Players’ Rights To Medical Care and Treatment
Section 20Prescription Medication and Pain Management Program
Joint Pain Management Committee.
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.
The Joint Pain Management Committee shall:
Implement “best practices” education protocols and guidelines for pain medication administration and patient engagement for club medical staffs (together, the “Pain Management Guidelines”).
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.
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”).
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.
Conduct surveys of clubs and players regarding pain, fatigue, recovery and related services (“Pain Survey”).
Undertake such other duties as the NFL and NFLPA may assign to the Joint Pain Management Committee.
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:
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.
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.
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.
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.
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.
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:
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”).
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.
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.
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).
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:
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.
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.
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.
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.
Fines: Any fine money collected pursuant to this Section shall be allocated to medical research programs as directed by the Parties.
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.
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.
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.