By Rachel Goodman and Kim Sachs
In the wake of the deaths of Garden City Community College defensive lineman Braeden Bradford and University of Maryland offensive lineman Jordan McNair, universities are beginning to make changes to the reporting structures in their athletics programs. For years, the majority of Division I sports medicine employees reported to university athletics administrators. Now, in the face of increased scrutiny and litigation, more and more universities are realigning the chain of command and requiring employees to report directly to medical professionals.
In May 2019, for example, the University of Kansas (“KU”) moved approximately 40 athletic trainers, strength and conditioning coaches, sports nutritionists, and athletics social workers from its athletics department to the University of Kansas Health System. A few weeks later, the University of Maryland (“UMD”) announced that it, too, would transition team physicians, athletic trainers, sports nutritionists, and student-athlete mental health practitioners from its athletics department to the University Health Center. The current Athletics Health Care Best Practices Statement issued by the National Collegiate Athletics Association’s (“NCAA”) acknowledges that “[m]ultiple models exist for collegiate sports medicine. Primary athletics healthcare providers may report to the athletics department, student health services, the institution’s medical school, a private medical practice or a combination thereof.”[1] New NCAA recommendations advising that strength coaches should not report directly to athletic coaching staff will take effect on August 1, 2019.
The Medical Model
In recent years, there has been an increased concern that coaches pressure sports medicine employees into making decisions that are adverse to student-athletes’ health. According to the results of a National Athletic Trainers’ Association (“NATA”) survey released on June 25, 2019, nineteen percent of athletic trainers claimed that college coaches have played an athlete who was deemed “medically out of participation.” Thirty-six percent believed that coaches’ influence over hiring and firing decisions equipped them with too much power over medical staff operations. Fifty-eight percent of that group felt pressured by an administrator or coach to make a decision that was “not in the best interest of a student-athlete’s health.”
The general reporting structure adopted by KU and UMD, which is known as the “medical model,” is designed, in part, to eliminate that pressure. According to Murphy Grant, Chairman of NATA’s Intercollegiate Council for Sports Medicine and the Associate Director of Sports Medicine at KU, however, the medical model’s benefits extend beyond its ability to reduce potential conflicts of interest. Grant asserts that in a much broader sense, the model ensures that medical staff is practicing sound medicine. For example, Grant explains that the restructuring has expanded sports medicine employees’ network, thereby “opening up a wider spectrum of care for the student-athlete.” Before KU made the switch, its athletics staff did have access to hospital facilities and personnel, but this model creates a “more efficient” way to capitalize on hospital resources.
While the changes at KU and UMD have recently garnered significant press and praise, the “medical model” is not particularly new. According to Scott Anderson, Head Athletic Trainer for the University of Oklahoma’s football team, this general reporting structure has been in existence at some universities for almost fifty years. Anderson pointed to the University of North Carolina, which implemented a similar model following the death of a football player in 1971. What we are seeing now, Anderson explained, is not a new idea, but a “renewed focus” on medical staff independence likely triggered by the pressure to respond to high-profile student-athlete fatalities.
Anderson endorses the medical model. However, he rejects the notion that the inherent “tension between an athlete’s performance and medical care” creates an unresolvable conflict among coaches, administrators, medical staff, and student-athletes. According to Anderson, a key to any team’s success is recognizing that “the best interests of the athlete are also the best interests of the entire program.” Whether switching to the medical model reporting structure will lead programs to that recognition still remains to be seen.
Effect on Future Litigation
The effect of the medical model on future litigation implicating student-athletes’ health is similarly unclear. These changes may present novel questions about agency, duty, and theories of liability. Parties’ interests and allegiances that traditionally aligned may begin to shift.
Despite this uncertainty, however, in a lawsuit alleging negligent care of a student-athlete, defendant parties are likely to benefit from an institutionalized medical model. Evidence that all sports medicine employees reported to a medical center—not the head coach or university administration—can ease jury concerns about the conflict between a coach’s desire to play an athlete and any health problems the athlete may have been suffering. Evidence that sports medicine employees were hired, fired, and paid by medical center staff is likely to be especially compelling in this regard. Demonstrating the ways in which sports medicine employees partner with physicians and utilize medical center resources will likely be similarly convincing. Proof that sports medicine employees were trained and given access to continuing medical education may also be persuasive. Medical reports and documented communications between sports medicine employees and their supervising physicians can help establish event timelines, individual actors’ knowledge, and compliance with applicable standard of care.
Given these potential benefits and the medical model’s increased popularity, all universities should evaluate their own reporting structures and consider the following:
Which employees administer care to student-athletes?
Who pays those employees?
Who hires those employees?
Who fires those employees?
How are those employees trained?
Where do those employees report?
To whom do those employees report?
What are those employees expected to report?
How is that reporting handled?
What are those employees expected to document?
Which employees have the final say about student-athletes’ care?
These questions become especially important in an era of increased media attention, scientific study, and litigation about alleged failures to properly care for student-athletes. While today, the KU may be praised for its forward-thinking and cutting-edge approach, there are ample reasons to believe that KU’s model will soon be all but standard across institutions of higher learning. As such, it may be in universities’ best interests to restructure before the national conversation changes from one among administrators about whether to implement a medical model to one between jurors about why the defendant did not.
Kim Sachs is an associate in Montgomery McCracken’s Litigation Department and a member of the firm’s catastrophic sports injury defense team. Kim has represented clients in a traumatic brain injury case. Rachel Goodman is a summer associate with Montgomery McCracken. Rachel recently completed her second year as a law student at Temple University Beasley School of Law. She graduated magna cum laude from the University of Pennsylvania in May 2015 with a B.A. in History.
[1] http://www.ncaa.org/sport-science-institute/athletics-health-care-administration-best-practices-0
