Markkula Center of Applied Ethics

Is This a Spider Bite?

An Ethics Case About Managing MRSA

Stage 2.) A Single Case
 
By Jack Penner

Not long after Coach Phillips' conversation with the athletic director, one of the basketball players, Jennifer Leary, notices a small pimple on her shoulder that looks like a spider bite. No one has ever said anything to the players about skin infections, and Leary assumes it's nothing to fret over. After a few days, however, the pimple has grown significantly and has become very deep and painful. Leary is embarrassed about the problem and she wears long sleeves to cover the unsightly pimple. She does show her arm to a friend, who tells her that it is probably just a hair follicle infection and will go away in a few days.

But it doesn't--the pimple remains large and painful and several new, smaller bumps have developed around the larger one. Leary is beginning to become alarmed so she decides to go visit the University's health center. The doctor at the health center explains that it is probably some sort of rash from her basketball jersey rubbing her shoulder while she plays. The athlete receives a prescription for a skin cream and is told that it will clear up the rash within a week. However, the skin condition only worsens, as more of these deep painful pimples develop all over her upper arm. Some of them have even broken open and begun to discharge pus and blood.

Extremely concerned for her own health, Leary goes to the Emergency Room. There, Dr. Marla Holmes looks at the bumps and immediately diagnoses the infection as MRSA. When the athlete explains the history of the condition, the doctor is appalled that it has been misdiagnosed up to this point. For an athlete in a high-contact sport, Leary is showing the textbook symptoms of MRSA.

Holmes puts Leary on the antibiotic Vancomycin, to which the MRSA bacteria are not resistant. She tells Leary that her infection is contagious, and that she must keep it covered to prevent spreading it to others. The doctor recommends that Leary not participate in any games or practice until the wounds have healed.

Leary is extremely reluctant to tell Coach Phillips about the diagnosis because she wants to continue playing. But she follows the doctor's orders and talks to the coach. Phillips feels vindicated and a bit angry about having raised the problem of MRSA earlier with the Athletic Director and having nothing done until one of his players is infected. Now Morgan is willing to put a prevention program in place, including wiping down training tables after every use and a thorough cleaning of the bathrooms and locker rooms by the custodial staff at the end of each day.

For Phillips, though, benching Leary, the team's center and one of its best players, is a problem. Waynesville has a game against their conference rival, St. Aloysius University, in two weeks, and Leary is key to her team's successful play. The season hasn't been going that well, and the athletic director has been on Phillips' back to improve their winning percentage. Didn't the doctor say Leary could prevent the spread of the infection by covering the wound?

Questions?

  1. How far does the coach's obligation to the safety of both his players and those of the opposing team extend? Is it not the coach's job to put his team in the best position to win the game? If so, where does the line fall in terms of the importance of winning vs. the POTENTIAL harm of spreading MRSA? Is covering Leary's infection and allowing her to play a reasonable risk to take?
  2. Would the team doctor have a right to intervene in the decisions of the coach?
  3. Should Jennifer have any say? It is her body that we are dealing with, so does she have the ultimate decision?

What do the experts say?

Go to Stage 3.) Outbreak

Jack Penner, a sophomore public health major at Santa Clara University, is the 2010 Denise and John York/49ers Foundation Fellow in Sports Ethics.

December 2010

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