Public Health Law Map - Beta 5 - Medical and Public Health Law Site

Team physicians’ duties are to their patients as individuals, not to the team or to the
school. The physician must have proper consent to provide medical care and must
respect patient confidentiality. No matter how interested the coach may be in a star
athlete, he or she has no right to participate in the medical care of the athlete without
the patient’s permission. Medical decisions must be made on medical grounds by the
physician responsible for the care.
The most difficult decision in sports medicine is determining when to allow injured
athletes to play. The football player with a sprained ankle may miss the entire season
if his activities are limited for as long as is usual in nonathletes. If he is allowed to
play too soon, he has a greater chance of reinjuring the ankle and being disabled for a
longer time. Blanket prohibitions on play for an extended period may encourage the
athlete to ignore the physician’s advice altogether. If the athlete is an adult who can
understand the risks of playing while injured, the physician may only need to provide
accurate information on the risks of continued play. If the athlete is a child, the
situation is more complicated. The parents must be involved in the decision and must
be given full information about the risks.
When sports medicine physicians are dealing with athletes with less information and
support than are available to professionals, they should be more conservative in
balancing the need to get back to play against the probability of impairing permanent
healing. For example, if a sprain can be adequately supported by tape, the athlete
should be taught to tape and be allowed to play. If an injury would heal without
surgery but surgery will speed the process, the athlete may choose to be operated on.
Although a physician may aid a professional athlete in a calculated decision to
compromise future healing for short-term gain, this should not be done for college
and high school players. Using pain killers or steroids to get the player back on the
field when this endangers permanent recovery is bad medicine and legally risky. The
promising player who wants to be in the game when the pro scout is there will not be
grateful if that game is his last because his injury becomes permanent.
2. Team versus Player
Team physicians face the ethical problem of determining when it is appropriate to
compromise an athlete’s long-term health for short-term performance. Informed
consent is at the heart of this problem. A physician must be sure that the athlete
understands the long-term consequences of the recommended medical treatment or
lack of treatment. Physicians who do not tell patients the risks of treatments that
allow an athlete to compete when it is medically contraindicated face substantial
malpractice liability. If there is evidence that the coach encouraged the physician to
withhold information about the risks of treatment, the physician may face punitive
damages for fraud.
An equally difficult problem is the degree to which players exercise the free choice
that is necessary for an informed consent. There is pressure to maintain team
performance, irrespective of the risk to the individual. Players who will not take risks
for the team do not last long in the starting lineup. It is arguable whether consent
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