this as quick as possible. I'm really comforted by the fact that a lot of the speakers today have had a lot of overlap with what I plan to say and there's a lot of synergy and alignment there so you're not going to be terribly shocked by anything that I say I'm going to just try to see how often I can say document communicate build relationship in the next 15 minutes. And I just want you to know that these risk management considerations for elite athletes are not wildly different from the general risk management considerations you would have for your other clients but it's it's higher stakes as you know because of the economic calculation of what they could lose and they're famous. So there is the publicity piece that Amy spoke about as well. And so risk management is just protecting yourself protecting your practice and considering yourselves just like these athletes are elite. You too are elite and you're operating at a high level. These are all things that you know but it bears repeating sometimes and it's just about being intentional. As the doctor said you're never going to eliminate all of these risks but we can evaluate and prioritize. And as much as this second bullet point is statistically true I can also put that in context by saying that there's not a lot of lawsuits that come about when they do come. You need to be prepared and have a posture and have a practice protocol that puts you in the most favorable light possible. But context is really important in terms of your risk management assessment and the legal considerations really really vary by geographic jurisdiction and you need to understand where you're operating and what applies to you specifically. This is just kind of a sampling of comparison that varies by state. I chose Pennsylvania because of the obvious but for example there's a constitutional provision prohibiting caps in Pennsylvania. That's that's part of the perfect storm that kind of resulted I think in the verdict that was recently rendered as compared with Louisiana. There is a five hundred thousand dollar cap on total damages plus the cost of future medical expenses. The providers are responsible for the first hundred thousand dollars of that and they do that by covering it with insurance or they can do a security deposit. So it's it's really specific by state. And so I say this to say you don't stay level don't get too worked up about one particular case. I know that you're going to address some of the concerns and the resultant outcomes from the recent verdicts but it really is the perfect storm for those particular cases. And so I'm going to say this to say you don't stay level don't the perfect storm for those particular facts and circumstances in that jurisdiction and that context. So some risk management strategies establish a consistent follow up and protocol. You're going to try to do things the same way all the time. Like the doctor said if you're going to do a service make sure that you document in the notes. It's really important to do this as contemporaneously as possible. It's easy to forget after the fact. And so if you just make that a disciplined habit it will serve you well. Nobody has a crystal ball. These things don't happen all the time but you want to put yourself in a posture and a practice where whenever something does happen the way that you practice the way that you do things supports an established record that can demonstrate that can help your attorneys demonstrate that you are consistently meeting an appropriate standard of care. So the real time documentation is really important. Sometimes you can eliminate high risk practice elements. And what I mean by that is for example there are some practices that you can look at data over a period of time to see where potential issues are coming from. You can you know isolate for age of a claimant or if a particular procedure usually results in pain in a certain area for a certain period. Literally the front end communication about the expectation helps to manage what the player is going to experience in that setting. So they won't think it you know odd that it still hurts or there needs to be some management of a complication or outcome that is anticipated but just hasn't been communicated adequately to them or that they were reminded of it. So plain language overview. I love what the doctor said about you know not being talking not talking down to the athletes not getting too heady with with complicated language really eyeball to eyeball kind of just as much as you can going over the risk benefits and alternatives and don't be afraid to talk about you know worst case scenario that usually does not cause them to lose trust that is existing but it does help you to have that conversation to manage those expectations and also to document that conversation. This is really important also for your treatment assessment and rationale just making sure you know for example the one case that was the verdict was just rendered. You're looking at what's happened years after the fact in the run up of a Super Bowl and even though you have respected colleagues who understand what's happened who agree with what you did having had that in the charts contemporaneously as it was happening you know around the surgery and the immediate follow up is very very helpful in those situations. So why invest in risk management. Truly it improves the quality of patient care and the players have better experiences with the communication with the practices that you're implementing that causes them to anticipate what they're going to experience. It decreases the incidence of lawsuits and minimizes the adverse resolutions. As I said you never know if or when you're going to meet this challenge but if and when that does happen if you've considered very thorough risk management analysis and implemented consistently have training consistently over your teams and everybody's kind of rowing in the same direction doing things the same way it puts you in the most favorable light possible when things don't go as well as everyone expects. So in particular with elite athletes they are higher risk simply because of the potential economic fallout the publicity as we said even when things have been determined relatively quickly that there was no wrongdoing or or or lack of meeting a standard of care that's appropriate. If there is a negative headline or something that's just disfavorable in the public sphere it's it does you no good. And I think that when you have the opportunity to just communicate build that trust that's going to help you in those situations. If you can also include in those conversations if they want to bring in members of their team people who their trust. These are actually witnesses to these conversations so it's not only in your notes there are people around who who also have heard the risk benefits and alternatives. The surgeon even when you are not immediately involved in the follow up largely is viewed by the player as the captain of the ship. I came to you you know I consulted with all these people and I chose you. And so to the extent possible if you can keep in communication I know the collegiate doctor just referenced the challenges of that. But to the extent possible even if it's you know if it's not in that context but if you have team members who that's their assignment to follow up to check in and to document that follow up and even if you're not able to maintain that communication if you have notes documenting your attempts that's also very helpful. So the keys to contest liability and causation if in fact you know an incident arises is going to be these habits these disciplined practices that you have worked into your methodology. These are the things that are actually going to help you in those situations. You want to not oversell your recommendations. You want to not dissuade people from going into those you know other second opinions third opinions even if they do patient consultation tours and there's conflicting advice. Talk about it. Explain your rationale and that is documentation of supporting your treatment assessment and the and the plan that you recommended and you're empowering that player and his team to understand all the risk benefits the analysis and you empower them to make that decision to the extent possible if you're faced with a situation where this player just for whatever reason does not have reasonable expectations empower yourself to the extent possible to to decline to you know do that work. If someone is nearing the end of their career and you go through you know worst case scenario this is what we think we can achieve and you don't think that's landing you know that's something to consider patient selection is a risk management strategy. Secure communications records retention is very important. Obviously they have the burden of proof if you if they are trying to say you did something that failed to meet a standard and it caused me harm and that has to be established. But to the extent you are exercising your medical judgment and you have you know the documentation of these conversations you've consulted with specialists yourself and this is where ego also gets checked as well as you might know you're the best. This is your strong opinion. This is your recommendation. But to the extent there's you know conflicting advice you give your recommendation and you empower the player to decide and confirm that they understand and they're choosing to do what they're going to do anyway. So I would say don't oversell enjoy it. I know this is concerning and troublesome times but this should not be at the top of your mind on a daily basis. Risk management is something that you focus on invest in evaluate you establish some protocols you do the training and then you put it on autopilot and you do that periodically. Once you establish these disciplines you can then go once you establish these discipline practices you're documenting you're communicating you're building relationship and trust. These things actually do help and it puts you in the best possible position. You know when you are faced with a lawsuit the four main defenses are this. I did nothing wrong. What's going to show you did nothing wrong. This documentation this communication this evidence that you've secured and that you've retained. What else is going to help you. Not only did I do nothing wrong. You weren't compliant. I gave you a treatment plan you were supposed to follow up. You didn't do this. I told you you couldn't do that. This would be the result. You assume the risk of playing with that injury even though it could have long term effects and we talked about it. And here's the note. So not only did I not do anything wrong but you did something wrong and in some of these jurisdictions that comparative fault is really relevant. The third thing is even if I did something wrong and even if you did nothing wrong. What happened did not cause this harm. And if you have the proper documentation the follow up the communication that we talked about that can really be helpful. You know the context really matters just like I said in in Louisiana. There's a medical review panel that has to look at the medical review panel that has to before any lawsuit is filed against a physician be reviewed by a panel of three physicians and an attorney for merit and a lot of these claims don't get past that medical review panel and even if they do the opinion of the panel is probative evidence. So that's going to be really persuasive around whether or not a standard of care was met. So the context really matters. Understand the context that you are in the jurisdiction that you're in. Get good advice before an incident happens and enjoy your practice. I really want to emphasize that you all are elite too and I would hope that you would continue to do this work for as long as you desire to do it. Thank you.

risk management

elite athletes

economic aspects

publicity aspects

legal considerations