MECHANISMS TRANSFORM SPORTS INJURIES TO CHILD ATHLETE ABUSE INVESTIGATIONS

Mechanisms Transform Child Athlete Not-Accidental, Preventable Injuries and Sexual Abuse To Child Athlete Abuse Forensic Investigations:

A. When it is properly Self-Reported timely by the victim to authorities i.e. Police, State Police, Child Protective Services (CPS) and/or County Attorney

B. When it is properly Reported by anyone who is a Non-Mandated Reporter, who has knowledge of the Child Athlete Abuse that resulted in Not-Accidental, Preventable Injuries and/or Sexual Abuse. Most everyone who has information about Child Abuse in every state in the U.S. has a Duty to Report all types Child Abuse, including Child Athlete Abuse to authorities, though not mandated.

C. When it is properly Reported by anyone who is a Mandated Reporter, who has knowledge of the Child Athlete Abuse that resulted in Not-Accidental, Preventable Injuries and/or Sexual Abuse.

• “Approximately 48 States, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands designate professions whose members are mandated by law to report child maltreatment. Individuals designated as mandatory reporters typically have frequent contact with children. Such individuals may include:
• Social workers
• Teachers, principals, and other school personnel
• Physicians, nurses, and other health-care workers
• Counselors, therapists, and other mental health professionals
• Child care providers
• Medical examiners or coroners
• Law enforcement officers
• Doctors can report directly to Child Protective Services and their County Attorney
[Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services]

D. When Child Athletes sustain Not-Accidental, Preventable Injuries and/or Sexual Abuse and are examined by a Doctor and/or Health Care Personnel

a. and then Doctor and/or Health Care Personnel properly Report the Injuries and/or Abuse to authorities they Transform to Child Athlete Abuse Forensic Investigations

b. and when Doctors and Health Care personnel properly document how the Injury and/or Abuse occurred during the history taking and during the physical, laboratory and radiological examinations they follow with proper use the ICD-9 modifier code for Child Abuse submitted to insurance carriers:

• because Doctor and/or Health Care Personnel discovered in the narration that the injury was a Not-Accidental and was Preventable
• because the Physical and/or Psychological Injuries and/or Improper Sexual Contact was inflicted, caused, created, or allowed to be inflicted, caused, created, directly or indirectly by a Problematic Coach and other Offender(s)
• Additionally, other offenders, when discovered in the narration, include colleagues and oversight administrators of Coaches who were involved in a Code of Silence and conspiracy to cover-up bad Coaching Behaviors and Child Athlete Endangerment and/or Sexual Abuse.
• Following the examinations and treatments the Doctor submits the ICD-9 injury Code
• and submits the ICD-9 Procedure Code, if a medical, surgical and/or orthopedic procedures were necessary during treatment
• and submits the ICD-9 modifier code for Child Abuse
• to insurance carriers which should in turn be 3rd party data mined that include Child Abuse authorities / investigators.
• These codes should be routinely data mined by researchers and authorities.
• Proper complete ICD-9 Coding is a means of Reporting Child Athlete Abuse to authorities when laws mandate that the diagnostic ICD-9 Child Abuse Codes be transferred to authorities, separate from the normal mandated Reporting.

E. CPS and County Attorney notify each other and confer and confer with Doctors and Health Care Personnel and decide where to charge the case. The County Attorney can bring charges in Adult Criminal Court following grand jury indictment and the County Attorney can bring charges in Family and Juvenile Court for Abuse without a grand jury.

F. Example: If a Child Athlete is hit in Left Eye by the fist of an angry Coach and sustains facial fractures such as a closed fracture of orbital floor (blow-out) and lateral orbital wall

• The Doctor Documents the Diagnosis / Treatment Plan in the ER/ED Medical Record
• Documents the Impression (Initial Differential Diagnoses):
• Closed fracture of orbital floor (blow-out) ICD-9 Code – 802.6
• Closed Fracture of lateral wall of orbit ICD-9 Code – 802.8
• Modifiers – Child Physical Abuse Confirmed ICD-9 Code – T74.12
• Modifiers – Child Physical Abuse Perpetrator Known ICD-9 Code – YO7
• The suspected Child and Youth Amateur Athlete Abuse ICD-9 Coding by the Doctor can be included in the differential diagnosis and is a call for an investigation by authorities into the circumstances of the injury when transmitted to investigative authorities.

*Facial X-Ray*

G. Federal and State Laws require Doctors to Report all forms of Child Abuse or risk charges of Failure to Report and also risk Malpractice Claims if they fail to Report and additional Athlete Injuries occur by the same un-Reported Problematic Coach because the Doctor failed to Report.

H. The 3 main objectives for understanding The Mechanisms That Transform Child Athlete Injuries To Child Athlete Abuse Forensic Investigations:
• Prevent Child Athlete Abuse Syndrome (CAAS) and Cruelty to Child and Youth Athletes, who Participate in Sports, Recreation and Exercise (SRE)
• Promote Athlete Safety 1st
• Prevent Criminal and Civil Risks for “Problematic Coaches” who don’t know about their legal relationship that they have with Children who participate in SRE

I. Forensic Medicine is the application of medical knowledge to questions of civil and criminal law, especially in court proceedings. Forensic Medicine is called forensic jurisprudence, legal medicine, medical jurisprudence. Forensic Medicine is also called legal medicine, when the applied use of medical knowledge or practice to the purposes of the law, as in determining the cause of death and the use of legal knowledge in the practice of medicine. Forensic Medicine is the interface of medicine and law. [Random House Dictionary, Random House, Inc. 2014.]

J. “Generally, disclosure of confidential clinical material to someone other than the patient will be an actionable breach of confidence; unlawful. There are, however, three circumstances when clinicians can release confidential clinical information:
• when the patient has given their consent;
• when the law requires disclosure (either under statute or a court order);
• when there is a public interest in disclosure.
[Medical records: Disclosing confidential clinical information Bridget Dolan, C Psychol, Barrister, Psychiatric Bulletin (2004) 28: 53-56]

K. American Academy of Pediatrics Policy Statement:
“When child abuse or neglect is suspected in a clinical setting, the physician may determine that release of information without consent is necessary to ensure the health and safety of the child. This policy statement provides an overview of HIPAA regulations with regard to the role of the pediatrician in releasing or reviewing patient health information when the patient is a child who is a suspected victim of abuse or neglect. This statement is based on the most current regulations provided by the US Department of Health and Human Services and is subject to future changes and clarifications as updates are provided. [From the American Academy of Pediatrics, Child Abuse, Confidentiality, and the Health Insurance Portability and Accountability Act, Pediatric Committee on Child Abuse and Neglect, Dec. 21, 2009, Pediatrics Vol. 125 No. 1 January 1, 2010 pp. 197 -201]

L. Pediatricians, Physicians and Doctors require no consent to release to proper authorities the medical records of a Child Athlete they suspect has been physically, psychologically and/or abused and/or suffered human rights violations.

M. Heger and colleagues report that “an international revolution in the process and protocols for evaluating sexually abused children” is taking place, including the increased involvement of medical professionals in these cases (Heger, Ticson, Velasquez, & Bernier, 2002, p. 654).
• Suspected sexual abuse victims often require more specialized forensic medical examinations than non-specialized medical clinics provide. Pediatric Forensic Pediatricians specially trained in examination of sexually abused children are more adept at identification in specialized clinics of injuries incurred. Results of this study suggest that Children’s Advocacy Centers, that provide more specialized forensic medical examinations, are an effective tool for furthering access to forensic medical examinations for child sexual abuse victims. They note that many children now have access to Children’s Advocacy Centers with medical experts. Children’s Advocacy Centers (CACs) are multidisciplinary organizations that investigate child abuse.
Additionally, states often have university teaching hospitals who have specialized forensic medical examiners.
• There are three purposes of exams. They can help identify medical evidence to prosecute the offenders (Britton, 1998; Kerns et al., 1994), screen for injuries and medical conditions and initiate medical treatment, and reassure victims and parents about the child’s physical well being (Britton, 1998; Hanson et al., 2001; Heger & Emans, 1992; Kerns et al., 1994). [ChildAbuse&Neglect 31 (2007) 1053–1068 Which sexual abuse victims receive a forensic medical examination? The impact of Children’s Advocacy Centers_Wendy A. Walsh a,∗, Theodore P. Cross b, Lisa M. Jones a, Monique Simone a, David J. Kolko c a Crimes against Children Research Center, University of New Hampshire, Durham, NH, USA b RTI International, Waltham, MA, USA c University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

N. The tools for understanding CAAS and Sports Violence are Education, Teaching, Scholarship, Research and Advocacy

O. Most individuals have a clear understanding of the meaning of violence. But the laws, policies and practices that are in place to protect children outside of sport are not always applied to organized sports play. Within certain sports, there appears a variety of definitions and situational circumstances that distort the meaning of the word, violence.

P. “Violence in sport can be defined as behavior that causes harm, occurs outside of the rules of the sport and is unrelated to the competitive objectives of the activity.” [conversation with Paul Melia and Karri Dawson Live, Beyond the Cheers]

Q. Currently, violence and abuse in sports have been neglected by many dysfunctional systems in crisis, some of whom were named by the Surgeon General and others included by this reporter following further research. [Surgeon General’s Workshop on Making Prevention of Child Maltreatment a National Priority: Implementing Innovations of a Public Health Approach, Office of the Surgeon General (US); 2005. NIH, Bethesda, Maryland, 2005]

R. These systems in crisis have resulted, sometimes from ignorance of the law, error, lack of will to enforce the law, and/ or frank maliciousness, resulting in obstruction of Athlete Safety 1st and CAAS Prevention:
• Public Health Services
• Sports Medicine
• Social /Child Welfare Systems
• Criminal Justice Departments
• Education-Awareness Groups
• Federal High School Athletic Federations
• State High School Athletic Associations
• Non-School Leagues and Associations

S. Free will is the voluntary choice or decision, the freedom of humans to make choices

T. Example: “I do this of my own free will”

U. Advances in our understanding of brain function will eventually change our views of free will, responsibility, and liability and could have a major impact on how the American legal systems treat and punish criminals. Maybe that bad behavior is related to brain pathology and not free will. Its suggested there is a link between brain pathology and some forms of criminal behavior and the reference emphasizes that neuroscience also provides a possibility of gaining insight into the cognitive processes of people.

V. “The link between the frontal lobes and social behavior dates back at least 150 years, to John Harlow’s descriptions of the injuries incurred by Phineas Gage, and the ensuing personality changes. Clinical observations of patients have enabled neurologists to localize behaviors to specific regions of the cerebral cortex. It is now relatively well established that the frontal lobes are involved in social cognition, as these processes are often impaired as a result of damage to this region of the brain.” [Free will, law & the brain, Mo Costandi, Neuroscience, Philosophy, April 17. 2007]

W. “In the American criminal justice system, the dominant justification for punishing individuals is that offenders have made a voluntary choice to break the law, thus validating the imposition of a societal sanction. However, recent discoveries in the field of genetics have called this theoretical assumption of individual, voluntary choice into question. Because genetic influences on behavioral traits may raise doubts about the nature of individual free will, some scientists have concluded that various members of society may be less able to refrain from breaking the law than others. Consequently, several commentators have suggested that this genetic research may shake the theoretical foundations of the criminal justice system to its core, and that a radical reorganization of the system is inevitable. Other commentators have predicted that the changes will be more subtle, perhaps manifesting themselves only in the context of specific criminal adjudications.” [Overcoming the Myth of Free Will in Criminal Law: The True Impact of The Genetic Revolution by Matthew Jones, 2003]

“To compensate for mental derangement, an insanity plea is when the defendant claims innocence due to mental incompetence at the time. Should there a verdict called “innocent by reason of insanity?” [Mental Illness and Innocence? Allan Schwartz, LCSW, Ph.D. Dec 5th 2011]

“With all of our technological progress, human beings still struggle with the same problems that have plagued us for millennia: unhappiness, loneliness, lack of love, war, poverty, bigotry, greed, exploitation, etc. In the United States today, 10% of the population takes anti-depressant medication. 50% of American marriages end in divorce. 66% of us are overweight or obese. There is clearly something amiss in the U.S..

“We Are ALL Innocent by Reason of Insanity” proposes that the basic problem facing humanity is our delusion about what is true. “Insanity” is defined as: confusing our mind-generated reality with actual reality. In practical terms, this translates as confusing subjective opinion with objective fact.

“Albert Einstein called this confusion of subjective belief with objective fact “the optical delusion of everyday consciousness.”

“We all star in our own personal reality-movie, playing constantly on an inner screen of awareness. We confuse this subjective melodrama with objective reality, which means we are deluded about what is real. [We Are ALL Innocent by Reason of Insanity, by Kathleen Brugger]

X. Child Advocacy (which includes Teaching, Scholarship, and Research) is considered to be both a methodology, as well an ideology that provides the protection of the rights and freedoms entitled to children. A child, whose legal classification as a minor allows for a multitude of supplementary legislature and requirements with regard to both the institution and the assurance that children are not subjected to abuse, neglect, harm, injury, or exploitation; in essence, the act of advocating for children is considered to be one of the primary precepts within the institution of the protection of children.
[http://child-abuse.laws.com/child-advocacy#sthash.qC4tolsV.dpuf]
[Child Advocacy Law, Aug 6, 2013 URL: http://guides.library.harvard.edu/content.php?pid=49820]

Y. Prevention of Child Maltreatment (CM) Through the Promotion Of Safe, Stable and Nuturing Relationships (SSNRs) Between Children and Caregivers, appears to be effective whether from brain pathology or “free will” .
• There is substantial evidence that promoting SSNRs can be effective in reducing child maltreatment. The most basic approach to facilitating SSNRs is
• positive reinforcement.38, 39 Some evidence also suggests that these types of programs can reduce CM.
• disseminated information, education
• teaching the information and skills to caregivers
• training caregivers, with programs that enable them to keep children safer and develop them more effectively
• SSNRs can also be facilitated by providing social support to caregivers
• Caregiver information, training and social support are often included within multicomponent child development programs
• Comprehensive child-caregiver centers, provide a stable, enriched learning environment
• children are exposed to a variety of caregivers other than their parents, including siblings, aunts, uncles, grandparents, family friends, daycare providers, school personnel, camp counselors and Coaches
• CM can occur at the hands of these caretakers; consequently the nature and quality of these relationships is also important to healthy childhood development.
• Example: to address the potential for child sexual abuse, such organizations should consider strategies for screening and selecting employees and volunteers (background checks), teaching guidelines for appropriate interactions between caretakers and children and policies for responding to inappropriate behaviors, and employee/volunteer training about child sexual abuse prevention.51
• In Sports, Recreation, and Exercise Participations the conclusion is the same as the Prevention Child Maltreatment (CM) Through the Promotion Of Safe, Stable and Developmental, not Detrimental, Relationships (SSDRs) Between Children and Coach Caregivers (Caretakers)
• Because Coaches are Temporary Substitute Caregivers (Caretakers)

Z. Society must train the Coaches in the 4 R’s of Coaching, which are necessary for Safe, Stable, Child Athlete Developmental Relationships (SSCADR’s) and Athlete Safety 1st. The 4 r’s are
Respect, Responsibility, Relationships, Recognition

I. Respect
“Coaches have a duty for the protection, safety, health, care, welfare and Human Rights of their Athletes. They should have a devotion-to and the highest regard for the humanity of their Athletes.

“Coaches are to regard and recognize the human dignity of their players. Coaches must pay attention, be compassionate recognize Athletes’ human value. Coaches should be considerate of players and athletes by treating them as humans. Coaches should dutifully respect the human life of their Athletes.

“Do unto others as you would want others to do unto you.”
Primum non nocere – “First do no harm to human life.”

II. Responsibility

“Coaches have an obligation of oversight for the Physical, Psychological (Emotional) well being and Human Rights of their Athletes during the administration of their coaching duties. Coaches must develop and implement responsible coaching policies and standards of Athlete Safety 1st.

“Coaches are accountable and hold an important position and Fiduciary duty of Trust by the players and athletes. Coaches have a designated authority for the proper care of their players and athletes.

“The Core of Coaching is Trust.

III. Positive Relationships

“Coaches should develop a positive relationship with their Athletes and develop an excellent level of mutual understanding and trust with good interpersonal communication.

“Devoting time for each player and athlete, the Coach will develop a positive relationship learning about each Athlete’s Ambitions, Abilities and Skills. Coaches develop a positive relationship by taking a personal interest with plans and techniques for each Athlete’s individualized improvement of play.

IV. Recognition

“Coaches should acknowledge and recognize Athletes when they accomplish their goals and execute their performance plans well. Special one-on-one notice and complementary attention to the Athlete will enhance the trust for the Coach and motivate the Athlete. A pat on the back or the butt goes a long way. [http://www.cappaa.com/category/4-rs-of-coaching]

“Coaches are shocked to learn that they can be reported, investigated, indicted and adjudicated in Court even after following High School Athletic Association Rules, Regulations and By-Laws to the letter.

A small core of researchers began investigating non-Accidental, Preventable Sports Injuries. In the beginning few researchers named the elephant in the locker room, the Problematic Coach. Bear in mind, there are many fine, upstanding, respected Coaches. However, a “few bad apples” spoil the lot in any profession.

Dr. Frederick Mueller, the director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina, said that all heat-related football deaths are preventable if proper precautions are taken, including providing players with plenty of water and rest.

There is also cheerleading injury crisis, Dr. Frederick Mueller said, “There are coaches who aren’t certified and knowledgeable enough to teach some of these stunts to their cheerleaders”.

“Youth athletes are not the same as small adults,” says Dr. E. Lyle Cain Jr. of the Andrews Sports Medicine & Orthopedic Center in Birmingham, Ala.

“Certain types of injuries “can cause permanent damage that affect their future growth.” Pitching offers a prime example. The Andrews clinic counts a five- to six-fold increase in serious shoulder and elbow injuries in youth baseball and softball since 2000. Traveling teams “play and train in some sports virtually year-round”. Cain reports, “Will we have a whole generation of middle-aged adults with early arthritis?”

“Baseball has high potential for overuse injuries. “Many of us in the sports medicine community have seen talented young players forced to end their careers prematurely because of shoulder or elbow injuries.”

“Dr. Andrews and Dr. Jobe have advocated a minimum of three to four months a year as time away from baseball and other overhead throwing sports.”

Dr. Kay Collier McLaughlin, in “A Longitudinal and Retrospective Study of The Impact of Coaching Behaviors on the 1961-1962 University of Kentucky Football Wildcats”, found Post Traumatic Stress Reactions are the dominating illness trait of Coach Charlie Bradshaw abused athletes 45 years after their abuse occurrence.

Guskiewicz et al reported that depression is the most cited psychological disturbance after traumatic brain injury, with prevalence rates from 6% in cases of mild traumatic brain injury to 77% in more severe TBI within the first year after injury.[WHO’S WINNING? Mbmsrmd 12/27/20012]

Doctors are in the center of the Comprehensive Model of organized Participation in Sports, Recreation and Exercise (SRE) and Coaching Supervision.

Doctors encourage Children to get involved in SRE for better health and social well being, providing that all safety rules are followed and Coaches adhere to normal supervisory / caretaker behaviors.

SRE begins with the Pre-Participation Physical Examination, interspersed with diagnoses and treatments following injuries and the end of participation which might end with no return to SRE participation following severe injuries.

In the event of an Epidemic of Morbidity and Mortality, Doctors will be called as expert witnesses to testify concerning the causes for injuries or deaths and/or SRE reforms or possibly a specific SRE termination. [Injury Prevention in Child and Adolescent Sport: Whose Responsibility Is It? Carolyn A. Emery, PhD,* Brent Hagel, PhD,† and Barbara A. Morrongiello, PhD‡Clin J Sport Med _ Volume 16, Number 6, November 2006]

However, “the main and first issue is that parents aren’t aware of the possible risks of playing a sports. Many parents just simply sign their children up for sports without looking into the dangers of participating.” [Dorine C.M. Collard, et al. “Acute Physical Activity And Sports Injuries In Children.” Applied Physiology, Nutrition & Metabolism 33.2 (2008): 393-401]

A second issue is that it is imperative that Doctors screen out the potential Athletes who are at risk for injury and death due to a medical conditions Doctors find during the Pre-Participation Physical Examination.

A third issue is that Doctors are mandated to report Child Athlete Endangerment, Maltreatment and Physical and Psychological Abuse and Sexual Abuse. Doctors have been negligent in that duty.

“The Chicago Tribune reported that in 1904, there were 18 football deaths and 159 serious injuries, mostly among prep school players. Obituaries of young pigskin players ran on a nearly weekly basis during the football season. The carnage appalled America.

“Newspaper editorials called on colleges and high schools to banish football outright. “The once athletic sport has degenerated into a contest that for brutality is little better than the gladiatorial combats in the arena in ancient Rome,” opined the Beaumont Express. The sport reached such a crisis that one of its biggest boosters—President Theodore Roosevelt—got involved.

At first “In life, as in a football game,” Roosevelt wrote, “the principle to follow is: Hit the line hard; don’t foul and don’t shirk, but hit the line hard!”

In 1903, the president told an audience, “I believe in rough games and in rough, manly sports. I do not feel any particular sympathy for the person who gets battered about a good deal so long as it is not fatal.”

“Football was fatal and in the 1905 season it appeared to be a “death harvest.” It resulted in 19 player deaths and 137 serious injuries and even Roosevelt acknowledged it required reform if it was to be saved. With his son Theodore Jr. now playing for the Harvard freshman team, he had a paternal interest in reforming the game as well.

“An intercollegiate conference, which would become the forerunner of the NCAA, approved radical rule changes for the 1906 season [How Teddy Roosevelt Saved Football, by Christopher Klein, History in the Headlines, September 6, 2012]

“The special legal duties and liabilities team physicians have are rapidly developing areas of law (Collum, 2001). Since 1990, there has been a significant increase in sports medicine related litigation (Gallup, 1995). The increasing economic benefits of playing sports, such as college scholarships or multi-million dollar professional contracts, have inspired injured athletes to seek compensation for injuries resulting from negligent medical care (Herbert, 1991).”

There were 7 areas for potential liability and concern for physicians and trainers who deliver care to Athletes described in this research. Maintaining malpractice insurance coverage was one of the areas included. [Practical and Critical Legal Concerns for Sport Physicians and Athletic Trainers ISSN: 1543-9518 by: Steve Chen & Enrico Esposito The Sport Journal, United States Sports Academy]

“Children and young adults are playing a large variety of sports in ever-increasing numbers.”
[LexisNexis 2012]

In the near future, will physicians be denied malpractice insurance for Athlete Injuries because of the “significant increase in sports medicine related litigation”?

Also worrisome is the other possibility, that premiums for malpractice coverage of Athlete Injuries might sky rocket and be cost prohibitive for Doctors and Trainers? Hence they will discontinue care for Athlete Injuries.

Concussion mismanagement is an example of an injury with significant malpractice risk for Doctors and Trainers.

Abstract: “The areas of liability that Sports Physicians and Athletic Trainers may face in their delivery of care: The major topics which were covered by this article included: (1) informed consent and participation risks, (2) physician-patient relationship, (3) immunity issues, and (4) risk management. In conclusion, seven protective strategies were recommended for sport physicians and athletic trainers to insure acceptable service standards. They were: (a) maintaining a good physician-client relationship with athletes; (b) obtaining informed consent and insist on a written contract; (c) educating the athletes, parents and coaches concerning issues of drug abuse, assumption of risks, confidentiality; (d) performing physical examinations carefully, and be cautious on issuing medical clearance; (e) formulating a risk management plan and properly document hazards and records; (f) participating in continuing education and recognize your qualifications; and (g) maintaining insurance coverage.” [Practical and Critical Legal Concerns for Sport Physicians and Athletic Trainers ISSN: 1543-9518 by: Steve Chen & Enrico Esposito The Sport Journal, United States Sports Academy]
[DOCTORS ARE IN THE CENTER OF SPORTS RECREATION AND EXERCISE, by mbmsrmd, October 17, 2013
http://www.cappaa.com/doctors-are-in-the-center-of-sports-recreation-and-exercise]

Doctors and Health Care Personnel have a dynamic interactive relationships with SRE Athlete Participants. Doctors and Health Care Personnel perform the Pre-Participation SRE Examinations, treat Athletes’ Injuries when they occur, release previously injured Athletes to return to play when indicated, recommend termination of an Athlete’s career when necessary, even declare them physically disabled to work certain employments and can be called as expert witnesses to testify concerning the causes for injuries or deaths and/or SRE.

“Parents and Guardians cannot give consent for their Child Athletes to participate in Sports, Recreation and Exercise (SRE) that includes serious Physical and Psychological Injuries and Death and Sexual Abuse on the Child Athlete Person. That consent is invalid because Maltreatments and Endangerments that cause these catastrophes are not “reasonably foreseeable hazard’s” that are inherent to the game. [ Kimberly A. Harris, Death at First Bite: A Mens Rea Approach in Determining Criminal Liability for Intentional HIV Transmission, 35 ARIZ. L. REV. 237, 248 (1993) (noting Model Penal Code does not allow consent as defense in cases of serious bodily harm; See id. at 248 n.104 stating Model Penal Code permits “consent as a defense to serious bodily injury only where such injury is a ‘reasonably foreseeable hazard’ of participation in sports or athletic contests”]

“The Rat Maze for Justice for Abused Child Athletes is a complex journey in the United States and Internationally. Once Child Protective State Laws reflect federal CAPTA 2010 Laws as the Supreme Rules, other systems that are dysfunctional for Abused Child Athletes, i.e. Public Health Services, Social and Child Welfare Systems, Education and Awareness Groups and Federal and State High School Athletic Associations etc. will begin to toe the line. They, too, will conform to legitimate Rules and Standards of Child Protection, Care and Welfare during SRE Participation.

As for Child Athlete Sports, Recreation and Exercise Participations, you can spice-it-up, cook-it-up and chew-it-up any way you want-to, but there’s only one way you can swallow-it-up and eliminate it, you got to do-it in accordance with State and Federal Child Protection Rules of Law.
[mbminixmd, NAVIGATING THE RAT MAZE OF JUSTICE FOR THE ABUSED CHILD ATHLETE, 3/8/2011]

“The studies, published in the journal Health Affairs, found that in 2013, almost eight in ten (78 %) office-based physicians reported they adopted some type of EHR system. About half of all physicians (48 %) had an EHR system with advanced functionalities in 2013, a doubling of the adoption rate in 2009.

Doctors can lead the way to Promote Athlete Safety 1st, Prevent Not-Accidental, Preventable Injuries and “swallow-CAAS-up and eliminate it”. Doctors got to do-it in accordance with State and Federal Child Protection Laws.

Doctors must do their Duty to Children for
• the Promotion of Athlete Safety 1st,
• Prevention of Not-Accidental, Preventable Physical and Psychological (Emotional) Athlete Injuries,
• Prevention of Child Athlete Sexual Abuse
• Prevention of Human Rights Violations
• and Promotion of Deterrence of Criminal and Civil Punishments for “Problematic Coaches”, who don’t understand the legal relationship that Coaches have with Children, who participate in SRE (Sports, Recreation and Exercise) by:
1. Reporting Child Athlete Abuse in accordance with state and federal Child Protection Laws in which Doctors are mandated to Report.
2. While preventing the Doctor’s risk of
a. charges of Failure to Report Child Abuse
b. of Malpractice Claims, if they fail to Report and subsequent additional Athlete Injuries occur by the same un-Reported Problematic Coach because the Doctor failed to Report after the first injury/abuse
3. Recording Child Athlete Abuse with the appropriate ICD-9 Codes and Modifier Codes, that are already provided in the International Classification of Diseases, 9th Revision (ICD-9) on submitted insurance claims, that will be data mined by researchers and authorities.

The laws, policies and practices that are in place to protect children outside of SRE must be applied during organized SRE participations. No one, in any profession and no citizen, from the President of the U.S., Doctors, Judges, Lawyers, teachers, Coaches and so on, is above the law.

“Health and Human Services announced $100 million in federal grant to improve health care quality and delivery systems for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).

The grants were funded by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). The money will help states implement and evaluate provider performance measures and utilize health information technologies such as pediatric electronic health records (ICD-9 Code data research) and other quality improvement initiatives.
“We all have a stake in the health of our nation’s children,”….“Exploring new technologies and initiatives will help ensure our kids get the high quality care they need and deserve.”

The grants are totally federally funded and are designed help establish a national quality system for children’s health care through Medicaid and CHIP.

“These grants will test the most current theories of how to improve the quality of care delivered to children,” said Cindy Mann, director of the Center for Medicaid and State Operations within CMS. “These awards will help create the foundation for a more responsive and effective national system of high quality health care for children.”

The Affordable Care Act Data will test a new set of child health quality measures, and will use the funds to implement health information technology (HIT) strategies for specifically planning to develop a new pediatric electronic health record format, including Child Abuse. [100 Million Awarded Over 5 Years to Test Innovations in Children’s Health Care, Health Management Technology News Archive More physicians and hospitals are using EHRs than before]

New child health quality measures should include new mechanisms to increase Doctor and Health Care Personnel Child Athlete Abuse Reporting and use of Child Athlete Abuse ICD-9 Child Abuse modifier codes, which will provide more data for Child Athlete Physical, Psychological and Sexual Abuse data mining for researchers and authorities.

No child should be left behind, suffering and/or disabled from Not-Accidental, Preventable, Abusive Sports Injuries and/or Child Athlete Sexual Abuse.

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