Public Health Committee
JOINT FAVORABLE REPORT
AN ACT CONCERNING THE PRACTICE OF ATHLETIC TRAINING.
Joint Favorable Substitute
SPONSORS OF BILL:
Public Health Committee
REASONS FOR BILL:
To revise statutes concerning the practice of athletic training to reflect changes within the profession.
RESPONSE FROM ADMINISTRATION/AGENCY:
NATURE AND SOURCES OF SUPPORT:
Douglas J. Casa, Athletic Training Education Director, University of Connecticut: Many athletic training students that graduate must consider moving out of state if they wish to practice athletic training outside the traditional work venues since Connecticuts scope of practice is limited. Many of our graduates wish to work in industrial, military, hospital and clinic settings. We are hopeful that an update of the state practice act can assist in keeping many of the phenomenal medical talent in the State.
Eleni Diakogeorgiou, Select Physical Therapy: SB 1051 would help maintain and create many jobs in the state by allowing athletic trainers to fully utilize their education, competency and training. This bill would allow more clinicians to practice in settings that currently has a shortage of professionals and help provide ample, quality care to citizens of Connecticut.
Gary E. Morin, Professor in Exercise Science, Southern Connecticut State University: The level of opportunities for athletic trainers in Connecticut have not coincided with the changes in education requirements, coursework in general medicine, pharmacology, orthopedic examination, therapeutic exercise, and emergency care that have been added to the athletic training curriculum across the country. Athletic trainers are not looking to care for individuals outside their education level, but simply to apply the knowledge acquired to individuals whose health care providers such as physicians believe would benefits from their skills.
Julie G. Alexander, MSEd, ATC, LAT, CSCS: Reference was made to two cases involving Division I student athletes. The first case dealt with a dislocated shoulder and the other with a spinal injury. Both cases involved a Certified Athletic Trainer working with other medical staff to ensure proper medical care was provided. These cases emphasize through real life situations the necessity of SB 1051. This bill allows Certified Athletic Trainers the freedom to do what they are educated and trained to do, while fostering a professional relationship with the team physician.
Justin LeDuc, Head Athletic Trainer, Trinity College: An athletic trainer is capable of providing services to student athletes that encompass prevention, assessment, and intervention of emergency, acute, and chronic medical conditions involving impairment and functional limitations. Athletic trainers have been valued by sports medicine specialists and physicians for more than 60 years. The proposed changes to the Connecticut Athletic Trainers Practice Act would allow “non athletes” the same access to a healthcare provider educated and trained to provide them with a high level of care. This legislation will allow athletic trainers to fill similar roles and practice within the full scope of their education and training. The passage of this bill would also increase employment opportunities that will benefit the Connecticut Athletic Training Education Programs.
Vicky Graham, Athletic Trainer, Wesleyan University: The current athletic training practices restricts athletic trainers to treating “athletic injuries”. Athletic trainers are highly trained in injury prevention and providing treatment that allows individuals to return to an extremely high level of function. This bill would update the athletic training practice act to reflect changes in current practice that are the result of growth in the profession. These changes would allow athletic trainers in Connecticut to practice to the fullest extent of their education and training, create jobs for athletic trainers, and improve the public's access to physical medicine and rehabilitation services.
Suggestions for changes are as follows:
● lines 18-21, “by a health care provide and (C) [the organization and administration of athletic training programs,
and (D) education and counseling to athletes, coaches, medical personnel, and athletic the community ies in the area of the prevention and care of athletic injuries]”.
● Proposed changes to line 64-68, “Written standing orders
may shall include guidelines for treatments and managements of traumatic brain injuries. And concussions. Written standing order shall be periodically annually reviewed by a the health care provider and the athletic trainer and may shall be renewed on an annual basis.”
● Proposed changes to line 89, “provider of an [athlete] individual who has an
athletic injury or clinical condition whose.” Finally, proposed changes to line 99, “[not under standing orders] who does so without the specific consent and direct of a.”
NATURE AND SOURCES OF OPPOSITION:
Katherine Harris, Chief Delegate of the Connecticut Physical Therapy Association: The athletic trainer's classroom and clinical education does not sufficiently prepare potential athletic trainers for the patient's settings or standard of supervision that is being considered in SB 1051. After comparing the Athletic Trainer Certification and the Physical Therapy Licensure content outline, it is clear that the Athletic Trainer Certificate content suggests that the depth of knowledge necessary to operate outside of the pre-screened populations without direct supervision is suggested in this bill. Athletic Trainer education and training is not sufficient to address the many needs of the potential patients that fall within the scope of this bill.
Joan-Alice Taylor, CT Physical Therapy Association: This bill would allow Athletic Trainers to work in settings where they have no experience. Written standing orders are no substitution for professional judgment developed through education as well as clinical experience. The interpretation of “Athletic Trainer” as proposed in this bill is virtually limitless. They would be allowed to perform any rehabilitative procedure as long as it is even a minimal part of their education and training. Allowing this type of loose restriction would be a mistake and an overreach.
Thomas Trojain, MD, University of Connecticut: There are issues of concern with this legislation. First, the removal of the phrase [organization and administration of athletic training programs], and [education and counseling to athletes, coaches, medical personnel, and athletic communities in the area of the prevention and care of athletic injuries] is detrimental to the care of athletes in the state.
Removing this language from the bill will also jeopardize training programs throughout the state. Oversight of athletic trainers is important as they work in conjunction with health care providers.
Another area of concern is the language that requires a health care provider's personal review of the athletic trainer's services. This requirement is excessive and an unnecessary oversight for a physician working with an athletic trainer.
Susan Goszewki, President, Connecticut Occupational Therapy Association (ConnOTA): Occupational Therapy is a science driven, evidence based profession that enables people of all ages to live life to its fullest by helping them promote health and prevent injury or disability. The proposed changes to the scope of practice of athletic trainers define athletic training with few parameters and allow athletic trainers to treat almost any individual that has sustained an injury through any type of movement. The athletic trainer scope of practice provisions as outlined by these changes are limited only by what is “within the limits of the education and training of an athletic trainer.” This would imply that should the education of an athletic trainer change then the scope of practice could expand without the need of amending the practice act.
Areas of concern are as follows:
In Section 1:
(1) an athletic trainer is able to provide evaluation and treatment to anyone regardless of their current or prior level of function. This would include medical treatment provided to both acute and chronic injuries. The language includes “rehabilitation” which is a broad area of practice.
(2) The term “athletic injury” is changed to any clinical condition and allows athletic trainers to evaluate and treat any “clinical condition” if deemed appropriate by a healthcare provider without any regulation, clarification, or explanation as to the competency of the individual proving services.
(3) The addition of wellness care and the deletion of the definition [athlete] is removed from the definition. It is proposed that Athletic Trainer would have the educational skills, knowledge and training to perform workplace ergonomics or injury intervention to anyone. After reviewing the National Athletic Trainers Association 5th Edition Competencies Document, information regarding competency in ergonomics and injury prevention in the workplace did not exist.
(4) This subsection implies that Athletic Trainers can work under “standing orders” which are not specific to the individual. This would include evaluation and treatment of an individual with a traumatic brain injury or concussion, it does not exempt any condition. The bill does propose oversight control and direction, but does not mention the frequency of review. It also allows the Athletic Trainer to provide interventions in the absence of a written or standing order and without direction of a healthcare provider.
Reported by: Danielle Duenos