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Medical autonomy on the athletic field is at the center of a trial that pits a former team doctor against college football powerhouse Penn State.

Scott Lynch, MD, claimed the university sacked him because he wouldn't let head football coach James Franklin overrule his decisions regarding the care of athletes. But the school said it fired him for another reason and did nothing wrong.

The case now unfolding in a Pennsylvania courtroom highlighted the health and safety of student-athletes at a university still stained by the 2011 Jerry Sandusky sexual abuse scandal.

These athletes face a high risk for orthopedic and neurologic injuries, with research showing that players are more likely to sustain head injuries during practice than during games. College football players are more likely than non-players to report cognitive impairment, frequent headaches, and cardiovascular disease later in life, researchers have found.

Lynch, a former director of athletic medicine at Penn State and orthopedic physician to the football team, sued for wrongful termination following his firing in 2019 one of the nation's highest-paid college football coaches.

The trial in the case began again earlier this month after a judge declared a mistrial during opening arguments in March.

In his lawsuit, Lynch claimed that Franklin tried to interfere with his "autonomous authority to determine medical management and return-to-play decisions related to student-athletes."

Lynch said he reported the situation to university officials and was then sacked at the request of two of them.

The defense has yet to present its full case in the trial. The university claimed that Lynch was fired because he lived 100 miles away, in Hershey, Pennsylvania, and officials wanted to hire someone who lived in the Penn State college town of State College, ESPN reported.

'Duty to the Patient'

"The medical profession's duty is to the patient, not to help a coach win games and/or keep their job," Lynch told ESPN in an interview. "When a coach tries to insert themselves into the patient's risk/benefit equation, it is wrong, and it must not be tolerated. There needs to be independent oversight of medical care. I am hoping that my case can be a catalyst for the rest of the country."

During the trial, Penn State team doctors testified that Coach Franklin tried to overrule medical decisions about athletes, including a suicidal player, according to The Philadelphia Inquirer. One doctor "detailed numerous meetings in which he said Franklin pressured him, Lynch, and the chief athletic trainer to alter their medical decisions and the treatment advice and options given to players."

Lynch himself testified that "Coach Franklin didn't like the number of players on the injury list," the newspaper reported. And he said the coach cleared patients for practice if they didn't report for injury therapy.

Franklin dismissed Lynch's claims in 2019 and said "the health and well-being of our student-athletes is of utmost importance to us."

Team Doctor-Coach Power Struggles

It's not uncommon for team doctors and trainers to argue with coaches over the care of athletes and their fitness to play. In 2019, the same year that Lynch sued Penn State, the NCAA tried to address the problem in Division I sports by affirming the "unchallengeable autonomous authority of primary athletics healthcare providers to determine medical management and return-to-play decisions related to student-athletes."

However, that same year, the National Athletic Trainers' Association reported that 19% of nearly 1800 trainers surveyed said a coach had cleared an athlete to play despite the player being declared medically ineligible. Only about three quarters said they have medical autonomy — "the unchallengeable authority to determine medical management of athletes."

Michael Fredericson, MD, a sports medicine physician and head team physician for Stanford University's track and field and swimming teams, told Medscape Medical News that medical autonomy is crucial in the athletic setting.

"We do our best to try and get the athletes back as quick as we can. But our primary mission is really their safety," he said. "When they come to see me as their team physician, I want them to feel like my decisions are in the best interest of their health and have nothing to do with what the coach wants. You have to establish that kind of trust."

At Stanford, varsity athletes have a stand-alone medical facility separated from the athletic facilities. "It allows us to really not be worried about the influence of coaches," he said. "Even though it's just across the street, the athlete does feel like they're going to a real doctor's office where they're going to be treated fairly."

Fredericson, who's treated team athletes for 30 years and has written about medical autonomy in athletics, said he learned an important lesson early on: "You don't want to be the fan: It's not your job is to be a fan of the athletes. Your job is to protect them and make sure that their health is the Number One priority."

May 30, 2024 — Editor's note: On May 29, a Pennsylvania jury found in favor of former Lynch in his lawsuit against the university, awarding him $5.2 million in punitive and compensatory damages. Lynch told EPSN that the NCAA should investigate medical autonomy in college athletics. "This is bigger than just Penn State," Lynch said. "It's really a national crisis and things have to change." Penn State said that it's considering whether to appeal.