Letter to the editor: Camp Business

May 1, 2008

Rodney J. Auth, Publisher

Camp Business

PO Box 1166

Medina, OH 44258-1166

I read with interest and concern the article Medical Matters in the May/June Camp Business. I believe it should be pointed out that no liability protection is provided by receiving doctor’s standing orders or physician protocols. I’m going to use the term protocol to refer to standing orders. This is the term used in the medical industry and by state statutes to define a physician directing a non-physician to do a procedure that is more than first aid. A physician issuing a protocol which the camp follows does not provide any liability protection to a camp.

There are two main issues that define how a protocol can be issued by a physician. The first is to whom the physician’s protocol is transmitted. That can be either a licensed health care provider within the scope of their duties as defined by state law or an employee of the physician under the supervision and control of the physician.

A licensed health care provider is a nurse, physician assistant, paramedic or emergency medical technician; someone is has been issued license by the state. Whether and how someone is licensed is controlled by state law and varies by state. The scope of the duties a licensed health care provider can provide outside of the supervision and control of a physician also varies by state. A good example is the states are split about evenly on whether an EMT can use epinephrine without a physician’s approval. This difference is also important if you are hiring a health care provider. Make sure you hire the person who is licensed by the state to perform the level of health care you expect under the law where the health care is to be performed.

The second, if a person is not a licensed health care provider they may still be able to act, however they must be under the direct supervision and control of a physician. That generally means the physician has trained the person in the procedure, the physician has employed the person to administer the procedure and the physician is within the distance required by law. Distance varies by state. In Colorado the physician must be within 30 minutes of where the procedure is being done and be able to get there. In Arizona the physician must be in the same room as the person administering the procedure.

As such, for most camps in most states physician protocols for non-licensed camp personnel provide no liability protection. Any liability protection that a proper protocol does provide does not stop any litigation; it just changes the claim from failure to provide proper first aid to a medical malpractice suit and ads the physician as a defendant.

Also of concern is asking a physician to issue a protocol that puts the physician at risk for review or worse by their state physician licensing agency.

Things have changed dramatically from my camp staff days. One of the main duties in preparing for the campers was scraping the m off M&M’s in anticipation of homesickness problems.



Sincerely,



James H. Moss
Editor Outdoor Recreation Law Review
www.snewsnet.com/lawreview
http://rec-law.blogspot.com/
For more information on this subject see: Legal Issues in First Aid #3: The prescription drug conundrum, Legal Issues in Wilderness First Aid: Value of various first aid certificates and training, Arizona adopts epinephrine Good Samaritan law, Legal Issues in Wilderness First Aid