For many years - decades actually - PIAA has required only a cursory physical examination of students prior to their beginning participation in interscholastic athletics. The re-certification process prior to each subsequent sport season was similarly perfunctory. The purpose of the reviews was to detect any readily apparent ailments that might preclude the student's participation or endanger competitors. For several reasons, the process was not intended to be a comprehensive one. First, few schools had the resources or capabilities to provide, at no or nominal cost to the students, comprehensive screenings for large numbers of athletes. Second, few students had health insurance that provided coverage for multiple physical examinations in a single year. Third, neither PIAA nor its member schools viewed themselves as being responsible for determining the complete health status of individual students merely because the students participated in interscholastic athletics. That was believed to be the responsibility of the families.

In recent years, there have been a series of developments that have caused PIAA to reassess its approach to pre-participation physical examinations. In particular,

1. a study disclosed that, nationally, 319 high school athletes died from heart failure during practice or contests from 1982 through 2000. 29 more died from heat stroke. Many others may have suffered from conditions which would have been detected through an appropriate pre-participation physical examination;
2. the NFHS conducted a study of state association use of pre-participation physical examinations and determined that most have more extensive requirements than does PIAA;
3. physicians have become increasingly reluctant to complete the existing PIAA Physician's Certificate as it does not provide for a health history or adequate guidance as to the standard of review nor does it provide for the type of examination which many physicians believe necessary prior to a student's participation in strenuous activity; and
4. the PIAA Sports Medicine Advisory Committee recommended discontinuance of the PIAA Physician's Certificate and the use of a more comprehensive form.

In light of the above, the PIAA Board of Directors has been considering various options and approaches to handling pre-participation physical examinations. This process began in earnest in 2002, when the Board of Directors approved the use of the Governor's Council on Physical Fitness and Sports Preparticipation Sports Physical Evaluation form ("Governor's Council Form") as an alternative to the PIAA Physician's Certificate.

In 2004, the Board of Directors took up the possibility of discontinuing use of the PIAA Physician's Certificate in its entirety. After considerable discussion, it was proposed that a new form, to be identified as the "PIAA Medical Examiner's Certificate," would replace both the PIAA Physician's Form and the Governor's Council Form. The new draft form incorporated much of the Governor's Council Form, but with some modifications. The proposal passed two readings but, in January 2005, was tabled for further assessment and review.

The issue essentially lay dormant until the spring of 2006, when the Board of Directors approved a revised proposal which essentially preserved the existing approach, continuing to allow use of the PIAA Physician's Certificate, but now adding the option of a more comprehensive examination, the Comprehensive Initial Pre-Participation Physical Evaluation (CIPPE). Students having a CIPPE would not, under most circumstances, be required to have re-certifications prior to each subsequent sport season. That proposal was approved on a third reading basis on May 25, 2006, to be effective June 1, 2006.

Finally, the Board of Directors also determined that the PIAA Physician's Certificate would be entirely eliminated, effective June 1, 2008. The Board is also considering, but has not yet taken any action, on the subject of whether schools should have a voice in determining whether a student who has used the CIPPE form must have a re-certification prior to a subsequent sport season. That issue is expected to be resolved in the next few months.

The Rule Now in Effect

The new language for ARTICLE V can be found on the PIAA Web site and in the PIAA Handbook, and will not be fully repeated here. It can be summarized as follows:

PREAMBLE: A Preamble has been added to ARTICLE V. The Preamble sets forth PIAA's approach and objectives in ARTICLE V.

Section 1, Sub-Section A: This Sub-Section essentially retains the previously permitted use of the PIAA Physician's Certificate or the Governor's Council Form, with the required re-certification prior to each subsequent sport season. The provision more precisely sets forth the standard of review to be applied by the Authorized Medical Examiner ("AME") and further specifies that the AME, prior to issuing such certification, should (a) have a working understanding of the physical requirements of the sport(s) in which the student is to participate; (b) review a health history of the student; and (c) perform an evaluation appropriate for the sport for which certification is being sought. This Sub-Section will be phased out, effective June 1, 2008.

Section 1, Sub-Section B: This Sub-Section is new. It authorizes the CIPPE and the use of the CIPPE form. It utilizes the same standard of review applicable in Sub-Section A but, as is apparent in comparing the applicable forms, requires a much more extensive examination and evaluation than is required under the PIAA Physician's Certificate. Additionally, a completed CIPPE form can be used for a period of one year from the date of the examination. A student is required to be re-examined only if there is an intervening illness or injury.

Discussion of Rule

The PIAA Board of Directors is aware of potential challenges faced by schools as they transition to the CIPPE, which is now optional and which will become mandatory in 2008. The approach utilized by many schools, where students are lined up and given a few minutes with an AME prior to the form being completed will not be feasible in the future. More planning, and more time between examinations may be required should schools continue to make arrangements to conduct the examinations. In the alternative, schools may elect to require students to make their own arrangements to have physicals conducted. Whether the student has health insurance may be a factor in that student's ability to meet the requirement. Hopefully, schools will be able to make arrangements appropriate for those in need to ensure that no student is unable to participate due to this requirement. Ultimately, though, the Board of Directors believes that having a CIPPE conducted is in the best interest of the student athletes, their teammates and opponents.

The revised By-Law has several distinct advantages over the prior language:

1. Regardless of which form is utilized by the student, the standard of review of the person conducting the evaluation is firmly established. The AME must certify that the student "is physically fit to participate in [interscholastic athletics] and that the student does not have any communicable illness or condition, which would pose a danger to teammates and/or competitors."
2. Regardless of which form is utilized by the student, the AME is expected to (a) have a working understanding of the demands of the applicable sport; (b) review a health history of the student; and (c) perform an examination appropriate for the applicable sport.
3. There is incentive to utilize the Comprehensive exam and form as a student doing so must obtain a re-certification only under certain conditions, while a re-certification is mandatory for those utilizing only the PIAA Physician's Certificate.
4. The requirement of a CIPPE is for the benefit of the student athlete and, hopefully, will prevent otherwise avoidable serious illnesses and injuries.