KIN 188 – Prevention and Care of

Athletic InjuriesStandards of Professional

Practice

Legal and Ethical Considerations

Standards of Practice

• Definition and perspective

• NATA Code of Ethics

• BOC Standards of Practice for Athletic Training

Definition

• Standards of practice are ethical responsibilities that guide one’s actions and promote high standards of conduct and integrity to assure high quality health care

Perspective

• ATC should never compromise the health of any participant/client

• Decisions regarding participation status should be based upon sound medical judgment

• Participants should be informed of risk, protected from injury when possible and if injured, should receive expedient health care and rehabilitation

• Patients/clients have a right to confidentiality regarding their health status

NATA Code of Ethics

• Basic principles to follow– Members shall respect the rights, welfare and

dignity of all individuals

– Members shall comply with the laws and regulations governing the practice of athletic training

– Members shall accept responsibility for the exercise of sound judgment

NATA Code of Ethics

• Basic principles to follow (continued)– Members shall maintain and promote high

standards in the provision of services

– Members shall not engage in any form of conduct that constitutes a conflict of interest or that adversely reflects on the profession

from www.bocatc.org (8/05)

BOC Standards of Practice

• “The Professional Practice and Disciplinary Process of the BOC are intended to assist and inform the public, certificants, and candidates for certification, of the BOC Standards of Professional Practice and the Disciplinary Process relative to professional conduct and disciplinary procedures. “

Legal Considerations

• Tort Law

• Standard of Care

• Clearance for Participation

• Negligence

• Legal Liabilities

• Legal Defenses

• Preventing Litigation

Tort Law

• Tort is a civil wrong done to an individual whereby the injured party seeks a remedy for damages suffered.

• Act of omission

• Act of commision

• Actions measured against a standard of care provided by individuals who have a direct duty to provide care

Act of Omission

• Occurs when an individual fails to perform a legal duty

Act of Commission

• Occurs when an individual commits an act that is not his or hers to perform

or

• Occurs when an individual commits an act that is his or her duty to perform, but carries out the wrong procedure leading to injury or harm

Standard of Care

• Standard of care measured by what another minimally competent individual, educated and practicing in that profession would have done in the same or similar circumstances

• Standard of care is dictated by profession’s duty or scope of care

Scope of Care

• Scope of care outlines the role and responsibility of an individual in that profession and delineates what should be learned in the professional preparation of that individual

Scope of Care

• In athletic training, scope of care is determined by the competencies that define the educational content that students must master

• Delineating scope of care for entry-level ATCs establishes the standard of care that the public can expect to receive from an ATC– Forces individuals practicing athletic training services

to hold ATC credential and state registration, certification or registration where applicable

Clearance for Participation

• Final authority regarding clearance for participation for an individual is outside the scope of care of an ATC

• Authority rests with team and/or primary care physician

• Parents of minors cannot assume risk involved in participation for their child

Negligence

• ATCs, coaches, etc. have a duty to provide care to participants under their supervision

• Failure to provide such care can result in liability or negligence

• Negligence may occur as a result of– Malfeasance– Misfeasance– Nonfeasance– Malpractice– Gross negligence

Negligence Definitions

• Malfeasance– Occurs when an individual commits an act

that is not their responsibility to perform

• Misfeasance– Occurs when an individual commits an act

that is their responsibility to perform, but uses the wrong procedure, or does the right procedure in an improper manner

Negligence Definitions

• Nonfeasance– Occurs when an individual fails to perform their legal

duty of care

• Malpractice– Occurs when an individual commits a negligent act

while providing care

• Gross negligence– Occurs when an individual has total disregard for the

safety of others

Negligence

• In order for an individual to be found liable or negligent, the injured party must prove that:– There was a duty of care owed to them– There was a breach of that duty– There was harm caused to them– The harm caused was a direct result of the

breach of duty

Legal Liabilities

• Several steps can be taken to minimize the risk of litigation in the following areas– Failure to warn– Foreseeability of harm– Informed consent– Refusing help– Product liability– Confidentiality

Failure to Warn

• Participants in sport/activity should be warned of the risks of injury associated with participation

• Especially important for parents of minors and for novices vs. advanced participants

• Typically done in pre-season meetings and with the use of signed assumption of risk forms – may also post warning signs and require appropriate protective equipment and adherence to safety related rules

Foreseeability of Harm

• Exists when danger is apparent or should have been apparent

• Danger must be recognized as potentially injurious and removed prior to injury occurring

• Typically done with regular inspection of facilities/equipment and adherence to established precautions/protocols regarding disease/infections

Informed Consent

• Implies that an injured individual has been reasonably informed of necessary treatment, possible alternatives, and advantages/disadvantages to each

• Individual must be physically/mentally competent or parent of a minor for informed consent to be valid – typical exceptions in case of emergency

Informed Consent

• Typically addressed with signed document at preseason meeting

• Consider exclusionary clause to address things not within the scope of care for practitioner

• Application of treatment without receipt of informed consent may constitute battery (unpermitted/intentional contact with another without their consent)

Refusing Help

• Injured individuals may refuse help due to religious beliefs, cultural differences, avoidance of additional pain/suffering, or desire to be treated by more advanced medical personnel

• As long as they’re conscious and medically competent, that is their right unless greater risk of injury to the individual and/or others exists if they’re not treated

• Best to establish witness to refusal of help

Product Liability

• Manufacturers of equipment have a duty of care to design, manufacture and package safe equipment that will not cause injury when used as it’s intended – known as implied warranty

• Expressed warranty is a written guarantee that the product is safe for use

Product Liability

• Strict liability makes the manufacturer liable for any and all defective or hazardous equipment that unduly threatens an individual’s safety

• Alteration/modification of equipment may invalidate manufacturer liability

• Important to supervise proper fitting, use and regularly warn participants of dangers associated with misuse of equipment

Confidentiality

• Individuals have a right to privacy

• Release of medical information must be acknowledged in writing by individual (parent if minor) before it’s shared

• Often have generic form in colleges and professional sports allowing exchange of information between ATCs and MDs

• Coaches and parents of non-minors have no right to information unless authorized by individual

Legal Defenses

• Assumption of risk

• Good Samaritan laws

• Comparative negligence

Assumption of Risk

• Some risks are inherently assumed via participation in sport

• Participants should be informed of risks and advised that participation is voluntary

• Participants do not assume the risk that a professional will breach their duty of care

Assumption of Risk

• Typically have participants sign an expressed assumption of risk form which– Acknowledges the material risks and

appreciates that injury and even death can occur

– Acknowledges an opportunity to ask questions and have them answered satisfactorily

– Affirms understanding of risks of participation and voluntary choice to participate assuming all risks of injury or death from participation

Good Samaritan Laws

• Crafted in 1960’s to encourage bystanders to assist others in need of emergency care by granting them immunity from potential litigation

• Immunity typically applied when individual– Acts during an emergency– Acts in good faith to help the victim– Acts without expected compensation– Is not guilty of any malicious misconduct or gross

negligence toward the injured party

Comparative Negligence

• Comparative negligence refers to the relative degree of negligence on the part of the plaintiff and defendant/s

• Damages awarded on basis proportionate to each person’s degree of negligence

Preventing Litigation

• Members of sports medicine team should be aware of their duty of care consistent with current state law and should complete that duty of care within established policies and standards of practice

Preventing Litigation

• Potential steps to reduce risk of litigation– Regular inspection of fields/facilities– Safety checks of equipment/facilities– Hiring qualified personnel– Proper supervision and instruction– Purchasing quality equipment– Maintaining accurate and complete records– Having a well organized emergency plan