All right, good afternoon, y'all. There's only a few people streaming out for the legal talk. Now that you've negotiated your baller deal and you've taken on the awesome responsibility of becoming a team doc, you need some tools, right? First, I'm Maggie Carlisle. I'm general counsel, senior vice president of the Lions. Thank you for having me here. It is an incredible honor to be among you all. The programming that I've been able to see today has been really, really impressive. It's wonderful to see friends. I see my PAC-12 medical board, who are my former colleagues here in the front. So it's great to be here. So thank you for having me. When I was asked to give the legal talk to team physicians, I was given very broad creative license. So I decided to keep it pretty practical. For business departments, I give a similar presentation called when to call your lawyer. For doctors and medical folks, I typically find it's more effective to give you a when you can't call your lawyer talk. So I'll be focusing on an is this legal framework for you all and how to implement legal considerations when you're giving care in the field and you might not have your lawyer around. Obviously, this is important to all of you personally. But when you become the team physician, the team doc, it's also important for you to be able to give tools to your staff to be able to implement in the field and to teach your teams how they can have a framework in their bag of tricks. So disclosure, I am and I have been employed by various professional and collegiate sports teams and leagues. This presentation is mine and my own. It's obviously informed by my work. But it's on my own behalf and not on the capacity of my employer. This is not legal advice. I'm not licensed in Arizona. This is how I think about legal frameworks and how I might advise my clients on how to think about things themselves. I realize that some of you may have robust legal departments. And I encourage you to use them always, whatever you have at your disposal. I also assume that many of you do not. So I encourage you to find at least one trusted lawyer that you can call in times of crisis or dilemma. And when you can't, find a framework like this or otherwise that works for you that you can implement in your daily practice. All eyes are on you. I think that the official title of this program in your pamphlets is Legal Pitfalls. So this is the pitfalls part. And I promised Dr. Ackerman that I would only scare everybody a little bit just at the beginning. The rest of it, it's not scary. Your jobs probably feel higher stakes than ever because they are, right? I don't have to convince you all, right? Like youth sports, AAU, college opportunities, professional opportunities, even in kids in middle school and high school are higher than ever. Collegiate athletes have higher expectations of compensation than ever. So the damages and the potential damages there are growing higher than they've ever been. And of course, in the professional ranks, those legal damages are higher than ever as well with their diversified portfolios, with their higher exposures. There's a lot of pressure. And I realize that right after I sent this first version of the deck, the news came out of a jury verdict out of Philadelphia that was brought by a former NFL player. I see some of you all nodding. That caught a lot of sports lawyers by surprise. First, just by the sheer volume. $44 million were awarded in that case. $30 million against one doctor, $14 million against the other. The other reason why it caught our surprise was because it was stemming from a relatively routine PCL and meniscus injury treatment that did not go well. And full disclosure, I have not read the full record from that case. It's a jury case, so there's not a full opinion drafted up. But just that in and of itself may be an outlier, but it exemplifies how much pressure is really on you all. So you need tools. First, this is the is it legal framework. The overarching question driving this framework, I think, is important to lay out, which is, is this the right thing to do, right? First, I think it's also important to know what laws are before I dump into it. I mean, laws are attempts, often imperfect, but attempts nonetheless to define in words what is the shared agreement in this community of at least the minimum behavior and actions that are expected in a situation. How to attempt to codify how to do the right thing. This is simplistic. And I'm sure that many of you who are well-versed in navigating the gray areas on your playing fields and in your pool areas and are thinking about the catch-22s that seem to be around every corner. And that is true. You're not right. But when all else fails, if you can come back to realizing what laws are there for, at their essence, they're to try to capture how to do the right thing. And this framework is informed by that overall arching theme. And you can hopefully use that theme to sort of guide you as you navigate it and what you're doing on a day-to-day basis. So without further ado, here is the framework. It's three-pronged. When you're considering how to respond to a situation and whether to approach something in a legal way, these are the three questions you're going to have to surpass. I don't know why this is clicked through. Apologies. On your shoulders, you need your doctor, you need your lawyer, you need your priest, your rabbi, your mom. The questions are threefold. Is it practical? That's your doctor. Is it straightforward? Is it reasonable? That's your lawyer. It's a standard of care. And is it ethical? That is your spiritual guidance. If you hit those three, it is probably legal. I won't say it always is. And I won't say you shouldn't still call your lawyer. But if you need a framework to guide you, if you do not know the specific laws or statutes that apply to a certain situation, if you hit these three, you are probably in the ballpark. And at the very least, can respond why you took an approach that you did. So the very first prong is, is it practical? Remember, this is the doctor on your shoulder. Another way to phrase this is, is this straightforward? I deal with this in a legal and a business realm with people who try to get too cute. How can I find a loophole in this situation? How can I skirt contractual obligations? I'm kind of annoyed that I have to follow. A legal phrase a lot of lawyers use is the blush test. Can I make this argument or justify this action with a straight face without blushing? If you have to come up with some sort of convoluted justification for why you think an approach might succeed, or there is a long list of contingencies that have to materialize for an approach to be a success, you may be veering away from practical. And you may be, at the very least, setting yourself up for being highly questioned later on why you took an approach if it doesn't work. Now, you all work in a very complex field. And I recognize that many times medicine is not straightforward. And sometimes you do need to try new and novel approaches. And sometimes a patient understands these risks, consents, and will deal with that later in the ethics prong. But in a moment of determining the approach and the scope of immediate and necessary care, the very often approach that is the one that you should use is the one that's most straightforward. It's not the time to reinvent the wheel, right? It's not the time to play Al Yankovich and see if you can perform an appendectomy with a chainsaw. So I will also point out, there's a little cross up there, I highly encourage you to know your local Good Samaritan laws. So that's when you're not on the clock, but somebody may be in need of care. They vary state to state. I don't expect you all to be lawyers, but a few of the things that you should have in your back pocket you'll see throughout this. One of them is your local Good Samaritan laws. Again, even if you don't know those, the overarching theme of these laws is do the right thing. So keep that in mind as you approach that. So this is the first one. Is it practical? If it seems that your approach is pretty straightforward or it's as straightforward as possible and it's necessary, let's go on to the next prong, which is, is it reasonable? So this is the status quo question, right? This is the lawyer on your shoulder. This is the legal standard of care, as you all have heard about. What would another medical person do in this situation? Is this approach wildly deviating from the norm, right? Do you know anybody else who's taken this approach in a similar situation? Were they reasonably competent? Again, along with your Good Samaritan laws, I would encourage you to know what your state's medical standard of care definition is. Even if you don't, most of them are fairly similar and generally the same, which is, so I'll give you, for instance, in Michigan where I currently practice. Would a similarly skilled medical provider have cared for the patient with the same or similar treatment under the same or similar circumstances, right? Would Dr. Smith, who I have confidence in as a competent physician, approach this in a similar way given the similar circumstances? That's your standard of care. Is this reasonable question? Again, even if you don't know your exact local legal standard of care, the overarching theme is do the right thing. And would another competent physician or medical provider also think, yeah, this is the right thing to do in this situation? One thing to keep in mind, standard practice is not the same as standard of care, all right? So you all understand that when you have a standard practice at your clinics or at your teams or at your programs, those are the policies that are drafted, the expectations for behavior that are set through habitual practice. These are the policies in your handbook. This is the training, formal or informal, that you or your team may get on how to approach different situations. That's a standard practice. That may exceed what your minimum standard of care is legally. And if it does, then now you need to meet your standard practice. That now becomes your new standard of care generally. But it might not even meet the standard of care, right? Just because your program has a policy of treating shoulder dislocations with witch hazel doesn't mean that that meets the standard of care. So know your policies for sure. But if something seems not quite up to snuff, you've got to work to have those updated. At the very least, you need to understand and you need your team to understand what that minimum standard of care is. What would other reasonably competent medical providers do with a shoulder dislocation in these situations, right? OK, so we've gotten through is it practical. And we have gotten through is it reasonable with your lawyer. Now this is when you call in your priest, your rabbi, your mom. Is it ethical? You have your approach. The final question comes to whether or not, you know, oh, there we go. You meet your general basis of ethics. I expect that most of you have taken a medical ethics course at some point in your training, if not continuing robust CMEs and ethics. So this is well-versed in your mind. You know, the bottom line is, is this approach likely to help? Is it likely to not hurt? Is it necessary right now? And of course, if possible, do I have consent? I love a good flow chart. I know that you can't see this. I don't know if you're going to have access to these materials later on. But if you do, I wanted to give this as a resource, sort of because it walks you through that ethics framework and how to think about it. And finally, you get through it, and you get to apply your framework. So that's it. The framework, is it practical? That's your doctor. Is this approach straightforward? Is it reasonable? That's your lawyer. Does it meet the basic standard of care? Would another medical provider do this in a similar situation? And is it ethical? Is it likely to do good and not do harm? Any Given Sunday is one of my favorite movies to apply this kind of legal and medical case study. Those of you who have seen it probably know why. I did not include this in my disclosures, but I come from the same small town in Texas as Jamie Foxx. So anytime I can plug some Jamie Foxx content, I will. And I know that some of you in this crowd may not be able to stomach this movie, and I get it. But those of you who can, I encourage you as an exercise to re-watch this movie with new eyes. Have your trainers and your fellows and your staff members watch it with new eyes, because it came out while they were still in diapers, and they probably haven't seen this movie yet. And try out the framework. There are a lot of opportunities in this movie to walk through what a doctor should or shouldn't do, what a trainer should or shouldn't do. And just keep practicing that framework so that you have that nailed in your brain, so that when you're done with the in-the-moment standard of care or giving of care on the field, in the arena, at the pool, you will have that approach. And then you can call and double-check your work later. So the take-home points. Be an expert. Know your policies. Know your standards of care. Know the Good Samaritan laws. But you don't have to be a lawyer. Know the basics. Know what applies to your day-to-day work. But then have a framework of some sort that you can use, that your team can use, to get in the ballpark of what might be, from a legal standpoint, parameters for what you can do safely in the care that you're giving for your folks. The good news is, if you follow all of this framework, you're probably also giving good medical care. So there's a lot of Venn diagram overlap there. And then finally, after the fact, when in doubt, call your lawyer. I would say the same thing about my friends who have a medical issue. You know, there's some self-care that you can give. But at the end of the day, call your doctor and find out. Thank you all for all the work that you do. I know that a lot of times your work can be long and thankless and complex, certainly not without its pressures and its stress. I appreciate everything you do, and I hope this has been helpful. Thank you.

3rd Edition, CASE 32

3rd Edition

Legal Issues

legal tools

team physicians

is it legal framework

Good Samaritan laws

medical standards