I have a question about the Dr. note procedure to allow an unconscious player back into the game. Ok, player knocked out. Unconscious. After halftime, the coach hands me a note from a physician stating player can come back in.

First of all, do I accept this note from a coach, player, or parent? For all I know, the school janitor could have thrown the letters DR in front of his name and said 'sure, you can go back in'. Or, do I accept this from a physician hand to hand.

Second, disregarding worrying about the above scenario, once I get this Dr's note, what do I do with it? Do I keep it and file it in a safe place after the game for liability issues? Do I give it to someone else?

Where, if any, does liability lye with the official? Once I see doctor's note signed by 'Dr. John Doe, MD', I just accept it and go on, or do I need to worry about authenticity? Do I keep the note and put it in safekeeping?

Any clarification would be great. Maybe I am overly scared over this, but having a background in the medical field, we take an entire course in legal liability and I have seen how stringent the law can become as far as determining liability.

1. Make sure you get the name of the doctor and if possible, his address and telephone number and write that down on the note if it isn't already there. If there is any ambiguity, tell the coach you want to talk to the doctor before allowing the player to return. If he refuses, don't let him in. I would also have the coach sign the note as well, saying something like (at the bottom), agreed to by coach ______, signed _____.

2. Keep the note/info above in your pocket or lock it up in your dressing room if that's available. Have a copy made to stay with the scorer.

3. Unless you are negligent in accepting the note or being willfully ignorant, there isn't a great deal of potential liability.

Medical issues are actually one of the few things that will get you in serious legal trouble on the court. However, most potential problems are more related to interfering with treatment rather than actually being present when something bad happens. Remember, you are there to officiate the game, not provide medical treatment. If you feel the kid is going to die or be seriously injured without your input and you are trained, go ahead only with the understanding that you are putting yourself at a huge liability risk. Otherwise, get everyone else away and let the medical providers do their job.

I wouldn't worry too much about this. No doctor is going to let anyone play who's been unconcious.

I agree, the doctor would have to be nuts to allow an knocked-out player to return to the floor after a half-hour's rest(as well as the coach for that matter.) In the odd event that the note is real, I'd want to keep the name of that Doctor for future reference - I won't be letting any of my family schedule appointments at his office!

QUOTE]Originally posted by Texas Aggie
I wouldn't worry too much about this. No doctor is going to let anyone play who's been unconcious. [/QUOTE]

Not true...had one in a boy's Varsity game several years back...two kids from home team slam heads together - one top of head to other's chin going for rebound...chin-boy hits ground and doesn't move - he is out cold. That was in the first quarter...paramedic in stands comes down and takes care of him...when we come out of locker room for 3rd quarter, coach is waiting with a note from a doctor (kid's dad took him down the street to an office) and wants the kid to play. Kid had an obvious concussion, but he tried to play...during a dead ball, I asked him who he was guarding and he told me #53...there was no #53 on the other team...coach overheard and finally took him out.

As far as the note - we had BOTH coaches and the scorer sign it, and then stapled it to the page of the scorebook.

Not true...had one in a boy's Varsity game several years back...two kids from home team slam heads together - one top of head to other's chin going for rebound...chin-boy hits ground and doesn't move - he is out cold. That was in the first quarter...paramedic in stands comes down and takes care of him...when we come out of locker room for 3rd quarter, coach is waiting with a note from a doctor (kid's dad took him down the street to an office) and wants the kid to play. Kid had an obvious concussion, but he tried to play...during a dead ball, I asked him who he was guarding and he told me #53...there was no #53 on the other team...coach overheard and finally took him out.

As far as the note - we had BOTH coaches and the scorer sign it, and then stapled it to the page of the scorebook. [/QUOTE]

Sheesh! Talk about really bad parenting!!!

I can only wonder if this same zeal is used when the kid wakes up and claims he's "sick" and has to stay home. "Sick? Damn, let's rush you over to the Doc's office so you won't have to miss any school." Yep, I wonder...

No doctor in his right mind would sign a note allowing a player who had lost consciousness to go back in a game. Your choice is pissed off coach or dead kid. A no brainer, so to speak . . .

You guyys are crazy. The bok says they gotta produce a note. If they do, who are we to tell em he can't play.

I believe this month's issue of Referee has some good discussion on this type of thing.

The only 'doctor' who would sign a note to let a kid play after losing consciousness would be a quack. Sometimes it's necessary to consult a higher authority.

I think you need to read my post above...it happens, and there really isn't anything we can do to stop it.

I appreciate your earlier post.

I want to encourage you to not permit a player who has been unconscious to participate. You might have to stick your neck out and say you're not convinced it's safe. Then the coach points to the rule. Then you say, coach, I'm not convinced it's safe. Better some jib flapping than the kid dies in his sleep that night.

If you personally ever have a child in that situation, I would encourage you to watch the child while he or she is sleeping at least through the first night - and, if you want to err on the side of caution, for several nights.

No doctor in his right mind would sign a note to let a child participate under the conditions you describe.

Thanks for the posts. Very helpful discussion. The sad thing is that, even though some of your are pointing towards a doctor NEVER allowing it (not to mention someone posted an actual story where it happened), I can see it happening because high school basketball has become about wins and losses. If this happened to a Kobe-esque player in the state semi's or something, I could definately see it happening.

Next question. I know the book says unconscious= must have doctors note. What about major concussive symptoms. The player is not on the floor with the eyes closed, but he or she has no clue where they are, etc. Is that worty of the doctor note procedure?

Basically, if the eyes are not closed on the while the player is laying on the floor, do I still need to require a Dr. note? A major concussion might as well be unconsious, IMO.

I just want to make myself perfectly understand this situation. In my short time as an official, I have learned that as soon as there is something I am not 100% clear on, it seems to find me on the court. Thanks.

Whistles & Stripes,
I agree with you on this one. However, I would take the note from the coach. I would then place said note in my pocket and after the game complete a special report to send to the state discussing the situation and have the school answer to the state on the legitimacy of the note.

Here's my advice.
I would file a report with your state association and include a copy but keep the original and file it for safe keeping. Keept it until the statute of limitations runs.

Do not staple it in the score book, dont let anyone else have it.

If there is litigation it is the one thing that may save you. Accepting the note places the MD in in the position of liability. You will have to show reasonable reliance on appropriate medical advice. However if it is not reasonable or appears to be bogus you can and should question it. When officiating football we have ahad notes come out of the stands and we always ask the basic questions so we know the guy is a MD and that he understands the liability is now on him.

It cant be anything less than a physician... No PA's. no nurses, no Physical therapists, etc

Is there a statute of limitations on liability claims? I always thought it only applied to criminal acts.

BITS, I think you have it backwards. You can't be protected by the statute of limitations for criminal acts. Murder someone and you can be arrested and tried anytime.

For most other matters, including medical malpractice and other liability suits, the statute limits the time someone can take legal action. Depending on which State the law applies, it ranges from 1 to 4 years from the date of incident, or in the case of a minor, 1-4 years from the date the minor reaches the age of majority (18 years old.)

I'm not a lawyer, but I slept in a Holiday Inn Express...

Don't let the kid play, and sleep well at night
 

New Zealand is different to USA in many ways, but a really relevant one is the whole business of liability and the "sue 'em" mentality that we see in the American society today. I am saying this to to emphasise that officials in any game have never been sued over issues we are discussing here.
Now consider the game of rugby: very tough, no protective padding (like in football), it's all blood and guts. Concussions are fairly common, as the result of the way the game is played.
So, wether it is a game at primary school level, or a world championship game, a player who is concussed or SUSPECTED of concussion receives an AUTOMATIC three week ban, full stop. No doctors notes, no appeals to higher authority, it can be your key player, and you have the champ finals coming up, that's it.
The aim is clearly to protect the player.
How does this translate to your situation? Imagine the scenario in which that kid turns up in the last quarter, presents you with the doc's certificate. You let the kid play. The next morning, kid does not wake up. Three days later, he dies, never coming out of coma. Yes, you followed the rule, so you must feel ok?
As refs, we all come across rules that we don't like, and some that we find downright stupid. Most of the time though, we carry on enforcing these rules, as that's what we do. But from time to time, admitedly not very often, but we do come across the rule that is past silly, or stupid, or illogical, and is downright dangerous.
I would argue that if the above scenario is to really happen, you would find your *** dragged in front of the courts, and no amount of "but the rule says" and "the note was genuine" will help you feel better about what you did.

People have been sued
 

I've heard of a couple of baseball cases (kid hit another kid with a bat in the on-deck circle was one). The most serious one a kid in NJ was struck by lightening (the very first bolt). He was dead by the time they got out there to him. Umpire was sued because games can't be going on during lightning (it was the very first bolt).

It could easily happen with basketball too (maybe it has). You want to be a good ref, but you want to be a good person too. I wouldn't let the kid come back in, and I'd take the heat from my board for it, knowing that I made a good choice, despite the rules. Some things are more important then a game of basketball.

Ok, so here is my next question. What is the process, or is there even a process, to ATTEMPT to get the NFHS to amend the rule (I know I'm a little fish in a HUGE pond)? I think if the player is unconscious, he or she should not play for the rest of the game. I think that would be a fair proposal that will take any liability out of the official's hands.

With several of the rules designed for player safety, how in the world can they justify allowing a player that was unconscious earlier in the game to come back in EVEN WITH A DR NOTE? It doesn't make sense to me. At very least suspend the player from playing for the duration of the game!

Australia is nowhere near as litigatious (sp?) as the USA so this is less of an issue for us.

There is nothing in the 2004 FIBA rules or referee's handbook that requires a player to present a doctor's certificate to re-enter the game after any type of injury.

As far as I am concerned, this is an example of society going nuts. In games played by adults (whether it be college, NBA or re-league) the player's judgement as to whether they are capable of returning to the court should be sufficient. For games with minors, it should be up to the coach and/or parents to make that decision. As a referee it is absolutely none of my business.

Does anyone know what the requriements are for a NBA player that has been knocked out to re-enter the game? What about College?

Thankfully the Australian legal system has some tools in place to protect sports officials. As well, all referees in Australia must be registered with Basketball Australia, which provides $20million personal liability insurance for all referees.

Reminds me, dj, of a Hockey story of a friend.

Bob [son of two doctors] got knocked to the ice and his eyes were a little glassy.
"How are you, Bob?" --> ... "Fine."
"Can you play?" --> ... "Sure."
"How many fingers am I holding up?" ..."Tuesday."

Bob left the ice for the evening.

mick