Snooze and We ALL Lose

 A couple of questions to consider:

When does your license expire?

Do you have the checks and balances in place to make sure you start the renewal process in plenty of time to stay current and legal?

Think it will never happen to you?

If you think it can't possibly happen to you, just check the Medical Board Examiners monthly disciplinary report and see how often it happens to some of our peers who probably thought the same way. The process is easy, but takes about a month to complete and it's OUR responsibility to make sure all the t's are crossed and all i's dotted in plenty of time to avoid any lapses.

The "our administrative lady forgot" or "the application was lost in the summer mail" excuse won't cut it; the State board doesn't play. All therapy charges are dropped, we can't work and then there's that little thing called a fine. By the way, did you know the fine is up to $1,000.00???

The Medical Board, like us, is fully committed to the safety of all under our care and working on  an expired license is illegal practice. At the end of the day it's not complicated; its just professionals being professional.

Poor Treatment of Athletes at Indiana University

Injured Indiana Athletes Describe Isolation, Poor Treatment by Staff. P. Lavigne, ESPN.com: OTL, April 23, 2017

The above referenced article is in response to allegations made by several student-athletes from Indiana University. This was brought to light by the firing of Indiana University’s head football coach, Kevin Wilson, following a series of issues regarding the treatment of injured athletes.

One such maltreatment allegation included Katlin Beck, a rower on the 2013-2014 Indiana University Crew team.  She went to the medical director of Hoosier Athletics for low back pain. She was prescribed physical therapy, conditioning modifications, and hydrocodone. She was compliant with all medical direction except the hydrocodone, which she refused to take due to the possibility of addiction and symptom masking. Her pain persisted for several weeks with no improvement, so she saw another IU physician, and then a third.  

The third physician informed her that the probable cause of her low back pain was tight hamstrings. By this time, her coach doubted the severity of her injury and “isolated” her from the team along with the other injured athletes. She was denied team gear for not meeting practice goals.

According to the ESPN Outside The Lines article, Hoosier athletes are instructed to see athletic department and school approved physicians and not personal physicians. Ms. Beck, frustrated with 15 months of pain and having seen three IU physicians, sought help from an outside spine specialist. This physician diagnosed her with a significant lumbosacral injury so severe that she was instructed to stop rowing immediately. She was told that scar tissue was the only thing connecting her lumbar spine to her sacrum.

The prevalence of maltreatment of IU athletes was well known throughout the athletic department and with the firing of head football coach Kevin Wilson, an investigation of other incidences began. The result of an investigation of the football program determined the athletes had not received improper care and the coaches had not exerted pressure on the medical staff. It did note, however, “behaviors by the coaching staff that may create an unhealthy environment for players”. With these occurrences brought to the publics attention, many changes have been implemented. One such change is employing physicians through Indiana University and naming a Chief Medical Officer.

The take away from these incidences is that we, as healthcare professionals are the first line of defense and support of the athletes in our care. The presence of overbearing coaches and others, as well as insufficient follow-on care, can make the lives of the athletes difficult and in some cases unhealthy. Our role as advocates should provoke us to action to ensure the recovery, health, and performance of those we care for.

The Robert Back Case

Robert Back Case: Athletic Trainer Testifies She Didn’t Know About Concussion Diagnosis.

S. Larson, Great Falls Tribune, March 19, 2018: https://www.greatfallstribune.com/story/news/crime/2018/03/19/robert-back-case-athletic-trainer-testifies-she-didnt-know-concussion-diagnosis/440251002/

The article referenced above relates the testimony of Jessica Klette, ATC, Athletic Trainer for Benefis Health System and Belt High School in Belt, MT. In September 2014, Robert Back, a 16 year old high school football player, suffered head trauma in a football game. It is claimed he should not have been playing in this football game due to a previous concussion diagnosis. Reports and testimony state that he suffered a concussion prior to that game and through communication breakdowns between the coach, athletic trainer, parents, and physicians, was allowed to participate in the game.

Several issues are brought up in this article.

One: Lack of communication between the Athletic Trainer and treating physician. (The AT states she was not told of the diagnosis and treated the athlete as if he had the flu.)

Two: Lack of communication between the Athletic Trainer and the athlete's parents.

Three: Coach was allowed to oversee a post injury ImPact test.

Four: Lack of apparent responsibility per the athletic trainer's contract to communicate with anyone except the school and coach regarding athlete medical issues.

Many lessons can be learned from this incident. Maintaining open lines of communication with everyone directly involved in the athletes’ wellbeing (coach, parents, and physicians) could prevent or at least reduce mistakes such as these. Contractual obligations should not preclude an AT from communicating. Non-medical professionals should not have access or be allowed to administer diagnostic testing on any athlete. Lastly, we should all remember to be an advocate for the athlete.

Protect Your Patients & Yourself

It's a mean world out there, and as much as we want to always believe that our athletes and patients are so happy WE are caring for them, if their return to play or life doesn't go as they expected it to, we can easily become a victim of legal problems.

Kornblau and Starling, in "Ethics in Rehabilitation", remind us to protect yourselfand list some steps we all should review:

  • Put your licensure law on your desk and read it frequently: It’s easy to think we're always doing the right thing.
  • Report ethical and legal violations to the licensure board: It's not "tattling" - It's protecting the integrity of our profession.
  • Open your eyes: If it doesn't seem right it usually isn't.
  • Follow the 4 "C's": Cover yourself with Contemporaneous, Complete and Comprehensive documentation. If it's not on paper it didn't happen.
  • Keep your athletes interest above all else: Do the right thing.
  • Understand the laws and rules that govern our world: JAHCO, Medicare and HIPPA give us important boundaries. Know them.

And finally, my personal advice: retain professional liability insurance. Your employer will protect you, but only if you do what you are legally allowed by your licensure and state laws. Nobody protects you like you.