[Michael Owen, knocked unconscious in a World Cup warm-up game, pleaded not to be taken off.] Owen later admitted, “I might have told them I was OK, but I didn’t feel OK.” … The last person to heed in the heat of a contest is the performer. Adrenaline overrules common sense.
Rob Hughes, Chief Sports Correspondent, The Times
Legal and regulatory issues specific to the practice of sports medicine are not especially new. They have been considered by commentators for the past 30 to 40 years at least.1–4 Examination of liability for physical harm to athletes caused by deficient medical care, in particular the management of injuries, occurred increasingly within the context of general works on sports medicine.5, 6
Where the attending clinician was engaged by a club or other sports organisation to treat athletes, the potential for a misplaced sense of obligation was recognised early on, as well as the question of whether the club or other organisation should incur liability in addition to the clinician.7, 8 Later, the expansion of anti-doping regimes and of human rights law brought substantial changes to the legal and regulatory environment in which sports medicine is practised.9–11
This chapter introduces readers to today’s complex sports medico-legal environment and provides explanations of key concepts and issues. It is important that clinicians maintain a relevant understanding of the field and are active in shaping the laws and regulations specific to sports medicine, with the aims of making that environment sensitive to the needs of clinicians and of achieving higher standards of care and more rewarding careers.
Every clinician pursues his or her career within a legal and regulatory framework. Qualifying for practice; the ongoing obligation to be licensed; controls over the prescription, dispensing and administration of pharmaceuticals; and the necessity to comply with professional and ethical standards or risk disciplinary measures; are some of the legal and regulatory controls encountered by all clinicians.
Conducting business will also involve legal issues pertaining to partnerships, employees, insurance, owning or leasing consulting rooms and taxation. Much of what is required of clinicians in those respects may be routine or, in the case of business matters, delegated to practice managers. This chapter does not explore that legal and regulatory framework, although reference is made to it occasionally.
This chapter focuses on the legal and regulatory issues that are specific to sports medicine. These include:
the standard of health care expected of sports clinicians
the difficulties arising from the tripartite relationship of athlete, clinician and sports organisation
the relationship between medical research, game rule change and legal liability, with special reference to neck injuries and concussion
drugs and anti-doping
the emergence of human rights law, with attention to single-sex sports and the sex status of athletes, pregnant athletes and athletes ...