Tuesday, May 20, 2014

Annual Sports Physicals and Fundraisers—A Healthy Combination for Kids? A Malpractice Risk for Physicians and Nurses?

By Tom Hearn

Like most school systems, Montgomery County [Md] Public Schools (MCPS) requires a student to get an annual medical clearance to participate in school-organized athletics. 

The medical examination for the clearance is called the Pre-Participation Examination, or PPE for short, and is supposed to screen for health risks like those related to sudden cardiac arrest, head injuries, and health issues unique to female athletes.  (Here are a link to the PPE form in English and Spanish.  Here is a supplemental medical history form for students with special needs.)

In the coming weeks, MCPS high schools will host sessions where high school athletes can get their PPE and medical clearance.  Physicians and nurse practitioners in the community donate their time to perform these PPEs and school booster clubs charge students a donation of $40 or so.  For one MCPS high school, the PPE fundraiser nets about $6,000 in donations. 

While kids need PPEs and school sports programs need funds, combining the two may not be good for kids.

The American Academy of Pediatricians and the American Academy of Family Physicians recommend that the PPE be conducted at what physicians call the student’s “medical home,” that is, the physician’s office.  

Conducting the PPE at a school gym or locker room may send a signal to both student and physician or nurse that the exam is merely a paperwork formality to go through for the student to be able to play sports.  This school setting may inhibit the student from being frank about a history of head injuries or other health risks that may jeopardize getting the clearance. 

Also, the annual PPE may be a student’s only encounter with the health care system.  Teen years are times when a student can first begin risky health behaviors, such as drug use, or find themselves in abusive relationships.  The teen years may also be when mental health issues begin.   The setting of a physician’s office is more conducive to an honest discussion about these issues than a school locker room.

Conducting PPEs at school fundraisers may also be bad for physicians and nurses who perform them.  One local physician told me that the health care provider he works for does not permit physicians they employ to perform PPEs at school fundraisers because of the liability issues.   Also, physicians and nurses should make sure medical malpractice coverage applies when they perform a PPE at a school fundraiser.

Some people say that what makes getting the PPE at the school fundraiser appealing is the difficulty of scheduling it at their physicians’ offices.  So maybe physicians can do a better job of making it less of a hassle to schedule.  

Funding school athletics programs is important so parents should still donate needed funds to their school’s booster club even if they don't participate in the PPE fundraiser.

Next blog post:  Are there some sports, like boxing, that a physician or nurse should not clear a student for, regardless of a student’s health history, because the health risk for kids is so serious?   

Tom Hearn is a parent in Montgomery County, Maryland.  He got interested in sports safety issues after his son sustained a concussion playing JV football. 

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