Club doctors and concussion injury management: A cross-jurisdictional review of conflicts of interest in professional football

This chapter examines the legal and ethical issues associated with the medical management of concussion injuries across two professional sports in two jurisdictions: the National Football League (NFL) in the United States and the Australian Football League (AFL) in Australia. The traditional tripartite model for managing concussion injuries in professional sport has come under intense scrutiny following heightened awareness of sport-related concussion and concerns about the inherent structural conflicts of interests arising when club doctors have dual obligations owing to clubs and players. In the NFL, public scrutiny through congressional hearings, litigation and compensation settlements, prompted changes in the NFL including the appointment of unaffiliated neurotrauma specialists. In Australia, the AFL practices are currently under review with the commencement of legal proceedings in concussion-related negligence claims and a coronial inquiry recommendation calling for greater independence in medical management. In both sports, recent iterations of collective bargaining agreements enhance player health and safety. Although the sports have enhanced mechanisms in concussion injury medical management, debate continues calling to address inherent structural conflicts of interest.