Athletic Trainers: MALPRACTICE AMONG ATHELTIC TRAINERS

Analyzing Athletic Trainer Malpractice Incidents

Todd Switzer
Marywood University

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Abstract
This paper explores four articles involving athletic training malpractice, two articles from the
Journal of Athletic Training, two eye witness incidents, and one text book overview. Research
was collected online as well as from textbook materials to compile a large sum of data and
research. The articles differ in research, but focus on the overall topic, which is malpractice
among athletic trainers and the consequences that follow. Overall, through my research I have
found that concussions are the toughest for trainers to diagnose and the consequences can lead to
death if the proper precautions and steps are not taken when evaluating an injured athlete.

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Analyzing Athletic Trainer Malpractice Incidents

Numerous studies and incidents have occurred around the world involving the neglect
and mistakes involving athletic trainers while performing care to their athletes. I once was a
student athlete myself, and I put my trust and health in the hands of athletic trainers during
practices and games. Their decisions may affect the outcome of an athletes short term, as well as
long term, health.
According to an article in 2013 written by Barry Petchesky, a High Schools Athletic
Director (AD) accused another teams trainer of misdiagnosing their star player with a
concussion. The incident occurred at a High School girls basketball game in Boston,
Massachusetts. New Mission High Schools star player, DeAndra Humphries, was injured in the
final quarter of the game when she took a hit to her eye. Since she was a part of the visiting team
her trainers were not present, therefore the opposing teams trainer evaluated her. Despite passing
all the concussion tests, the trainers deemed her unfit to return to the game. Her team would
eventually give up the lead and lose the game. I started crying when they told me I had a
concussion because I knew I didnt have one (Petchesky, 2013).
Humphries went to the hospital shortly after the game where she received a series of tests
and eventually the doctors concluded she did not have a concussion. Cory McCarthy, New
Missions AD, was at the game that night. She was very coherent. She was jumping up and down
cheering on her teammates. I know what a kid with a concussion looks like and that wasnt it
(Petchesky, 2013). He has filed several formal complaints to the league, claiming that her injury

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lead to the loss of their playoff game that night. Spokesman from the league dismissed
McCarthys complaints and released a statement saying, An independent and qualified medical
athletic trainer made a decision to remove a player who had no response to standard cognitive
concussion questions (Petchesky, 2013).
An article out of the Journal of Athletic Training titled Management of sport related
concussion, discussed one of the biggest misdiagnosed injuries of all, the concussion.
According to Guskiewicz, Bruce, Cantu, Ferrara, Kelly, McCrea, Putukian, and McLeod, sports
are now more important than ever before. With the growth of sports comes the responsibility to
minimize the risk of injury and the increased pressure put on trainers, as well as physicians, to
keep athletes healthy. Research based recommendations made for football between 1976 and
1980 resulted in significant reduction in the incidence of fatalities and nonfatal catastrophic
injuries, and in 1968 thirty six brain and cervical spine fatalities occurred in high school and
collegiate football (Guskiewicz, 2004). The authors go on to say that by 1990 that number has
dropped to zero and has averaged about 5 fatalities per year since 1990.
This reduction in fatalities has been made possible simply by rule changes, player
education, higher equipment standards, and alternative assessment. Lowering contact during
practice, higher awareness of the risks of returning an athlete to competition too early, and the
athletes awareness of the risks associated with concussions are also reasons why fatalities are
decreasing. According to the article athletic trainers care for about 7 concussions per year, which

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has changed the way they manage concussions. New standards have been put in place for
athletes who show even the slightest concussion, like symptoms after a contact to the head, and
will be treated as if they have a mild concussion.
There are many procedures that should be followed by athletic trainers when accessing an
injury, and if they are not followed the consequences could be severe. ATCs (Certified Athletic
Trainers) should recognize both the obvious signs of a concussion which include: fluctuating
consciousness, balance issues, memory and concentration difficulties, and also the more common
side effects such as headache, nausea, and ringing in the ears (Guskiewicz, 2004). Failure to
recognize these symptoms may have serious results on both the athlete, as well as the trainers
future.
In a 2012 article written by Levin &Perconti a former High School athlete was suing an
athletic trainer for $4.4 million due to a head injury. Under Illinois law, when someone accepts a
job in which they are responsible for providing a service to another person, and they fail to
uphold that care and an injury occurs, it is enough to hold that person liable in an Illinois
personal injury lawsuit (Levin &Perconti, 2012). This is exactly what happened in 2012 when a
public school agreed to pay $4.4 million in a settlement to a former high school athlete who
suffered a head injury playing high school football. The injury was so severe that now he must
communicate through a keyboard.
The boy sustained a concussion in an earlier game and the trainers allowed him to
participate in the next game where his permanent injury occurred. The young man was a High
School senior linebacker and took a hit to the head which caused his concussion, but the head
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coach ignored the signs and symptoms of the concussion (Levin &Perconti, 2012). According to
the transcripts from the case, the assistant athletic trainer documented that the signs and
symptoms of the concussion were ignored. A week before the injury the young man complained
to the trainers about severe headaches, which allowed him to miss several practices leading up to
the next game. Just minutes before the game he asked the head coach if he could miss the first
quarter because he was having a severe headache, but the head coach made him play. Just
minutes after the first quarter ended, he collapsed on the sideline.
He was taken to a nearby hospital where doctors had to remove part of his skull because
of excessive pressure due to internal bleeding. The internal bleeding inside his brain caused
irreversible brain damage. This is just one example of a growing trend among football players all
across the United States. According to a study in 2012 more than 20 concussion-related lawsuits
brought against the NFL by former players were consolidated in a federal court (Levin
&Perconti, 2012). In this particular case it was the athletic trainers responsibility to examine the
athlete and decide whether or not he was fit to play. By ignoring the students signs and
symptoms, they violated their duty of care to the athlete. When an individual is personally and
legally responsible for someone elses health and an injury occurs, it may be enough for a lawsuit
to be filed, in which the individual responsible may be forced to pay compensation for the
injured party (Levin &Perconti, 2012). Today the former athlete is confined to a wheel chair and
he cannot stand nor speak, simply because the trainers failed to provide appropriate care.

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In a 2001 journal article from the Journal of Athletic Training Barbara Osborne
emphasizes that athletic trainers may protect themselves from liability by including pre testing
and examinations. This involves using objective tests rather than subjective judgment to evaluate
athletes who show concussion-like symptoms. Working closely with physicians and keeping upto-date records is key to limiting your risk of being charged with a lawsuit. As an athletic trainer
you must document and log every interaction and every symptom an athlete shows, and if this is
not done the consequences can be either severe injury or death. According to the article more
than 300,000 sport-related, traumatic brain or head injuries occur every year in the United States
(Osborne, 2001). An abundance of concussions have been reported in basketball, football, soccer,
boxing, baseball, rugby, and ice hockey (Osborne, 2001). Repeated concussions can lead to
permanent brain damage or even death. On the other hand, trainers can have lawsuits filed
against them for not letting a player play as well. When a player has been suspended from play
indefinitely, there have been instances where the player has sued the health professional for not
allowing them to return to play (Osborne, 2001).
More cases dealing with negligence or medical malpractice involve a physician and an
athlete; the medical condition generating the most media attention involves death as a result of a
cardiac condition (Osborne, 2001). According to Barbara Osborne, she states that In law, a tort
is a private wrong or injury suffered by and individual as the result of another individuals
conduct (Osborne, 2001). This law provides injured individuals the right to be compensated
until the recovery of damages is complete. This entitles the injured athlete to be compensated for
all the damage caused and in some cases more. Negligence law was founded on the principle
that those who are harmed as the result of others carelessness or failure to carry out
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responsibilities properly must be compensated (Osborne, 2001). In order for negligence to be

called and a lawsuit to be filed you must have four things. Number one you must prove that there
is a duty of care owed as of a certain relationship between the two parties. Next you must prove
that the defendant breached the duty owed to the injured party. Next there must be proof that the
breach of the duty was the cause of harm to the plaintiff. Fourth, there must be actual harm to the
plaintiff, not just potential for harm to have occurred. All four must be proven in order to the
plaintiff to be compensated, if not all four are proven the plaintiff will not be compensated and
no negligence would have occurred.
Barbara Osbornealso goes on to say, The athletic trainers responsibility, like that of the
team physician, is to protect the health and safety of the athletes (Osborne, 2001).There are
several legal duties as a result of the trainer-athlete relationship. They include: the duty to
properly assess the athletes condition, duty to provide or obtain proper medical treatment, duty
to provide clearance to participate, and the duty to inform the athlete of the risks of athletic
participation given the particular medical condition (Osborne, 2001). Each one of these is an
obligation that must be followed in order to help prevent a lawsuit from being filed.
In a similar lawsuit listed in this same article a hearing took place between Pinson and the
state. An athletic trainer argued that his failure to report Pinsons headaches and other underlying
symptoms to the teams physician was not the cause of Pinsons overall injury. The court
determined that the failure to report the information provided was a factor in bringing about the
permanent damage which was caused to Pinsons brain (Osborne, 2001). The athletic trainer
failed to diagnose his first injury, provided no care to Pinson, and also never reported any of the
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symptoms. If the athletic trainer had reported his headaches and other symptoms to a physician,
more tests would have been conducted and this could have been avoided. The court concluded
that if the trainer actually performed his duty, Pinson would likely have had little or no
permanent damage. Many elements of negligence were described throughout this article, but the
fourth element is damage. The athlete must prove that actual damage exists for there to be a case.
The injured party typically seeks damages in several areas, which include: pain and suffering,
medical expenses, and diminution of earning capacity all within the past, present and future
(Osborne, 2001). During this case Pinson was awarded $1.5 million dollars in damages,
including $450,000 from the athletic trainer (Osborne, 2001).
In a 2012 article written about professional liability insurance, the unknown author states
that due to the high risk of brain injuries each year (over 300,000) it is important for trainers to
purchase professional liability insurance to protect their financial standing if a lawsuit may occur
(Unknown, 2012). There are two separate forms of negligence listed in this article: mission and
commission. Omission lawsuits are a result of an athletic trainer failing to act in a particular
situation (Unknown, 2012). Commission lawsuits are the types of lawsuits that result from an
athletic trainer acting in an improper manner, which may include a situation such as an athlete
being sent back into a game even though he/she already has a concussion. In order for a plaintiff
to win a negligence case the incident must meet four criteria which include: duty to act, breach of
duty, causation and damage (Unknown, 2012).
In an article written by Steven Goff, in 2012, a D.C. United soccer player filed a $12
million dollar lawsuit against the team for claiming medical negligence involving a career ending
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concussion suffered in a 2009 match. Bryan Namoff who is a long time D.C. United defender
filled a lawsuit because he claimed they failed to properly evaluate his injury and cleared him to
play too soon. The defender was injured in a game at RFK Stadium on Sept 9, 2009 and he stated
they were negligent in their management, care, and treatment (Goff, 2012). After sustaining an
injury he played three days later, which was the final appearance of his nine year career. Now at
age 33, Bryan suffers from brain damage and cognitive, memory and sensory loss. Permanent
headaches and fatigue, as well as sleep problems and sensitivity to motion are also symptoms
Bryan is suffering from. Bryan and his wife are seeking $10 million for medical negligence and
$2 million for the impact this has had on their marriage (Goff, 2012). Due to this injury Bryan
has been unable to work for the past two years and is accumulating medical expenses. He will
also be adding the teams athletic trainer, team physician, and commonwealth Orthopedics to the
lawsuit as well (Goff, 2012).
According to this Goff more than 3,000 NFL players have filed lawsuits against the
league, claiming they have concealed the long-term effects of head trauma for decades (Goff,
2012). In 2000, Merril Hoge received $1.55 million dollars in a lawsuit against a former Chicago
Bears team physician. He claimed that the mistreatment of a concussion lead to more serious
injury. In 2012, Clay Rush who is a former Arena Football League player reached a settlement
with a Denver hospital chain over a lawsuit that a physician had cleared him to play despite
having two concussions in 15 days (Goff, 2012). Several Major League Soccer (MLS) players
have retired permanently because of concussions, including Alecko Eskandarian, Josh Gros, and
Devon McTavish who all were former teammates of Bryans.
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In the game in which Bryan was injured he extended himself to head the ball when an
opponent ran into him with his shoulder, colliding with Namoffs head to create a whiplash
motion. He was treated, but remained in the match. After the game he experienced vision
problems and a headache and requested treatment. Proper treatment was not given according to
the lawsuit and he was cleared to play without any restrictions. In the next three days Bryan had
a break between games, but he was not assessed, examined, or evaluated by the teams trainer or
physician and was cleared to play in the teams next match against Seattle (Goff, 2012). During
the match he was in severe pain and experienced dizziness. He told the medical staff something
was wrong and they replied with, We will monitor you (Goff, 2012).
Over the next several months Namoff experienced severe migraines, nausea, and
dizziness which are all signs of a concussion. Bryan had discovered that the whiplash from the
match had caused upper cervical trauma, affecting the joints and ligament in his vertebrae.
Namoff tried to make a comeback, but in 2010 he suspended his career and took a job as the
front office special projects manager for D.C. United. The headaches continued and he
eventually left the club completely. He then served as a public speaker educating children about
the importance of recognizing concussion symptoms at the early stage. Shortly after completing
his speeches, he must step out due to sensitivity of fluorescent lights, which is a common
symptom of concussions. Bryan told a reporter, Every minute of every day, I have a headache.
Its the invisible nightmare (Goff, 2012).
According to the textbook The Well Managed HealthCare Organization, written by
White & Griffith, Achieving excellent care results from correct application of protocols and
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interdisciplinary plans of care (IPOCs) combined with ongoing performance measurement,

continuous improvement, and rewards (White & Griffith, 2010). In order to achieve excellent
care one must follow the correct guidelines and rules, combined with provided care to and
individual. If one does not follow these laws, lawsuits may arise similar to the ones discussed
throughout this paper.
During my lifetime I have been around athletic trainers for years. In my experience, most
provide excellent care and are absolutely terrific. Occasionally signs of negligence are seen and
malpractice occurs. One example I have, comes from my time spent in Missouri at a small NAIA
college. A sophomore womens soccer player came into the athletic training room complaining of
a sore hamstring. After several tests the trainers told her it was only a strained muscle and she
could return to practice. After several days of playing in practice, as well as several games, the
pain had not gone away and the hamstring began to bruise (Soccer Player X, 2012). The trainers
informed her that it was just a sprain and no further damage would occur. Fed up with the pain,
she went to the hospital to have tests done on her leg. The results came back and she had a torn
hamstring and the bruising was in fact blood from the tear running down into the back of her
knee. The doctors informed her that if she had simply rested for a few weeks the tear would have
never happened. Due to the mistake of the trainer, she needed surgery to fix the hamstring and
was unable to play for the remainder of the season.
The examples I have provided throughout this paper are only a small fraction of the
negligence and malpractice that occur in the sports industry today. It is seen from the high school
level all the way up to the professional level. Being educated and knowing the early signs and
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symptoms of injuries may help prevent players from becoming another statistic in a long line of
court cases and lawsuits across the United States.

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References
Goff, Steven. (2012). Bryan Namoff files $12 million lawsuit against D.C. United, claiming
Medical negligence involving career ending concussion in 2009 match.Link to article
Guskiewicz, Kevin M., Bruce, Scott L., (2004). National Athletic Trainers Association
Position Statement: Management of sport related concussion. Link to article
Levin &Perconti. (2012). Former High School Athlete wins $4.4 Million Settlement
Against Negligent Athletic Trainers, Link to Article
Osborne, Barbara. (2001). Principles of Liability for Athletic Trainers: Managing Sport Related
Concussion, Link to Article
Petchesky, Barry. (2013). High School AD Accuses Opposing Trainer of Misdiagnosing
ConcussionTo Remove Star Player From Game, Link for article
Soccer player X. (2012). My first hand witnesses to athletic training miss diagnosis
Unknown Author. (2012). Professional Liability Insurance News & Information Link to Article
White, Kenneth R., John R. Griffith, (2010) The Well-Managed Healthcare Organization,
Health Administration Press a division of the Foundation of the American College of
Healthcare Executives, Chicago Illinois