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, patients 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 physicians 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 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