legal issues in athletic training. credentialing licensure** certification registration exemption
TRANSCRIPT
Legal Issues in Athletic Training
Credentialing
• Licensure**
• Certification
• Registration
• Exemption
Risk Management
• Help organization identify and manage risks
Obvious
- holes in playing field
- unpadded obstacles
Inferences
- does artificial turf / rubber floor increase injury rates?
- one ATC : sport coverage
Reducing Risks• Preparation for activity
• Pre season exams - assess activity areas• Fitness levels - monitor environmental conditions
• Conduct of activity- maintain equipment - adequate work / rest intervals
- proper instructional techniques
• Injury management- physician supervision - evaluate / treat promptly
- supervise AT students
• Records management- document dr. orders, tx plan, tx. record, patient’s progress
Malpractice
• “liability generating conduct associated with an adverse outcome of patient treatment”
• Negligent care• Failure to obtain informed consent• Intentional conduct• Breach of contract• Use of defective product• Abnormally dangerous treatment
Examples of Malpractice
• Failure to prevent injury by permitting an athlete to participate when he is not medically qualified to do so
• Failure to have an ambulance, or qualified medical personnel
• Failure to have a “plan of action”• Failure to identify a condition• Failure to examine an athlete properly after an
injury
Torts
“legal wrong other than breach of contract for which a remedy will be provided”
• Initiated by plaintiffs in civil court as opposed to criminal cases initiated by the government
- intentional tort – libel or slander- negligent tort – more common in
AT
Negligence
• Fails to act as a reasonably prudent athletic trainer would act under the circumstances.
• Standards set by• Implicit expectations (treat with respect)• Policy and procedure manuals• NATA Role delineation / Educational
Competencies• Position statements (ACOSM, NCAA,
NATA)
• Omission
–Failure to do something
• Commission
- performs an act that should not have
been done
Five Components of Negligence
• Conduct
• ATC did or did not take action• Thoughts, attitudes, intentions not relevent
Existence of Duty
• What is our “duty”?
- job descriptions
- NATA competencies• Abandonment
- once services are provided, patient
must agree / voluntarily terminate relationship
- substituting practitioner could be charged
Breach of Duty
• Standard of Care- perform duties as other competent athletic trainer would exercise under the circumstances- comparisons to geography, conditions, other health care professions
- Herbert, D.L., (1992). The sports medicine standards book. Canton OH.
Causation
• Must prove the breach was the legal cause of the injury
Actual cause: actions were a determining factor in damage (may be shared)
Proximate cause: was injury foreseeable?
Damage
• Must prove suffered damages
- Harm has to be proven
- physical damage
- emotional distress
- loss of …..
Other Issues
• Statue of Limitations
• Assumption of Risk
• Sovereign Immunity
• Good Samaritan Immunity
• Comparative/Contributory Negligence
• Product Liability
Case #1: Palsgarf v Long Island RR Company
• RR employee helping a passenger on to train
• Passenger drops box containing fireworks which goes off and injures the passenger
• Court ruled that was not foreseeable
• Proximate Cause
How do you reduce the risk of litigation as a coach, athletic
trainer/allied health professional?
Coach
• Warn athletes of potential dangers involved in sport
• Supervise regularly and attentively• Prepare and condition athletes• Instruct athletes on skills of their
respective sports• Ensure proper and safe equipment and
facilities
Athletic Trainer
• Work to establish good working relationships with athletes, parents and coworkers
• Establish policies regarding athletic training facility and coverage
• Develop emergency action plan• Know the medical history of athletes• Maintain adequate records
• Detailed job description
• Obtain written consent relative to providing health care
• Maintain confidentiality
• Exercise caution with regards to medication distribution and modality use
• Ensure safe equipment and facilities
• Follow physician’s orders, particularly when dealing with participation of athlete
• Purchase liability insurance
• Know scope of practice
• Use common sense
Professional Liability Insurance
• Protect against damages that may arise from injuries occurring on school property
• Covers against claims of negligence on part of individuals
• Because of rise in lawsuits, professionals must be fully protected, particularly in regards to negligence
• Current National Injury Data-Gathering Systems– State of the art injury surveillance is still developing– Ideal situation
• Epidemiological approach that studies relationship of various factors that influence frequency and distribution of injury in sport
• Extrinsic factors (activity, exposure, equipement)• Intrinsic factors (age, gender, neuromuscular aspects,
structural aspects….etc)
– Number of different surveillance systems in place
• Surveillance Systems– National Safety Council (general sports injury data)– Annual Survey of Football Injury Research (public
school, college, professional, sandlot football injury data)
– National Center of Catastrophic Sport Injury Research (Tracks catastrophic injuries in all levels of sports)
– NCAA Injury Surveillance System (data collected on most major sports- ATC data collection)
– National Electronic Injury Surveillance System (Monitor injuries relative to different products --consumer safety, determine if products are hazardous or defective)
– National High School Sports Injury Registry (tracks injuries in specific sports at 150-200 high schools)
Universal Precautions in Athletic Environment
• 1991 OSHA (Occupational Safety and Health Administration) established standards for employer to follow that govern occupational exposure to blood-borne pathogens
• Developed to protect healthcare provider and patient
• All sports programs should have exposure control plan– Include counseling, education, volunteer testing, and
management of bodily fluids
“The Law”- Selected Major Laws
• Family & Medical Leave Act (FMLA) (Federal)
• Non-discrimination laws (Federal and State)
• Workers’ Compensation laws (State)
• Wage & hour laws (Federal and State)
Family and Medical Leave Act
• Staff member must meet eligibility criteria– At least 1250 hours of service in prior 12 months
– At least 12 months of employment
• Must be taken for a qualifying condition – “serious health condition”
• If eligible, can take up to 12 weeks in a 12 month period
Non-discrimination Laws• Includes state and federal laws
• Do not discriminate on the basis of a protected class & remember: Assume everyone is in a protected class!!
• Harassment (sexual and on other grounds) falls here– Same sex harassment is actionable (1998 Supreme Court
decision)
• Includes Americans with Disabilities Act, which may impose an obligation to accommodate if the person has a disability
Wage and Hour Laws
• Fair Labor Standards Act – Federal
– Exempt employees
– Non-exempt employees