Keeping a person’s health information confidential is vital. As a pediatrician, I am ethically and legally bound to protect the medical information of my young patients, and I take that duty very seriously. My patients and their parents count on it.
A Florida school district recently made headlines over concerns that teenage athletes were being asked to submit sensitive health information prior to scholastic sports participation. Athletes in this district are required to fill out a health questionnaire online and the responses are digitally stored by a private company. Parents voiced alarm about questions that asked athletes about their menstrual periods.
While the five questions about menstrual history were optional, families found them particularly concerning given the U.S. Supreme Court’s Dobbs decision, which deprives Americans of abortion rights that were previously recognized as guaranteed by the Constitution. Florida has an abortion law in place that bans the procedure after 15 weeks of pregnancy. Anyone who “willfully performs, or actively participates in, a termination of pregnancy” is subject to felony charges.
Concerns were raised that law enforcement could subpoena information from a third party about adolescents’ menstrual periods to pursue criminal charges related to abortion. Amid the backlash, Palm Beach County school officials asked the state’s high school athletics association to remove the questions about periods. But this is not an unusual case. Student athletes in many other regions of the country are required to submit sensitive medical information to play sports.
Undergoing a preparticipation physical evaluation (PPE), or sports physical, is customary for young athletes. Sports physicals allow health care providers to screen children and adolescents for life threatening conditions and other health problems that could make involvement in sports riskier. The PPE also offers medical providers the opportunity to counsel young athletes about how to prevent sports-related injuries.
As part of the PPE, health care providers ask young athletes about their current health, previous medical problems and family history of conditions that affect sports participation, and perform a comprehensive physical examination. Health care providers typically use questionnaires to ask young athletes about prior bone and joint injuries, symptoms of heart problems, and other conditions.
Some of the questions on medical history forms address sensitive topics, such as eating disorders, mental health, drug and supplement use, and frequency of menstrual cycles. Answers to these questions help health care providers determine if an athlete is at increased risk of injury or illness. For example, an athlete with irregular menstrual periods may be at increased risk of stress fractures. All records related to medical history and physical examination are confidential and protected by laws intended to ensure patient privacy, such as the Health Information Portability and Accountability Act.
While nearly all states require high school athletes to have a sports physical, each state’s high school sports association has its own rules about who can perform the PPE and what type of documentation must be submitted for an athlete to be eligible to play. The American Academy of Pediatrics has collaborated with other professional organizations to create guidelines for conducting the PPE and to create three separate, standardized medical history, physical, and medical eligibility forms. About half of the state athletic associations have adopted a version of these forms.
The history and physical forms are intended to become part of an athlete’s medical record. The medical eligibility form documents which sports an athlete can safely be cleared to play. This form also provides a section for health care providers to share relevant emergency medical information. The medical eligibility form is the only document designed to be shared with coaches, teachers, principals, and other school administrators and provides all the information necessary to promote safe sports participation.
While students should not be required to share such protected health information, the AAP recognizes the benefits of school-based athletic trainers and school nurses having access to health history and physical examination forms. Athletic trainers are health care professionals who have a critical role in preventing injury and providing acute medical care to athletes and they are bound by privacy rules that apply to medical personnel. The AAP encourages parents of student athletes to share information with school nurses and athletic trainers, if they are comfortable doing so.
The AAP is calling on state high school athletic associations, sports organizations and schools to amend their processes related to the PPE requirement so that only essential medical eligibility information is accessible to non-medical personnel.
Young athletes should not be forced to compromise protected health information to play sports.
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ABOUT THE WRITER
Dr. Rebecca L. Carl is a pediatric sports medicine at the Ann & Robert H. Lurie Children’s Hospital in Chicago and a member of the American Academy of Pediatrics Council on Sports Medicine and Fitness.
