10 April 2012

Malpractice and sporting events

This came across my twitter stream; I forget the source:

From Outside Online, an article about how physicians are increasingly hesitant to provide volunteer medical coverage at athletic events:

Last year, 13 Americans died during running races, and another eight while competing in triathlons. While those numbers might seem troubling, the deaths are attributable mostly to the booming popularity of endurance sports—13 million Americans enter running races each year, and 2.3 million compete in triathlons. But the rising participation and the proportional death toll—especially in cases like Hass’s—highlight the need for quality medical care at these events. And usually that care comes from volunteer doctors. 
At least it used to. More and more doctors are refusing to donate their services, and it’s for one frustrating reason: they can’t get medical-malpractice insurance. Most doctors’ insurers typically won’t issue one-day policy riders for sporting events, and race organizers haven’t stepped up to offer alternative coverage. After the 2008 Ironman World Championships, volunteer medical director Franklin Marcus famously resigned because race organizers had refused to offer coverage
I've run into this myself, and it can be a really tricky issue. The problem is that this is a place where Good Samaritan laws and "duty" overlap in a way that's murky at best and damaging at worst.

For those not familiar with this aspect of malpractice law, here's a ten-second primer. In order to be liable for malpractice, three things need to be present:
1. A duty to treat
2. A breach of that duty (commonly thought of as "standard of care")
3. A harm resulting from that breach

So when a patient rolls into the ER, as the ER doc who has agreed to be present for emergency cases (or as a surgeon who has agreed to be on call, etc) the duty is implicit. Also, of course, when there is a pre-existing doctor-patient relationship that duty is satisfied. But what of the "man on the street" situations? If I am walking down a street and see someone keel over, I'm under no obligation to render assistance (in most jurisdictions). I have no duty to treat. In theory, that means that I could render aid without any risk of being sued, and in order to encourage physicians to render aid in such situations all 50 states have passed so-called "Good Samaritan laws." They vary from place to place, but they generally immunize a doctor from malpractice barring recklessness or willful and wanton negligence should they render emergency assistance.

The problem is that this usually only applies when you have no duty to treat. So if I am at a (not at all hypothetically) karate tournament with my dojo and I see a contestant injured, I can provide first aid without fear of malpractice. But if I am asked in advance to be the "tournament doctor" then it becomes a murkier issue, because then I am acting as an agent of the event and its organizers and as such might meet the definition of "duty to treat." This raises a whole secondary set of concerns — are the facilities and supplies adequate to treat injured contestants, can I pull an athlete who wants to continue, etc. Some locations extend Good Samaritan protections to doctors who act as volunteers without expectation of compensation. Others do not. Most organized athletic events have some sort of liability insurance, but that would probably not cover a physician's professional liability, and smaller events (say, a recreational kids' soccer league or a local karate federation) don't have the resources to get their own med-mal policies.

So this puts the doc in an uncomfortable situation. We want to support the local organizations, whatever they may be, but you have some tough choices to make. You can go "naked," without insurance, which is not unreasonable in most cases since the actual risk of injury, let alone getting sued is very low in most activities. But for some sports, the risks are higher, and many doctors are too afraid of getting sued to run that sort of risk. So then you are left begging your insurer for a rider allowing you to do this or begging your skeptical partners to make this an underwritten part of the group's policy. The cost for this sort of coverage is trivial, and in fact some insurers will give it for free, but some insurers and some groups won't allow it at all. It varies a lot by specialty. Ortho docs, in my experience, tend to be much more invested in local athletics (if nothing else, it's good business!) so they are more comfortable viewing this as a necessary and reasonable business expense. Pediatricians, too, since there are so many kids' sports leagues and the serious injury rate is so low. Your mileage may vary.

It was nice to see in the linked article that malpractice coverage is becoming more available (and at a very affordable price of $60 per doc). Hopefully that will become the standard for event liability insurance in the future.

7 comments:

Nurse K said...

I'm the tournament first aid chick at our karate tournaments. Great.

A view from down under said...

Im an ER doc, a scout master, and a dad.

My question, "why would I even want the 60$ insurance?"

The good samaritan laws protect me as long as I get no compensation. this means no T shirt, entree fee, meal, nothing! I don't want to be listed as the doc of the event. If asked, or if needed, I will be very willing to help.

If something goes wrong and a lawyer is enlisted is he/she going to be more eager to sue doctor "a" who has a 60$ event malpractice insurance or doctor "b" who willingly donated his service under the good samaritan clause?

Hint - Doctor "A" can be sued for performing at less than "standard of care" (whatever that is) but Doctor "B" can be sued only for "gross negligence".

Stay away from these jobs and stay away from cheep insurance. The jobs are risky and the insurance makes them much more risky.

Kiwi doc

ER Jedi said...

Why do we even need doctors at these events in the first place? If the injury is serious enough to actually require a doctor, what doctor is going to be able to do much about it with nothing more than his bare hands on scene? (Anyone can do CPR) Would not everyone benefit in having a EMS crew on hand instead, who can start actual ACLS treatments if needed and get the patient to advanced care in a hurry?

Anonymous said...

A doctor is able to tell people if they need emergent treatment, or any treatment at all.

Eg, Competitor hurts his ankle. Apply Ottawa ankle rules to determine if he needs to go to the ER or just needs some ice

Ben Rush MD said...

The time for America's adult conversation about liability & litigation in general is long overdue.

Lift chair recliners said...

The reason why do we even need doctors at these events within the 1st spot? If the injury is serious enough to really require a doctor, just what doctor is going to be enabled to do much about it alongside nothing more than his bare hands in scene? (Anyone can do CPR) Will never everyone benefit in having a EMS team in hand instead, who is able to begin actual ACLS treatments if required and get the individual to advanced care and attention in a hurry?

jwg said...

Where are you? Is everything OK?