Child and Spouse Abuse and Neglect: The nature of child and spouse abuse and neglect requires a careful patient history and physical examination to identify or rule out past and present injuries caused by abuse or neglect. The policies and guidelines established by the Navy Family Advocacy Program must be followed. This program is discussed in some detail later in this chapter.
SUBSTANCE ABUSE PREVENTION AND CONTROL
Drug and alcohol abuse is costly in terms of lost work hours and unnecessary administrative and judicial processing and is a critical drawdown on morale and espirit de corps. It undermines the very fiber of professional readiness, safety, discipline, judgement, and loyalty. It is not just the abuser who is affected, but the abuser’s shipmates as well. “Zero Tolerance” recognizes that drug and alcohol abuse is incompatible with the maintenance of high standards of performance, military discipline, and readiness and is destructive of Navy efforts to instill pride and professionalism.
Medical personnel become professionally involved in the substance abuse program when called upon to withdraw blood or urine from an individual suspected of drug or alcohol abuse. Few areas cause as much concern and confusion to health care providers as the question of when those bodily fluids can be lawfully extracted.
At the outset a few basic facts must be discussed. First, the health care provider should not undertake a fluid extraction procedure when to do so is medically contraindicated. Second, refusal to perform an extraction in the face of lawful authority could subject the health care provider to charges of obstruction of justice or willful disobedience of an order. Third, the health care provider is not an arbiter of the law. In other words, the admissibility of evidence derived from a blood or urine sample is not a matter for Medical Department personnel to decide. Finally, common sense and cooperation with command and law enforcement officials should be the guideposts in every instance where extraction of bodily fluids is an issue.
The following are the circumstances where withdrawal of blood or urine from active duty military members is authorized.
Consensual withdrawal. If an individual expressly consents to an extraction of bodily fluids and there is a legitimate reason for extraction, the health care provider may perform the procedure.
Valid medical purpose. Specimens maybe obtained from an individual for a valid medical examination provided the individual has expressly or implicitly consented to the examination.
Competency for duty examinations. The competency for duty examination request form (NAVMED 6120/1) contains a block for the submitting authority to request laboratory analysis. See figures 14-1 and 14-2. The following procedure should be used in handling competency for duty requests.
The command initiating the request should complete items 1 through 12 of the form. The individual submitting the request must have authority to make the request. Normally, this will be a commanding officer, executive officer, or duty officer of the initiating command.
After proper initiation of the request, the medical officer or other authorized health care provider will complete blocks 13 through 49 on the form.
If the command has requested laboratory analysis, the patient should first be requested to give written consent to the procedure. If the patient will not give consent but will allow extraction, then the sample should be taken. If the patient refuses consent and will physically resist extraction, then the requesting command should be notified and no extraction attempted unless a search authorization is issued, which is discussed further in the probable cause search and seizure section.
PROBABLE CAUSE SEARCH AND SEIZURE
Under the authority contained in the Military Rules of Evidence, nonconsensual extraction of bodily fluids, including blood and urine, may be made from an individual pursuant to a search warrant or authorization. Further, when there is a
