Responses to sports medicine scenarios
By David D. Teuscher, MD
In the Summer 2005 issue of Orthopaedic Medical Legal Advisor (OMLA), several scenarios were provided for your opinion in the article on “Moral Reasoning of the Team Physician.” The article and questions can be viewed on the AAOS Web site under Library & Archives. What follows is a consensus of the AAOS fellows who responded on line.
When faced with treating an injured player who makes a threat of intentional physical retaliation, physicians have an obligation to help prevent someone else from harm. Fellows advised that you notify the team official/employee most appropriate for the situation, probably the team trainer and/or coach.
The practice of paying for the right to serve as team physicians raised concerns about the primary allegiance to the patient-athlete and whether the best qualified physician would handle the injured athlete’s case. NFL Commissioner Tagliabue banned the practice of sponsorship agreements that “involve a commitment to provide medical services by team physicians” on September 7, 2004. Though it may be permitted in other sports, it was considered a “slippery slope” and respondents recommended it be avoided or eliminated. The AOSSM recently adopted a position statement on “Principles for Selecting Team Medical Coverage,” which you can view at www.sportsmed.org.
Requests by management to “re-evaluate” a player with the implication that you would change your assessment for nonclinical reasons raised ethical concerns. While re-evaluation is not inherently wrong—especially if the condition is “difficult to evaluate objectively,” maintaining the independence and objectivity of your clinical judgment is critical. If there remains doubt by the athlete or team, a second opinion from another reputable physician is advised.
A policy of “no comment” and referral of all questions by the media on the status and prognosis of a player’s injury to the player and team spokesman/sports information director is highly advised. If you have already made comment and find yourself with threat of potential litigation, consult with your attorney before making any more comments.
Fellows advised against the practice of mischaracterizing the location or nature of an injury. Instead, characterizing this as an “undisclosed injury” and letting the team spokesman elaborate further would be the prudent course. Again, if you refrain from public comment as a matter of policy, there is no problem.
An inquiry from collegiate recruiters or professional teams regarding the health status of an amateur athlete under your care presents a myriad of legal issues with serious pitfalls. If the athlete is a minor, the parents absolutely must be involved, and it is good policy to seek parental participation even if the athlete has reached majority. Under HIPAA, personal health information cannot be shared without the patient’s express permission. It would be prudent to advise the athlete and his parents of your honest and independent opinion before receiving this permission. A dictated counseling note in the presence of the athlete and his parents can serve as an excellent reminder in case someone gets amnesia and threatens legal action.