Medication Policy

[scouts-a-lot]

here is the policy as listed in the GSS:

 

The taking of prescription medication is the responsibility of the individual taking the medication and/or that individual's parent or guardian. A Scout leader, after obtaining all the necessary information, can agree to accept the responsibility of making sure a Scout takes the necessary medication at the appropriate time, but BSA does not mandate nor necessarily encourage the Scout leader to do so. Also, if your state laws are more limiting, they must be followed.

 

So let's say that state law does not prohibit someone else dispensing it. What is your Troop policy?

 

We typically have the kids self medicate and if they cannot then a parent must be there to do it. What if the parents are not campers or cannot camp on a particular weekend? We have a new boy that MUST take meds and if he does not camp he falls behind in rank advancement since most of the advancement is done there. But the SM has a policy in place that says adults do not medicate. do we leave that boy at home? Is if fair to him that he cannot remember to take his meds? And it is not that he is forgetful he has medical issues that cause memory loss (caused by said meds). What do you think?

[Beavah]

Yah, so I'm more sanguine about medication than most, eh? I think it's personally just fine to help a lad take medications, and I think yeh need to in some cases if yeh want to provide access to scouting for kids with special needs.

 

That having been said, I think each volunteer needs to decide what level of responsibility they're willing to take on. Yeh can't force someone to take on a role they're uncomfortable with.

 

I'd suggest two things. One, yeh might have the lad's doctor talk to the SM. Sometimes, it's more da fear of the unknown that drives people to be wary. If the SM knows more about the meds and the condition, he might decide differently. Second, most units have at least someone on da committee or among the parents who are medical pros, eh? Nurses, docs, PAs, EMTs. Perhaps one of them would be more comfortable takin' on the medication role on an outing if the SM is uncomfortable with it.

 

Beavah

 

[frank10]

I understand asking a scout to be responsible for his own meds, but I never understood the concept of letting him keep them in his possession. Bad enough when I have to deal with a stolen candy bar or missing flashlight. I want them under lock and key.

[evmori]

We always had an adult assigned to "med duty" and kept the meds locked up. This helped ensure the kids got their meds and there was no abuse or theft.

[rdclements]

Depends on several factors: maturity of the scout, how critical are the medication and dosing timings, preferences of the parents.

You also need to protect the scout - not just HIPAA regs, but basic respect of privacy.

 

A troop that I knew had a morning ritual at summer camp with a line of scouts waiting to see the mom (ASM) who was holding all the meds. Some guys were too embarrassed to stand in the medicine line so they begged their parents to stop the meds during camp, or chose not to come to camp. Neither was a good solution.

 

In another situation, the camp staff was screen medical forms before doing swim checks. The health officer is reading the forms out loud and calling out the scouts: "Johnny Scout, ADD, Ritalin twice a day - where's Johnny Scout?!" It was humiliating to the scouts. We put a stop to that.

[evmori]

You also need to protect the scout - not just HIPAA regs, but basic respect of privacy.

 

HIPAA doesn't apply.

[nldscout]

HIPPA may not apply, however you need to know what your state laws are on the possession of someone elses MED's.

 

In most states its a crime to possess Med's not presribed to you or your family.

 

Is it really worth it if something happens and they start asking why you were handing out medice without a license?

[rdclements]

The BSA med form has a release to the unit leaders about dispensing meds, but I don't know if it has been tested. It is certainly a place to be really careful.

 

While HIPAA regulations were created to address electronic medical records, any health information matched with an identity (name, address, SSN, etc) qualifies as Protected Health Information (PHI) and is covered. HIPAA covers any information about your past, present or future physical or mental health - including information about payment for care. Paper records and even oral conversation are covered. This is necessary because so much older information is in paper form.

 

Private information on paper is the same as private information in a database. PHI in all forms is covered by HIPAA. The BSA medical record form specifically authorizes medical providers to disclose PHI to the adult in charge for purposes of medical evaluation of the participant, follow-up and communication with the participants parents or guardian, and/or determination of the participants ability to continue in the program activities.

 

The BSA form specifically references Standards for Privacy of Individually Identifiable Health Information, 45 CFR. 45 CFR is known as the HIPAA Enforcement Rule and contains provisions relating to compliance and investigations, the imposition of civil money penalties for violations of the HIPAA Administrative Simplification Rules, and procedures for hearings.

 

Whomever made the BSA form seems to think that HIPAA might apply. I personally will continue to act as if it does.

 

[dScouter15]

Seems like this topic comes up about once a month or so...

 

Personally, I feel that the suggestion in the G2SS does not adequately address today's hyper-medicated society, where a huge percentage of the scouting population takes a variety of medications, that can be very sensitive to missed doses, over doses, etc.

 

The strategy I've adopted while serving as the medical officer at a council level week long youth training course was to keep all meds stored in the health lodge, and develop a master list of the names of scouts who need to take meds, and the time they should take them. Meds are placed into a ziploc bag with the scout's name on it, and stored in a lock box in the health lodge, which is also temperature/humidity controlled. When a scout arrives to take his meds, I simply hand him the ziploc bag with his name on it, ask him to confirm that his own medication is in the bag, and then he takes the appropriate medication. I check his name off of my master list - that way I can see at a glance whose taken their medication, and who has missed it. This is handy should a scout ever need to be transported to the hospital, as I can show with relative certainty which medications the scout has taken (or not taken) recently.

 

And, to answer all of the obvious questions: rescue meds are to be kept on the scout's person at all times. Also, I am more than willing to make special accommodations on a case-by-case basis if the scout or his parents are not comfortable with our baseline policy.

 

Granted, this is a policy I've developed for a council level week long training program, but I believe it is easily adaptable to a unit level program. Also, I am a paramedic, and have had this policy approved by our council professional staff as well as the physician liaison who works with our council's camp programs.

 

Typically in a thread like this there are several comments warning you about "state laws" which address the "administration" of medication. Speaking as a health care professional myself, I would encourage you to review any legal concerns directly with your council professional staff. If your unit is fortunate enough to have access to either a lawyer or a medical provider familiar with the laws in your area, I would recommend speaking with them to clarify any legal issues that may affect the way your troop handles medication. With no disrespect intended towards the well-meaning, experienced Scouters who raise such concerns and advice on this forum... the majority of us here simply do not have expertise in the medical-legal area to address such a complicated issue, and can unintentionally contribute to the spreading of those inaccurate "urban myths" we all despise so much. In short, while there are some excellent resources available through this forum, my experience has shown that medical/legal advice is not one of them ;-)

[evmori]

HIPAA applies to doctors and hospitals and emergency care facilities. It does not apply to the BSA.

 

If you have the written permission of the parents to hold and dispense their sons meds, you are covered regardless of state law. Common sense people!

[scouts-a-lot]

@dScouter15 - our unit has more lawyers than we need and all of them have an opinion!

 

No offense taken. I am really just looking for what other units do to see where we are in relation to that. Our policy is in line with the GSS but what do we do in that special circumstance when a Scout need our help as adults. Currently, I am faced with that issue and just looking for an opinion other than the same opinions I hear every Monday.

 

I do appreciate the feedback.(This message has been edited by scouts-a-lot)

[dScouter15]

Ed - HIPAA more accurately applies to the health *insurance* field, but you are right that it has limited applicability to the BSA. I wonder why people keep bringing it up?

 

scouts-a-lot - Perhaps it would be worthwhile to speak directly with your council professional staff for advice. If you still can't get a concrete answer from anyone, I'd recommend holding a meeting with the parents of the scout in question, your SM and CC, and any other concerned adult leader whose responsibilities may reasonably include assisting this scout while camping. Let all parties raise concerns and suggestions, and hopefully reach an agreement that allows the scout to fully participate in the troop's program. If there is a reliable adult leader who is comfortable with ensuring that the scout is taking his medication, and the scouts' family is comfortable with that arrangement, that may be the way to go. However, keep in mind that while its always desirable to keep every scout involved in the program, it is more important to guarantee their health and safety.

 

And I certainly wasn't intending to be offensive, and I apologize if I came off that way. I am, however, trying to emphasize that, when it comes to medication, health care, and other people's kids, the stakes are *really* high - both from a medical and a legal perspective. That's why I'm encouraging you to speak directly with the scouts' parents, and professionals in the field. I guess my perspective is that this issue is not so much a scouting issue, but a medical and policy issue, and should be treated as such. Like I said, this forum is usually a wealth of valuable information, and a great resource for volunteer scouters. However, speaking as a health care professional, with some degree of first-hand familiarity with both the medical and legal sides of the issue, I have to conclude that this forum is just not a good resource for accurate medical/legal advice.

 

(This message has been edited by dScouter15)

[Beavah]

Ed - HIPAA more accurately applies to the health *insurance* field, but you are right that it has limited applicability to the BSA. I wonder why people keep bringing it up?

 

Yah, it's a culture thing in da BSA. People like to sound authoritative, and they think that quotin' laws and such at other people makes them sound authoritative. I reckon it's just because they haven't been around enough laws and lawyers to realize how stupid most of 'em are. So in actual fact, da legal mumbo-jumbo doesn't make 'em look authoritative, it makes 'em look like one of those dumb lawyer jokes.

 

HIPAA does not apply to scout troops, period. Not for PHI, not for anything. Anybody who tells yeh otherwise is a fool, a liar, or one of da characters from the dumb lawyer joke brigade.

 

With due respect to nldscout, dispensing Rx medications to a lad which have been prescribed to the boy in accordance with da physician's orders is not dispensing medications without a license, and it's hard to fathom a circumstance in which even da most dimwitted county prosecutor would spend any time on a scouter holding meds for kids on an outing. I'd wish him the best of luck. (Exception might be if a lad could self-medicate but the SM insisted on taking the kid's meds and keeping them under lock and key, and somethin' bad happened as a result. I'm not hugely fond of da lock-and-key nonsense, having intervened once or twice in camps that insisted on locking up asthma meds and epi pens. )

 

So having dispensed with the usual pseudo-legal mumbo jumbo, we can return to our regularly scheduled program. What's the best practice for handling meds within a troop, so that boys who have conditions which require medication can participate fully without feeling singled out or embarrassed in any way? Perhaps, as scouters, we can address da needs of children instead of trying to throw up false or misleading roadblocks.

 

Our goal should be doin' the things that make sense to help our boys and families.

 

Beavah(This message has been edited by Beavah)

[shortridge]

In the situation described by scouts-a-lot, does the SM have anything against the Scout holding and administering the medicine, with the leaders keeping track and reminding him to take it? Or does he/she simply not want anything to do with medication, period?

[Eamonn]

I'm not a lawyer or a doctor, have never played one on TV. - Did spent a week in a holiday Inn Express a week or so back.

I don't really understand HIPPA.

Seems to me that most ordinary folks don't.

 

As a parent I was fine and dandy with my son taking his own meds. (He had allergies.)

As an adult leader I was OK with looking after a Lads meds and reminding him when to take them.

 

As a leader I know at times I broke the rules!

If a Lad came and informed me that he had an upset stomach or a headache I pointed him to my car where there was OTC meds.

I know and am aware that I was taking a risk.

I used to get upset when leaders told me that my son had to hand over his meds and I made a point of telling them not to!

If an adult is uncomfortable giving a Lad his meds? That is up to the individual.

He really doesn't have to.

Ea.