Article 39Players’ Rights To Medical Care and Treatment
Section 1. Club Physician(a)Medical Credentials.
Each Club will have a board-certified orthopedic surgeon as one of its Club physicians (“Head Team Orthopedist”), and all other physicians retained by a Club to treat players shall be board-certified in their field of medical expertise. Each Club will also have at least one board-certified internist, family medicine, or emergency medicine physician (“Head Team Primary Care Sports Medicine Physician”). Each Club shall designate either its Head Team Orthopedist or its Head Team Primary Care Sports Medicine Physician as the “Head Team Physician.” Any Club medical physician (internist, family medicine or emergency medicine) or any Head Team Physician (orthopedic or primary care sports medicine) hired or appointed to that role after the effective date of this Agreement, must have one of the following:
- i. A Certification of Added Qualification (CAQ) in Sports Medicine; or
- ii. Certification by a current NFL Head Team Physician that the physician has:
- a. Three (3) years affiliation with an NFL Club’s medical staff, during which the physician must have attended and participated in Training Camp(s), NFL Scouting Combine(s), and a minimum of sixteen (16) games (including preseason and away games); and
- b. Comprehensive knowledge of the NFL Head, Neck and Spine Committee’s Concussion Protocol, the NFL Policy and Program on Substances of Abuse, the NFL Policy on Performance-Enhancing Substances, the NFL’s Behavioral Health Program, the NFL’s Pain Management Guidelines, the NFL’s policy on spinal injuries, the NFL Emergency Action Plan, the prevention, diagnosis and treatment of Heat-Related Illness; and the DICON Program for Infection Prevention in the NFL.
All Clubs shall have consultants with the following certifications:
- (i) Neurological: All Clubs are mandated to have a neurological consultant. The Club neurological consultant must be board certified in neurosurgery, neurology, sports medicine, emergency medicine, or physiatry (physical medicine and rehabilitation). If the designated physician is board certified in physiatry (physical medicine and rehabilitation), he/she must demonstrate extensive experience in mild and moderate brain trauma;
- (ii) Cardiovascular: Board certified in cardiovascular disease;
- (iii) Nutrition (athletes): licensed;
- (iv) Neuropsychologist: Ph.D and certified/licensed;
- (v) Behavioral Health Specialist (as set forth below); and
- (vi) Pain Management Specialist (as set forth below).
Other physicians who may not meet the requirements set forth in Sections 1(a) and 1(b) of this Article may serve as Team Consultants, provided that they work under the supervision of an existing, qualified physician as set forth in Section 1(a).(c)Credentials.
The parties shall jointly appoint an independent, third-party credentialing organization to verify that the medical professionals appointed satisfy the requirements of this Article 39 possess the respective required medical credentials.(d)Head Team Physicians.
Within an individual Club, either the Head Team Orthopedist or the Head Team Primary Care Sports Medicine Physician, as applicable, shall have the exclusive and final authority to determine whether a player is cleared to return to participation in football activities. All Club personnel involved in performance optimization activities and/or other health-related issues (e.g., strength and conditioning coaches and sports performance staff) shall keep the Head Team Physicians fully informed regarding their activities with Players and shall in no event take any measures inconsistent with Players’ medical care and management overseen by the Head Team Physicians. If the Head Team Physicians determine that any such areas involve medical care and management, the Head Team Physicians shall have the final authority to make, modify or override decisions in such areas. For the avoidance of doubt, this Subsection is not intended to impact a player’s right to obtain a second opinion as provided in this Article, the Grievance procedures in Article 43 and Article 44 of this Agreement, or the Injury Protection and Extended Injury Protection procedures in Article 45 of this Agreement.(e)Medical Providers and Allegiance.
The cost of medical services rendered by Club physicians, Club Athletic Trainers, Physical Therapists, and other medical providers (together, “Club medical personnel”) will be the responsibility of the respective Clubs, but the Club medical personnel’s primary duty in providing player medical care shall be not to the Club but instead to the player-patient regardless of the fact that he/she or his/her hospital, clinic, or medical group is retained by the Club to diagnose and treat players. The Club medical personnel shall not disclose confidential player health information except as permitted. In addition, all Club medical personnel shall comply with all federal, state, and local requirements, including all ethical rules and standards established by any applicable government and/or other authority that regulates or governs the medical profession in the Club’s city. All Club physicians are required to disclose to a player any and all information about the player’s physical condition that the physician may from time to time provide to a coach or other Club representative, whether or not such information affects the player’s performance or health. If a Club physician advises a coach or other Club representative of a player’s serious injury or career threatening physical condition which significantly affects the player’s performance or health, the physician will also advise the player in writing. The player, after being advised of such serious injury or career-threatening physical condition, may request a copy of the Club physician’s record from the examination in which such physical condition was diagnosed and/or a written explanation from the Club physician of the physical condition.
Section 2. Club Athletic Trainers
By the opening of training camps for the 2021 Season, each Club shall employ or retain the services of at least one (1) athletic trainer to serve as the Head Athletic Trainer and two (2) additional athletic trainers to serve as Assistant Athletic Trainers on a full-time basis. Any individual hired for the first time after the execution of this Agreement to perform services as an athletic trainer for a Club must, as of the hiring date; (a) have a Master’s Degree; (b) be a Member of the National Athletic Trainers Association (NATA) and be certified by the Board of Certification (BOC); and (c) hold a current certification in Basic Cardiac Life Support or Basic Trauma Life Support. In addition to these requirements, any individual hired for the first time after the execution of this Agreement to perform services as a Head Athletic Trainer for a Club must, as of the hiring date, have at least five (5) years of experience as an athletic trainer since he/she first received the foregoing NATA/BOC certification and demonstrated experience working with elite athlete populations (i.e., Division I Collegiate, Olympic, or professional level athletes). Each Club must also employ or retain the services of at least one (1) full-time physical therapist. For the avoidance of doubt, the full-time physical therapist may also serve as one (1) of the two (2) Assistant Athletic Trainers if he or she meets the qualifications of both positions. Any individual hired for the first time after the execution of this Agreement to perform services as a physical therapist must have a Doctorate of Physical Therapy. All Athletic Trainers and Physical Therapists, regardless of dates of hiring, shall complete annual Continuing Education Units (CEUs)/Evidence Based Practices (EBPs) specific to concussion, heat acclimatization, behavioral health, and pain management.
Section 3. NFLPA Medical Director
The NFL recognizes that the NFLPA Medical Director has a critical role in advising the NFLPA on health and safety issues. Accordingly, the NFL agrees that the NFLPA Medical Director shall be a voting member of all NFL health and safety committees, including the following; (1) Accountability and Care Committee; (2) NFL Health and Safety Executive Committee; (3) General Medical Committee; (4) Musculoskeletal Committee; (5) Head, Neck and Spine Committee; (6) Pain Management Committee (as set forth below); (7) Comprehensive Mental Health and Wellness Committee (as set forth below); (8) Field Surface Safety & Performance Committee (as set forth below); and (9) Engineering and Equipment Safety Committee (as set forth below), and their related subcommittees. The preceding sentence shall not limit or restrict the NFL Chief Medical Officer’s ability to consult with and/or seek counsel from experts regarding medical, scientific and/or other health and safety-related subjects without the involvement of the NFLPA Medical Director. The NFLPA Medical Director shall have access to all of the same data, records and other information provided to the NFL and/or any other members of NFL health and safety committees, including to the Injury Surveillance System’s data. The NFLPA shall have access to the Injury Surveillance System’s data. If the NFLPA or the NFLPA Medical Director requests, on behalf of the NFLPA, that any data analysis be conducted, the cost of that analysis shall be borne by the NFLPA. The Parties agree that data for use in medical research shall be disseminated in accordance with the agreed-upon Medical Research Protocol, as set forth in this Article and in Appendix X of this Agreement.
Section 4. Emergency Action Plan
The parties shall jointly select an expert in the field of emergency medicine (the “EAP Expert”) to help them establish minimum standards, protocols, and a standardized format for an Emergency Action Plan (“EAP”) that shall be required to be submitted by every NFL Club to address player medical, cardiac and/or surgical emergencies that occur at games hosted at their home stadium, as well as at the practice facility (if different from the game day venue). The EAP Expert will also be responsible for reviewing every EAP submitted and offering an opinion as to whether such EAP meets the criteria set forth by the parties. The parties (through the NFL Chief Medical Officer and the NFL Players Association Medical Director) must review all EAPs prior to the start of the season and, following consideration of the EAP Expert’s opinion, approve, deny, or request modification of the submitted EAP. Every NFL Club is required to have an approved EAP in place prior to their first preseason home game. At the end of each season, the parties, in consultation with the retained expert, shall review the minimum requirements for EAPs and update as appropriate (any changes requires consent of both parties). The EAP requirements shall be published to every NFL Club prior to March 15 of each year to ensure that Club medical staffs have adequate notice of any changes.(a)Emergency Action Plan Components. .
EAPs shall, at a minimum:(a)(i)
Identify a suitable Level I or Level II Trauma Center to which neurological, medical, cardiac and/or surgical emergencies shall be transported.(a)(ii)
Identify a suitable group of Airway Management Physicians (AMPs) (see Subsection (b) below);(a)(iii)
Define the method of transport and route(s);(a)(iv)
Schedule at least two drills that must be completed prior to the Club’s first preseason home game, one at the practice facility and one at the stadium venue. The drills must address the following scenarios (at a minimum):
- Spine/head trauma
- Isolated head trauma
- Heat Illness
- Cardiac arrest/arrhythmia
- Truncal Trauma w/ hypotension
Contain a listing of Visiting Team Medical Liaison (VTML) physicians available for Clubs visiting the Club’s home city to coordinate local medical care and prescriptions, if necessary.(b)Airway Management Physician. .
Every NFL Club is required to provide an Airway Management Physician (AMP) at every home game hosted by the Club. Each Club must identify at least two but not more than four physicians that they intend to retain to serve as an AMP for the upcoming season by July 1. The EAP Expert shall review each physician proposed and make a recommendation as to whether the physician recommended is suitable for the role. The parties (through the NFL Chief Medical Officer and NFLPA Medical Director) must jointly approve a physician in order for him/her to be retained by a Club to serve as an AMP. In order to serve as an NFL Club’s AMP, a physician must have the following qualifications:(b)(i)
Board certified in Emergency Medicine or Anesthesia.(b)(ii)
Credentialed at a Level I or Level II trauma center where (s)he performs a minimum of eight intubations and airway management in a trauma resuscitation environment annually. It is preferred that AMPs have privileges at the trauma center designated by the EAP.(b)(iii)
Capable, at a minimum, of performing airway management via rapid-sequence intubation, laryngeal mask airway, and/or video laryngoscopy.(b)(iv)
Capable of performing intubations with the patient on the ground and on a stretcher in an on-field environment. Experienced in using capnometry post-intubation or post-airway control, including maintaining eucapnia in head-injured patients.
Section 5. Accountability and Care Committee(a)
The parties agree to establish an Accountability and Care Committee, which will provide advice and guidance regarding the provision of preventive, medical, surgical, and rehabilitative care for players by all Clubs during the term of this Agreement. The Committee shall consist of the NFL Commissioner and the NFLPA Executive Director (or their designees). In addition, the Commissioner and Executive Director shall each appoint three additional members of the Committee, who shall be knowledgeable and experienced in fields relevant to health care for professional athletes.(b)
The Committee shall meet in person or by conference call at least twice per year, or at such other times as the Commissioner and Executive Director may determine.(c)
The Committee is charged with the following responsibilities:
- i. Encourage and support programs to ensure outstanding professional training for team medical staffs, including by recommending credentialing standards and continuing education programs for Team medical personnel; sponsoring educational programs from time to time; advising on the content of scientific and other meetings sponsored by the NFL Physicians Society, the Professional Football Athletic Trainers Association, and other relevant professional institutions; and supporting other professional development programs;
- ii. Develop a standardized preseason and postseason physical examination and educational protocol to inform players of the primary risks associated with playing professional football and the role of the player and the team medical staff in preventing and treating illness and injury in professional athletes;
- iii. Conduct research into prevention and treatment of illness and injury commonly experienced by professional athletes, including patient care outcomes from different treatment methods;
- iv. Conduct a confidential player survey at least once every three years to solicit the players’ input and opinion regarding the adequacy of medical care provided by their respective medical and training staffs and commission independent analyses of the results of such surveys;
- v. Assist in the development and maintenance of injury surveillance and medical records systems;
- vi. Develop and issue joint position statements on health and safety issues relevant to and impacting professional football players (e.g., CTE, concussion, lower extremity injuries);
- vii. Annually review and develop a mandatory education program concerning health and safety issues relevant to NFL players, including but not limited to, concussion, CTE, and NFL injury data, to be presented to all NFL players by the parties throughout the course of each NFL Season;
- viii. Analyze and provide recommendations regarding injury trends;
- ix. Coordinate public statements by the NFL, NFL Players Association, Clubs and other interested parties regarding football-related health and safety issues;
- x. Beginning with the 2020 regular NFL Season, conduct an annual comprehensive review of Club rehabilitation equipment, facilities and modalities, and thereafter establish and implement minimum standards concerning these areas. The NFLPA shall have the right to commence a Non-Injury Grievance pursuant to Article 43 of this Agreement should a player or the NFLPA believe that a Club’s equipment, facilities or modalities have failed to meet the standards set by the Committee or presents an undue risk of injury. Should the NFLPA file such a grievance, the Parties will arrange an inspection of such facility. If a deviation from the standards set by the Committee or an unduly unsafe condition is found, the Club will be given a reasonable opportunity to cure. If the Club contests whether a condition fails to meet the standards set by the Committee or is unduly unsafe, the Non-Injury Grievance will proceed, and a Non-Injury Grievance arbitrator will decide whether a deviation from the Committee’s standards has occurred or whether a condition is unduly unsafe. If the Non-Injury Grievance Arbitrator finds a deviation or determines that a facility, equipment or modality is unduly unsafe, he or she will issue an order to cure;
- xi. Review any proposed playing rules changes for health and safety impact;
- xii. Examine any subject related to player safety and welfare it desires, and make non-binding recommendations to the parties; and
- xiii. Undertake such other duties as the Commissioner and Executive Director may assign to the Committee.
A player may submit a complaint to the Committee regarding Club medical care. The complaint shall be referred to the NFLPA, the League and the player’s Club, which together shall determine an appropriate response or corrective action if found to be reasonable. The Committee shall be informed of any response or corrective action. Nothing in this Article, or any other Article in this Agreement, shall be deemed to impose or create any duty or obligation upon either the League or NFLPA regarding diagnosis, medical care and/or treatment of any player.(e)
Each Club shall use best efforts to provide its players with high quality medical care appropriate to their needs as elite professional football players consistent with professional standards for the industry.(f)
Separate from and in addition to the procedures set forth in Subsection (d) above, any player or Club, the League or the NFLPA shall have the right to commence an investigation before the Committee concerning the health, safety or medical care provided by Club-affiliated personnel. Within 60 days of the initiation of an investigation, two or more neutral physicians (or other subject-matter experts) will be selected to investigate and report to the Committee on the situation. The neutral physicians shall issue a written report within 60 days of their selection, and their recommendations as to what steps shall be taken to address and correct any issues shall be acted upon by the Parties.(g)
A joint subcommittee of the Accountability and Care Committee, as set forth in this Article, shall analyze injury information and data from performance tracking technology to study training methods, practices and drills that may lead to injuries, focusing on training camp and preparation for training camp, including without limitation, any conditioning testing. The subcommittee will also analyze whether Offseason Workout and training camp loads affect regular season performance and injury rates. The subcommittee will also endeavor to make recommendations or identify best practices that NFL players and Clubs may follow to ensure players are sufficiently conditioned, including evaluating any Club conditioning tests, and prepared for the start of the Offseason Program and training camp, including a training camp “Acclimation Period.” The results of the subcommittee’s analysis will be available to the NFL and the NFLPA but will not be publicly disseminated unless authorized pursuant to the NFL Player Scientific & Medical Research Protocol, as set forth in Section 18 of this Article and Appendix X of this Agreement. Performance tracking technology data will be returned to the Clubs following the subcommittee’s work and may not be retained, distributed or used for other purposes by the subcommittee or its members. The subcommittee does not have the authority to bind either Party. The Parties shall negotiate in good faith to determine what actions, if any, are appropriate in light of the subcommittee’s recommendation(s).
Section 6. Player’s Right to a Second Medical Opinion
A player will have the opportunity to obtain a second medical opinion. As a condition of the Club’s responsibility for the costs of medical services rendered by the physician furnishing the second opinion, such physician must be board-certified in his field of medical expertise; in addition, (a) the player must consult with the Club physician in advance concerning the other physician; and (b) the Club physician must be furnished promptly with a report concerning the diagnosis, examination and course of treatment recommended by the other physician. A player shall have the right to follow the reasonable medical advice given to him by his second opinion physician with respect to diagnosis of injury, surgical and treatment decisions, and rehabilitation and treatment protocol, but only after consulting with the Club physician and giving due consideration to his recommendations.
Section 7. Player’s Right to a Surgeon of His Choice
A player will have the right to choose the surgeon who will perform surgery provided that; (a) the player will consult unless impossible (e.g., emergency surgery) with the Club physician as to his recommendation regarding the need for, the timing of and the doctor who should perform the surgery; (b) the player will give due consideration to the Club physician’s recommendations; and (c) the surgeon selected by the player shall be board-certified in his field of medical expertise. Any such surgery will be at Club expense; provided, however, that the Club, the Club physician, trainers and any other representative of the Club will not be responsible for or incur any liability (other than the cost of the surgery) for or relating to the adequacy or competency of such surgery or other related medical services rendered in connection with such surgery.
Section 8. Standard Minimum Preseason Physical
Each player will undergo the standardized minimum preseason physical examination and tests outlined in Appendix K, which will be conducted by the Club physician(s) as scheduled by the Club. A copy of the Preseason Physical exam results will be provided to the player via the player’s Electronic Medical Record. No Club may conduct its own individual testing for anabolic steroids and related substances or drugs of abuse or alcohol.
Section 9. Substance Abuse and Performance-Enhancing Substances
General Policy. The Parties agree that substance abuse and the use of performance-enhancing substances are unacceptable within the NFL, and that it is the responsibility of the Parties to deter and detect the use of performance-enhancing substances and to offer programs of intervention, rehabilitation, and support to players who have substance abuse problems. Accordingly, in fulfillment of these objectives, the Parties have agreed upon The Policy and Program on Substances of Abuse and the Policy on Performance-Enhancing Substances, which are incorporated into this Agreement.
Section 10. Club Visiting Team Locker Rooms
By the opening of training camp for the 2021 season, each Club shall take reasonable steps to ensure that all visiting team locker rooms contain the following minimum facilities; six (6) urinals; four (4) toilets; twenty (20) showers; and one (1) private medical examination room.
Section 11. Field Surface Safety & Performance Committee
In furtherance of NFL and the NFLPA’s ongoing efforts and express intention to enhance the safety and performance of NFL field surfaces and playing areas, and thereby advance the safety and protect the health of NFL players, the Parties have agreed;(a)
To establish a joint committee to provide advice and guidance regarding the safety, performance, and testing practices of NFL game-day and practice field surfaces and thereby improve and protect the safety and health of NFL players. The Field Surface Safety & Performance Committee shall perform research and advise the Parties regarding (i) injury prevention, (ii) improved field surface testing methods, (iii) the adoption of tools and techniques to evaluate and improve field surface performance/playability (e.g., metrics to gauge minimum softness; quantitative cover ratings; measuring head impact criteria), (iv) establish and implement safety and performance testing metrics for NFL game-day and practice field surfaces, and (v) undertake such other duties as the Parties may assign.(b)
The Field Surface Safety & Performance Committee shall consist of (i) two (2) subject matter experts, one selected by each Party, (ii) the NFLPA Medical Director and the NFL Chief Medical Officer, and (iii) one (1) representative from each Party. The Committee shall meet in person or by conference call at least two (2) times per year.(c)
The Field Surface Safety & Performance Committee shall review the Mandatory Practices for the Maintenance of Natural and Synthetic Surfaces for NFL Games (the “Mandatory Practices”) and the Mandatory Field Wall Padding and Non-Slip Surfaces Policy and agree upon improvements, as necessary. Every stadium in which an NFL game is to be played must be in compliance with the Committee’s revised Mandatory Practices prior to the beginning each NFL season. The Committee will regularly review its mandatory and recommended practices and agree upon updates and improvements as necessary.(d)
The NFL Stadium Playing Area Inspection Program will test NFL playing and practice surfaces to ensure that they are in compliance with the Mandatory Practices (and the mandatory practices and metrics set forth by the Field Surface Safety & Performance Committee pursuant to this Section) and to ensure that every NFL Stadium is in compliance with the Mandatory Field Wall Padding and Non-Slip Surfaces Policy. To the extent any playing area is found to be out of compliance, that stadium field manager must initiate remedial measures in coordination with the NFL Football Operations Department. For field surfaces that are found to be out of compliance, the NFL will update the NFLPA’s designee(s) regularly about the remedial measures, including the scheduling of additional testing. In furtherance of the foregoing, any field surface where flooring or staging is to be used on the field for an extended period of time prior to and within one (1) day of an NFL game (e.g., concerts, Hall of Fame ceremony), the stadium field manager (or other NFL designee) shall provide at least three (3) days’ advance notice to NFL Football Operations. The NFL will notify the NFLPA designee(s) of the same and the NFL’s Playing Area Inspector and NFLPA’s field testing consultant shall have an opportunity to confirm compliance with the Mandatory Practices after such flooring or staging has been removed. In the event any playing surface is found to be out of compliance on game day, that stadium field manager shall initiate remedial measures as appropriate in coordination with the NFL Football Operations Department and the NFL will immediately notify the NFLPA’s designee(s) and take all reasonable measures to remedy. Should a player or the NFLPA allege that an NFL Stadium is not in compliance with the Mandatory Practices, as applicable, or any other metrics or standards set by the Field Surface Safety & Performance Committee pursuant to this Section, the NFLPA shall have the right to commence a Non-Injury Grievance pursuant to Article 43 of this Agreement.(e)
The NFLPA’s designated field surface consultant will be granted equal access to all NFL playing fields and field test results. For the avoidance of doubt, this access includes non-traditional venues (e.g., London, Mexico City, Hall of Fame Game). The NFLPA’s field surface consultant will coordinate site visits with the NFL’s Playing Area Inspector.(f)
Any research conducted by the Joint Field Surface Safety & Performance Committee shall be conducted in conjunction with the Joint Engineering and Equipment Safety Committee and funded by the Joint Contribution Amount, as set forth in the following Section.
Section 12. Joint Engineering and Equipment Safety Committee
The NFL and NFLPA shall establish a Joint Engineering and Equipment Safety Committee to provide advice and guidance regarding the safety and performance of playing equipment used by NFL players. The Committee shall consist of the NFL Chief Medical Officer, the NFLPA Medical Director, and two (2) appointees designated by each of the NFL Chief Medical Officer and the NFLPA Medical Director, who shall be knowledgeable and experienced in engineering and other fields relevant to the safety of playing equipment used by professional football players. Each member of the Committee shall have one vote. The Committee is charged with the following responsibilities; (i) develop and implement testing protocols to evaluate and test playing equipment used by NFL players; (ii) develop standards and metrics that NFL players’ equipment must meet in order to be used by any NFL player during an NFL game or practice; and (iii) such other duties as the Parties may assign. Should the Joint Engineering and Equipment Safety Committee determine that any playing equipment does not meet the standards and metrics developed by the Committee, the Committee shall have the authority to prohibit the use of any such equipment by NFL players. The Committee’s determinations concerning whether any particular equipment will not be permitted to be used in NFL games and practices shall be binding. Research conducted by the Joint Engineering and Equipment Safety Committee shall be funded by the Joint Contribution Amount as set forth in Article 12, Section 5 of this Agreement. For purposes of clarity, the Parties shall have joint control over such funding.
Section 13. Sleep Studies
For purposes of this Section “Sleep Studies” shall mean any effort to test, monitor, observe, analyze or collect information on or in connection with the sleep activity of an NFL player or players, without limitation, through the use of wearable sleep trackers and any future iterations thereof. This Section does not and is not intended to affect a Club physician’s ability to order sleep testing of an individual player when clinically indicated (e.g., to determine if such player is suffering from a medical condition, such as sleep apnea). The Parties hereby agree that NFL Clubs may perform Sleep Studies, subject to the following limitations:(a)
Any NFL Club desiring to perform a Sleep Study must hire a qualified third-party company to conduct the Sleep Study,(b)
Sleep Studies will only be conducted during Organized Training Activities or preseason training camps. Sleep Studies may not be performed at any other time during the year unless approved, in writing, by the NFL Players Association. The NFL Players Association’s consent shall not be unreasonably withheld, and once given, will be effective for an entire NFL Season, unless the NFLPA rescinds such consent in writing during the season.(c)
Player participation in any Sleep Study is strictly voluntary. Clubs may not require player participation in a Sleep Study. Prior to conducting any Sleep Study, the Club shall inform each player in writing that such participation is voluntary.(d)
Each participating player shall own his individual data collected during participation in the Sleep Study. Throughout or at the conclusion of a Sleep Study, each participating player shall be given (i) a complete copy of his results from the Study and (ii) the prescriptive performance plan used to improve player’s sleep, if applicable. Ownership of any and all data collected during the course of a Sleep Study shall remain with the individual player(s) participating in the Sleep Study. Participation in a Sleep Study shall not require or cause a player to transfer ownership of his data to the Club or any other thirdparty. No exchange or transfer of player data collected during the course of a Sleep Study will result in a transfer or change of ownership.(e)
The data and information collected from a player participating in a Sleep Study may not be shared with or transferred to the Club unless or until such player provides informed written approval of such transfer. If player gives such consent, the resulting data will only be shared with the Club medical, sports performance and athletic training staffs. Notwithstanding the foregoing, a Club may require a player to provide written consent for the transfer of his individual Sleep Study data as a prerequisite to the Club paying for the player’s participation in the Sleep Study. Such consent, once given, may not be rescinded. In the event a player opts not to participate in a Sleep Study, the Club may give the player the option to contract directly with the third-party company for the same services.(f)
Information arising from a Sleep Study and transferred to the Club shall not be used by the Club or any third-party for any purpose other than supporting player health and/or performance through improving sleep habits. If a player consents to transfer data to his Club, the receiving Club shall not transfer player data to the NFL, any other NFL Club, or other third-party. Any and all data/information collected during a Sleep Study must remain separate from and not be entered into or used in connection with a player’s electronic medical record. Clubs must have policies in place that ensure the confidentiality, privacy, and security of any and all data/information collected during Sleep Studies. Clubs must ensure that all those involved, directly or indirectly, in a Sleep Study take all appropriate steps to protect personally identifiable information of the player participants from disclosure and ensure compliance with all applicable laws. No data/information collected during a Sleep Study may be sold or transferred to third parties.(g)
NFL Clubs intending to conduct a Sleep Study must notify the NFL Management Council of their intention to do so, indicating the intended date(s) of the testing and identifying the third-party company retained to conduct such testing and forwarding a copy of the player consent form to be used in connection with the testing. The NFL Management Council will forward that information to the NFL Players Association to ensure compliance with this Section.
Section 14. Club-Wide Biospecimen Collection
For purposes of this Section “Club- Biospecimen Collection” shall mean any effort to collect, monitor, analyze information on or in connection with the blood, urine or other biospecimen. The provisions of this Section shall not affect a Club physician’s ability to order blood or other biospecimen collection and/or testing of an individual player when he or she determines it is clinically indicated (e.g., to determine if such player is suffering from a medical condition at the player’s request or based on the physician’s clinical judgment). NFL Clubs may not perform Club Biospecimen Collection without the prior written approval of the NFL Players Association. Approved Club Biospecimen Collection is subject to the following limitations:(a)
Player participation in any Biospecimen Collection is strictly voluntary. Clubs may not require player participation in a Club Biospecimen Collection. Prior to conducting any Club Biospecimen Collection, the Club shall inform each player in writing that such participation is voluntary.(b)
Each participating player shall own his individual data collected during participation in the Club Biospecimen Collection. Throughout or at the conclusion of a Club Biospecimen Collection, each participating player shall be given (i) a complete copy of his results from the Collection and (ii) any treatment or medical recommendations, if applicable. Ownership of any and all data collected during the course of a Club Biospecimen Collection shall not require or cause a player to transfer ownership of his data to the Club or any other third-party. No exchange or transfer of player data collected during the course of a Club Biospecimen Collection will result in a transfer or change of ownership. (c) The data and information collected from a player participating in a Club Biospecimen Collection may not be shared with or transferred to the Club unless or until such player provides informed written approval of such transfer. If a player gives such consent, the resulting data will only be shared with the Club medical, sports performance and athletic training staffs. Notwithstanding the foregoing, a Club may require a player to provide written consent for the transfer of his individual data as a prerequisite to the Club paying for the player’s participation in the Collection.(d)
Information arising from a Club Biospecimen Collection and transferred to the Club shall not be used by the Club or any third-party for any purpose other than supporting player health and/or performance. If a player consents to transfer data to his Club, the receiving Club shall not transfer player data to the NFL, any other NFL Club, or other third-party. Clubs must have policies in place that ensure the confidentiality, privacy, and security of any and all data/information collected during Club Biospecimen Collections. Clubs must ensure that all those involved, directly or indirectly, in a Club Biospecimen Collection take all appropriate steps to protect personally identifiable information of the player participants from disclosure and ensure compliance with all applicable laws. No data/information collected during a Club Biospecimen Collection may be sold or transferred to third parties.(e)
NFL Clubs intending to conduct a Club Biospecimen Collection must notify the NFL Management Council of their intention to do so, indicating the intended date(s) of the testing and identifying any third parties involved in conducting such testing and forwarding a copy of the player consent form to be used in connection with the testing. The NFL Management Council will forward that information to the NFLPA to ensure compliance with this Section.
Section 15. DICON
The NFL and the NFLPA have consulted with the Duke Infection Control Outreach Network (“DICON”) regarding the risk of common infection to NFL Players. In order to address this risk, DICON has suggested a comprehensive program involving implementation of certain preventative measures at NFL Club facilities, the training of Club employees and education of NFL players about the risks presented by infection and practices that may reduce their susceptibility. The NFL and NFLPA jointly retain DICON to design and administer the “DICON Program for Infection Prevention in the NFL”. This Program, as outlined by DICON in the Parties’ agreement with DICON, includes:
- (a) the design of facility-specific protocols for each NFL Club;
- (b) education of players and relevant Club employees as to “best practices” for infection prevention;
- (c) development of response plans for MRSA and other transmissible infectious diseases;
- (d) presentations at the annual NFL Combine and NFL Rookie Symposium;
- (e) research on infectious disease in NFL Players and Facilities, as mutually agreed upon by the Parties;
- (f) outbreak investigation; and
- (g) such other tasks as deemed appropriate by the Parties. The Parties agree that the NFL, or the individual Member Clubs, shall be responsible for the entire cost of this program.
Section 16. NFL Head, Neck and Spine Committee’s Concussion Diagnosis and Management Protocol
The NFL’s Head, Neck and Spine Committee has developed a comprehensive set of protocols regarding the diagnosis and management of concussions in NFL players (the “Concussion Protocol”). The Concussion Protocol, as agreed upon by the Parties, is incorporated into this Agreement, as set forth in Appendix W. Fifty percent (50%) of the cost of administering the Concussion Protocol, including but not limited to payments associated with Unaffiliated Neurotrauma Consultants and Certified Athletic Trainer Spotters and periodic training and education sessions associated with the Concussion Protocol shall be treated as a Player Benefit Cost (the allocation of this budget is subject to agreement between the Parties).
Section 17. NFL Game Concussion Protocol Enforcement
The prevention, diagnosis and management of concussion is important to the National Football League, its member clubs, the players, and the NFL Players Association. As required by this Article, the NFL Management Council, on behalf of the NFL, and the NFLPA, through their respective medical advisory committees, have developed a protocol to address the in-game evaluation and diagnosis of potential concussions, and the subsequent management and treatment of players diagnosed with concussions, entitled the NFL Game Day Protocols Regarding the Evaluation and Management of Concussion (“NFL Game Concussion Protocol”), which is incorporated by reference into Section 17 of this Article and Appendix W attached hereto. The NFL Game Concussion Protocol is a necessary component of player medical care in the NFL and is therefore deemed mandatory by the Parties. Pursuant to the joint and continuing obligations set forth in this Article, the Parties have agreed to evaluate and address the potential deviations from the NFL Game Concussion Protocol, as set forth below:(a)
General Policy: The NFL’s Head, Neck and Spine Committee, in consultation with the NFLPA’s Mackey-White Committee, have issued a mandatory NFL Game Concussion Evaluation and Management Checklist (“NFL Concussion Checklist” or “Checklist”), which provides a clear summary of the steps required by the currently existing NFL Game Concussion Protocol, following a specified triggering incident, and is attached to the Concussion Protocol set forth in Appendix W of this Agreement.(b)
Enforcement: The application of the NFL Concussion Checklist to evaluate potential concussions during NFL preseason and regular season games is mandatory. Club medical teams must complete every step in the Checklist. Pursuant to the NFL Game Concussion Protocol, a player identified as requiring evaluation under the terms of the NFL Concussion Checklist shall not be permitted to return to play until each step in the Checklist has been completed and the player has been cleared by the Club physician. A player’s failure to participate in the evaluation process shall preclude him from returning to play in that game. Should a Club employee or other member of the Club medical staff knowingly and materially fail to follow a mandatory step in the Checklist, they will be subject to discipline, as set forth herein:
- 1. The NFL Management Council and NFLPA shall each designate one (1) or more representatives to monitor the enforcement of the NFL Concussion Checklist and investigate potential deviations therefrom (the “Representatives”). In addition, the NFL and NFLPA’s designated medical advisors will be provided with copies of the Unaffiliated Neurotrauma Consultant (“UNC”) and Booth ATC reports from every game, when they are filed with the NFL.
- 2. The NFLPA, the NFL Management Council or any player involved in an alleged failure by a club employee or other member of a club’s medical staff to follow any of the mandatory steps required by the NFL’s Concussion Checklist shall each have the right (independently or collectively) to bring forward a complaint about such alleged failure to the Representatives, which complaint shall be submitted in writing. The complaint shall be investigated and resolved by the NFL Management Council and the NFLPA as described herein.
- 3. Upon initiation of an investigation, the Representatives will have the authority to interview involved parties, witnesses and others reasonably believed to be in possession of information relevant to the inquiry (including players, league employees, club employees and members of the involved club’s medical staff) and, upon request from any Representative, shall be provided, as quickly as reasonably possible, with a copy of all game film, other recorded evidence and any other documentation relevant to the investigation of the complaint. Such requests shall not be unreasonably denied. Representatives shall complete their investigation and produce a report of their findings within two (2) weeks following the filing of a complaint. These reports shall remain confidential. Neither party is required to share its report with the other. These reports shall not be publicly disseminated.
- 4. No later than three (3) weeks following the filing of a complaint, or sooner if practical, the Executive Director of the NFLPA and the NFL Deputy General Counsel, Labor shall be advised of the status of the investigation and shall attempt to determine if a violation occurred and, if so, the proper disciplinary response. If the Parties are unable to agree upon whether or not a violation occurred or the appropriate discipline that should be imposed within three (3) weeks following the filing of a complaint, the matter will be immediately referred to the Impartial Arbitrator (as established by Article 16), who will review the complaint under the authority of this Article, using the following standards and procedures:
- a. Review: The Impartial Arbitrator shall determine: (1) whether a Club employee or member of a club’s medical team knowingly and materially failed to follow any of the mandatory steps in the NFL Concussion Checklist and, if so, (2) whether there were any relevant mitigating or aggravating factors present in the incident, including, without limitation: (a) whether the deviation resulted from an ambiguity in the Checklist or its failure to address the facts triggering the underlying violation, (b) whether any player interfered with the club employee or medical team’s ability to perform its duties, and (c) whether competitive concerns motivated the deviation. The parties recognize the Impartial Arbitrator is not a medically-trained professional and therefore his or her review and decision shall be limited to whether or not all of the steps required by the NFL Concussion Checklist were followed or whether there was a knowing and material failure to follow any of the required steps. The Impartial Arbitrator shall not opine on the quality of the care provided or whether additional measures should have been taken.
- b. Procedure: The Impartial Arbitrator shall conduct a hearing as soon as is reasonable (but no later than thirty (30) days following the date on which the matter is referred to the Impartial Arbitrator), using the following procedures: The designated Representative(s) of the NFL and the designated Representative(s) of the NFLPA may present whatever documents, film, or summary they deem relevant to the Impartial Arbitrator’s inquiry. The Impartial Arbitrator is free to request additional information or live witness testimony, should he or she determine that such additional evidence is relevant and necessary to a decision. Any party that is the subject of the inquiry shall have the right to participate in the proceeding and to present a defense. Within one (1) week of the close of evidence, the Impartial Arbitrator will issue a written report to the NFL Commissioner, the NFLPA Executive Director and the involved parties detailing his or her findings as to: (1) whether a club employee or other member of a club’s medical staff knowingly and materially failed to follow any of the mandatory steps required by the NFL Concussion Checklist and, if so, (2) whether there were any relevant mitigating or aggravating factors, including, without limitation: (a) whether the deviation resulted from an ambiguity in the Checklist or its failure to address the facts triggering the claimed underlying violation, (b) whether any player interfered with the medical team’s ability to perform its duties, and (c) whether the deviation from the Protocol was motivated by competitive concerns. The Impartial Arbitrator shall not offer his or her opinion as to the appropriate discipline, if any, that should result from the violation.
- 1. First Violation in a League-Year: In the event that the Impartial Arbitrator finds, or in the event that the NFL and NFLPA agree, that a club employee and/or a member of a club’s medical staff knowingly and materially failed to follow any of the mandatory steps required by the NFL Concussion Checklist, the Commissioner shall impose discipline against the club by: (a) issuance of a letter of reprimand advising that club employee(s) and/or member(s) of the club’s medical staff knowingly and materially violated the NFL Game Concussion Protocol, (b) requiring the club employees or medical team members involved with the deviation from the Protocol to attend remedial education; and/or (c) a fine against the club in an amount no more than Five Hundred Thousand Dollars ($500,000); and any other discipline that the Commissioner deems warranted by the violation. In the event that the Impartial Arbitrator finds, or the Parties agree, that the violation involved aggravating circumstances, the Club shall be subject, in the first instance, to a fine in an amount no less than One Hundred Thousand Dollars ($100,000). In this regard, the Commissioner shall consider the Impartial Arbitrator’s findings with regard to relevant aggravating factors in making his determination as to appropriate discipline.
- 2. Second and Subsequent Violation(s) in a League-Year: In the event that the Impartial Arbitrator finds, or in the event that the NFL and NFLPA agree, that a club is responsible for a second knowing and material failure to follow any of the mandatory steps required by the NFL Concussion Checklist in the same league year, regardless of whether such deviation was caused by the same employee and/or member of a club’s medical staff involved in the first incident, the Commissioner shall impose a fine of at least Two Hundred and Fifty Thousand Dollars ($250,000) against the club plus whatever other measures he deems warranted. The Commissioner shall consider the Impartial Arbitrator’s findings with regard to relevant aggravating or mitigating factors in making his determination as to appropriate discipline.
- 3. Competitive Considerations: In the event that the NFL Commissioner determines that the violation of the NFL Concussion Checklist was motivated by competitive considerations (e.g., intent to leave player in game and knowingly, intentionally and materially disregard the Protocol in order to gain a competitive advantage) the Commissioner may require the club to forfeit draft pick(s) and additional fines exceeding those amounts set forth above.
NFL Players: The Parties have determined that club medical teams must apply each step of the NFL Game Concussion Evaluation and Management Protocol when evaluating an NFL player for a potential concussion during an NFL game. The Parties also recognize that player participation and cooperation is essential to the diagnosis and management of this injury. To that end, the Parties shall jointly develop education and messaging to be shared with players on a regular basis, including, but not limited to, the importance of (i) reporting concussion symptoms and (ii) cooperating with team medical staffs in all areas of concussion care. For purposes of enforcement, if an NFL player interferes with the medical staff’s ability to perform its duties under the Protocols, such interference shall be considered by the Parties or the Impartial Arbitrator as a mitigating factor and may serve as an affirmative defense to discipline under Section 4 (c) above.(e)
Fines: Beginning in the 2022 League Year, all fine amounts set forth in this Section shall increase by three percent (3%) each League Year. All fines shall be assessed and collected by the Commissioner pursuant to this Article and shall be used by the league in furtherance of its player-related medical and scientific research programs.(f)
Amendments: Any and all changes to the NFL Game Concussion Protocol and/or the NFL Concussion Checklist shall be subject to mutual agreement by the Parties. The Parties, through their respective medical advisory committees, shall regularly review the same and implement changes and improvements as necessary.
Section 18. NFL Player Scientific & Medical Research Protocol
This Section governs the protection, extraction and analysis of certain player health information from the NFL Electronic Medical Record System (“EMR”) database as set forth in Article 40 of this Agreement, and its subsequent use and dissemination in furtherance of various player health and safety initiatives. This Section establishes guidelines for active or interventional research involving NFL players. Each request governed by this Section must follow the steps outlined in Appendix X to this Agreement— a failure to obtain the necessary consent/approval at any step in the process will result in the request being denied (i.e., where the approval of multiple parties is required, the denial by any one party will result in the request being denied).(a)
Data Set: As part of the League’s Injury Surveillance System, IQVIA collects and analyzes relevant data from the EMR regarding the occurrence of injuries and illnesses that may impact a player’s ability to practice and play. IQVIA subsequently produces injury/illness reports, which encompass all reportable injuries and broadly describe analyses of injury occurrence, time trends, rates, examinations based on setting, player position, contact level, team activity, player activity, impact source and other factors potentially related to injuries, such as turn type, timing within the season, and severity of injury. Such data collection and reporting is not and will not be used for treatment purposes and IQVIA does not and will not have the ability to modify a player’s record in any manner. The Parties agree that the purpose and intent of these activities is to assess, improve, and advance player health, safety, care, treatment and outcomes throughout the NFL and in the operation of the Clubs. This is done through the work of IQVIA and various committees, subcommittees, panels, boards, and others that advise the NFL, the Clubs, the players, and the NFLPA on health and safety-related issues, policies, research and programs. These assessment and improvement efforts are also intended to yield education and technological opportunities and improvements for the NFL, the Clubs, and the players. Various projects and efforts may be undertaken for these purposes on an ongoing basis in the future. Activities necessary for these assessment and improvement efforts include, but are not limited to, observing, monitoring, gathering, reviewing, surveying, organizing, processing, aggregating, assessing, and analyzing player data, club data, and league-wide data for purposes relevant to: (1) player health and safety, including without limitation, player injuries and illnesses, player medical care, treatment methods, player treatment outcomes, and development of clinical best practices; (2) the use of equipment and technologies; (3) league-wide rules, standards, guidelines, and policies; and (4) practice environments and game environments. The Health Insurance Portability and Accountability Act of 1996 (as amended and implemented through regulations (“HIPAA”) applies to medical records maintained by health care providers, health plans, and health clearinghouses. HIPAA does not apply to information which exists outside of health care facilities and the files of health care providers, including, without limitation, information that is maintained by an entity in its capacity as an employer. Unlike medical records maintained and used by health care providers for treatment purposes, employment injury/illness surveillance records that are not used for treatment purposes are not subject to HIPAA. Without limiting the foregoing, the Parties reserve their respective positions concerning the nature of the information and data at issue in this Section and the applicability of HIPAA thereto. Notwithstanding the foregoing, the Parties have voluntarily chosen to adopt certain processes for using and disseminating this data in a manner that is intended to ensure its privacy and safeguarding, as further detailed herein. These processes do not constitute rights, duties or obligations undertaken or assumed outside the scope of this Agreement.(b)
Data Use and Disclosure: In accordance with past practice, IQVIA will continue to analyze relevant injury/illness data collected and will submit reports to the NFL, the Clubs via the Injury Surveillance System. The NFL will produce a copy of such reports to the NFLPA (i) prior to distributing such reports publicly and (ii) whenever such reports are distributed to NFL health and Safety Committees in accordance with this Article.. The NFLPA may also request that the NFL direct IQVIA to produce certain data sets and analysis and the NFL will not unreasonably deny such requests, provided that the NFLPA shall bear the cost of any such analysis it requests. Any such reports produced to either party relating to traditional employer injury/illness surveillance data will always be disseminated to the NFL, NFL Clubs and the NFLPA with players’ names, if any, redacted. Furthermore, IQVIA will use best efforts to preserve the confidentiality of individual players by only reporting the minimal information necessary to identify the concept, trend, or subject of any given report; however the Parties understand and acknowledge that certain traditional employer injury/illness surveillance reports may contain information that would result in the information not being considered de-identified data under HIPAA. If data or analyses furnished by IQVIA to the NFLPA does not contain only de-identified data, then the NFLPA expressly understands and agrees that it may not disseminate such reports beyond the NFLPA’s Executive Committee, Medical Director, health and safety consultants, legal staff, and/or Mackey-White Committee members absent agreement from the NFL. For purposes of clarity, the foregoing shall not be interpreted to limit the NFLPA’s ability to disclose relevant health, safety and/or injury information contained in such reports to the NFLPA membership. Further, nothing in this Section is intended to limit the NFLPA’s rights to or use of information it is otherwise entitled to under this Agreement and/or applicable law.
Section 19. Behavioral Health Program(a)
Comprehensive Mental Health and Wellness Committee: The Parties will establish a Comprehensive Mental Health and Wellness Committee (the “Joint Behavioral Health Committee”) that will consist of six (6) members (three (3) appointees each), including the NFL Chief Medical Officer, the NFLPA Medical Director, the NFLPA Director of Wellness and the NFL Vice President of Wellness and Clinical Services. Each member of the Joint Behavioral Health Committee shall have one vote. The Joint Behavioral Health Committee is charged with the following responsibilities:(a)(i)
Developing and scheduling educational programs for Players, coaches and Club personnel regarding mental health including, but not limited to: mental health first aid; QPR (Question, Persuade, Refer); ASIST (Applied Suicide Intervention Skills Training); clinical concerns and issues (i.e., depression and/or anxiety); drug and alcohol use and abuse; gambling addiction; violent behaviors’ suicide prevention; athletespecific stressors (i.e., media, identity, social support, injury and navigating sports-specific relationships); and other topics that the Committee deems relevant for such personnel. Each Club’s Team Clinician (see below) shall be responsible for implementing such educational and training programs at his/her Club.(a)(ii)
Developing sample programming for a mental health/wellness workshop for parents and significant others of Players to ensure they are aware of signs and symptoms that may be indicative of mental health concerns, the resources available to Players and family members, and to know where to turn should they need support.(a)(iii)
Collaborating with local and national mental health organizations to promote stigma reduction related to mental health.(a)(iv)
Collaborating with local and national suicide prevention organizations to promote prevention and awareness.(a)(v)
Developing models of the following Player programs that Clubs may use that include but are not limited to:
- (A) Addressing the stresses and needs of Players transitioning out of NFL;
- (B) Promoting social connectedness and resilience;
- (C) Integrating the Player’s family ecosystem in development and provision of mental health resources;
- (D) A model peer development program; and
- (E) Development of effective methods to communicate with Players regarding mental health and ways to associate and implement positive mental health practices with on-field performance. The NFLPA shall be granted access to and have the right to participate in any and all Player Educational programing developed in connection with this Agreement.
Team Clinician: Every Club shall identify and retain a Team Clinician, in accordance with the procedures set forth below.(b)(i)
Qualifications: The Team Clinician must be a: a) board-certified psychiatrist; b) doctoral level clinical or counseling psychologist; or c) professional counselor with a master’s degree in counseling or social work. The Team Clinician must have a minimum of seven (7) years of relevant clinical experience working with a multicultural population. The Team Clinician shall have a valid license to practice medicine as required under applicable state law, and any other applicable jurisdiction, that has never been denied, suspended, revoked, terminated, voluntarily relinquished under threat of disciplinary action or restricted in any way.(b)(ii)
Approval: After each Club has identified the individual who it would like to serve as its Team Clinician, the NFL and NFLPA shall each designate one person to review and approve the nominee. Such approval shall not be unreasonably withheld. In considering whether to approve the nominee, the Parties shall consider whether the nominee possesses the requisite clinical skills for:
- (A) effective player engagement;
- (B) behavioral health treatment (within his/her areas of expertise);
- (C) triage and referral for other community-based behavioral health providers and services;
- (D) consulting effectively with the Club Medical Staff and the Club Director of Player Engagement;
- (E) availability for and skill in engaging in modern electronic communication methods as used in professional football; and
- (F) working effectively with a diverse, multicultural player and staff population, with an awareness and understanding of the culture of football at an elite level.
Duties. The Team Clinician shall:(b)(iii)(A)
Ensure that all mental health treatment and records created or obtained during the course of providing services to a Club’s Players (including any voluntary mental health evaluations) (collectively, “Mental Health Records”) remain confidential and are maintained, used and disclosed in compliance with applicable laws (see below).(b)(iii)(B)
Be responsible for developing and supervising a comprehensive referral network to provide mental health care for the Club’s Players. This network must include professionals that are qualified to address (if any are beyond the scope of the Team Clinician’s expertise):(b)(iii)(B)(1)
Intimate Partner Violence or Abuse(b)(iii)(B)(4)
In-and Out-Patient Psychiatric Treatment(b)(iii)(B)(5)
Be responsible for implementing the mental health educational programming developed by the Joint Behavioral Health Committee at his/her Club by conducting a minimum of two (2) training sessions per season that are attended by the entire team and coaching staff as well as the voluntary mental health/wellness workshop for parents and significant others.(b)(iii)(D)
Be available on-site to Players at least twice weekly, for a total of eight to twelve hours each week, (and more frequently, if clinically indicated) during training camp, preseason, regular season, and if applicable, postseason. Team Clinicians must also be available for consultation during the week on an as-needed basis either at the Club’s facility or at an off-site location (to include the Team Clinician’s office).(b)(iii)(E)
Be allotted space conducive to privacy and confidentiality in the Club’s facility for direct service provision and consultation to Players and the space and resources necessary to maintain the confidentiality of any and all electronic and paper Mental Health Records in a manner that complies with applicable laws, including but not limited to the Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”) and the Americans With Disabilities Act (the “ADA”),. The Team Clinician shall also be permitted access to any part of the Club facility accessible by Players. Should the Team Clinician, or any member of the Club, learn of an unauthorized disclosure of a Player’s mental health prescription record that results in the disclosure of such confidential information to an individual other than the Head Internal Medicine Physician or Team Clinician, the individual learning of such an unauthorized disclosure shall immediately bring notice of this unauthorized disclosure to the attention of the Head Team Physician, Team President, the NFL Chief Medical Officer and the NFLPA Medical Director.(b)(iii)(F)
At the Player’s request only, be available to meet (in-person, if possible, or by phone/video conference) with any Player placed on Injured Reserve (IR) or designated Physically Unable to Perform (PUP) as soon as is reasonably possible in order to assess the need for any behavioral health interventions relevant to the Player’s IR or PUP status. For the avoidance of doubt, the Parties do not contemplate that a Player would be required to attend any such meeting, evaluation or assessment by the Team Clinician.(b)(iii)(G)
Contact all Players transitioning out of the NFL for a voluntary interview and mental health evaluation. During this interview, the Team Clinician shall explain to the Player all mental health and career transitioning programs available via the NFL and NFLPA. For the avoidance of doubt, the Parties agree that any mental health evaluation of a Player shall be voluntary. The Parties further agree that the NFL, the Team Clinician, and the NFLPA shall comply with the ADA with respect to such voluntary mental health evaluation including, without limitation, the ADA’s confidentiality requirements.(b)(iii)(H)
Participate in continuing education and case consultation programming created for Team Clinicians.(b)(iii)(I)
Participate in a certain number of conference calls per year and attend scheduled meetings as set by the Joint Behavioral Health Committee.(c)
Confidentiality & Breach:(c)(i)
Confidentiality: Any Mental Health Records (as defined above) that the Team Clinician creates when providing mental health services shall be considered protected health information (“PHI”) and subject to HIPAA. The Team Clinician may only disclose such PHI as permitted by HIPAA. For the avoidance of doubt, the Team Clinician may NOT share any details regarding treatment provided to a Player with any member of the Club, other than with the Head Team Primary Care Sports Medicine Physician when medically necessary to provide treatment to the Player. All materials that contain PHI, including but not limited to, player files, notes, etc. left at the Club facility, must be stored in a secured location that cannot be accessed by other Club personnel. In the event any records created by the Team Clinician when providing mental health services are not deemed to be PHI and thereby not subject to HIPAA, the Parties hereby agree that such records will remain confidential. Subject to the Parties’ review, satisfaction and approval of the necessary procedures for the protection and limited disclosure of prescription drug information, the records and information relating solely to a clinical diagnosis and/or prescriptions issued by the Team Clinician (i) may be shared with the Head Team Primary Care Sports Medicine Physician solely for purposes of medical treatment and identifying drug interactions, and (ii) shall be maintained electronically in the Player’s NFL EMR, in a confidential mental health record section. The Team Clinician shall be responsible for informing the Player of the same. Specifically, prior to providing consultations or services to any Player, the Team Clinician shall inform the Player that (1) Mental Health Records relating to a clinical diagnosis and/or prescriptions issued may be shared with the Head Team Primary Care Sports Medicine Physician solely for purposes of medical treatment and identifying drug interactions and (2) the same would be maintained in the Player’s NFL EMR in a confidential mental health record section.(c)(ii)
Breach: Should there be an unauthorized disclosure of a Player’s Mental Health Records, the Team Clinician shall notify the Head Team Physician and Club President as well as the NFL Chief Medical Officer and NFLPA Medical Director. To the extent that the unauthorized disclosure constitutes a “Breach” as defined by HIPAA, the Team Clinician and/or Club shall comply with any breach notification requirements outlined in HIPAA at 45 CFR §§ 164.404. If there has been unauthorized access to Mental Health Records stored in the segregated part of the EMR, the Parties will cooperate in investigating such unauthorized access and provide appropriate remedial measures (including, without limitation, discipline, training and/or terminating access to EMR). For purposes of clarity, any intentional and/or knowing unauthorized access to or dissemination of Mental Health Records (e.g., clinical diagnosis and/or prescription(s)) will be considered a material violation of this Agreement and subject to the discipline procedures set forth below. Should a Player or other individual allege a Breach or violation of this Agreement by a Club employee or member of a Club’s Medical Staff, the Parties will investigate the matter and, if a Breach or violation of this Agreement is established, the Commissioner shall impose discipline as set forth below. For the avoidance of doubt, the preceding sentence applies to situations in which a Club employee or member of the Club’s Medical Staff (other than the Team Clinician) improperly discloses the defined Mental Health Records. Should a Team Clinician be found to have improperly disclosed such information, that Clinician shall be subject to termination. If the Parties are unable to agree upon whether or not a Breach or violation of this Agreement has occurred, then either Party may immediately refer the matter to the Impartial Arbitrator (as established by Article 16 of the CBA).(c)(iii)
Discipline: In the event that the Parties agree or the Impartial Arbitrator finds that a Club, or an individual acting under its control, willfully violated the provisions of this Agreement or willfully committed a Breach of its confidentiality obligations pursuant to HIPAA, then the Commissioner shall impose discipline against the Club in the form of a fine of no less than Five Hundred Thousand Dollars ($500,000) and such other measures the Commissioner deems necessary as a deterrent for future violations (e.g., loss of Draft Picks). For the avoidance of doubt, the preceding sentence applies to situations in which a Club employee or member of the Club’s Medical Staff (other than the Team Clinician) improperly discloses the defined Mental Health Records. Should a Team Clinician be found to have improperly disclosed such information, that Clinician shall be subject to termination.(c)(iv)
Fines: Any fine money collected pursuant to this Agreement shall be allocated to medical research programs as directed by the Parties.(d)
Annual Certification: The Team Clinician shall sign an annual certification that she/he shall submit to the NFL Chief Medical Officer and the NFLPA Medical Director (i) detailing any and all “Breaches” as defined under HIPAA from the prior 12month period ending March 31st; (ii) confirming that he/she meets all state requirements to provide mental health services, including any licenses and certifications; (iii) confirming that his/her licenses has never been denied, suspended, revoked, terminated or voluntarily relinquished under threat of disciplinary action or restricted in any way; and (iv) that he/she has complied with all laws regarding the corporate practice of medicine, health care fraud and abuse laws, and laws regarding the privacy and security of patient information including but not limited to the ADA, HIPAA, and any applicable state laws. Nothing in this provision is intended to create a supervisory requirement on the part of either Party.(e)
Corporate Practice of Medicine: Neither the NFL nor the NFLPA shall engage in the practice of medicine nor in any way direct or control the practice of medicine or direct the provision of health services required to be provided by a licensed medical practitioner and nothing herein shall be construed to the contrary.(f)
Mental Health Record Accessibility and Storage: All Mental Health Records, with the exception of diagnosis and prescription drug information related to the mental health services provided by the Team Clinician contemplated in this Section, shall be maintained by the individual Team Clinician in a record separate from the NFL EMR, which shall be afforded all protections that the clinician’s other patient records enjoy. Subject to the Parties’ review, satisfaction and approval of the necessary procedures for the protection and limited disclosure of diagnosis and prescription drug information, all diagnosis and prescription information shall be maintained electronically in the confidential mental health section of the NFL EMR as set forth in Subsection (c) of this Section.(g)
Data Privacy Training: This Committee, in conjunction with the NFL Management Council and the NFL Players Association shall design and implement data privacy education and requirements for handling Player mental health records. Such training shall be provided annually.(h)
Mental Health Emergency Action Plan: By the start of training camp of each NFL Season, every NFL Club must have designed and implemented an approved Mental Health Emergency Action Plan (“MEAP”). (i) MEAP Components: Each Club must develop and post a MEAP which must define the Club’s response to a mental/behavioral health crisis including suicidal/homicidal ideation or intent, highly agitated or threatening behavior, player or immediate family member death or other major incident that may result in extreme mental health stress. The MEAP shall clearly define roles and expected communications. (ii) MEAP Approval: The Parties will jointly designate and retain an expert to review each Club’s proposed MEAP. This will be done on an annual basis and the Club must have an approved MEAP prior to the start of training camp each season. Once approved, the MEAP shall be circulated to all relevant parties and the Club shall conduct a practice drill of the MEAP annually. The Club shall document its compliance with the annual drilling requirement.(i)
Club Mental Health and Wellness Team: Each Club’s mental health and wellness team will be led by its Team Clinician. The team shall also include, at a minimum, the Head Team Primary Care Sports Medicine Physician, Director of Player Engagement, Head Athletic Trainer, Head Strength and Conditioning Coach and Team Chaplain. This team shall meet at least one (1) time per month during the season and quarterly during the offseason to discuss ongoing mental health education and identify potential issues or concerns. The Team Clinician shall facilitate such discussions and provide education but shall maintain the privacy and confidentiality of any Player-patients. All such discussions among members of the Club’s mental health and wellness team shall remain strictly confidential.
Section 20. Prescription Medication and Pain Management Program(a)
Joint Pain Management Committee.(a)(i)
The Parties agree to establish a Joint Pain Management Committee (the “Joint Pain Management Committee”) to provide guidance and establish uniform standards addressing club practices and policies regarding pain management and use of prescription medication by NFL players, including the administration of certain federally scheduled drugs. The Joint Pain Management Committee shall consist of the NFLPA Medical Director and the NFL Chief Medical Officer. In addition, the NFL and NFLPA shall each appoint one additional voting member to the Joint Pain Management Committee, who shall be knowledgeable and experienced in fields relevant to pain management for professional athletes. The Joint Pain Management Committee shall meet in person at least two (2) times per year.(a)(ii)
The Joint Pain Management Committee shall:(a)(ii)(A)
Implement “best practices” education protocols and guidelines for pain medication administration and patient engagement for club medical staffs (together, the “Pain Management Guidelines”).(a)(ii)(B)
The Pain Management Guidelines will reflect the FDA mandate that (i) players are given the FDA drug warning and interaction sheet for each prescription at the time the prescription is given to the Player (as generated by the pharmacy dispensing the medication), (ii) players understand the potential adverse consequences and side effects for any medications prescribed, and (iii) the club medical staff document whatever further communications occurs with regard to the prescription. The Pain Management Guidelines shall also provide best practices for club medical staff to follow-up with the player-patient at specified intervals.(a)(ii)(C)
Develop and implement standardized player education about the use of pain medication, including access to treatment information, opioid risks, opioid therapy alternatives, patient engagement in medical care decisions and the efficacy of any prescribed pain medications, as well as any side-effects, including addictive behavior and risks of marijuana use (e.g., schizophrenia) (“Standardized Player Education”).(a)(ii)(D)
Conduct joint-research into pain management, addiction, personalized medicine and alternative therapies, including marijuana and THCbased therapies, to include the impact on athletic performance, if any, from use of such substances. The Joint Pain Management Committee shall provide ongoing advice and guidance regarding the use of such alternative therapies by club medical staffs and may issue recommendations regarding the same.(a)(ii)(E)
Conduct surveys of clubs and players regarding pain, fatigue, recovery and related services (“Pain Survey”).(a)(ii)(F)
Undertake such other duties as the NFL and NFLPA may assign to the Joint Pain Management Committee.(b)
Prescription Drug Monitoring Program. The Parties will establish a prescription drug monitoring program (“PDMP”) that will monitor all prescriptions issued to NFL players in all 32 clubs by Club physicians and unaffiliated physicians. The PDMP shall include:(b)(i)
An electronic database that tracks de-identified data on all prescriptions dispensed to NFL players by Club medical staff and unaffiliated physicians. The data collected will include the name of the drug, dosage, amount, the number of prescriptions issued, the issuing doctor, pharmacy, date filled, and diagnosis related to prescription (the individual player/patient will not be identified). The electronic database will be used by the Parties to collect, maintain, monitor, and analyze electronically transmitted prescribing and dispensing data for prescription medications used by NFL players on each NFL Club. The data may be used by the Parties to support education, research, best practices for prescribing pain medications, and addiction and abuse prevention. The data may not be used for any other purpose without a signed agreement by the Parties.(b)(ii)
Club Reporting Requirements. Every NFL Club will be required to update the PDMP on a monthly basis from the start of Training Camp until the week following the Club’s last game of the season.(b)(iii)
Player Reporting Requirement. NFL players are required to report all prescription drugs that they are taking to either their Club’s Head Internal Medicine Physician or Pain Management Specialist (see below). The Club physician shall record all prescriptions in the player’s EMR for upload to the PDMP. Players shall provide the same information as required for Club physician-issued prescriptions (see Section 2(a)). The Parties acknowledge that certain medications prescribed for mental health purposes may be afforded heightened confidentiality protections and thereby excluded from the foregoing disclosure requirement. For purposes of clarity, nothing herein is intended to subordinate or alter those heightened confidentiality protections.(b)(iv)
PDMP Reports. No less than twice per NFL Season, a report shall be compiled from the PDMP Database detailing the prescriptions issued for players at each Club. The report will include the number of prescriptions filled, drug name, dosage, and the physician issuing the prescription. The periodic Club reports shall be shared with the NFL Chief Medical Officer and the NFLPA Medical Director. Aggregated, deidentified information generated from the reports will be shared with the Joint Pain Management Committee.(c)
Pain Management Specialist. Each Club shall appoint a team consultant specializing in pain management (“Pain Management Specialist”) prior to the start of each NFL season. Each Pain Management Specialist shall be a minimum of five-years post residency and be board certified in anesthesiology, emergency medicine, family medicine, psychiatry, physical medicine & rehabilitation, or neurology. A physician nominated to serve as a club’s Pain Management Specialist must actively engage in pain management (at least 25% of her/his practice) as certified by the chairperson of the hospital in which they practice. The Pain Management Specialist may not be the Head Team Physician, Head Team Orthopedist or the Head Team Primary Care Sports Medicine Physician of the Club. The duties and responsibilities of the Pain Management Specialist will be defined by the Joint Pain Management Committee.(d)
Enforcement. Failure to comply with the terms of this Agreement, including without limitation the Club Reporting Requirements, the Pain Management Guidelines, the PDMP, and the Standardized Player Education, shall be governed by the following procedures and may subject any Club in violation to a fine and other discipline as set forth herein:(d)(i)
The NFL Management Council and NFLPA shall each designate one or more representatives to monitor the enforcement of this Agreement and investigate potential violations thereof (the “Representatives”).(d)(ii)
The NFLPA, the NFL Management Council, or any player-patient alleging a violation of this Agreement shall each have the right (independently or collectively) to present in writing a complaint about such alleged violation(s) to the Representatives and the complaint shall be investigated and resolved by the NFL Management Council and the NFLPA as described in this Section.(d)(iii)
Upon the initiation of an investigation following receipt of a written complaint, the Representatives will have the authority to interview the complaining party and all other parties, witnesses, and others reasonably believed to be in possession of relevant information (including players, league employees, club employees, and members of the relevant club(s)’medical staff(s)). Upon request from any Representative, the parties, witnesses, and other persons described in the preceding sentence shall provide to the Representatives, as quickly as reasonably possible, all evidence relevant to investigating the complaint. Such requests shall not be unreasonably denied. The failure to produce or maintain relevant documents shall be deemed a violation of this Agreement and such violation shall result in discipline as specified herein. The Representatives will make a good faith effort to complete their investigation as soon as possible following the filing of a complaint.(d)(iv)
Within fifteen (15) business days following the completion of the investigation, or sooner if practical, the Executive Director of the NFLPA and the NFL Commissioner shall be advised of the status of the investigation and shall attempt to determine if a violation occurred and, if so, the proper disciplinary response. If the Parties are unable to agree upon whether or not a violation occurred, or as to the appropriate discipline, then either Party may immediately refer the matter to the Impartial Arbitrator (as established by Article 16 of the CBA).(d)(v)
Procedure. The Impartial Arbitrator shall conduct a hearing as soon as practicable (but in no event—absent mutual agreement of the Parties—later than thirty (30) days following the date on which the matter is referred to the Impartial Arbitrator). The following procedures shall apply:(d)(v)(A)
The designated Representative of the NFL and the designated Representative of the NFLPA may present whatever documents, records, summaries, witnesses or any other arguments or evidence that they deem relevant to the Impartial Arbitrator’s inquiry. The Impartial Arbitrator is free to request additional information or live witness testimony, should he or she determine that such additional evidence is relevant and necessary to a decision. For purposes of clarity, the Parties agree that the Impartial Arbitrator shall have the power to compel a non-party witness to testify and/or produce documents if relevant to his/her inquiry. Any party that is the subject of the inquiry shall have the right to participate in the proceeding and to present a defense.(d)(v)(B)
Within one week of the close of evidence, the Impartial Arbitrator will issue a written report to the NFL Commissioner, the NFLPA Executive Director and the involved parties detailing his findings and decision.(d)(v)(C)
The Impartial Arbitrator shall decide whether any Club (or anyone acting on its behalf, e.g., Club employee or a member of a Club’s medical staff or Club medical consultant), willfully or negligently committed a material violation of the terms of this Agreement (including the Pain Management Guidelines, Club Reporting Requirements, the PDMP, and the Standardized Player Education). For purposes of finding a violation, it shall not matter whether or not the complaining party suffered any injury. The Impartial Arbitrator shall make findings of fact and determinations of relief, including without limitation, Club discipline.(d)(vi)
Club Discipline. In the event that the Parties agree or the Impartial Arbitrator finds that a Club committed a violation of this Section, including, without limitation, failure to accurately update the PDMP database and/or abide by the terms of the Pain Management Guidelines, then the Commissioner, following consultation with the NFLPA Executive Director, shall impose discipline against the Club, which may include an order that the relevant Club medical staff attend remedial training and/or a fine plus whatever other measures the Commissioner deems necessary as a deterrent for future violations, commensurate with other cases of Club discipline (e.g., loss of Draft Picks). A second material violation of this Section by a Club within a twenty-four (24) month period will result in a minimum fine of $250,000 (Two Hundred and Fifty Thousand Dollars) and such other measures the Commissioner deems necessary as a deterrent for future violations.(d)(vii)
Fines: Any fine money collected pursuant to this Section shall be allocated to medical research programs as directed by the Parties.(e)
Specific Performance. The Parties agree that in the event of any breach of this Section, including failure to fully implement the Club Reporting Requirements, the Pain Management Guidelines, the PDMP, the Pain Survey and the Standardized Player Education within the time periods agreed to herein, the non-breaching Party shall be entitled to compel specific performance of this Section by filing a Non-Injury Grievance pursuant to Article 43 of the CBA.(f)
Settlement of Non-Injury Grievance. For the avoidance of doubt, the NFLPA withdraws the Article 43 Non-Injury Grievance it filed on April 28, 2017 against the NFL and its member Clubs that related to the administration of federally scheduled drugs and painkillers to NFL players by NFL Clubs.(g)
No Waiver; Reservation of Rights. The Parties hereby acknowledge and agree that nothing in this Agreement is intended to waive, preempt or otherwise impact any rights, remedies and/or claims any player may have against the NFL, NFL Clubs(s) and/or member(s) of an NFL Club medical staff pursuant to the CBA. The Parties hereby expressly reserve their respective positions on the impact, if any, of this Agreement on the rights, remedies and/or claims to which a player may otherwise be entitled under applicable law or agreement.
Section 21. Remedies
The Parties hereby affirm that the NFLPA and any player has the right to file a Non-Injury Grievance, pursuant to Article 43 of this Agreement, for any alleged violation of this Article 39.