Legal Issues Regarding Medical Eligibility
for Athletic Participation
Paul W. Baumert, Jr., M.D., FAAFP
Sports Medicine Rounds
February 23, 2006
Introduction
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Preparticipation examination (PPE)
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Medical objective=Legal objective
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Ensure fitness
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Prevent unnecessary exclusion
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Differing levels of competition create unique relationships
•
Legal characterization of this relationship determines the parties’
respective legal rights and duties
Disclaimer
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No nationally uniform legal rules
•
General legal principles are applied on a case-by-case basis
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Growing body of legal precedent provides some guidance
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Many unresolved issues
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No objective certainty regarding the law governing sports-related
eligibility issues
Issues to consider
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Does a team or sponsoring entity have a legal duty to provide a
PPE?
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What are the legal parameters of a sports medicine care
provider’s duties when providing a PPE and determining eligibility?
•
What is the legal framework for resolving disputes concerning an
athlete’s medical eligibility to participate in sports?
Legal duty
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High School
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College
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Professional
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Olympics
Legal duty
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High School
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Minors/custodial relationship
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General duty of reasonable care to protect their health and safety
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California case (1934) held that school not liable for injury caused by a
latent medical condition
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Suggests no legal duty to require exam
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Absent immunity or valid waiver, school probably liable
Legal duty
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College
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Recruited adult student-athlete/scholarship + school’s promises create
contractual relationship
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NCAA Sports Medicine Handbook recommends PPE, but doesn’t establish
specific parameters
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Wallace vs. Broyles (NCAA recommendations “relevant” in
determining university duty)
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Ivey vs. Catholic University (Alleged negligence if failure to
follow the NCAA recommendations)
Legal Duty
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Professional
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Unionized team sports: Club’s duty is well defined
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Unclear role of governing body in individual sport athletes
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Olympic
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Athlete contractual relationship with NGB, customary practice may vary
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Special Olympics requires PPE
Legal Duty Disclaimer
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Regardless of duty, team or sponsoring entity has the legal right
to protect athletes’ health and safety, including conditioning the opportunity
to participate on medical clearance
Legal Parameters
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State licensing laws determine the authorized scope of practice
•
Legal duty of care owed to athlete when team physician conducts PPE with
intent to benefit the athlete
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Appropriate nature and scope of the PPE
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General
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Specific
Nature and Scope of PPE
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General
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Professional standard of care
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Potential liability if physician deviates from reasonable, customary, or
accepted care within specialty
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Courts hold physicians certified in sports medicine (or those holding
themselves out as specialists in sports medicine) to a HIGHER standard of
care within their respective specialties
Nature and Scope of PPE
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Specific
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Potential liability
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Affirmative act during an exam that injures
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Failure to discover/disclose medical condition (athlete also has duty)
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Malpractice liability
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Failure to discover latent medical condition only if non-compliant
with reasonable, customary, or accepted scope
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Classen vs. State
(no liability if extensive exam in accordance with accepted medical practice)
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Generally, no specific legal requirements on the medically appropriate
scope of the PPE
Legal Effect of Guidelines
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Varies by state
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Given greater weight if valid scientific and/or clinical basis
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Become the legal standard of care if generally accepted or customarily
followed
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Physician deviation likely to be some evidence of lack of appropriate
care
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Document!
Testing and Diagnosis
of Symptomatic Athletes
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Must conduct appropriate tests to determine nature and severity of
athlete’s condition and/or capacity to safely participate in athletic activity
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Goldman vs. St. Francis Hospital of Port Jervis
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Potential liability for failure to refer to specialist or obtain consult
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Warn athlete of possible consequences for disregarding your
recommendations
Medical Clearance Recommendations
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Strong potential for legal liability
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Non-medical factors impair the exercising of medical best judgement
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Not fully informing athlete of material health risks of participation
with their condition
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Should refuse to medically clear if condition creates significant risk of
substantial harm to the athlete
Medical Clearance Recommendations
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Factors to consider:
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Intensity and physical demands of sport
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Athlete’s specific condition
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Athlete’s prior participation with condition
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Available clinical evidence and scientific data
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Probability and severity of harm to athlete & others
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Current guidelines
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Available means of minimizing health risks
Medical Clearance Recommendations
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Athlete’s waiver of future malpractice claims against physician in
exchange for clearance is probably unenforceable and will NOT shield a physician
from legal liability
•
Easier to defend an athlete suit against a team challenging
exclusion, than a malpractice suit against team physician arising out of an
on-field tragedy
Legal Disputes
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Courts are increasingly recognizing the team physician’s role as
gatekeeper and deferring to his or her medical judgement, even if other
physicians would medically clear the athlete.
•
Recent judicial precedent upholds the legal authority of the team
physician to medically disqualify
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Knapp vs. Northwestern
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Pahulu vs. Univ. of Kansas
Knapp vs. Northwestern
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“Medical determinations of this sort are best left to team doctors and
universities as long as they are made with reason and rationality and with full
regard to possible and reasonable accommodations”