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Supervision of Nonphysician Personnel

In most cases, the physician is not a full-time employee for the team. Most routine first aid and training programs are carried out by nonphysician personnel. This creates the same liability issues as supervision of nonphysician personnel in other medical settings.

Trainers were once a luxury reserved for professional athletes and world-class amateurs. Today large high schools often employ trainers on their coaching staffs, and professional coaches are also taught these skills. The trainer is both an athletic coach and a medical assistant. Treating minor injuries, doing physical therapy, and overseeing such preventive measures as taping and reconditioning are all part of the trainer's job. Consequently, the team physician must oversee the activities of the trainer in the same way that the physician would supervise a nurse or a physical therapist. This is a politically sensitive issue because trainers are usually given a free hand in both diagnosing and treating medical conditions. That trainers violate the medical practice act in many states is usually ignored by the state boards of medical examiners. When a physician is involved, however, infractions by the trainer are grounds to discipline the supervising physician, and they subject the physician to medical malpractice liability. Physicians must ensure that trainers comply with applicable scope-of-practice laws.

The team physician may not delegate control of prescription medications to a nonphysician. Providing the trainer with a bottle of codeine tablets to use when someone gets hurt is illegal. As with other drug law violations, there is a high probability that the physician will face criminal charges if the practice is discovered. Although narcotics are the most likely to lead to trouble, there is increasing scrutiny of prescriptions for other drugs, such as anti-inflammatory agents and hormones. Prescriptions can be written for direct use by only the affected individual. If a physician wishes to stock and dispense medication, it must be done in compliance with the pharmacy laws of the state. Writing a prescription for office use and letting the trainer dispense the drugs is no longer acceptable practice, nor is allowing nonphysicians to distribute samples of prescription drugs.

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