3Risk Management Help organization identify and manage risks Obvious - holes in playing field- unpadded obstaclesInferences- does artificial turf / rubber floor increase injury rates?- one ATC : sport coverage
4Reducing Risks Preparation for activity Conduct of activity Pre season exams assess activity areasFitness levels monitor environmental conditionsConduct of activity- maintain equipment adequate work / rest intervals- proper instructional techniquesInjury management- physician supervision evaluate / treat promptly- supervise AT studentsRecords management- document dr. orders, tx plan, tx. record, patient’s progress
5Malpractice“liability generating conduct associated with an adverse outcome of patient treatment”Negligent careFailure to obtain informed consentIntentional conductBreach of contractUse of defective productAbnormally dangerous treatment
6Examples of Malpractice Failure to prevent injury by permitting an athlete to participate when he is not medically qualified to do soFailure to have an ambulance, or qualified medical personnelFailure to have a “plan of action”Failure to identify a conditionFailure to examine an athlete properly after an injury
7Torts“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
8NegligenceFails to act as a reasonably prudent athletic trainer would act under the circumstances.Standards set byImplicit expectations (treat with respect)Policy and procedure manualsNATA Role delineation / Educational CompetenciesPosition statements (ACOSM, NCAA, NATA)
9OmissionFailure to do somethingCommission- performs an act that should not havebeen done
10Five Components of Negligence ConductATC did or did not take actionThoughts, attitudes, intentions not relevent
11Existence of Duty What is our “duty”? - job descriptions - NATA competenciesAbandonment- once services are provided, patientmust agree / voluntarily terminate relationship- substituting practitioner could be charged
12Breach of Duty Standard of Care - perform duties as other competent athletic trainer would exercise underthe circumstances- comparisons to geography, conditions,other health care professions- Herbert, D.L., (1992). The sports medicine standards book. Canton OH.
13Causation 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?
14Damage Must prove suffered damages - Harm has to be proven - physical damage- emotional distress- loss of …..
15Other Issues Statue of Limitations Assumption of Risk Sovereign ImmunityGood Samaritan ImmunityComparative/Contributory NegligenceProduct Liability
16Case #1: Palsgarf v Long Island RR Company RR employee helping a passenger on to trainPassenger drops box containing fireworks which goes off and injures the passengerCourt ruled that was not foreseeableProximate Cause
18How do you reduce the risk of litigation as a coach, athletic trainer/allied health professional?
19Coach Warn athletes of potential dangers involved in sport Supervise regularly and attentivelyPrepare and condition athletesInstruct athletes on skills of their respective sportsEnsure proper and safe equipment and facilities
20Athletic TrainerWork to establish good working relationships with athletes, parents and coworkersEstablish policies regarding athletic training facility and coverageDevelop emergency action planKnow the medical history of athletesMaintain adequate records
21Detailed job description Obtain written consent relative to providing health careMaintain confidentialityExercise caution with regards to medication distribution and modality useEnsure safe equipment and facilitiesFollow physician’s orders, particularly when dealing with participation of athletePurchase liability insuranceKnow scope of practiceUse common sense
22Professional Liability Insurance Protect against damages that may arise from injuries occurring on school propertyCovers against claims of negligence on part of individualsBecause of rise in lawsuits, professionals must be fully protected, particularly in regards to negligence
23Current National Injury Data-Gathering Systems State of the art injury surveillance is still developingIdeal situationEpidemiological approach that studies relationship of various factors that influence frequency and distribution of injury in sportExtrinsic factors (activity, exposure, equipement)Intrinsic factors (age, gender, neuromuscular aspects, structural aspects….etc)Number of different surveillance systems in place
24Surveillance SystemsNational 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)
25National 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 high schools)
26Universal Precautions in Athletic Environment 1991 OSHA (Occupational Safety and Health Administration) established standards for employer to follow that govern occupational exposure to blood-borne pathogensDeveloped to protect healthcare provider and patientAll sports programs should have exposure control planInclude counseling, education, volunteer testing, and management of bodily fluids
27“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)
28Family and Medical Leave Act Staff member must meet eligibility criteriaAt least 1250 hours of service in prior 12 monthsAt least 12 months of employmentMust be taken for a qualifying condition – “serious health condition”If eligible, can take up to 12 weeks in a 12 month period
29Non-discrimination Laws Includes state and federal lawsDo not discriminate on the basis of a protected class & remember: Assume everyone is in a protected class!!Harassment (sexual and on other grounds) falls hereSame 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
30Wage and Hour Laws Fair Labor Standards Act – Federal Exempt employees Non-exempt employees