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How athletes’ rights can be better protected when it comes to retroactive Therapeutic Use Exemptions

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Abstract

Therapeutic Use Exemptions (‘TUEs’) provide athletes a route to take prohibited substances for medically supported therapeutic reasons without violating anti-doping rules. They were instituted for the purpose of protecting an athlete’s right to medical care; however, the current retroactive TUE policy under the World Anti-Doping Program fails to uphold this right. In order to obtain a retroactive TUE, athletes are required to prove not only that they meet the criteria for obtaining a prospective TUE (i.e., their use of a prohibited substance or method is medically necessary and will not enhance their performance above a normal state of health) but also that their circumstances fall into one of four ‘exceptions’. The ‘fairness provision’—the last of the four exceptions—is the ‘catch-all’ provision that permits athletes to receive a retroactive TUE only if both the World Anti-Doping Agency (‘WADA’) and the relevant Anti-Doping Organization agree that fairness requires the grant of a retroactive TUE. Since its inception, this ‘fairness provision’ has been narrowly interpreted by TUE Committees, thus preventing athletes from avoiding anti-doping rule violations even in instances where they have met the test to obtain a prospective TUE. The Ultimate Fighting Championship’s (‘UFC’) TUE Policy, in contrast to WADA’s policy, more broadly permits athletes to obtain retroactive TUEs, in the end helping them avoid getting caught up in the anti-doping system. As the fourth edition of the WADA Code will be approved in the next year, we believe WADA stakeholders should consider a broader and more equitable use of the ‘fairness’ provision or adapt its policy to better protect all athletes’ right to medical care.

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Notes

  1. Liam Morgan, WADA defend use of TUE system following Fancy Bears cyber-attack, 20 November 20, 2016, https://www.insidethegames.biz/articles/1043907/wada-defend-use-of-tue-system-following-fancy-bears-cyber-attack (Accessed 7 December 2018).

  2. Ibid.

  3. WADA Code (2015), pp. 12–13.

  4. Ibid., p. 12.

  5. Therapeutic Use Exemptions Guidelines (2016), p. 4.

  6. International Standard for Therapeutic Use Exemptions (2016), p. 14.

  7. Article 3.1 of the WADA Code (2015): ‘Where the Code places the burden of proof upon the Athlete… alleged to have committed an anti-doping rule violation to rebut a presumption or establish specified facts or circumstances, the standard of proof shall be by a balance of probability.’.

  8. International Standard for Therapeutic Use Exemptions (2016), p. 10.

  9. Ibid.

  10. The CAS is considered the ‘Supreme Court of sport law’.

  11. See, CAS 2017/A/5061, Nasri v. UEFA, Award of December 15, 2017, para. 110 (‘According to the introductory part of Article 4.1 of the 2016 version of the ISTUE, ‘an Athlete may be granted a TUE (and only if) he/she can show, by a balance of probability, that each of the following conditions is met.’ Therefore, it is the Appellant’s onus to establish that the collective requirements of both Articles 4.1 and 4.3 ISTUE are accomplished.’).

  12. WADA Code (2015), p. 11.

  13. International Standard for Therapeutic Use Exemptions (2016), pp. 10–11.

  14. Which would be, for example, Article 4.4.5 of the WADA Code where athletes who are neither International- or National-Level athletes are explicitly permitted to apply for a retroactive TUE. See, Article 4.4.5, WADA Code (2015), p. 35.

  15. As Article 7.1 of the TUE Guidelines explains, ‘A medical emergency or acute medical situation occurs when the Athlete’s medical condition justifies immediate Administration of a Prohibited Substance or Method and failure to treat immediately could significantly put the Athlete’s health at risk.’ See, Therapeutic Use Exemptions Guidelines (2016), p. 13.

  16. Ibid. (‘Exceptional circumstances occur when a TUE cannot be granted in time through No Fault of the Athlete. The following examples could be considered ‘exceptional circumstances’:

    • A healthy Athlete is suddenly affected by a medical condition days prior to an Event and is unable to request and be granted a TUE by a TUEC in the time allotted.

    • A young Athlete with a medical condition whose prior Competition level did not require an advance TUE, and whose anti-doping education is limited, is suddenly named to a national team.’).

  17. See Ibid. (‘This is applicable to Persons who are not International-Level or National-Level Athletes (Code Article 4.4.5) and (where the relevant [National Anti-Doping Organization (‘NADO’)] so chooses) to National-Level Athletes in sports specified by the relevant NADO (ISTUE Article 5.1 Comment)…’).

  18. See, CAS 2017/A/5061, Nasri v. UEFA, Award of 15 December 2017 (failed to meet conditions under sections (a) and (b) after the athlete was given an intravenous infusion to combat vomiting and feeling ill) ; CAS 2008/A/1511, Jamie O'Hara v. WADA & UEFA, Award of 21 October 2008, (received retroactive TUE for acute medical condition); CAS 2005/A/990, P. v. IIHF, Award 24 August 2006, (received retroactive TUE for emergency medical treatment); CAS 2008/A/1577, USADA v. Reed, Award of 15 December 2008, (TUE application for use of marijuana was denied);  CAS 2015/A/4127, Ian Chan v. CWSA & CCES, Award 11 December 2015 (was not emergency situation when prohibited substance was ingested).

  19. CAS 2015/A/3876, Stewart v. FIM, Award of 27 April 2015.

  20. Ibid. at para. 5.

  21. Ibid. at paras. 7–8.

  22. Ibid. at paras. 10–12.

  23. Ibid. at paras. 17–26.

  24. Ibid. at para. 80.

  25. CAS 2016/A/4772, Dominguez v. FIA, Award of 12 January 2018.

  26. Ibid. at paras. 5–7.

  27. Ibid. at paras. 9–14.

  28. Ibid. at para. 15.

  29. Ibid. at para. 16.

  30. Ibid. at paras. 16–17.

  31. Ibid. at para. 18.

  32. Ibid. at para. 19.

  33. International Standard for Therapeutic Use Exemptions (2016), pp. 10–11.

  34. CAS 2016/A/4772, Dominguez v. FIA, Award of 12 January 2018, para. 99.

  35. Ibid. at 102.

  36. Ibid. at paras. 103–130.

  37. USADA Press Release (2017a).

  38. USADA Press Release (2017b).

  39. Ibid.

  40. See, ITF Press Release, ‘Decision in the case of Spencer Furman’, 3 April 2018, http://www.sportsintegrityinitiative.com/decision-case-spencer-furman/ (Accessed 7 December 2018).

  41. CAS 2016/A/4772, Dominguez v. FIA, Award of 12 January 2018, para. 16.

  42. Article 10.8, WADA Code (2015), p. 72.

  43. CAS 2013/A/3274, Mads Glaesner v. FINA, Award of 31 January 2014.

  44. Ibid. at paras. 5–7.

  45. Ibid. at paras. 8–9.

  46. Ibid. at para. 20.

  47. Article 10.1 of the WADA Code (2015) states:

    ‘An anti-doping rule violation occurring during or in connection with an Event may, upon the decision of the ruling body of the Event, lead to Disqualification of all of the Athlete’s individual results obtained in that Event with all Consequences, including forfeiture of all medals, points and prizes, except as provided in Article 10.1.1.

    Factors to be included in considering whether to Disqualify other results in an Event might include, for example, the seriousness of the Athlete’s anti-doping rule violation and whether the Athlete tested negative in the other Competitions.’ See WADA Code (2015), p. 60.

    The Glaesner Panel found Article 10.1 of the FINA Anti-Doping Code (which is based on the World Anti-Doping Code) was more specific to the circumstances at hand than Article 10.8 since it explicitly addressed what to do with results from events within the same competition. See, CAS 2013/A/3274, Mads Glaesner v. FINA, Award of 31 January 2014, paras. 72–76.

  48. See, CAS 2013/A/3274, Mads Glaesner v. FINA, Award of 31 January 2014, paras. 82–89.

  49. Ibid. at para. 85.

  50. Ibid. at paras. 85–86 (finding ‘reference to “fairness” in relation to the commencement of the period of ineligibility’ in the 2003 Code was ‘interpreted in a rather broad sense’ and that ‘[i]t is for exact [sic] this reason that the provision relating to the commencement of the period of ineligibility was changed in the revision process leading up to the WADC 2009 deleting the word “fairness” and only referring to “delays not attributable to the athlete”’).

  51. Ibid. at para. 88.

  52. Ibid. at paras. 86–89.

  53. CAS 2016/O/4463, IAAF v. ARAF & Kristina Ugarova, Award of 29 November 2016, para. 141.

  54. See Manninen and Nowicki (2017).

  55. Ibid. at pp. 16–17.

  56. Ibid. at p. 17.

  57. One other factor considered is ‘Gaps’ in a blood Doping Scheme, see, ibid. at pp. 14–16.

  58. CAS 2016/A/4772, Dominguez v. FIA, Award of 12 January 2018, para. 16.

  59. Ms. Phillips also tested positive for a specified substance called Canrenone; however, following the terms of the Code, the FEI only charged Ms. Phillips with one anti-doping rule violation, specifically for testing positive for amphetamine because it carries a harsher sanction than Canrenone. See, Decision of the FEI Tribunal, Human Doping Case 2017 – 01 Alyssa Phillips, Decision of 25 May 2018.

  60. Ibid. paras. 3.4 & 4.6.

  61. Ibid. at para. 3.6.

  62. Ibid.

  63. Ibid. at paras. 3.9, 4.6, & 5.2.

  64. USADA Press Release (2018).

  65. The categorization of prohibited substances is left entirely to WADA’s Prohibited List Expert Group and determined without any published justification.

  66. Athletes who test positive for specified substances can receive a period of ineligibility as low as a reprimand and as high as two years, assuming the anti-doping organization cannot prove the athlete committed the anti-doping rule violation with intent. See, Articles 10.2.1.2 and 10.5.1.1, WADA Code (2015).

  67. USADA Press Release (2018).

  68. Ibid.

  69. Ibid.

  70. Even in circumstances that would clearly fall within the other three exceptions listed in Article 4.3, an athlete’s failure to apply for a retroactive TUE has led to an athlete being suspended. See CAS 2017/A/5317, Medvedev v. RUSADA, Award of 15 December 2017. (Athlete received a six-month suspension for failing to apply for a retroactive TUE after testing positive for a prohibited substance while being treated in a hospital for a concussion caused by a biking accident.)

  71. Collective Bargaining Agreement between Major League Soccer and Major League Soccer Players Union, https://mlsplayers.org/resources/cba, (Accessed 24 May 2019), refers to a ‘Substance Abuse and Behavioral Health Program and Policy’ in Exhibit 5, but the MLS’s Policy is not readily available publicly to review.

  72. Major League Baseball’s Joint Drug Prevention and Treatment Program (2019).

  73. National Football League’s Policy on Performance-Enhancing Substances (2018).

  74. Collective Bargaining Agreement between National Hockey League and National Hockey League Players’ Association (2019).

  75. Steven Marrocco (2015).

  76. Ultimate Fighting Championship Policy for Therapeutic Use Exemptions (2015), Article 3, p. 2.

    Similar to the ISTUE, the UFC Anti-Doping Program also explicitly permits (and encourages) emergency treatment. See, UFC Anti-Doping 2018 Athlete Handbook, p. 14 (‘NOTE: In rare circumstances when a prohibited substance or method is required for emergency treatment, an athlete must file a TUE application with full medical documentation from the emergency as soon as reasonably possible after the treatment. Emergency treatment should not be withheld, as the athlete’s health and well-being remain the top priority. In such cases, the emergency TUE request will be considered by a TUE Committee after treatment has taken place, per the WADA ISTUE.’).

  77. See, Ultimate Fighting Championship Policy for Therapeutic Use Exemptions (2015), Article 3, p. 2 (‘Furthermore, applications for retroactive TUEs will only be considered where the Use of the Prohibited Substance or Prohibited Method is medically justified….’).

  78. USADA Press Release (2017c).

  79. Ibid.

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Correspondence to Matthew Kaiser.

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Disclaimer: Global Sports Advocates represented Ms. Alyssa Phillips, Mr. Cesar Colunga, Mrs. Molly Beckwith-Ludlow, and Mr. Aleksei Medvedev in their respective anti-doping cases.

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Greene, P., Kaiser, M. How athletes’ rights can be better protected when it comes to retroactive Therapeutic Use Exemptions. Int Sports Law J 19, 29–37 (2019). https://doi.org/10.1007/s40318-019-00154-7

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