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

first aid and training programs are carried out by nonphysician personnel. This
creates the same liability issues as supervision of nonphysician personnel in other
medical settings.
Trainers were once a luxury reserved for professional athletes and world-class
amateurs. Today large high schools often employ trainers on their coaching staffs,
and professional coaches are also taught these skills. The trainer is both an athletic
coach and a medical assistant. Treating minor injuries, doing physical therapy, and
overseeing such preventive measures as taping and reconditioning are all part of the
trainer’s job. Consequently, the team physician must oversee the activities of the
trainer in the same way that the physician would supervise a nurse or a physical
therapist. This is a politically sensitive issue because trainers are usually given a free
hand in both diagnosing and treating medical conditions. That trainers violate the
medical practice act in many states is usually ignored by the state boards of medical
examiners. When a physician is involved, however, infractions by the trainer are
grounds to discipline the supervising physician, and they subject the physician to
medical malpractice liability. Physicians must ensure that trainers comply with
applicable scope-of-practice laws.
The team physician may not delegate control of prescription medications to a
nonphysician. Providing the trainer with a bottle of codeine tablets to use when
someone gets hurt is illegal. As with other drug law violations, there is a high
probability that the physician will face criminal charges if the practice is discovered.
Although narcotics are the most likely to lead to trouble, there is increasing scrutiny
of prescriptions for other drugs, particularly steroids. Prescriptions can be written for
direct use only by the affected individual. If a physician wishes to stock and dispense
medication, it must be done in compliance with the pharmacy laws of the state.
Writing a prescription for office use and letting the trainer dispense the drugs is no
longer acceptable practice, nor is allowing nonphysicians to distribute samples of
prescription drugs.
5. Performance Enhancement
The most controversial issue in sports medicine is performance enhancement beyond
what can be achieved by proper nutrition and general conditioning. The publicity has
focused on drugs: first amphetamines, now steroids, next human growth hormone
and other genetic engineering products. The problems are not limited to drugs.
Biomechanics and the use of direct muscle stimulation tools are changing the nature
of training and allowing the selective overdevelopment of muscle groups. Improperly
used, these techniques can increase the probability of injury and disability.
Taking drugs to improve athletic performance has been publicly deplored but
privately practiced for years. It has become a risky practice for both the athlete and
the physician. Most competitive athletic organizations have rules against any use of
drugs or doping to enhance performance. Urine testing has become cheap, quick, and
easy. The athlete who gets caught is likely to be excluded from participation for
some time. Blood doping is less easily detected but may be more dangerous. Even
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