The Doctor’s Advocate | Fourth Quarter 2023
An Ounce of Prevention

Medical Malpractice and the Volunteer Team Physician

Michael C. Koester, MD, Slocum Center for Orthopedic and Sports Medicine

Community physicians have long served as team physicians for their local high schools. While collegiate and professional team physicians typically complete a sports medicine fellowship training program (orthopedic surgeons or primary care physicians), no such requirements or expectations exist for most high school team physicians. In fact, depending upon local needs and resources, motivated nurse practitioners and physician assistants may also provide medical coverage to school athletic programs.

At the high school level, a team physician may be asked to provide sideline coverage for events such as varsity football, act as a supervising physician for an athletic trainer (depending on state statutes), assist in developing return-to-play protocols, or perform preparticipation physical examinations (PPEs). While no data are currently available, the number of community physicians filling the high school team physician role appears to be declining.

Concerns about liability risks are a potential barrier to filling the team physician role. Due to limited training in residency or fellowship, many physicians—even fellowship-trained sports medicine specialists—may be unaware of the potential liability risks for team physicians.

Sports Medicine Standard of Care

Litigation against team physicians in professional sports draws a great deal of media attention, but malpractice cases in sports medicine remain relatively rare. Negligence standards in sports medicine do not deviate from those that apply to general medical practice. Issues of patient confidentiality regarding medical conditions and injuries can arise, so team physicians should be aware that federal privacy laws, such as HIPAA and the Family Educational Rights and Privacy Act (FERPA), may be applicable in the scholastic sports setting.

In general, courts will look to the standard of care in determining liability in the care of athletes. In the sports medicine context, consider two important factors: First, the physician has a duty to disclose material information relevant to the risks of play following the diagnosis and treatment of an injury or medical condition. Second, although team physicians are most often orthopedic surgeons, the standard of care for all team physicians is “good medical practice,” defined as applying the skill and care of someone with similar specialty training.¹

Good Samaritan Laws

Good Samaritan statutes may provide volunteer physicians who cover school or other youth amateur athletic organizations with immunity from liability. Other statutes provide immunity to “volunteer health providers” in addition to providing comprehensive legal immunity to youth coaches and officials. A few states have statutes specifically applicable to team physicians performing the PPE and the supervision of athletic trainers. Because immunity from liability varies by state statute, physicians interested in acting as a team physician should discuss the relevant state statutes with their professional liability insurers.

The take-home message for high school team physicians is that almost all of the relevant statutes specifically focus on volunteer team medical providers who work with youth and/or amateur athletics. Physicians who accept remuneration for their services (which may include in-kind advertising) or who work with collegiate and professional athletes should discuss potential liability risks with their malpractice insurers.

Amateur athletes now have the ability to profit from name, image, and likeness (NIL) sponsorships and retain their amateur status. NIL sponsorships may introduce a higher risk of legal action against a team physician based on lost wage claims after injury, but we have yet to see any case law on this issue at either the high school or collegiate level.

It is also important to be familiar with state statutes mandating specific care for a condition or injury. Over the past 15 years, all states have passed legislation regarding evaluation, management, and return-to-play protocols for minors who have a suspected concussion. While not yet widespread, many states have recently looked at mandating specific testing during the PPE to evaluate conditions that may cause sudden cardiac arrest.

Preparticipation Physical Exams

The goal of the PPE, or sports physical, is to identify serious conditions that may prevent safe athletic participation. Conditions that may result in increased risk for sudden cardiac arrest are of particular concern.

Experts agree that the PPE is best conducted by the young athlete’s primary care practitioner in the office setting. Procrastination on the part of parents, lack of a primary care home, or financial constraints, however, often lead athletic directors and/or athletic trainers to arrange for the PPE to be done in a mass screening by the team physician a few weeks prior to the start of the sports season. If the patient requires further evaluation and has a primary care practitioner, the team physician should contact the practitioner to facilitate the evaluation and ensure appropriate follow-up.

The Physician-Patient Relationship

A physician-patient relationship may be established by performing a PPE, diagnosing or treating an injury, or providing medical clearance for return to play after an injury. Depending on the legal venue, a court may hold that conducting a PPE or performing a sideline injury evaluation creates a physician-patient relationship with the same legal duties as that of an established private practice patient. To limit risks, the team physician should consider the following strategies—ideally communicating them in writing:

• Explain to the patient and the parents or legal guardian the nature and scope of the physician-patient relationship.
• Emphasize that the PPE relationship is solely related to the examination for safe athletic participation and does not replace an annual well-child exam.
• Ensure, when possible, that the parent or legal guardian provides consent to evaluate the athlete.
• Emphasize that the sideline evaluation is exclusively related to the specific injury being evaluated. If further follow-up is deemed necessary, inform the parents or legal guardian and at least one team representative (athletic trainer, head coach, or athletic director). This is especially important if you believe that the athlete should not return to participation without further medical evaluation.
• Remain aware that the standard of care in the sports medicine context consists of the physician’s duty to disclose material information relevant to the risks of play following the diagnosis and treatment of an injury or medical condition and that the diagnosis and treatment standard of care for all team physicians is “good medical practice,” regardless of specialty training.

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