Negligence lawsuits in our society have increased significantly over the past couple of decades. Personal fitness trainers (PFTs) and their employers (e.g., managers/owners of health/fitness facilities) have not been immune to this litigation. In addition to PFTs, employers often are included as defendants in negligence lawsuits because they can be held liable for the negligent acts of their employees through a legal doctrine called respondeat superior. This article provides a summary (Table) and an analysis of eight lawsuits in which injured clients (plaintiffs) sued their PFT and the facility (defendants) for negligence. The analysis revealed three major liability exposures that PFTs and their employers can minimize by implementing various risk management strategies.
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TABLE: Negligence Lawsuits Against Personal Fitness Trainers
DEFENSES TO NEGLIGENCE
To understand the last column in the Table (Appellate Court's Ruling), a review of how defendants use certain defenses (e.g., assumption of risk and waivers of liability)to help refute negligence claims made against them is necessary. Defendants often file a motion for summary judgment requesting the trial court to dismiss the case, claiming that there is no legal question to be decided because the plaintiff assumed the risks or signed a waiver. The trial court's ruling to grant or dismiss this motion is sometimes appealed to an appellate court. The appellate court then decides to uphold or reverse the trial court's ruling or to remand the case (send it back for a new trial). These defenses can be effective in protecting the defendants from liability (see Rostai and Avant in the Table) or ineffective (see Corrigan and Johnson in the Table), which may then lead to the defendants being held liable for the plaintiff's injury.
LIABILITY EXPOSURES REVEALED
Liability exposures are situations that increase the risk of injury and subsequent litigation. Although several liability exposures were evident from the analysis of these cases, three major ones were revealed. Each is described.
1. Unnecessary High-Intensity Training.
In three cases (Rostai, Sanford, and Guthrie), the PFTs continued to push their clients to work at high intensity levels despite their requests to stop and/or complaints of exhaustion/fatigue. One question that arises is "Why didn't the clients just stop or slow down on their own?" It is important to realize that many clients will rely on and trust their PFT as the expert and will follow their PFT's advice as did Guthrie whose PFT assured her that exercises were appropriate and would not harm her. Therefore, it is essential that PFTs provide advice that is safe, given the health and fitness status of each client. PFTs also need to understand that not only is high-intensity training unnecessary for many clients who want to improve their health and fitness but that it also increases the probability of an untoward event as demonstrated by the heart attack that Rostai experienced toward the end of his first training session. PFTs should be familiar with an ACSM and American Heart Association Joint Position Stand (11) that states "…vigorous exertion transiently increases the risk of AMI (acute myocardial infarction) and SCD (sudden cardiac death), particularly among habitually sedentary persons with occult or known CAD (coronary artery disease) performing unaccustomed, vigorous physical activity" (p. 890) and "even in exercise-conditioned individuals" (p. 894).
2. Training Outside Scope of Practice.
Scope of practice (4) can be defined as "activities in which a professional engages…that are within the boundaries or limitations of that particular profession, e.g., health/fitness professionals should practice within the limitations of their education, training, experience, and certification" (p. 390). Professionals that cross over into a licensed profession (e.g., practicing dietetics or medicine without a license) can face criminal charges as well as civil claims such as negligence. The PFT in Capati advised his client to take dietary supplements but did not advise her that there may be negative health consequences for her to do so while on hypertension medication. Providing individual dietary advice, such as advising clients to take certain supplements, is outside the scope of practice of PFTs (10). However, PFTs can provide general education regarding nutrition/supplements and recommend their clients consult with their physician and/or dietitian for individual dietary advice.
The PFT in Makris seemed to make a "medical diagnosis" of her client's pain, that is, it was due to upper-body weakness, and then seemed to "treat" her client's pain by having her continue with the exercises despite complaints of intense pain. PFTs should not attempt to diagnose and treat various types of pain that clients might describe to them but instead refer them to their physician for diagnosis and treatment. PFTs also need to be able to distinguish signs and symptoms that might be associated with a possible medical problem and those that are typically associated with exercise. Like the PFT in Makris, the PFT in Rostai also did not seem capable of making this distinction. The PFT in Rostai misinterpreted his client's signs (i.e., shortness of breath and profuse sweating) as usual signs of physical exertion rather than those of a heart attack.
Scope of practice also is relevant when courts determine the professional standard of care. van der Smissen (12) states "if one accepts responsibility for giving leadership to an activity or providing a service, one's performance is measured against the standard of care of a qualified professional for that situation" (p. 40). Therefore, the professional standard of care is situation based and determined by (a) the nature of the activity (e.g., the PFT should be aware of the skills/abilities each client needs to safely participate in the activity - if these are complex, the PFT should have knowledge to apply these skills/abilities), (b) the type of participants (e.g., the PFT should be aware of individual factors related to each client such as any health conditions that impose increased risks and then how to minimize those risks), and (c) the environmental conditions (e.g., the PFT should be aware of any conditions such as heat and humidity and how to minimize risks associated with these conditions) (4,12). Although clients in four of these cases had known cardiac risk factors, known heart disease, or some other diagnosed medical condition, it seems that the PFTs did not conduct preactivity screening procedures before training them. In addition, the client in Avant claimed that his serious physical and emotional injuries were due to a program that was negligently designed by his PFT. It is doubtful that the conduct of these PFTs would be commensurate with the professional standard of care if they did not possess and/or apply the necessary knowledge, skills, and abilities (KSAs) to properly administer preactivity screening procedures for clients with medical risks/conditions or design an individualized exercise program.
3. Improper Instruction and Supervision.
Providing clients with proper instruction and supervision are important responsibilities of PFTs. The clients in Corrigan and Johnson claimed that their PFT did not provide them with proper instruction on how to safely execute the exercises when first learning how to perform them. Failure to provide proper supervision was a claim made by the clients in Corrigan and Sanford whose PFTs walked away abandoning their client during a training session. Although providing proper instruction and supervision is considered a basic responsibility of PFTs, given the nature of one-on-one training, the PFTs in several of these cases allegedly failed to carry out these responsibilities. Obviously, when a client is paying for individualized training, the PFT should carefully instruct and continually supervise the client as he/she learns and performs every exercise.
CONCLUSION
It is likely that many of the injuries experienced by clients (and the subsequent litigation) in these cases could have been prevented if the PFTs would have possessed and applied the necessary KSAs to safely train their clients. It is essential that PFTs obtain adequate education and training before becoming a PFT, so they fully understand and appreciate the many potential liability exposures they can face and how to minimize them in their practice. Employers also have a responsibility to take steps to help ensure that their PFTs are safely training clients such as administering periodic job performance appraisals that involve evaluating the conduct of each PFT.
This column provides general legal information and is not intended to substitute for individualized legal advice.
References
1. Avant v. Community Hospital, 826 N.E.2d 7 (Ind. Ct. App., 2005).
2. Capati v. Crunch Fitness International,
et al. Analyzed in: Herbert DL. $320 million lawsuit filed against health club.
Exerc Standards Malpract Rep. 1999;13(3):33,36 and Wrongful death case of Anne Marie Capati settled for in excess of $4 million.
Exerc Standards Malpract Rep. 2006;20(3):36.
3. Corrigan v. Musclemakers, Inc., 258 A.D.2d 861 (N.Y. App. Div., 1999).
4. Eickhoff-Shemek, JM, Herbert DL, Connaughton DP.
Risk Management for Health/Fitness Professionals: Legal Issues and Strategies. Baltimore (MD): Lippincott Williams & Wilkins; 2009.
5. Guthrie v. Crouser, Analyzed in: Herbert DL. Qualifications/certifications of personal trainers again in the news.
Exerc Standards Malpract Rep. 2008;22(3):33, 36-8.
6. Johnson v. UBAR, LLC, 210 P.3d 1021 (Wash. Ct. App., 2009).
7. Makris v. Scandinavian Health Spa, Inc., Ohio App. LEXIS 4416 (Ct. of Appeals, 7th Dist., 1999).
8. Rostai v. Neste Enterprises, 41 Cal. Reptr.3rd 411 (Cal. Ct. App., 4th Dist. 2006).
9. Sanford v. Vision Quest Sport and Fitness. Analyzed in: Herbert DL. Personal trainer sued in Washington.
Exerc Standards Malpract Rep. 2009;23(1):8-10.
10. Sass C, Eickhoff-Shemek J, Manore M, Kruskall L. Crossing the line: understanding the scope of practice between registered dietitians and health/fitness professionals.
ACSM Health Fit J. 2007;11(3):12-9.
11. Thompson PD, Franklin BA, Balady GJ,
et al. Exercise and acute cardiovascular events: placing the risks into perspective.
Med Sci Sports Exerc. 2007;39(5):886-97.
12. van der Smissen, B. Elements of negligence. In: Cotten DJ, Wolohan JT, eds.
Law for Recreation and Sport Managers, 4th Ed. Dubuque (IA): Kendall/Hunt Publishing Company; 2007.
