By Austin Spears
Over a three-week span in August of this year at least six teenage football players died, with the oldest being only 16-years-old. Four of these athletes died from heat-related causes, while the other two deaths resulted from head trauma. Any death in teenage sports is unacceptable, but six within a month causes significant questions about the safety of these sports and the potential need for increased athletic trainer (AT) presence at these events.
So, what are athletic trainers, and what is their role in protecting young athletes? According to the National Athletic Trainers Association (NATA), ATs are “highly qualified, multi-skilled health care professionals who collaborate with physicians to provide preventative services, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions. Athletic trainers work under the direction of a physician as prescribed by state licensure statutes, and it takes four years for them to earn their degree.”
NATA recently hosted its annual Back-To-School Sports Safety Virtual Media briefing, where many alleged flaws in how ATs are treated were identified throughout this meeting. The main discrepancies included pay, work-life balance, job enjoyment, and company involvement. The average annual athletic trainer’s pay in Texas is $55K a year, and in many states, that figure is even lower. Yet, ATs work long and inconsistent hours and are often afterthoughts to coaches and administrators who want them to be available constantly. An opinion voiced multiple times at the conference was that athletic trainers must be consistently treated better, or they will continue to leave school jobs for private jobs that pay better and have better hours. A figure brought up in the meeting was that roughly 30% of secondary school ATs leave their job or the profession entirely due to the conditions of their employment.
Another major issue surrounding ATs was the amount of jobs being offered by schools. There is rarely federal funding for ATs. Some states, like Mississippi and Alabama, supply state funding for ATs, while others supply none, leaving resources for ATs very limited. In these cases, schools have to rely on local levy funding to pay for their ATs, but these funds pay for multiple positions and are rarely sufficient. This lack of funding has led to only 60-65% of Alabama high schools having athletic trainers. This number is highly concerning as it means that potentially 40% of the time these athletes perform without medical supervision.
Professor Opines on Liability Issues for School Districts that Don’t Employ ATs
Another set of questions regarding the lack of ATs in schools is what the legal liabilities for the schools and districts are when something happens to one of their kids in a sporting environment. We recently contacted Dr. Rachel Silverman, who holds a PhD in Sport Management from Troy University and is currently an assistant professor at the University of Nebraska Kearney, and she answered some of these questions regarding liability.
Question: What is the legal liability surrounding schools that don’t have an athletic trainer present at practices/games and something happens to a player?
Dr. Rachel Silverman: “The laws vary from state to state. In April 2021, a jury found South Carolina School District liable for two counts of gross negligence: 1. Letting a player play football without an athletic trainer present and 2. Failing to evaluate the player for concussion symptoms. After post-trial motions filed by the defendants, the school district owed $625,000 in damages.” She continued with “On August 13, 2019, Imani Bell, a 16 year-old student at Elite Scholars Academy in Jonesboro, GA died after collapsing during running drills during an outdoor basketball practice in 100-degree weather (Silverman, 2023). There was no athletic trainer present. The head basketball coach, athletic director, principal, and assistant principals were sued for failing to pay attention to the heat index, monitor students for signs of overheating, and provide rest periods and water breaks. The case became a criminal case in July 2021, when a grand jury in Clayton County indicted the head coach and assistant coach on charges of 2nd degree murder, cruelty to children, involuntary manslaughter, and reckless conduct. In the civil lawsuit, the parents and school district reached a $10 million settlement. The criminal case is still ongoing as far as I know.”
Question: Does just having an athletic trainer present remove liability from the school/district or are there still scenarios in which they can be liable?
Dr. Rachel Silverman: “Not having an athletic trainer present does not remove liability from the school/district. There are still scenarios in which they can be liable. Even if there is an athletic trainer present, if they do not follow or do not have an emergency action plan, the school can still be liable. If the athletic trainer does not operate within their scope of practice, which is dictated by the state… For example, in March 2016 in Montana, a plaintiff initially sought $20 million from the school district, athletic director, football coaches, and athletic trainer at a hospital for allegedly disregarding the state’s concussion law by returning a 16-year old back to play after a concussion. The player then suffered a second head injury that caused him to be a quadriplegic (Back v Belt School District, 2016). The judge dropped the trainer and coach from the civil lawsuit and the school district’s insurance company settled for $750,000… Another example – Athletic staff at the University of Maryland did not follow their emergency action plan and made mistakes that led to the death of a 19 year old football player. Walters Inc was hired by the university to do a full investigative report and released a 74 page report stating that athletics staffers did not identify the athletes heat-related illness at practice. They did not give the athlete a cold-immersion bath, which is the ideal form of treatment. The failure to diagnose and properly treat led to the athlete’s death. There was also confusion when the emergency responders arrived because they did not know where to go when they arrived on campus. There was no one designated to help them. The family of the athlete has filed a letter with the state indicating their intent to sue and will be seeking damages totaling $30 million.”
Question: What else can schools do to protect themselves from liability in a student injury/death case?
Dr. Rachel Silverman: “Schools need a risk management plan to identify risks, evaluate options to reduce risks, and implement risk reduction policies and procedures. An emergency action plan needs to be sport, site, and condition specific and rehearsed at a minimum of annually with all personnel involved. There may be some state statutes that dictate the actions necessary (ie concussion laws). The individual high school activities association may also have standards that need to be followed. If an injury or death occurs, everything needs to be well-documented, including waivers, injury reports, and every step taken by the school and personnel. The National Athletic Trainers’ Association has online training on legal liability for athletic trainers. There is a standard of care established by an Inter-Association Consensus Statement on best practices for sports medicine management for secondary schools and colleges.”
Athletic trainers are one of the most vital jobs in schools, and they are the primary safety net for young student-athletes. They are arguably underpaid and understaffed, leading to a lack of athletic trainers where they’re needed. Not only does a lack of athletic trainers typically lead to less safe environments for students, but it also can lead to liability for the school and school districts.
Austin Spears is a rising junior Sport Management major at UT Austin. He is currently an analytics intern with the Texas Longhorns baseball team and plans to pursue a career in sports law.
