Privacy for safety: The NCAA sickle-cell trait testing policy and the potential for future discrimination

Iowa Law Review

Volumn 97, Issue 2, 2012, Pages 665-691

  Quick, Heather R ^a  

^a UNIVERSITY OF IOWA COLLEGE OF LAW   (United States)

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EID: 84856156659     PISSN: 00210552     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (138)

1. Brett Zarda, Lawsuit Prompts NCAA To Screen Athletes for Sickle Cell, USA TODAY (July 2, 2010, 2:34 PM), http://www.usatoday.com/sports/college/2010-06- 30-sickle-cell-ncaacover-N.htm.
2. Vence L. Bonham et al., Screening Student Athletes for Sickle Cell Trait-A Social and Clinical Experiment, 363 NEW ENG. J. MED. 997, 997(2010).
3. Dennis Dodd, NCAA To Recommend Schools Test for Sickle Cell Trait, CBSSPORTS. COM (June 29, 2009), http://www.cbssports.com/collegefootball/story/ 11903550.
4. Division I schools are the largest NCAA member institutions. In order to qualify as a Division I institution, a school must meet several criteria, including offering fourteen sports, two of which must be team sports, and also offer a sports team for the fall, winter, and spring seasons. Differences Among the Three Divisions: Division I, NCAA, http://www.ncaa.org/wps/wcm/connect/ public/ncaa/about+the+ncaa/who+we+are/differences+among+the+divisions/ division+i/(last visited Sept. 27, 2011).
5. Michelle Brutlag Hosick, Protocol Decided for Sickle Cell Testing, THE NCAA NEWS (Apr. 13, 2010), http://www.meacsports.com/fls/20800/Compliance/ Bulletins/LoopApril152010.pdf?DB-OEM-ID=20800.
6. 2011-2012 NCAA DIV. I MANUAL § 17.1.5.1(2011) [hereinafter NCAA Manual].
7. Madison Park, NCAA Genetic Screening Rule Sparks Discrimination Concerns, CNNHEALTH (Aug. 4, 2010, 8:13 AM), http://www.cnn.com/2010/HEALTH/08/04/ncaa. sickle.genetic. screening/index.html?iref=allsearch.
8. NCAA MANUAL, supra note 12, at § 13.11.3.7.3 (requiring testing before prospective student-athletes can participate in weight training or conditioning workouts);
9. NCAA v. Tarkanian, 488 U. S. 179, 190-99(1988) (finding that a state university's compliance with NCAA regulations does not make the NCAA a state actor);
10. Susan K. Menge, Should Players Have to Pass to Play?: A Legal Analysis of Implementing Genetic Testing in the National Basketball Association, 17 MARQ. SPORTS L. REV. 459, 466(2006). As this claim would likely fail with the waiver option, this Note will focus on what actions should be taken to protect a student-athlete's privacy right under the current policy.
11. THE NAT'L COLLEGIATE ATHLETIC ASS'N, QUESTION AND ANSWER DOCUMENT, NCAA DIVISION I PROPOSAL NO. 2009-75-B 2 (June 2, 2010), http://www.ncaa.org/wps/wcm/ connect/e833fc8042c462ce92bdfbffd1ce0240/NCAA+Division+I+Sickle+Cell+Trait+QA+ for+institutions+5+25+2010.pdf?MOD=AJPERES&CACHEID= e833fc8042c462ce92bdfbffd1ce0 240.
12. THE NAT'L COLLEGIATE ATHLETIC ASS'N, supra note 16, at 2.
13. See University of Vermont Athletic Medicine Department Sickle Cell Position Statement, UNIV. OF VT., http://uvmathletics.com/sports/2010/12/15/ athmed-1215105511.aspx?path=athleticmed (last visited Sept. 19, 2011) (click on the hyperlink "UVM Sickle Cell Position Statement," which will open a word document);
14. Sickle Cell Trait Fact Sheet, PRINCETON UNIV., available at http://www.princeton.edu/uhs/pdfs/Sickle-Cell-Trait-Fact-Sheet.pdf ("The recommendation of the Princeton University Athletic Medicine... is that every student-athlete be tested or show proof of prior testing for sickle cell trait.").
15. 45 C. F. R. §§ 160, 164 (A) & (E) (2010).
16. 20 U. S. C. § 1232g (2006).
17. A student-athlete being marked as a carrier of the sickle-cell trait can also have negative consequences when attempting to gain insurance. According to Title I of GINA, a group health plan or "a health insurance issuer offering group health insurance coverage in connection with a group health plan" cannot use a person's "genetic information. " Genetic Information Nondiscrimination Act of 2008, Pub. L. No. 110-233, 122 Stat. 881, 883(2008)
18. (codified as amended at 42 U. S. C. § 2000ff-8 (a) (7) (Supp. 2008)). Yet GINA only provides protection for carriers who wish to obtain health insurance and fails to provide protection in "life insurance, disability insurance, or long-term care insurance."
19. SECRETARY'S ADVISORY COMMITTEE ON HERITABLE DISORDERS IN NEWBORNS AND CHILDREN, SCREENING U. S. COLLEGE ATHLETES FOR THEIR SICKLE CELL DISEASE CARRIER STATUS 12(2010)
20. [hereinafter SECRETARY'S ADVISORY COMMITTEE], available at http://www.hrsa.gov/advisorycommittees/mchbadvisory/heritabledisorders/ recommendations/correspondence/briefingcarrierstatus.pdf.
21. 122 Stat. 881.
22. What Is Sickle Cell Disease?, SICKLE CELL DISEASE ASS'N OF AM., http://www.sicklecelldisease.org/index.cfm?page=about-scd (last visited Oct. 6, 2011).
23. Carlton Haywood Jr. & Michael Pena, Sidelined by Sickle Cell Trait?, JOHNS HOPKINS BERMAN INST. OF BIOETHICS (May 4, 2010), http://bioethicsbulletin. org/archive/sickle-celltrait/.
24. Background on Sickle Cell Trait and the NCAA, NCAA. ORG (Sept. 9, 2010), http://www.ncaa.org/wps/wcm/connect/public/NCAA/Resources/Latest+News/ 2010+news+stories/September+latest+news/ Background+on+sickle+cell+trait+and+the+NCAA.
25. Neil K. Kaneshiro, Sickle Cell Test, MEDLINEPLUS, http://www.nlm.nih.gov/ medlineplus/ency/article/003666.htm (last visited Oct. 6, 2011).
26. SECRETARY'S ADVISORY COMMITTEE, supra note 25, at 8.
27. SECRETARY'S ADVISORY COMMITTEE, supra note 25, at 7-8 (analyzing the number of Division I athletic programs that tested for the sickle-cell trait prior to the NCAA mandate, including those institutions that only tested African Americans)
28. (citing C. E. Clarke III et al., Sickle Cell Trait Preparticipation Screening Practices of Collegiate Physicians, 16 CLINICAL J. SPORT MED. 440(2006)).
29. Luke Atkinson, University of Oklahoma Trainer Leads Research To Protect Athletes with Sickle Cell Trait, OKLA. DAILY, Sept. 16, 2009, available at http://www.foxnews.com/story/0, 2933, 549283, 00.html.
30. Family Educational Rights and Privacy Act (FERPA), 20 U. S. C. § 1232 (g) (2006);
31. Health Insurance Portability and Accountability Act (HIPAA) of 1996, Pub. L. No. 104-191, 110 Stat. 2033. The Fourteenth Amendment does not prevent the NCAA from asking for a student-athlete's genetic information in this situation, as the NCAA is not considered a state actor.
32. NCAA v. Tarkanian, 488 U. S. 179, 193-99(1988). HIPAA and FERPA allow states to enact statutes that offer more protection. Not all states offer further protection, however, and if they do the statutes usually only cover employment situations and further limit what constitutes genetic information.
33. Amy Foster, Note, Critical Dilemmas in Genetic Testing: Why Regulations To Protect the Confidentiality of Genetic Information Should Be Expanded, 62 BAYLOR L. REV. 537, 551-53(2010). FERPA also allows states to enact statutes providing more protection, but the level of protection also varies from state to state.
34. See generally Susan P. Stuart, A Local Distinction: State Education Privacy Laws for Public Schoolchildren, 108 W. VA. L. REV. 361(2005) (discussing how states have enacted more privacy laws in an attempt to make up for the downfalls of FERPA).
35. Charles O'Hara, HIPAA Privacy Standards and University Athletic Departments, CATS NEWSLETTER, (Coll. Athletic Trainers Soc'y, Pittsburg, PA), Spring 2003, at 9-11, available at http://www.collegeathletictrainer.org/ newsletter/getfile.php?fetch=5-1.
36. U. S. DEPT. OF HEALTH & HUMAN SERVICES & U. S. DEPT. OF EDUCATION, JOINT GUIDANCE ON THE APPLICATION OF THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT (FERPA) AND THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996
37. (HIPAA) TO STUDENT HEALTH RECORDS 3-4 (Nov. 2008) [hereinafter JOINT GUIDANCE], available at http://www.hhs.gov/ocr/privacy/hipaa/understanding/ coveredentities/hipaaferpajointguide.pdf.
38. See James Blake Hike, Note, An Athlete's Right to Privacy Regarding Sport-Related Injuries: HIPAA and the Creation of the Mysterious Injury, 6 IND. HEALTH L. REV. 47, 53-54(2009).
39. U. S. DEPT. HEALTH & HUMAN SERVICES, OFFICE FOR CIVIL RIGHTS PRIVACY BRIEF: SUMMARY OF THE HIPAA PRIVACY RULE 1-2(2003) [hereinafter SUMMARY OF THE HIPAA PRIVACY RULE], available at http://www.hhs.gov/ocr/privacy/hipaa/ understanding/summary/privacysummary.pdf.
40. Health Insurance Portability and Accountability Act (HIPAA) of 1996, Pub. L. No. 104-191 § 264, 110 Stat. 2033;
41. see also SUMMARY OF THE HIPAA PRIVACY RULE, supra note 56, at 1-2(2003).
42. SUMMARY OF THE HIPAA PRIVACY RULE, supra note 56, at 1-2.
43. 45 C. F. R. § 160. 103(2010).
44. JOINT GUIDANCE, supra note 53, at 3.
45. 45 C. F. R. § 160. 103;
46. JOINT GUIDANCE, supra note 53, at 3.
47. Richard Bell et al., The Impact of the HIPAA Privacy Rule on Collegiate Sport Professionals, 11(2) SPORT J. (2008)
48. (citing David Jones, HIPAA: Friend or Foe to Athletic Trainers? ATHLETIC THERAPY TODAY, Mar. 2003, at 17, 17-19(2008)), available at http://www. thesportjournal.org/article/impact-hipaa-privacy-rule-collegiate-sport- professionals.
49. Stephen K. Phillips, A Legal Research Guide to HIPAA, 3 J. HEALTH & LIFE SCI. L. 134, 140(2010)
50. (citing 42 U. S. C. § 1320d-9(2006)).
51. 45 C. F. R. § 160. 103(2002). The Centers for Medicare and Medicaid Services have issued a flow chart in an attempt to help entities determine whether they are covered entities under HIPAA.
52. Covered Entity Charts, CTRS. FOR MEDICARE & MEDICAID SERVS., available at http://www.cms.gov/HIPAAGenInfo/Downloads/CoveredEntitycharts.pdf (last visited Sept. 19, 2011).
53. THOMAS N. SHORTER, UNDERSTANDING HIPAA: A GUIDE TO SCHOOL DISTRICT PRIVACY OBLIGATIONS 17-18(2004) (internal quotation marks omitted);
54. C. F. R. § 160. 103.
55. 45 C. F. R. § 164.502 (a) - (b);
56. SUMMARY OF THE HIPAA PRIVACY RULE, supra note 56, at 11.
57. SECRETARY'S ADVISORY COMMITTEE, supra note 25, at 9.
58. Interview with Terrance G. Noonan, supra note 17. Some athletic departments cover the cost of testing all athletes.
59. Report: N. C. A&T Trainer Urged Against Sickle Cell Test, USA TODAY (January 7, 2011 2:50 PM), http://www.usatoday.com/sports/college/2011-01-07-nc- atstudent-dies-N.htm (quoting the school's chief athletic director as stating "[p]lease make sure the [athlete is] actually on the team before this test is done. The reason for this is that the student health center is charging the athletic department for this test to be done." (internal quotation marks omitted)).
60. SECRETARY'S ADVISORY COMMITTEE, supra note 25, at 7. Even if the athletic-training departments do not need to bill insurance and transmit documents electronically in that instance, the departments likely will do so for some other reason as they provide services in a variety of circumstances.
61. 34 C. F. R. § 99.1 (d) (2011);
62. JOINT GUIDANCE, supra note 53, at 1.
63. JOINT GUIDANCE, supra note 53, at 1.
64. 34 C. F. R. § 99.3;
65. see also JOINT GUIDANCE, supra note 53, at 1-2.
66. 34 C. F. R. § 99.3(4).
67. 34 C. F. R. § 99.11 (f).
68. JOINT GUIDANCE, supra note 53, at 7.
69. see also Susan M. Pitz, HIPAA and the Sports Media: Separating Fiction from Reality, NEV. LAW., Aug. 2003, at 12, 12.
70. JOINT GUIDANCE, supra note 53, at 3, 7;
71. see also John L. Nicholson & Meighan E. O'Reardon, Data Protection Basics: A Primer for College and University Counsel, 36 J. C. & U. L. 101, 111(2009).
72. CLIFFORD A. RAMIREZ, FERPA CLEAR AND SIMPLE: THE COLLEGE PROFESSIONAL'S GUIDE TO COMPLIANCE 41(2009).
73. 45 C. F. R. § 164. 502 (d) (2) (2010);
74. see also 45 C. F. R. §§ 164. 502 & 164.514 (a) - (b);
75. Stacey A. Tovino, The Use and Disclosure of Protected Health Information for Research Under the HIPAA Privacy Rule: Unrealized Patient Autonomy and Burdensome Government Regulation, 49 S. D. L. REV. 447, 455-56(2004).
76. Paul Ohm, Broken Promises of Privacy: Responding to the Surprising Failure of Anonymization, 57 UCLA L. REV. 1701, 1737(2010) (citations omitted).
77. 45 C. F. R. §§ 164. 512 (i) (1) (i) - (iii);
78. SUMMARY OF THE HIPAA PRIVACY RULE, supra note 56 at 8;
79. U. S. DEP'T OF HEALTH & HUMAN SERVS., HEALTH INFORMATION PRIVACY: RESEARCH (Apr. 3, 2003), available at http://www.hhs.gov/ocr/privacy/hipaa/ understanding/special/research/research.pdf.
80. See OFFICE OF RESEARCH COMPLIANCE, IMPACT OF HIPAA MEDICAL PRIVACY RULE ON RESEARCH AT USC (2003), available at http://orc.research.sc.edu/PDF/ HIPAAoverview.pdf.
81. Family Educational Rights and Privacy Act (FERPA), ED. GOV, http://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html (last visited Sept. 19, 2011);
82. see also 20 U. S. C. § 1232g (b) (2006);
83. C. F. R. § 99.31(2011).
84. Lynn M. Daggett, FERPA in the Twenty-First Century: Failure to Effectively Regulate Privacy for All Students, 58 CATH. U. L. REV. 59, 101(2008).
85. (citing Marisol Bello, Securing Students' Data Top Tech Issue, USA TODAY, Mar. 20, 2008, at A3).
86. Stefanie Hoffman, UC Berkeley Database Hacked, 160,000 Records Compromised, CRN (May 11, 2009, 5:45 PM), http://www.crn.com/news/security/ 217400303/uc-berkeley-databasehacked-160-000-records-compromised.htm?itc= refresh.
87. Nicolas P. Terry, What's Wrong with Health Privacy?, 5 J. HEALTH & BIOMEDICAL L. 1, 7(2009);
88. LaToya Rembert-Lang, New HIPAA Rules Go into Effect February 17, 2010: Are You Ready?, MARKETING RESEARCH ASS'N (Jan. 11, 2010), http://www. marketingresearch.org/news/2010/01/11/new-hipaa-rules-go-into-effect-february- 17-2010-are-you-ready.
89. Stephanie Humphries, Note, Institutes of Higher Education, Safety Swords, and Privacy Shields: Reconciling FERPA and the Common Law, 35 J. C. & U. L. 145, 157(2008)
90. (citing Gonzaga Univ. v. Doe, 536 U. S. 273, 283-91(2002)).
91. See 45 C. F. R. § 164. 508 (c) (2010) (detailing the requirements for written authorization to release PHI);
92. 45 C. F. R. § 164. 508 (c). Because of this, many HIPAA covered universities have their waivers written very generally. For example, Iowa State University's waiver form lists many entities that the school can release medical information to, including coaching staff and the media. See infra note 122.
93. Interview with Terrance G. Noonan, supra note 17.
94. See NCAA MANUAL, supra note 12, 17.1.5.1.
95. NAT'L COLLEGIATE ATHLETIC ASS'N, NCAA DIVISION I PROPOSAL NO. 2009-75-B QUESTION AND ANSWER DOCUMENT 1-2(2010), available at http://www.ncaa.org/wps/ wcm/connect/e833fc8042c462ce92bdfbffd1ce0240/ NCAA+Division+I+Sickle+Cell+Trait+QA+for+i nstitutions+5+25+2010.pdf?MOD= AJPERES&CACHEID=e833fc8042c462ce92bdfbffd1ce0240.
96. After announcing the legislation, and after the publication of the New England Journal of Medicine article critiquing the mandate, the NCAA responded with slightly more comprehensive guidelines for when a student-athlete tests positive, but still left much up to the individual athletic programs.
97. The NCAA recommended that athletic programs follow the Sports Medicine Handbook when a student-athlete tests positive for the trait and gave further vague instructions like
98. "[d]evelop a year-round strength and conditioning program" and "allow[] longer periods of rest and recovery." Background on Sickle Cell Trait, supra note 38. The NCAA also provided a video on dealing with student-athletes that test positive for the sickle-cell trait.
99. Drake Athletic Training Staff, Sickle Cell Trait Test Information, GODRAKEBULLDOGS. COM (June 9, 2010), http://www.godrakebulldogs.com/ViewArticle. dbml?DB-OEM-ID=15700& KEY=&ATCLID=204957972&SPID=39420&SPSID= 602748 (requiring students to provide test results, without mentioning the option of a waiver). However, whether these schools are notifying each student individually of their rights is unknown. Regardless, this information is not publicized on their website to current or potential student-athletes.
100. Glossary of Terms, NCAA. ORG, http://www.ncaa.org/wps/wcm/connect/public/ NCAA/Issues/Enforcement/Rules+Enforcement+glossary+of+terms#major (last visited Oct. 6, 2011).
101. For the waiver form used, see University of Nebraska, Medical History for Student Athletes, available at http://www.huskers.com//pdf6/80708.pdf?SPSID= 184&SPID=41&DB-OEM-ID=100;
102. see also Iowa State University, Authorization for Release of Medical Information, available at http://www.cycloneathletictraining.com/documents/ filelibrary/forms/Authorization-for-Release-of-Medica-EB56D90AF4BD0.pdf (showing the waiver form used by Iowa State University).
103. Pat Forde, Leadership Lacking in Latest Mess, ESPN (Jan. 18, 2011), http://sports.espn. go.com/ncf/columns/story?columnist=forde-pat&id=6069090 (criticizing University of Iowa coaches for their handling of football players' hospitalizations).
104. In fact, curiosity about the University of Iowa players' medical condition was so high that University of Iowa Hospitals and Clinics staff illegally accessed the players' files in violation of HIPAA. UI Investigating Access to Players' Medical Data, KCCI. COM (Jan. 28, 2011, 4:37 PM), http://www.kcci.com/sports/26653381/detail.html.
105. J. H. GERARDS ET AL., GENETIC DISCRIMINATION AND GENETIC PRIVACY IN A COMPARATIVE PERSPECTIVE 12(2005).
106. SECRETARY'S ADVISORY COMMITTEE, supra note 25, at 11 (citing the case of Lawrence Berkeley Laboratory testing employees for "sickle cell trait, syphilis, and pregnancy without their knowledge."). Also, testing for a genetic marker like the sickle-cell trait also reveals information about the potential genetic information of family members, leading to nonconsensual disclosure in some cases.
107. Rhonda B. Evans, Recent Development, "Striking Out": The Genetic Information Nondiscrimination Act of 2008 and Title II's Impact on Professional Sports Employers, 11 N. C. J. L. & TECH. 205, 220(2009).
108. Mark A. Rothstein, Discrimination Based on Genetic Information, 33 JURIMETRICS J. 13, 14-15(1992).
109. Daniel Schlein, New Frontiers for Genetic Privacy Law: The Genetic Information Nondiscrimination Act of 2008, 19 GEO. MASON U. C. R. L. J. 311, 313-14(2009). In fact, part of the motivation for passing GINA was the history of widespread testing for sickle cell in the 1960-70s and the discrimination that African Americans received as a result.
110. SECRETARY'S ADVISORY COMMITTEE, supra note 25, at 11. This discrimination against African Americans who carried the sickle-cell trait also led to the passage of the Sickle Cell Anemia Control Act, "which withholds federal funds from States unless sickle-cell testing is voluntary."
111. Pub. L. No. 110-233, 122 Stat. 881(2008)
112. (codified as amended at 42 U. S. C. § 2000ff (Supp. II 2008)). Because the sickle-cell trait is much more predominant in African Americans, employers would use the positive test result as a reason to not hire an African American, when the end goal was to simply discriminate against a person because of his or her race.
113. SECRETARY'S ADVISORY COMMITTEE, supra note 25 at 11
114. (citing National Sickle Cell Anemia Control Act, Pub. L. No. 92-294, § 2, 86 Stat. 136(1972)
115. (codified as amended at 42 U. S. C. 300b (2006)));
116. Some argue GINA may not cover any employment where physical capabilities are relevant to the job description, including in professional-sports leagues. The argument is that GINA might not apply because (1) GINA assumes that a person's genetic information has no bearing on a potential employee's ability to perform the job, and this is not the case with professional football, and (2) GINA also assumes that genetic information deals with concerns of future risk because of a genetic disposition, while the NFL is concerned with current risk due to the trait. Adam Y. Siegel & Frank Alvarez, Sickle-Cell Testing and the Implications of GINA, SPORTS LITIG. ALERT, May 21, 2010, available at http://www.hackneypublications.com/sla/archive/001055.php. The NFL tests for the trait during the annual scouting combine but leaves the decision whether to test all players up to each individual team.
117. Katie Thomas & Brett Zarda, In N. C. A. A., Question of Bias over a Test for a Genetic Trait, N. Y. TIMES, Apr. 12, 2010, http://www.nytimes.com/ 2010/04/12/sports/12sickle.html. Previously, this type of situation would have been regulated by the Americans with Disabilities Act. In Chevron U. S. A. Inc. v. Echazabal, the Court upheld the EEOC's regulation which stated that a company may refuse to hire an individual because performing the job would be a danger to his or her health.
118. U. S. 73, 76(2002).
119. SECRETARY'S ADVISORY COMMITTEE, supra note 25, at 12.
120. Michael S. Schmidt & Alan Schwarz, Baseball's Use of DNA Raises Questions, N. Y. TIMES, July 21, 2009, http://www.nytimes.com/2009/07/22/sports/ baseball/22dna.html.
121. 42 U. S. C. § 2000ff-1 (b) (4) (Supp. III 2010);
122. How Does GINA Impact ME?, COAL. FOR GENETIC FAIRNESS, http://www.geneticfairness.org/ginaresource-impact.html (last updated Nov. 10, 2008).
123. 42 U. S. C. § 2000ff-1 (b) (4).
124. 42 U. S. C. § 2000ff (a).
125. Gregory Katz & Stuart O. Schweitzer, Implications of Genetic Testing for Health Policy, 10 YALE J. HEALTH POL'Y L. & ETHICS 90, 108(2010) (discussing how proving unlawful discrimination under GINA will be difficult "because of loopholes in the law").
126. In a disparate-impact claim, an employee does not need to prove intent to discriminate but simply that an employer's policy or practice leads to discrimination. Smith v. City of Jackson, Miss., 544 U. S. 228, 241(2005).
127. See Mary L. Anzalone et al., Sickle Cell Trait and Fatal Rhabdomyolysis in Football Training: A Case Study, 42 MED. & SCI. SPORTS & EXERCISE 3, 6(2010).
128. (citing J. A. Kark et al., Sickle-Cell Trait as a Risk Factor for Sudden Death in Physical Training, 317 NEW ENG. J. MED. 781, 781-87(1987));
129. SECRETARY'S ADVISORY COMMITTEE, supra note 25.
130. North Carolina A&T Fires Athletic Director over Student Death, USA TODAY (Oct. 15, 2010, 7:52 PM), http://www.usatoday.com/sports/college/2010-10- 15-ncat-athletics-directorfired-N.htm [hereinafter North Carolina].
131. A&T Welcome, OFFICIAL SITE OF AGGIE ATHLETICS: N. C. A&T, http://www.ncataggies.com/ViewArticle.dbml?DB-OEM-ID=24500&ATCLID=204937491 (last visited Oct. 6, 2011);
132. see also NCAA Members by Division, NCAA. ORG, http://web1.ncaa.org/ onlineDir/exec/divisionListing (last visited Oct. 6, 2011).
133. North Carolina, supra note 167.
134. see also Memorandum from Chancellor Harold L. Martin, Sr. to the University Community (Oct. 15, 2010), available at http://www.ncataggies.com// pdf8/716820.pdf.
135. 45 C. F. R. § 164.502 (c) (2010).
136. GARY HARRELSON ET AL., ADMINISTRATIVE TOPICS IN ATHLETIC TRAINING: CONCEPTS TO PRACTICE 112(2009).
137. Eric A. Storch et al., Self-Reported Psychopathology in Athletes: A Comparison of Intercollegiate Student-Athletes and Non-Athletes, 28 J. SPORT BEHAV. 86, 87(2005).
138. Matthew J. Mitten & Timothy Davis, Athlete Eligibility Requirements and Legal Protection of Sports Participation Opportunities, 8 VA. SPORTS & ENT. L. J. 71, 116(2008).