical treatment data (and/or drug administration data)  is unique.  By definition, it only exists because we chose to collect  the data.

And if it isn't needed after the activity, why did we bother to create, secure, store, and destroy the data later?

See the difference?

[Hawk200]

Just wondering about something.

If we had medications "stored" at a central point during an activity, wouldn't that be considered a "dispensary", "pharmacy" or something similar? If it would, does CAP have the authorization, permission, or allowance to conduct such an operation?

Are there any HSO's, doctors, nurses or pharmacists out there that could shed some light on this?

CAP may direct something, but is that direction potentially in conflict with any Federal law, statue, regulation or rule concerning such an operation?

Not arguing for or against, just looking for some additional info.

[Eclipse]

Just wondering about something.

If we had medications "stored" at a central point during an activity, wouldn't that be considered a "dispensary", "pharmacy" or something similar?

No.

[Hawk200]

Just wondering about something.

If we had medications "stored" at a central point during an activity, wouldn't that be considered a "dispensary", "pharmacy" or something similar?

No.

OK, what is the definition of them then? What exactly excludes such a CAP operation from being considered one? I do know that controlled substances require certain handling, what exactly permits us to do so?

[Ned]

Just wondering about something.

If we had medications "stored" at a central point during an activity, wouldn't that be considered a "dispensary", "pharmacy" or something similar?

Maybe, mabe not, depending on your state law. CAWG just finished an encampment with over 280 cadets present.  If we had required them all to turn in their medications, the "central pill storage place" would likely have had over 200 pill bottles, containing everything from aspirin to antibiotics to heavy controlled substances.  Each of which would have to have been inventoried, secured, and accounted for.

It does begin to sound a bit like a pharmacy.

But even it is only the legal equivelent of the "medicine cabinet" in my bathroom, it still presents a serious legal issue.  If a cop looked in my medicine cabinet, and found prescription drugs with someone else's name on it, or if I could not produce a prescription for all the drugs that required one,  I'd be in serious trouble.  At least in California.

And I can assure you that there is no special "encampment exception" to the drug and pharmacy laws in California.

CAP may direct something, but is that direction potentially in conflict with any Federal law, statue, regulation or rule concerning such an operation?

Remember, there is no current requirement that CAP seize medications from cadets at an activity.  And nothing in the proposal would require anyone to do so.  Indeed, quite the opposite.

And the proposal does recognize that state laws vary in this area and provides for supplements if required by local law.


Ned Lee
Former Legal Officer

[Eclipse]

Just wondering about something.

If we had medications "stored" at a central point during an activity, wouldn't that be considered a "dispensary", "pharmacy" or something similar?

No.

OK, what is the definition of them then? What exactly excludes such a CAP operation from being considered one? I do know that controlled substances require certain handling, what exactly permits us to do so?

How about instead of trying to argue the negative, you or anyone else provide the CAP regulation or relevant law that applies, instead of these assertions that encampment HSO's require PhD's in neurosurgery and climate controlled medication storage?

This is almost the textbook case of a circular argument - there is no regulatory guidance from CAP on this...none.  Those of you arguing about law, legal precedents or similar are simply ignoring the fact that this is not confiscation, dispensing, administering, prescription, or advising.

This is voluntarily surrendering and securing potentially hazardous substances and insuring they are taken as required by prescription and indicated by the cadets' parent.  It is essentially what Nathan described, we keep them safe for the cadet, make sure they take them, and return them in the end.  We make reasonable compromises regarding epi-pens, inhalers, or similar, because that's what we are, reasonable adults trying to protect our cadets and insure they stay healthy.

I can't remotely speak to some of the nonsense behavior a few have you have mentioned any more than I can speak to dog bowls, rainbow t-shirts, or encampment triage units, but one thing that should be remembered is that encampments are not some double-secret unit activity that happens as a black-operation in a bunker at Nellis (though that would be cool!).

Encampments are wing-level (at a minimum) activities with review and audit by the Wing Commander(s), State Directors, Region Commanders, and even sometimes NHQ.  Generally very little happens at these events from a procedure standpoint which someone at a corporate level is not aware of and has approved.

While not spoken to in the regulations, the practice we're discussing is supported by literally years, perhaps even decades of CAP precedent across many Wings and hundreds of activities.

I have personally been involved in encampments for 9+ years, and commanded one for 6.  In that time,  I have never had a single parent make an issue of this process, but I have had parents remark on their appreciating it.  The only problem we've ever had is the requirement that the meds be in their original containers, as some like to use those "pill-a-day" setups.

I have also had the "pleasure" of cadets who failed to mention their medication requirements collapse, either literally or emotionally, because they decided to adjust their prescription on their own.  We get them for a few days to a week at a time.  With some of the cocktails these cadets have, a few hours off their dose can affect their levels and life for weeks.

As I said to Ned via PM, this has been considered the "best-case" compromise of a difficult and potentially serious risk for a long time, reviewed and accepted by a lot of Wing CC's.  At such time that NHQ feels it is important enough they speak to it in a regulatory way, I will act in whatever way I am directed or required.  Until then, this posturing about all the legal ramifications of well-intentioned adults acting to protect their cadets is misguided at best.

[Eclipse]

But even it is only the legal equivelent of the "medicine cabinet" in my bathroom, it still presents a serious legal issue.  If a cop looked in my medicine cabinet, and found prescription drugs with someone else's name on it, or if I could not produce a prescription for all the drugs that required one,  I'd be in serious trouble.  At least in California.

If they are in your medicine cabinet at home, that is an issue.

If they are in an inventoried container as part of a structured, government-sponsored activity, the conversation is not quite so simple.  Let's not comparing apples and grapes just to make the argument, there's enough gray here already.

[Eclipse]

Maybe, mabe not, depending on your state law. CAWG just finished an encampment with over 280 cadets present.  If we had required them all to turn in their medications, the "central pill storage place" would likely have had over 200 pill bottles, containing everything from aspirin to antibiotics to heavy controlled substances.  Each of which would have to have been inventoried, secured, and accounted for.

I seriously doubt that in excess of 70% of the cadets at the encampment were taking medication.  I suppose anything is possible, but generally the numbers at the ones I've done are under 20%.  We're a medicated society, but things aren't that bad.

My people are usually tracking down 10 or 20 cadets tops - at the one you're referencing, that's probably be about 40, but even the 200 isn't unmanageable, you just get more staff.  If the CAWG Encampment CC is comfortable not tracking the meds, that's fine.  Since again there's no guidance, its essentially up to the risk tolerance of the respective wing.

Mine's a lot lower.

[RiverAux]

At such time that NHQ feels it is important enough they speak to it in a regulatory way,

See the NB agenda.

[Eclipse]

At such time that NHQ feels it is important enough they speak to it in a regulatory way,

See the NB agenda.

Is this issue being considered?  I didn't realize that...

[DC]

See Agenda Item 6, page 19.

[Eclipse]

See Agenda Item 6, page 19.

Do you guys actually read the whole threads?  Ned's been telling us its under review the whole time.

[RADIOMAN015]

After reading this thread a mighty salute to those senior members that volunteer to staff these cadet encampments.   However, I can see why most senior members have no interest in participating in cadet encampments

Although there seems to be some legal ramifications in what is currently being done or not done, in the end isn't it the senior member encampment staffs' moral responsibility to insure that Cadet Joe & Cadet Mary return home no worse than when they got to the encampment

Good luck on this one  --- You all will need it! :redx:
RM

[arajca]

See Agenda Item 6, page 19.

Do you guys actually read the whole threads?  Ned's been telling us its under review the whole time.

Just like the HSO track that has been under review for several years now? Until today, the NB minutes were not generally available to show that this issue is nearing resolution.