Doctors Face Upset on Barring Players From Competition

Just because the team physician tells a player to get off the team doesn’t mean the player is history.

A player can rewrite history by getting a lawyer and taking the medical disqualification to a federal judge for a second opinion. Under legislation designed to protect the disabled, the judge may send the athlete back into the game.

The Americans With Disabilities Act and the Rehabilitation Act of 1973 set standards that can confound medical ones, according to an article in a medical journal, the Physician and Sportsmedicine.

The laws were designed to ban discrimination against people with physical abnormalities or impairments, said the article’s author, Matthew J. Mitten, a law professor at South Texas College of Law in Houston.

The law makes it illegal for team officials to keep an “otherwise qualified” player off the team, the article said. “An athlete is ‘otherwise qualified’ if he or she can satisfy all of the team’s requirements in spite of physical impairment,” Mitten wrote.

That principle is clouded when it comes to cases. The courts are arguing among themselves about what “otherwise qualified” means.

In a Northwestern University case, a court “substituted its judgment for that of the team physician,” Mitten said. The Chicago-area school’s team physician had declared guard Nick Knapp ineligible because Knapp suffered cardiac arrest in a high school game.

But Judge James Zagel said his reading of the medical testimony was that Knapp’s risk of death is not great enough to keep the player disqualified. The judge told Northwestern to give Knapp a chance to play.

On the other hand, a judge in Kansas sided with the team doctor in sidelining a football player who suffered temporary quadriplegia during a scrimmage. The doctor in this case felt there was an unacceptably high risk that the player’s pinched nerve could result in permanent paralysis in the future.

“It becomes a difficult situation for us,” said Dr. Bryan W. Smith, head team physician for the University of North Carolina, Chapel Hill. The statutes “put this incredible burden on you.”

Disqualifying a player is tough enough when the law is not an issue, Smith said. “It’s probably one of the hardest jobs that the sports medicine physician faces because it becomes a very abrupt end to an athlete’s career.”

“Our goal is to get people to play--obviously safely, but we want to get them back to competition,” said Dr. Gary Green, team physician for UCLA and Pepperdine University.

Disqualification is a way to protect a player from catastrophe, and the job becomes harder when the player is allowed to take the field anyway, Smith said. “You still have to make sure you do everything in your power to keep them from having that catastrophe, but the risk is still there,” he said.

A doctor should not sign a clearance just because the player threatens to sue, Mitten said. Mitten recommends telling the player the medical cause and then accepting the possibility of a legal challenge. Green suggests meeting with the player, coaches, parents and university officials to make certain everyone agrees.

And having athletes refuse to accept medical advice is something that a doctor should expect occasionally, Green said. “They really want to play, and they look at it like you are trying to take something away from them,” he said.