Med question!

Started by Daniel, August 11, 2009, 06:50:00 AM

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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 >:D >:D >:D

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.................. >:D
Contrarian and Curmudgeon at Large

"You can tell a member of National Headquarters but you can't tell them much!"

Just say NO to NESA Speak.

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?   ::) ;D

Ned

Quote from: LtCol057 on August 13, 2009, 10:23:07 PM
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?   ::) ;D

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

#44
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).
Nathan Scalia

The post beneath this one is a lie.

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

#46
Quote from: RiverAux on August 14, 2009, 12:45:02 AM
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

#47
Quote from: Spike on August 14, 2009, 01:39:36 AM
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.

"All of the true things that I am about to tell you are shameless lies"

Book of Bokonon
Chapter 4

Nathan

Quote from: IceNine on August 14, 2009, 02:02:06 PM
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.
Nathan Scalia

The post beneath this one is a lie.

Airrace


Ned

Quote from: Nathan on August 14, 2009, 03:22:55 PM

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

Quote from: Ned on August 16, 2009, 08:16:58 PM
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.

"That Others May Zoom"

Ned

Quote from: Eclipse on August 16, 2009, 08:24:34 PM
Quote from: Ned on August 16, 2009, 08:16:58 PM
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

Quote from: Hawk200 on August 16, 2009, 08:59:38 PM
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.

"That Others May Zoom"

Hawk200

Quote from: Eclipse on August 16, 2009, 09:02:00 PM
Quote from: Hawk200 on August 16, 2009, 08:59:38 PM
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

Quote from: Hawk200 on August 16, 2009, 08:59:38 PM
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.

Quote

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

Quote from: Hawk200 on August 16, 2009, 09:06:05 PM
Quote from: Eclipse on August 16, 2009, 09:02:00 PM
Quote from: Hawk200 on August 16, 2009, 08:59:38 PM
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.

"That Others May Zoom"

Eclipse

#58
Quote from: Ned on August 16, 2009, 09:21:00 PM
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.

"That Others May Zoom"

Eclipse

Quote from: Ned on August 16, 2009, 09:21:00 PM
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.

"That Others May Zoom"