MOBILITY OF RACE PHYSICIANS IN MOTORSPORTS INCLUDING THE
MOBILITY OF RACE PHYSICIANS IN MOTORSPORTS INCLUDING THE INDYCAR EXPERIENCE Andrew Stevens, M. D. , Medical Director, Road to Indy Series David Mattingly, J. D. , Partner, Ice Miller Legal Council ICMS ANNUAL CONGRESS 2014 12. 10. 2014 1430 -1500
Disclosure • There are no relevant financial relationships to disclose • Topics discussed in this lecture are components of the emergency medicine core curriculum as defined in the 2007 Model of the Clinical Practice of Emergency Medicine (American Board of Emergency Medicine (ABEM) website) • The content of this lecture was developed following an extensive literature search and is the most up to date, evidence-based information available
Objectives • Brief History Team Physician • Review of Literature – Survey State Medical Boards • Indycar Specific Example • Recent Headlines • The Legal Perspective
History • Herodicus, a Thracian physician of the fifth century BC, – foundational theories on the use of therapeutic exercise for the maintenance of health and the treatment of disease. • In 1890 at Harvard University in Cambridge, Massachusetts – apparent that unattended, uncoached, and academically unsupervised team sports activities frequently produced significantly large numbers of musculoskeletal injuries
History • E. A. Darling The effects of training. A study of the Harvard University crews Boston Medical and Surgical Journal, 141 (9) (1899), p. 205 • Also, Dr. Darling emphasized the need for medical supervision of the athletes
History • E. H. Nichols, F. L. Richardson Football injuries of the Harvard squad for three years under the revised rules Boston Medical and Surgical Journal, 160 (2) (1909), p. 33 • Mandatory to report all injuries, and to wear head gear, shoulder, and thigh pads, and “braced” shoes
History • 1905 20 football deaths • President T. Roosevelt • NCAA by 1910
History • The Germans were the first to use the term “sports physicians” in 1904, and they held a sports physicians congress in 1912 • St. Moritz, Switzerland in 1920, German leadership led to discussions with Olympic dignitaries that ultimately produced the formation of an international sports medicine organization, Association International Medico-Sportive (AIMS)
History • (Federation Internationale de Medico. Sportive et Cientifique) 1936 Berlin 1500 Physicians from 40 Countries • Little American Involvement • WWII
History • J. C. Hughston The role of the team physician C. L. Baker Jr. (Ed. ), The Hughston Clinic sports medicine book, Willliams & Wilkins, Philadelphia (1995), pp. vii–ix 3– 4 • 1950’s Georgia to Alabama
History • 1954 American College of Sports Medicine – 40 year flurry of academic sharing regarding disease (Ortho and PCP) • 1993 Certification Of Added Qualification in Sports Medicine; IM, FP, Peds & EM • Fellowships in Sports Medicine for Ortho & Primary Care • Today Description of PCP for athletes and families (Travelling Circus)
History • May 25, 1988 – A group of medical, scientific and educational professionals met in the Petticrew Auditorium at Methodist Hospital of Indiana in Indianapolis and conducted the First World Congress on Motor Sports Medicine
History
History In The Making
Recent Literature
Recent Literature Methods • (2) Surveys – 58 State medical licensing boards – 20 Malpractice Carriers • Also reviewed available legislative data for 54/58 • Compared the response to statutes
Recent Literature
Results • 54/58 (93% response rate) • 18 allow out of state license (33%) – 16 specific statute – Montana and Wyoming doe not require • 36 do NOT have a pathway (67%) – 27 have statute specifically requiring local state license • Variable consultant exemption and special considerations
Results • 11/20 malpractice carriers (55% response rate) • 2 provide policy territories of USA • 5 would require written notice and likely state licensure • 4 no coverage regardless
Conclusions • 30% of states cover you or will not pursue you • Malpractice coverage variable
California • • 10 th amendment police powers applied to state regulation of practice of medicine All 50 states allow “emergency exception” • Business and Profession Codes Statute 2076 – (a) Notwithstanding any other provision of law, a physician and surgeon who is licensed to practice medicine in another state or country shall be exempt from licensure requirements under this act while practicing medicine in this state if all of the following conditions are met: • (1) The physician and surgeon has an oral or written agreement with a sports team to provide general or emergency medical care to the team members, coaching staff, and families traveling with the team for a specific sporting event to take place in this state. • (2) Except as provided in Section 2058 or 2060, the physician and surgeon may not provide care or consultation to any person residing in this state, other than a person described in paragraph (1). – – – (b) The exemption shall remain in force while the physician and surgeon is traveling with the team, but shall be no longer than 10 days per individual sporting event. (c) The executive director may grant a physician and surgeon additional time for exemption, up to 20 additional days per sporting event, upon prior request by the physician and surgeon. The total number of days a physician may be exempt, including additional time granted upon request, may not exceed 30 days per sporting event. ( d) A physician and surgeon who is exempt from licensure requirements under this section is not authorized to practice medicine at a health care clinic or facility, including an acute care facility.
California • Fully allowed on catchment statute • Pair with local physicians as coconsultants in care
Recent Headlines • Crossing Boundaries: A Comprehensive Survey of Medical Licensing Laws and Guidelines Regulating the Interstate Practice of Pathology Hiemenz, Matthew C. ; Leung, Stanley T. ; Park, Jason Y. March 2014, Vol 38, Issue 3 – 32 states & Wash DC allow consultation with state practitioner
Recent Headlines • Interstate Medical Licensure Major Reform of Licensing to Encourage Medical Practice in Multiple States • Robert Steinbrook, MD 1 JAMA August 20 th 2014: 312(7): 695 -696 • Relates to emerging reform and telemedicine
Recent Headlines Federal drug agents launch surprise inspections of NFL teams following games Nov 16 th 2014 49 ers in NJ, Seahawks in KC, Buccaneers in MD • Reportedly triggered by 1300 player Class Action Lawsuit • Specific DEA and CSA
Legal Perspective • Conclusion – We need consultation
Legal Perspective • Q&A with David Mattingly
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