Team Doctors Find It’s Not Easy to Just Say No to Players : Sports: If they bar an athlete on medical grounds, they can be sued. But if they allow the athlete to participate and an injury results, they can be sued.

Teams and physicians face a legal dilemma when someone who has a potentially disabling physical problem still wants to play.

If the person is denied the chance to play on a team in a federally funded organization such as a public school, the athlete could file suit, according to an article in a medical journal, The Physician and Sportsmedicine.

On the other hand, if the player is allowed on the team and gets hurt, the player also could sue, the article said.

At the heart of the quandary are federal laws and court interpretations of them.

The Rehabilitation Act of 1973 bars excluding otherwise qualified individuals from participating in federally funded programs, said the report, written by two doctors and a lawyer. Athletes with medical problems or disabilities also can use the Americans with Disabilities Act in suing to make the team, the article’s authors said.

Another expert supports this. “If an athlete has a chronic injury defined as a disability, he has full right to participate at his own risk,” said Dr. Mark R. Hutchinson, a team physician, director of sports medicine services and assistant professor of orthopedics at the University of Illinois at Chicago.

The only conditions under which an athlete can be barred from play occur when his physical problems would place other athletes at risk of injury or illness, Hutchinson said. When the athlete’s own problems do not affect others, things get murky, he said.

“If the question becomes that the athlete is solely at increased risk of injuring himself, even if the risk is death, we enter the ‘gray zone’ of ethics and the courtroom,” Hutchinson said.

The results of those court actions have varied, but judges have held that Congress wanted people to be able to take risks, if they choose--even if doctors think the choice is unwise, the journal report said.

One line of defense is a system of screening based on standards for participation. Courts have held that, if a player or the player’s parent signs an informed consent form that spells out the risks involved in playing, then responsibility for those risks can shift away from the team, the article said.

In a typical system, a doctor screens the potential player and recommend whether the athlete is fit for the game. The athletic administrator, who sets the qualification standards, then decides if the player has met them.

The informed consent system has to look at “all predictable risks to each individual--not just to athletes with medical problems or disabilities,” the report said.

But it must point out how problems resulting from injury to a disabled or ill player would exceed the team’s ability to handle them, the review article said. And it must note the potential consequences of ignoring medical advice.

This doesn’t mean a signed consent form solves the problem. The team must show that the athlete or his or her parent has read and understands the form. And even that may not be enough.

“Even with an informed consent, the athlete retains the right to suit,” Hutchinson said. “Unfortunately, I believe that there are no crisp and clean rules to this issue until the courts define the terms better.”

The journal article suggests using forms with blanks that the would-be participants, or their guardians or parents, must fill in.

Another possible technique: a videotape record of the meeting in which the problems mentioned in the informed consent were discussed.

The review was written by two California doctors, Robert L. Kronisch of Santa Cruz and Frank M. Flowers Jr. of Riverside, and a specialist in sports-injury law, Richard T. Ball of Northern Arizona University, Flagstaff.