The NFL season ends Sunday, as it always does, with two teams of the walking wounded pounding each other one last time. This year it's the Baltimore Ravens against the San Francisco 49ers—or if you're inclined to credit their respective medical teams, it's MedStar Union Memorial vs. Stanford Hospital & Clinics. The Ravens and 49ers are among the 23 NFL teams with "official" health care providers. (That figure is a hand count that the league declined to confirm.) These arrangements differ, but the standard deal includes reduced-rate medical care and/or a payment from the hospital to the team in exchange for the medical provider getting to ballyhoo the affiliation in its marketing. "The halo effect is huge," Lew Lyon, vice president of the Ravens-affiliated MedStar Sports Medicine, tells me. "Friends will call me and say, 'Can you get me into see one of the Ravens docs?' And they're very accessible. They have private practice like other physicians."
But the opacity of these marketing arrangements should give you pause as you're weighing whether to drag your balky knee to the local jock docs. For one, by league policy, individual players are free to opt out of any official team arrangement and see another medical provider, as the Ravens' Ray Lewis did this year when he had surgery on his triceps (and when the linebacker allegedly ingested deer-antler spray to aid in his comeback). More fundamentally, fans ought to think through the inherent conflicts of interest at play when a doctor serves both a team and a patient who happens to be that team's employee.
To a lot of us freelance contractor types, the idea of an employer covering our health care sounds like a Cadillac plan fit for a CEO. But consider the logjam for a physician in this setting. Privacy, confidentiality, speed of recuperation, treatment regimens—all of them stand to suffer when players see a doctor employed by an organization that prefers they return to work ASAP. Then imagine this added conflict: The doctor who just cleared you for duty was so thrilled to have the gig that she paid your employer for the privilege. Now you're getting closer to the situation many pro athletes face. Put yourself in their cleats for a moment. Would you want to be treated by a doctor who had your employer's profitability anywhere on her list of concerns? And further, would you be forthcoming about your health problems to someone with a direct pipeline to managers with the power to effectively fire you for poor health?
The expansion Carolina Panthers and Jacksonville Jaguars signed the first known medical sponsorship deals in the mid-'90s. Since then, health care providers have been cutting deals with teams for the right to advertise themselves as the franchise's "official" choice—even paying millions for those marketing rights.
Medical ethics codes expressly forbid conflicts that could place financial gain ahead of patient welfare; the 1,500-year-old Hippocratic Oath protects patients against "harm and injustice." Yet it's standard for teams to sell their affiliations to the highest bidder. After the New York Yankees won the 1999 World Series, the team solicited $1.5 million for its health care marketing rights. Among the hospitals to decline that honor was the Yankees' longtime care provider, Columbia Presbyterian Medical Center. Its executive vice president told the Daily News: "Even if we were flush, I'm not sure I would do it. I'm not comfortable with that kind of deal, and I don't think it would necessarily be good for the institution." Other doctors have voiced similar concerns. Then-Atlanta Falcons team doctor Andrew Bishop told the New York Times in 2004 that he would resign if the team entered a hospital sponsorship deal: "It compromises you as a physician. The perception is that if this individual was so eager to do this he's willing to pay to do it, then he's going to do whatever management wants to keep the job he paid for."
Perhaps no conflict was as glaring as that of the Boston Red Sox when Arthur Pappas, the team's longtime orthopedic surgeon, was also part-owner. Marty Barrett, a player and a patient, tore his ACL during the 1989 pennant race, and later won a suit against Pappas in which the player claimed that the doctor/owner disclosed to Barrett neither the extent of his injuries nor the time needed for proper recovery. A 1995 Sports Illustrated report on Pappas and other team docs cited a Chicago Bears doctor who botched a knee operation and then tried erasing part of a videotape of the surgery so as not to lose his contract with the team. No less than Bill Walton, Dick Butkus, and Carlton Fisk also believe their injuries worsened when team physicians hustled them back into the lineup. (Pappas was Fisk's doctor as well.)
In 2002, former Jaguars offensive lineman Jeff Novak won a malpractice suit against Stephen Lucie, who had been the Jaguars' team doctor since the team's founding. (Lucie's employer,Jacksonville Orthopaedic Institute, is still the team's "exclusive sports medicine partner" after winning its bid for that right.) Novak suffered a bone bruise that the lawsuit claimed Lucie squeezed and scraped at. Novak played hurt, which led to infection, profuse bleeding and, ultimately, his retirement. John Jurkovic, a teammate of Novak's in Jacksonville, described the health culture that coach Tom Coughlin fostered there: "[The team trainer] would never intervene on a player's behalf. He was browbeaten. Coughlin controlled him. That's who has no spine. He's a puppet." Novak said Coughlin was prone to kvetching that injured players were "sick, lazy and lame." Far from becoming a pariah, Coughlin has since won two Super Bowls with the New York Giants.
Only when health outcomes turn into news are these marketing deals exposed for the morass they are. Weeks before St. Louis Cardinals pitcher Darryl Kile died of a heart attack during the 2002 season, the team's official health care provider had published a publicity shot of him with a Washington University doctor as evidence of the hospital's bona fides. The doctor, George A. Paletta, explained soon after Kile's death that a normal battery of tests for a 33-year-old athlete wouldn't have caught the 90 percent blockage in two of Kile's arteries. ESPN.com found doctors who disagreed, saying Kile's father's fatal stroke at 44 should've prompted a stress test for the pitcher. Cardinals manager Tony La Russa took the opportunity to advise his players to retain a physician unaffiliated with the team to administer off-season tests, as La Russa himself did.
None of this is meant to impugn every team doctor. But it's worth noting that there's a lot at stake here beyond merely keeping players upright. These multiyear contracts include marketing components such as gate sponsorship, in-stadium signage, presence at league health events, training camp sponsorship, training facility sponsorship, athlete and coach endorsements, as well as medical components beyond just caring for players and their families. MedStar, for example, also has the contract to provide medical services at Ravens home games, a setting that MedStar Sports Medicine VP Lew Lyon describes as a war zone, albeit one imagined by Joseph Heller. He recalled one incident in which a woman aspirated on a chicken bone and went into cardiac arrest. The medics got the bone out and got her heart going again. When they tried to move her to a hospital, she threw a fit, saying she'd paid to see the game. "They didn't even sell chicken wings at the stadium," Lyon said. "She had brought in a bucket under a jersey or something."
Serving as the official bone-removal crew for dying Ravens fans—now there's a real endorsement. But if players have reason to prefer doctors of their own hire, why don't players hire the doctors in the first place? When contacted for this story, an NFL spokesman would say only that the league does not allow marketing contracts that require a team to hire a partner hospital's doctors exclusively.
It's time for the NFLPA and other unions to go further, and to insist on hiring players' main sports medicine physicians. Steve P. Calandrillo suggested as much in a 2006 Saint Louis University Law Journal article about sports medicine conflicts of interest; he says malpractice insurance may even be cheaper without the perception of divided loyalties, and that teams could thus shed worker's comp liability.
Until the players are choosing the doctors, leagues should bar sponsorship deals that let hospitals describe themselves as an "official" health care provider for this or that team. You don't assume that all NFL players drink Bud Light or drive GM trucks just because those brands sponsor the league, and no one is harmed if you're that gullible anyway. Health care is different. Such branding implies that players trust those doctors with the most vital service they can get in a high-risk occupation. The truth is something else. Players may have their own favorite surgeons. Or they may not trust the doctors' competing allegiances to patient health and management's demands. How could you blame them?
