Brad Wolverton’s investigative piece on trainers who have to fight with coaches (who may be the trainer’s boss) over medical decisions is a must read. In general, it is yet another example of the tightrope college athletics administrators feel they must walk. Stay too distant and you risk not working effectively with a successful coach and being fired. Get too close and professional judgement can be compromised, not to mention hitching your wagon to the wrong coach can make the team’s on-field performance part of your job requirement as well.
But when it comes to the credibility, authority, and independence of trainers and physicians in college sports, the NCAA absolutely has a role to play when it comes to the relationship between coaches and sports medicine staff. Even if establishing that role is easier said than done:
But Brian Hainline, the NCAA’s chief medical officer, cautioned that the association’s powers are limited.
“We can say, ‘This is how we believe medical care should be delivered,’” he says. “That said, the NCAA is not the NFL. We can’t just shift and say, ‘Now everyone’s going to do this.’”
Hainline is correct that as membership association, at some point the membership (or some representatives of the membership) are going to have a say about NCAA regulation of athlete medical care. But the national office, the Executive Committee and Division I Board of Directors should force the membership to face this question as soon as possible.
Detailed requirements where the NCAA dictates the type of medical care to be delivered are not necessary to combat this power dynamic. What is needed are clear regulations about who makes medical decisions in an athletic department and who oversees the people who make those decisions.
The NCAA has dabbled in this area before. The Division I Manual includes four separate bylaws covering how voluntary workouts must be conducted. Each of those bylaws includes this language:
a member of the institution’s sports medicine staff (e.g., athletic trainer, physician) must be present during all voluntary conditioning activities (running, not lifting) conducted by the institution’s strength coach. The sports medicine staff member must be empowered to have the unchallengeable authority to cancel or modify the workout for health and safety reasons, as he or she deems appropriate.
“Unchallengeable authority” is the type of unambiguous language needed. If a trainer modifies a voluntary workout, and is then fired or otherwise disciplined for it, the university has committed an NCAA violation. Beyond what penalty such a violation might carry, it gives the NCAA an opening to demand corrective action from the school about how voluntary workouts will be overseen. The goal now should be to expand that authority beyond voluntary workouts.
Proposal 2013-16 is the next step. This proposal, which could be voted on as soon as January, requires Division I institutions to appoint a team physician for each or all of their teams. There are a couple of problems with Proposal 2013-16 though. The legislation was originally offered as an emergency/non-controversial proposal, but was then moved to the standard legislative cycle. Apparently there was significant debate about whether teams should be required to have an appointed team doctor.
The authority given to team physicians under Proposal 2013-16 is also not as clear or as strong:
The team physician shall be authorized to oversee the medical services for injuries and illnesses incidental to a student-athlete’s participation in intercollegiate athletics.
Authorization to oversee medical services is a far cry from being empowered with unchallengeable authority. The strong language currently reserved for voluntary workouts should be the standard way the NCAA talks about the power of sports medicine staff to make medical decisions.
The NCAA needs a new, more expansive proposal which does the following:
- Requires institutions to designate both a team physician and full-time athletic trainer for each of their teams to oversee medical care;
- Requires members to give final and unchallengeable authority to the sports medicine staff on all decisions involving student-athlete medical care; and
- Prohibits the sports medicine department or staff from being overseen by a coaching staff member or a noncoaching staff member with sport-specific responsibilities (i.e. a director or operations).
That proposal should be passed as emergency or noncontroversial legislation as soon as possible, either by the Legislative Council or Board of Directors. At the very least, it would show that the NCAA is attacking this problem. If the members want to object via the override process, that would lay bare where the resistance is.