As most of you will know from the news barrage, the UK High Court has overturned an earlier decision of the Health Professions Council to have sports physiotherapist Stephen Brennan struck off.(1)
Background: Brennan admitted his part in the ‘Bloodgate’ scam. He provided fake blood capsules to the player (Tom Williams) in order to deceive match officials into accepting a replacement, thereby allowing a specialist kicker to take the field. Brennan also ‘took an active role in the drafting of false witness statements’ in an effort to sustain the deception.(1) The HPC decided he displayed a degree of premeditation in his actions because he purchased and carried blood capsules in his bag for the purpose of removing players from the field. Brennan had used the capsules a number of times previously. However it appears that he administered these for ‘player welfare reasons’ indicating that he felt deception was required to achieve health aims.
New stuff: Are disciplinary measures warranted? Yes, absolutely. Using deception for health aims is arguably defensible; deception for the purpose of cheating is not. Also, we should not forget that Brennan falsified documents to sustain the lie.
However, being struck off is a serious decision, and while the mechanism for doing so should always be retained, it should be reserved for certain situations such as threats to public health and safety posed by incompetent or malicious practitioners. Brennan was clearly a highly regarded and very competent physiotherapist (he was appointed as physiotherapist to the England rugby team immediately prior to these events).(1) Brennan was neither malicious nor incompetent, and while the actions were wrong, they did not pose a threat to public health or safety.
The public expects health professionals to be trustworthy and Brennan has fallen short of this expectation. The act of falsifying documents demonstrates a lack of integrity and veracity. For this lapse and for the original deception; some action is warranted. But what is appropriate? To be struck off seems harsh, especially for a first offense. Mandatory training in ethics and professionalism seems more reasonable, but some suggest this may not be enough.(2) It seems highly unlikely that Brennan will reoffend.
However, simply disciplining the individuals involved fails to attend to the issues central to the ‘Bloodgate’ scandal and common to the practice of medicine in sport. Health professionals are required to act in the best interests of their patients but identifying these can be problematic in the sports setting. Sports health professionals commonly face pressure within their employment setting that does not relate specifically to patient health.(3) Employers and coaches may make demands on sports health professionals contrary to the primary role of caring for players.(4)
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1. Health Professions Council Committees Findings. Stephen Brennan Physiotherapist. 13/9/2010. www.hpc-uk.org accessed 30th September 2010
2. Holm, S. & McNamee, M. Ethics and Sports Medicine. BMJ 2009; 339:b3898
3. Meldan Devitt, B. & McCarthy, C. ‘I am in blood Stepp’d in so far…’: Ethical dilemmas and the sports team doctor. Br J Sports Med. 2010. 44: 175-178
4. Furrow, B. The problem of the sports doctor: serving two (or is it three or four?) masters. Saint Louis University Law Journal. 2005: 50 165-183