ETHICAL & LEGAL CONSIDERATIONS

Scenario You are a high school ATC and are covering a night soccer game. You notice that some bad weather is on its way. It is 9:30 pm, you have worked a long day and are hoping that the rain, thunder, and lightning will hold off until that game is over because any sight of lighting will result in at least a 30 minute delay. There is 1 minute left of the game and your home team is winning by 1 goal and you see strike of lightning in the distance. What do you do?

Scenario You are a high school ATC and your team’s safety makes a hard tackle on the opposing team’s star receiver. Your team’s player runs back to the huddle clearly unaffected. However, the opposing team’s star appears very shaken and walks slowly to the sideline. A few plays later the opposing team’s player is back in the game, but it is obvious that he is not thinking clearly. You rush to the opposing sideline and try to express your concern that a concussed player should, at a minimum, be removed from the game. Their athletic trainer and coach are not responsive to your opinion and obstruct your attempts to examine the athlete. What do you do?

INTRODUCTION Ethics = morals; a set of principles or values that influence behavior. Right vs. Wrong. What are some examples of your morals/values? Members of the sports medicine team are responsible for their actions and for conducting themselves in an ethical and legal manner. Sports Medicine professionals are often in the spotlight because sports are played in front of crowds and cameras. Lawsuits can result from inappropriate ethics and behavior.

SPORTS MEDICINE TEAM ETHICS SM teams work best when the members share the same ethics. Team ethics are essential to bring about the best experience for all participants both on and off the field. Give 3 examples of good ethical behavior that should be exhibited from each member of the sports medicine team. Give 3 poor examples.

SPORTS MEDICINE TEAM ETHICS Establishing a written set of guidelines is the best way to make sure expectations of conduct are understood! Verbal agreements do not count! Sports Medicine professionals have a: Code of Ethics = written standards for conduct, behavior, and moral philosophy. See the NATA code of ethics, it is an excellent example of the type of behavior expected of athletic trainers and other sports medicine professionals.

ATHLETE ETHICS School districts usually have written contracts or athletic philosophies that outline the behavior expected of their athletes. What do you think should be included in an athlete’s code of ethics? Athletes and the parent/guardian should sign the contract indicating that they have read and accept the expectations described.

ACTIVITY Create a skit that demonstrates an ethical decision making dilemma by a member of the sports medicine team. 3 groups of 6 students – Best skit earns credit cards!

MINI PROJECT Find an example of a moral dilemma or lawsuit that a sports medicine professional or healthcare provider encountered. Can be real or fictional. Describe the ethical conflict or lawsuit and the outcome. Do you agree or disagree? Write a one page, summary and opinion. (One paragraph summary, One paragraph opinion) Present your scenario to the class using a PowerPoint/Google Doc slide describing the case! Include a video clip or picture (optional).n Grey’s Anatomy fictional example: A criminal that is on death row and will be executed in five days is an organ donor match for a dying child in need of a transplant. What will they do? zvPfHR62dUAqgZbzWK-hIlGZ zvPfHR62dUAqgZbzWK-hIlGZ

Breaches of Ethical Codes Breach = breaking a rule. The purpose of creating codes of ethic and regulations is so that the expectations of appropriate behavior are made clear and demonstrated by everyone involved. Unfortunately, not everyone plays by the rules. It is important to enforce all rules and report those who violate them. “Looking the other way” when rules are broken is not acceptable!

Breaches of Ethical Codes Examples of breaches of conduct: An athlete that uses tobacco, alcohol, or drugs. These actions are a “no brainer” for breaches in conduct because it involves the safety and well-being of an athlete. It is the ATC’s duty to notify appropriate sports medicine team members if an athlete is observed putting their health or mental well-being in danger. It is not always this easy! It may be harder to report breaches of conduct if it seems as though no one is being hurt. (Gambling, hazing, etc.)

Warm Up You are a high school ATC and one of your athlete’s a football player, is under a doctor’s care and being treated for a skin infection. The skin infection appears to have cleared up, but you are awaiting a note of clearance from the athlete’s doctor. It is Saturday morning, just hours before their big rivalry football game and your athlete comes into your office with his doctor’s clearance note eager to play in the game. You take a quick glance at the photocopy of the doctor’s note and see that it says Billy is cleared to play on ____ (today’s) date. You tell him he is cleared to suit up for the game. A few minutes later you take a closer look at the note and notice that it looks as if the date was altered. What do you do?

Liability Risk Management = reduction of the potential for injury. As a health care provider you should DOCUMENT everything to protect yourself from litigation! Litigation = a lawsuit that is examined by the court of law. Lawsuits determine liability, the legal responsibility for any loss or damage that occurs as a result of a person’s actions or failure to act. If it is decided that someone is liable for an injury, then damages (financial compensation) is awarded to the injured person.

Liability Standard of care = the degree of care, skill, and diligence an equally qualified caregiver in the profession would provide in similar circumstances. Failure to provide standard of care can result in liability or negligence charges. Negligence = the failure to give reasonable care or to do what another prudent person with similar experience, knowledge, and background would have done under the same circumstances. Tort = a wrongful act resulting in injury to another person, for which the injured party is entitled to compensation.

Negligence Torts Malfeasance = when the care provider performs an act that is not their responsibility or standard of care. Example: An ATC relocating a dislocated elbow joint) Misfeasance = when the care provider commits an act that is their responsibility to perform, but used the wrong procedures. Example: An ATC that improperly stabilizes a dislocated elbow while waiting for paramedics, causing further injury) Nonfeasance = when the care provider fails to perform their legal duty of care. Example: All signs of an assessment indicate an ankle fracture and the care provider does nothing)

Negligence Torts Gross Negligence = when the care provider has total disregard for the safety of others. Malpractice = when the care provider commits a negligent act while delivering care. Professional misconduct or lack of professional skill that results in injury to the patient. Negligence by a professional, such as a physician, nurse, ATC, or coach.

Negligence The majority of sports medicine lawsuits involve claims of negligence! To be a legitimate claim of negligence a person’s action or inaction must create an unreasonable risk or harm to others. One of the best ways to prevent negligence lawsuits in sports medicine is to avoid issues of “failure to warn.” Failure to warn means failing to inform participants of the risks associated with the activity. Have athletes/parents sign acknowledgement of risk forms. Carry malpractice insurance.

Scenario 16 year old Johnny was participating in a regular basketball practice with the rest of his team when Johnny slipped in a puddle of water while horseplaying with another player an hit his head. This blow to his head caused Johnny to lose consciousness. As a result of this injury he was taken to the ER and hospitalized for 24 hours. At the time of injury, the coach was on his cell phone in his office, and therefore not directly supervising the practice. Is the coach negligent? What type? From a risk management standpoint, how could the ATC have prevented the problem from occurring.

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Risk Management The ultimate goal of risk management is to make the activity/sport as safe as possible for all participants. This will reduce the risk for lawsuits. Lawsuits in sports usually result from one of the following situations: Inadequate supervision of the athlete or client. Inadequate training of the athlete or client. Improper or inadequate medical treatment by one or more members of the sports medicine team. Faulty equipment or facilities. Sexual harassment, discrimination, or other inappropriate behavior.

Risk Management To avoid potential risk of injuries and to keep athletes S.A.F.E., perform the following duties daily: S – Supervision: Keep a close watch on athletes before, during, and after practice, including in the locker rooms and on the field. A – Aid: Aid athletes when needed, including keeping proper records of physicals, injuries, treatments, etc. F – Facilities : Must be checked daily for possible hazards. E – Equipment: Equipment in all facilities should be checked daily as well, including the athletic training room, weight room, etc.

Risk Management Lawsuits are better prevented than defended. Litigation is time consuming and expensive. Additional steps you can take to avoid legal wrong-doing include the following: 1) Do not allow a client/athlete to begin any program without physician clearance, informed consent, and acknowledgement of risk paperwork.

Risk Management 2) Agree upon fees/costs and put them in writing before the start of services. 3) Make sure there is equality for both male and females to avoid charges of discrimination. 4) If possible, avoid being alone in a room with an athlete or client. 5) Keep detailed documentation!

Risk Management 6) Become familiar with the products and supplies used. Read all manufacturer’s warnings and disclaimers, and make sure the athletes or client’s are aware of them. 7) Develop an Emergency Action Plan for every sport. 8) Follow appropriate procedures on all injury assessments. 9) Ensure supervision of athletes during treatment and make yourself aware of any health concerns.

Risk Management 10) Make sure coaches are up to date on all training techniques related to their sport. 11) Conduct pre and post season reviews, and learn from both the positive and negative events that occurred and make appropriate adjustments if needed. 12) Create a daily approach to safety. Make a daily checklist for key items of concern.

Risk Management 13) Create a safety committee. 14) Know limitations and scope of practice. For example, dispensing medication is not in an ATC’s scope. 15) Be aware of changes in standard of care and any other changes that affect the field of work. Sports Medicine requires ongoing education.

Scenario A track athlete was recruited to play football. He had never played organized football before. He was recruited primarily because of his speed and was going to be used a receiver. Unfortunately, he was severely injured while tackling an opposing player after an interception. The athlete sued, contending that the injury was the result of insufficient training, conditioning, and supervision. Investigation showed that he had only received one practice session on tackling. Expert testimony stated that tackling can be an extremely dangerous skill and that proper technique and instruction is paramount to avoiding injury. The jury found the head coach to be 40% negligent and the line coach 60% negligent and awarded the plaintiff $6.5 million. The jury emphasized that the injured athlete was a senior who had trained primarily in track and did not receive adequate training and instruction in football. How could this situation have been prevented?

The Rights of the Patient Patient’s have a Bill of Rights, what they are entitled to during their course of treatment. A patient’s injury and treatment is confidential! It should never be discussed with anyone outside of the sports medicine team. Violating this right can lead to litigation. Health Insurance Portability and Accountability Act (HIPAA) = A federal regulation establishing national standards for health care information to protect personal health information. See Patient’s Bill of Rights