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Health Law and Ethics
Clinician's Corner
December 21, 2005

Medical and Legal Issues in the Cardiovascular Evaluation of Competitive Athletes

Author Affiliations

Health Law and Ethics Section Editors: Lawrence O. Gostin, JD, Center for Law and the Public's Health at Georgetown University, Washington, DC, and the Johns Hopkins University, Baltimore, Md; Helene M. Cole, MD, Contributing Editor, JAMA.


Author Affiliations: Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Fla (Drs T. E. Paterick and Fletcher); and the Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minn (Dr Maron). Mr Timothy J. Paterick is an undergraduate student at Richmond University, Richmond, Va.

JAMA. 2005;294(23):3011-3018. doi:10.1001/jama.294.23.3011

Healthy-appearing competitive athletes may harbor unsuspected cardiovascular disease with the potential to cause sudden death. This fact raises issues of physician responsibility in preparticipation screening and eligibility/disqualification decisions. A number of medical-legal cases now represent a framework for screening and eligibility decision making in high school and college athletes. Physicians screening competitive athletes should strictly adhere to recommendations from the American Heart Association. Precedent exists for disqualifying athletes with heart disease from competition to prevent unnecessary exposure to risk of injury or death. By virtue of the court decision in Larkin v Archdiocese of Cincinnati, high school students with heart disease have no compelling right to participate in interscholastic sports without medical clearance. In Knapp v Northwestern University, an appellate court ruled that college athletes can be medically disqualified from sports and supported the use of national association medical guidelines by team physicians in formulating eligibility/disqualification decisions. This medical-legal analysis provides guidelines for physicians participating in medical evaluations of competitive athletes by clarifying the standard of care, potential pitfalls, and the evolving liability associated with this clinical practice.