Abstract
More individuals are participating in athletics today than ever before. Physicians treating athletes confront unique diagnostic and treatment challenges and an increased risk of legal liability. The key areas regarding liability are preparticipation examinations, determination of eligibility, evaluation of significant on-field injuries, and information disclosure. The issues surrounding preparticipation physicals and determination of eligibility are closely linked. Physicians must be prepared to seek guidance from specialists, particularly when there are cardiac, spinal, or neurologic issues. Appropriate on-field evaluation of potential concussions, spinal injuries, and heat stroke are key areas of concern for the physician. Privacy issues have become more complex in the age of federal regulation. Physicians and all athletic staff should be aware of privacy laws and ensure proper consent documentation is obtained from all athletes or their parents. All athletic programs should develop a plan that details roles and procedures to be followed in a medical emergency. Sports caregivers must take affirmative steps that better protect their patients from harm and physicians from legal liability.
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References
1982–2001 NCAA Participation Stat Report. Available at: www.ncaa.org/about/fact_sheet.pdf. Accessed January 10, 2008.
2004–05 NFHS High School Athletics Participation Survey. Available at: www.nfhs.org. Accessed January 10, 2008.
American Heart Association and American College of Sports Medicine. Joint position statement: automated external defibrillators in health/ fitness facilities. Med Sci Sports Exerc. 2002;34:239–244.
American Orthopaedic Academy of Sports Medicine. Team physician consensus statement. Available at: www.aoasm.org/pdf/TP_Consensus_Statement.pdf. Accessed January 10, 2008.
Andersen J, Courson RW, Kleiner DM, McLoda TA. National Athletic Trainers’ Association position statement: emergency planning in athletics. J Athl Train. 2002;37:99–104.
Bailes JE, Hudson V. Classification of sport-related head trauma: a spectrum of mild to severe injury. J Athl Train. 2001;36:236–243.
Birrer RB. The sports medicine physician. In: Birrer RB, Griesemer BA, Cataletto MB, eds. Pediatric Sports Medicine for Primary Care. 3rd Ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002:9–14.
Bonci CM, Bonci LJ, Granger LR, Johnson CL, Malina RM, Milne LW, Ryan RR, Vanderbunt EM. National athletic trainers’ association position statement: preventing, detecting, and managing disordered eating in athletes. J Athl Train. 2008;43:80–108.
Cantu RC. Second-impact syndrome. Clin Sports Med. 1998;17:37–44.
Cantu RV, Cantu RC. Current thinking: return to play and transient quadriplegia. Curr Sports Med Rep. 2005;4:27–32.
Collum J. Legal developments regarding injuries related to participation in and or affiliated with athletic events. Sports Parks Rec Law Rep. 2001;14:56–58.
Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296:1593–1601.
DuRant RH, Seymore C, Linder CW, Jay S. The preparticipation examination of athletes. Comparison of single and multiple examiners. Am J Dis Child. 1985;139:657–661.
Echemendia RJ, Putukian M, Mackin RS, Julian L, Shoss N. Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clin J Sport Med. 2001;11:23–31.
Fahrenbach MC, Thompson PD. The preparticipation sports examination. Cardiovascular considerations for screening. Cardiol Clin. 1992;10:319–328.
Feinstein RA, Colvin E, Oh MK. Echoradiographic screening as part of a preparticipation examination. Clin J Sport Med. 1993;3:149–152.
Gallop EM. Law and the Team Physician. Champaign, IL: Human Kinetics; 1995:ix.
Ghiselli G, Schaadt G, McAllister DR. On-the-field evaluation of an athlete with a head or neck injury. Clin Sports Med. 2003;22:445–465.
Glover DW, Maron BJ. Profile of preparticipation cardiovascular screening for high school athletes. JAMA. 1998;279:1817–1819.
Gomez JE, Lantry BR, Saathoff KN. Current use of adequate preparticipation history forms for heart disease screening of high school athletes. Arch Pediatr Adolesc Med. 1999;153:723–726.
Graf-Baumann T. Medicolegal aspects of doping in football. Br J Sports Med. 2006;40(Suppl 1):i55–57.
Hassanein T, Razack A, Gavaler JS, Van Thiel DH. Heatstroke: its clinical and pathological presentation, with particular attention to the liver. Am J Gastroenterol. 1992;87:1382–1389.
Heck JF, Clarke KS, Peterson TR, Torg JS, Weis MP. National Athletic Trainers’ Association Position Statement: head-down contact and spearing in tackle football. J Athl Train. 2004;39:101–111.
Herbert DL. Verdict for school in football player’s heat stress case to be retried. Sports Med Stan Mal Rep. 2007;19:17–20.
Isaacs CA. Conflicts of interest for team physicians: a retrospective in light of Gathers v Loyola Marymount. Alb LJ Sci & Tech. 1992;2:147–174.
Jeffers v D’Alessandro, 03 CVS 13863 (North Carolina Court of Appeals, 2005).
Kim DH, Vaccaro AR, Berta SC. Acute sports-related spinal cord injury: contemporary management principles. Clin Sports Med. 2003;22:501–512.
Kleinknecht v Gettysburg College, 92–7160, 25 (Fed R Serv 3d 1992).
Klossner D, ed. NCAA Sports Medicine Handbook. Indianapolis: National Association of Intercollegiate Athletics; 2005.
Knapp v Northwestern University, 101 F 3d 473 (7th Cir 1996).
Larkin v Archdiocese of Cincinnati, No C-90-619 (SD Ohio August 31, 1990).
Lewin v Fitworks of Cincinnati, LLC, Case NO A0305312 (Hamilton County, Ohio; June 28, 2005).
Lewis JF, Maron BJ, Diggs JA, Spencer JE, Mehrotra PP, Curry CL. Preparticipation echocardiographic screening for cardiovascular disease in a large, predominantly black population of collegiate athletes. Am J Cardiol. 1989;64:1029–1033.
Lovell MR, Collins MW, Iverson GL, Johnston KM, Bradley JP. Grade 1 or ‘ding’ concussions in high school athletes. Am J Sports Med. 2004;32:47–54.
Majerske CW, Mihalik JP, Ren D, Collins MW, Reddy CC, Lovell MR, Wagner AK. Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance. J Athl Train. 2008;43:265–274.
Maron BJ. Sudden death in young athletes. Lessons from the Hank Gathers affair. N Engl J Med. 1993;329:55–57.
Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA. 2002;287:1308–1320.
Maron BJ, Epstein SE, Roberts WC. Causes of sudden death in competitive athletes. J Am Coll Cardiol. 1986;7:204–214.
Maron BJ, Gohman TE, Aeppli D. Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol. 1998;32:1881–1884.
Maron BJ, Isner JM, McKenna WJ. 26th Bethesda conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. Task Force 3: hypertrophic cardiomyopathy, myocarditis and other myopericardial diseases and mitral valve prolapse. Med Sci Sports Exerc. 1994;26(Suppl):S261–267.
Maron BJ, Thompson PD, Puffer JC, McGrew CA, Strong WB, Douglas PS, Clark LT, Mitten MJ, Crawford MH, Atkins DL, Driscoll DJ, Epstein AE. Cardiovascular preparticipation screening of competitive athletes. A statement for health professionals from the Sudden Death Committee (clinical cardiology) and Congenital Cardiac Defects Committee (cardiovascular disease in the young), American Heart Association. Circulation. 1996;94:850–856.
Martineau C, Kingma JJ, Bank L, Valovich-McLeod T. Guidelines for treatment of sport-related concussions. J Am Acad Phys Assist. 2007;20:22–28.
Matheson GO, ed. Preparticipation Physical Evaluation. 3rd ed. Minneapolis, MN: Physician and Sportsmedicine; 2005:1–2.
Mitten MJ. Emerging legal issues in sports medicine. St Johns Law Rev. 2002;76:7–86.
Mogabgab v Orleans Parish School Board, 239 so2d 456 (US Court of Appeals, Los Angeles 1970).
Murry PM, Cantwell JD, Heath DL, Shoop J. The role of limited echocardiography in screening athletes. Am J Cardiol. 1995;76:849–850.
NATA issues tips to reduce severity of sports concussions. Sports Med Stan Mal Rep. October, 2007:58–59.
National Senior Games Association. Available at: www.nsga.com/. Accessed June 18, 2008.
NFL player’s death a shock. Sports Med Stan Mal Rep. April 2006:28.
Nofsinger CC. Negotiating contractual relationships. Clin Sports Med. 2007;26:193–199.
Pahulu v University of Kansas, 897 F Supp 1387 (Kans Dist 1995).
Paterick TE, Paterick TJ, Fletcher GF, Maron BJ. Medical and legal issues in the cardiovascular evaluation of competitive athletes. JAMA. 2005;294:3011–3018.
Patterson D. Legal aspects of athletic injuries to the head and cervical spine. Clin Sports Med. 1987;6:197–210.
Pearsall AW, Kovaleski JE, Madanagopal SG. Medicolegal issues affecting sports medicine practitioners. Clin Orthop Relat Res. 2005;433:50–57.
Pearsall Z, Portman R, Kovalseski J, Madanagopal SG. The team physician and legal aspects of informed consent. Newslet Am Orthop Soc Sports Med. 2004:4–7.
Phillips GC. Medicolegal issues and ergogenic aids: trade, tragedy, and public safety, the example of Ephedra and the Dietary Supplement Health and Education Act. Curr Sports Med Rep. 2004;3:224–228.
Rutherford GJ, Schroeder T. Sports-related Injuries to Persons 65 Years of Age and Older. Washington, DC: US Consumer Products Safety Commission; 1998:4.
Ryan E. Judge: Korey Stringer lawsuit to proceed. Washington Post. Available at: www.washingtonpost.com/wp-dyn/content/article/2007/02/01/AR2007020101414.html. Accessed June 24, 2008.
Sanders AK, Boggess BR, Koenig SJ, Toth AP. Medicolegal issues in sports medicine. Clin Orthop Relat Res. 2005;433:38–49.
Stringer v Minnesota Vikings, A03-1635 (Minnesota State Supreme Court 2002).
Suk M, Udale AM, Helfet DL. Orthopaedics and the law. J Am Acad Orthop Surg. 2005;13:397–406.
Torg JS, Sennett B, Pavlov H, Leventhal MR, Glasgow SG. Spear tackler’s spine. An entity precluding participation in tackle football and collision activities that expose the cervical spine to axial energy inputs. Am J Sports Med. 1993;21:640–649.
Van Camp SP, Bloor CM, Mueller FO, Cantu RC, Olson HG. Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc. 1995;27:641–647.
Van Kampen DA, Lovell MR, Pardini JE, Collins MW, Fu FH. The ‘value added’ of neurocognitive testing after sports-related concussion. Am J Sports Med. 2006;34:1630–1635.
Weidenbener EJ, Krauss MD, Waller BF, Taliercio CP. Incorporation of screening echocardiography in the preparticipation exam. Clin J Sport Med. 1995;5:86–89.
Wen DY. Preparticipation cardiovascular screening of young athletes. Phys Sportsmed. 2005;33:31–42.
Wharton SJ, Richter ST, Burns CE. Automated external defibrillators in collegiate athletic training programs. Med Sci Sports Exerc. 2005;37:S356.
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We thank M. M. Manring, PhD, for his assistance in preparing the manuscript.
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Kane, S.M., White, R.A. Medical Malpractice and the Sports Medicine Clinician. Clin Orthop Relat Res 467, 412–419 (2009). https://doi.org/10.1007/s11999-008-0589-5
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DOI: https://doi.org/10.1007/s11999-008-0589-5