Mixed messages about medical services

[SJFedor]

My question is simply the liability aspect for the member in acting in loco parentis when theyre a qualified medical professional. I was hoping you might be able to give some insight as the legal guru of the board

[Ned]

A couple of quick responses since it is getting late.

Standard caveat.  I am not a currently licensed attorney and cannot give legal advice to anyone.  And if you take anything you read for free on the internet as personal legal advice, you are a fool, my friend.

But I can try to explain some legal concepts, so here we go.

Adults who supervise minors (acting in place of the parents or in loco parentis for those who love their Latin) are held to the standard of care of a reasonable person in the same or similar situation.  IOW, if you act with the care and caution of a person with ordinary prudence in the same or similar situation (even if you are wrong), you will not be acting negligently and thus generally not liable.

Medical professionals, however, are held to a higher standard of care - that of a licensed medical professional with the minimum training required for their profession.  This is one of the reasons that - in my opinion - tactical officers (and similar officers in charge of the cadets) can actually do more of the routine personal care (blisters, tummyaches, etc) than CAP medical folks can do.

This is a little hard to understand, so bear with me.  If I - as a ordinary tactical officer - run across a 13 year old troop complaining of a stomach ache right before PT, I'm gonna ask a few questions ("when did it start?  How bad does it hurt?  Are you gonna throw up? Has this happened to you before?  How are you enjoying encampment?  Doing OK at PT?, etc.)  and then make some sort of decision.  As long as I am act reasonably, I will be fine (and hopefully the troop will be, too.)  My actions will be judged against what any other reasonable adult would do in the same or similar situation.

But if I were a doc, and I have a cadet patient complaining of abdominal pain, the standard of care is going to call for at least a limited physical examination before reaching any conclusions.  My actions will be judged against the standard of care of a licensed physician.

Medical professionals cannot be judged by lay standards, which makes sense because otherwise no one would ever win a malpractice suit.  Doctors cannot call a "time out" and say "well, I was treating this minor as a lay person, not as a physician so I cannot be held to the higher standard of care of a medical professional."

This is another way of saying that medical professionals cannot act in loco parentis  - medical professionals always have to act as medical professionals, which is a higher standard of care that we put on parents (or those acting in loco parentis.)

Clear as mud?

I'm going to bed now.

[SJFedor]

A couple of quick responses since it is getting late.

Standard caveat.  I am not a currently licensed attorney and cannot give legal advice to anyone.  And if you take anything you read for free on the internet as personal legal advice, you are a fool, my friend.

But I can try to explain some legal concepts, so here we go.

Adults who supervise minors (acting in place of the parents or in loco parentis for those who love their Latin) are held to the standard of care of a reasonable person in the same or similar situation.  IOW, if you act with the care and caution of a person with ordinary prudence in the same or similar situation (even if you are wrong), you will not be acting negligently and thus generally not liable.

Medical professionals, however, are held to a higher standard of care - that of a licensed medical professional with the minimum training required for their profession.  This is one of the reasons that - in my opinion - tactical officers (and similar officers in charge of the cadets) can actually do more of the routine personal care (blisters, tummyaches, etc) than CAP medical folks can do.

This is a little hard to understand, so bear with me.  If I - as a ordinary tactical officer - run across a 13 year old troop complaining of a stomach ache right before PT, I'm gonna ask a few questions ("when did it start?  How bad does it hurt?  Are you gonna throw up? Has this happened to you before?  How are you enjoying encampment?  Doing OK at PT?, etc.)  and then make some sort of decision.  As long as I am act reasonably, I will be fine (and hopefully the troop will be, too.)  My actions will be judged against what any other reasonable adult would do in the same or similar situation.

But if I were a doc, and I have a cadet patient complaining of abdominal pain, the standard of care is going to call for at least a limited physical examination before reaching any conclusions.  My actions will be judged against the standard of care of a licensed physician.

Medical professionals cannot be judged by lay standards, which makes sense because otherwise no one would ever win a malpractice suit.  Doctors cannot call a "time out" and say "well, I was treating this minor as a lay person, not as a physician so I cannot be held to the higher standard of care of a medical professional."

This is another way of saying that medical professionals cannot act in loco parentis  - medical professionals always have to act as medical professionals, which is a higher standard of care that we put on parents (or those acting in loco parentis.)

Clear as mud?

I'm going to bed now.

That's about what I thought. Thanks for the info.

[High Speed Low Drag]

Thanks, Ned.  That answered my questions and concerns.

[RADIOMAN015]

Adults who supervise minors (acting in place of the parents or in loco parentis for those who love their Latin) are held to the standard of care of a reasonable person in the same or similar situation.  IOW, if you act with the care and caution of a person with ordinary prudence in the same or similar situation (even if you are wrong), you will not be acting negligently and thus generally not liable.

Frankly this all gets down to your personal risk management and what you want your exposure to be.  You can be legally right and bankrupt yourself (OR your organization) defending that you are right.

If it isn't cost effective to defend, a settlement will be in order.

Frankly, IF a cadet at an encampment or other CAP activity has pain or has an injury, bring them to a medical professional to get evaluated.  There's no incentive to you the senior member to personally take ANY chances   and you really don't know when the various levels of CAP'ers start second guessing you on your decision (not to bring to professional medical treatment), what the overall implications will be.

RM

[Ned]

Frankly, IF a cadet at an encampment or other CAP activity has pain or has an injury, bring them to a medical professional to get evaluated. 

Taking every hangnail and blister to the ER is just as silly as telling a cadet with a 104-degree fever to "suck it up" and get out there for PT.

Both extremes are an abdication of the common sense required of all of our adult leaders.

This really isn't all that exotic or mysterious; which is why we have had a vigorous and challenging encampment program for over 60 years without a single senior member ever being sued for exercising common sense supervision over our cadets.

(Notice I said "never been sued" which is even better than "never paid a nickel".)

Cadets are not some sort of IED waiting to go off in your face.  If you are not comfortable exercising common sense in supervising a youth-oriented leadership program, you should consider belonging to another organization.

[CadetProgramGuy]

I guess in the end, it really comes down to what my MedicoLegal instructor hit on.

"What would a prudent person do in this situation?"

I think we have to look at this from a EMT-Basic or a common Lay Person.

I choose EMT - Basic level for these reasons: 

1.  It takes effort to kill a patient.  Grossly ignoring a blister will not kill your cadet.
2.  When you are over your head in a situation, you are taught to call for additional resources, (call 911)
3.  Bandage and transport the bleeders or stay and play while calling 911
4. EMT - B's cannot give medications other than Oxygen, and assist Patients with their own Aspirin, inhaler, Nitro.

You get my drift.

On the meds issue....Just don't think we have the liability to dispense meds.  I do believe that as prudent persons (in loco parentis) we should secure them and herd the cadets to have them open, take out, consume, and resecure the original container.  All we should do is handle the container.

[HGjunkie]

I guess in the end, it really comes down to what my MedicoLegal instructor hit on.

"What would a prudent person do in this situation?"

I think we have to look at this from a EMT-Basic or a common Lay Person.

I choose EMT - Basic level for these reasons: 

1.  It takes effort to kill a patient.  Grossly ignoring a blister will not kill your cadet.
2.  When you are over your head in a situation, you are taught to call for additional resources, (call 911)
3.  Bandage and transport the bleeders or stay and play while calling 911
4. EMT - B's cannot give medications other than Oxygen, and assist Patients with their own Aspirin, inhaler, Nitro.

You get my drift.

On the meds issue....Just don't think we have the liability to dispense meds.  I do believe that as prudent persons (in loco parentis) we should secure them and herd the cadets to have them open, take out, consume, and resecure the original container.  All we should do is handle the container.

How much effort?

[JayT]

4. EMT - B's cannot give medications other than Oxygen, and assist Patients with their own Aspirin, inhaler, Nitro.

You get my drift.

Which goes back to one of the big issues here in terms of different laws and jurisdictions.

Our EMT-B's can give albuterol, aspirin, and EpiPens on standing order. Some states allow their EMT-B's to administer Nitro on standing.

Even our career field can't establish a very basic certification across different states. How can we expect CAP to establish any sort of medical program across 50 states?

And for the record, it takes a lot to kill a patient. I've met EMT's who I swear are government trained assassins who haven't managed to do it yet.

[HGjunkie]

4. EMT - B's cannot give medications other than Oxygen, and assist Patients with their own Aspirin, inhaler, Nitro.

You get my drift.

Which goes back to one of the big issues here in terms of different laws and jurisdictions.

Our EMT-B's can give albuterol, aspirin, and EpiPens on standing order. Some states allow their EMT-B's to administer Nitro on standing.

Even our career field can't establish a very basic certification across different states. How can we expect CAP to establish any sort of medical program across 50 states?

And for the record, it takes a lot to kill a patient. I've met EMT's who I swear are government trained assassins who haven't managed to do it yet.

:clap: :clap:     

[Major Lord]

I have seen plenty of medical people put patients with COPD on high flow O2 and cut off their respiratory drive, occasionally resulting in a death. Killing a patient by accident can be remarkably easy. Ditto with Nitro. My rig partner had a patient killed by a helpful citizen performing CPR......

Major Lord

[EMT-83]

My rig partner had a patient killed by a helpful citizen performing CPR......

Something tells me this patient didn't need CPR? Kinda tough to kill a dead guy.

[JayT]

I have seen plenty of medical people put patients with COPD on high flow O2 and cut off their respiratory drive, occasionally resulting in a death. Killing a patient by accident can be remarkably easy. Ditto with Nitro. My rig partner had a patient killed by a helpful citizen performing CPR......

Major Lord

Me: "Umm, Jack, this guy has rigor....."
FTO: "What? The cops put another dead guy in my bus!"

[RADIOMAN015]

Cadets are not some sort of IED waiting to go off in your face.  If you are not comfortable exercising common sense in supervising a youth-oriented leadership program, you should consider belonging to another organization.

I think every senior member will just have to decide for themselves what they want their personal risk exposure to be in regards to cadets .  There's nothing in a CAP regulation that states that adult senior members need to emerse themselves into every aspect of the cadet program.  I'm sure there's some that never have contact with cadets

Your explanation about why we shouldn't have qualified medical personnel onsite at encampments & other activities, is the EXACT reason why I would limit myself in these cadet activities.   

RM 

[Ned]

I think every senior member will just have to decide for themselves what they want their personal risk exposure to be in regards to cadets .  There's nothing in a CAP regulation that states that adult senior members need to emerse themselves into every aspect of the cadet program.  I'm sure there's some that never have contact with cadets

The cadet program is the largest part of CAP.  Indeed, the majority of our members primarily work directly in or primarily support CP.  You may well be correct that there could be some W.C. Fields-like seniors out there who actively avoid cadets. 

But the point is that there is effectively no significant "risk" in working with cadets.  No senior has ever paid a nickel in damages while exercising reasonable care while working with cadets.

Your explanation about why we shouldn't have qualified medical personnel onsite at encampments & other activities, is the EXACT reason why I would limit myself in these cadet activities.   

All CAP personnel - including "qualified medical personnel" are welcome onsite at encampment.  We have a critical need for trained folks to work with our cadets as tactical officers, communicators, HSOs, etc.  HSOs have a vital role to play in reviewing applications, advising commanders on safety and environmental risks, and training the staff and cadets.

In fact the only thing HSOs cannot do is to perform non-emergency medical care.

[CadetProgramGuy]

I guess in the end, it really comes down to what my MedicoLegal instructor hit on.

"What would a prudent person do in this situation?"

I think we have to look at this from a EMT-Basic or a common Lay Person.

I choose EMT - Basic level for these reasons: 

1.  It takes effort to kill a patient.  Grossly ignoring a blister will not kill your cadet.
2.  When you are over your head in a situation, you are taught to call for additional resources, (call 911)
3.  Bandage and transport the bleeders or stay and play while calling 911
4. EMT - B's cannot give medications other than Oxygen, and assist Patients with their own Aspirin, inhaler, Nitro.

You get my drift.

On the meds issue....Just don't think we have the liability to dispense meds.  I do believe that as prudent persons (in loco parentis) we should secure them and herd the cadets to have them open, take out, consume, and resecure the original container.  All we should do is handle the container.

How much effort?

Remember we are talking about Basics's here.....

Hi Flo O2 on COPD will do it in an hour......
Ignoring allergic reactions will do it.....
Ignoring your patient will do it.....

Like I said it takes effort......

[isuhawkeye]

In my limited experience it is hard for EMTs and below ti inflict negative outcomes on patients by their actions.  Generally at this level negative outcomes are a result of inaction.  Paramedics and above on the other hand can inflict serious harm by their actions. 

[Major Lord]

Never underestimate the killing power of an enthusiastic EMT! I am sure the Medical people among us will know the rules of "The House of God" and know that its treatment that kills patients, not diseases. Trauma on the other hand, is a horse of a different color.

Major Lord

[JayT]

Never underestimate the killing power of an enthusiastic EMT! I am sure the Medical people among us will know the rules of "The House of God" and know that its treatment that kills patients, not diseases. Trauma on the other hand, is a horse of a different color.

Major Lord

Rule No. 13.