Med question!

[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.