injuryupdate
09-01-2004, 09:13 AM
Team physicians questioning their future
by Scott Kober
September 2002, from Orthopaedics Today
Ask nearly any orthopedic surgeon serving as team doctor for a professional sports team why they do it and they will likely tell you about the prestige and the perks and the wonderful camaraderie with their colleagues. Historically, the money involved has never really been much of an issue.
But suddenly, the money has become the big issue in team physician care. And it’s leading a whole gaggle of orthopedic surgeons to question whether they can afford to remain involved in one of the glamorous posts in sports medicine.
“This training camp, unfortunately, I have written my resignation letter,” said Andrew Bishop, MD, who has been the team doctor for the Atlanta Falcons for the last nine years. “I’ve told the team that I will not go into the regular season as their doctor unless something changes. Doctors have a long history of screaming and yelling and then quietly going along after it’s all over. But eventually we’re going to have to take a stand and act on what we say. That’s what I’m doing right now.”
A pair of recent lawsuits filed by players in the National Football League against team doctors, both seeking millions of dollars from juries, have served as the call to action amongst orthopedic surgeons who have, in the past, been willing to ignore their personal financial exposure.
Philadelphia Eagles team doctor Arthur R. Bartolozzi, MD, was forced to resign his post with the team and came within hours of temporarily shutting down his entire practice on Aug. 20 because of the skyrocketing malpractice costs in Pennsylvania.
For most team physicians, however, it’s not the cost of malpractice coverage that is scaring them. Most frightening are the costs beyond what malpractice insurance can provide.
In many states, doctors can only obtain malpractice insurance up to $1 million per individual occurrence and $3 million for group coverage. Neither figure approaches what team doctors are finding they’ll need to protect themselves against professional athletes seeking multimillion dollar jury verdicts.
“To me, the frightening thing with this is that players, especially at the end of their careers, are looking for their last big payday,” Bishop said. “These guys have made lots of money so they’re looking anywhere they can. There is rarely a guy who leaves the league without some type of injury. And if they’re going to hold doctors responsible for their injuries and be able to have juries compensate them for what they perceive their income to have been, that’s a frightening concept. You’re talking millions and millions of dollars.”
Two recent cases in Florida have made team doctors in every professional sport familiar with that sort of costly vocabulary.
The first involved Jeff Novak, an offensive lineman for the Jacksonville Jaguars in the 1990s. Novak was a starter for the Jaguars fighting to protect his position during training camp in 1998, when on July 28 he injured his knee during a team practice.
After the pain persisted for several days, Novak went to see team physician Stephen Lucie, MD, on Aug. 3. Lucie was with the Jaguars from 1995-2001.
Lucie drained blood and fluid from Novak’s knee, later testifying that he “had a patient who was in a lot of pain who was having trouble walking around and wanted relief; the best way to provide relief was to remove this pressure and drain the hematoma.”
Novak returned to practice two days after the surgery, but on Sept. 10, he was back in the operating room. This time, Lucie treated him for staph and E-coli infections, as well as bleeding episodes. After two operations, Novak played in three more games. He was not offered a new contract by Jacksonville following the season and retired.
Novak eventually sued Lucie, who was an employee of the Jacksonville Orthopedic Institute and not the NFL’s Jaguars, for medical malpractice.
Novak’s case was finally heard this summer and a jury awarded him $5.35 million for pain and suffering, as well as lost potential income from pro football. A circuit court judge eventually overturned the ruling, claiming that Novak had not proven that he had received negligent medical treatment.
Still, the message of financial vulnerability sounded to team doctors everywhere. Immediately following the jury’s ruling, the Jacksonville subspecialists formerly used by the team sent a letter to the Jaguars’ management stating that they would refuse to see injured players as patients in the future.
The second high-profile case involving an NFL player and his team doctor was filed in Miami in June. There, former Miami Dolphins wide receiver O.J. McDuffie has charged former team physician John Uribe, current team physician Dan Kanell and radiologist Michael Thorpe for malpractice and gross negligence stemming from a 1999 toe injury which McDuffie is claiming led to the end of his playing career.
McDuffie is reportedly seeking upwards of $10 million in damages.
“If I were a partner of somebody who got sued for $5 million and they took some of my money, I would tell them to reconsider taking care of these professional athletes because if this is what is going to happen, then the risk-gain value is not that high for us,” said John Bergfeld, MD, who has been caring for the Cleveland Browns since the mid-1970s. “It’s nice to take care of the team, it’s good publicity, it’s a fun job, but it’s not so much fun that it might cost you $2.5 million. Doctors in private practice, if they can’t get enough insurance to cover it, then it’s not worth doing.”
Brokering a deal, however, with professional leagues and individual teams has proven in the past to be difficult.
In recent years, team physician organizations in the four major U.S. sports have tried to reach agreements that would make team doctors employees of the league and eliminate their personal financial exposure, but they have been met with significant resistance. David Apple, MD, who worked with the Atlanta Hawks for nearly 25 years, said that when a group of NBA physicians approached the league in the late 1980s requesting that the league provide malpractice coverage beyond insurers’ limits, “the league wouldn’t touch it.”
Chip Burke, III, MD, president of the NHL Physicians Society, reported a similar experience.
“We’ve tried to address it in the NHL for years, asking to get extra coverage, asking for the teams to employ us so we fall under workers’ comp, but obviously, the league and the teams don’t want to take on the responsibility for the actions of the doctors,” Burke said. “And in some ways, you can’t blame them because their point would be that if a case of malpractice does occur, why should we as team or the league be responsible?”
But then, surgeons are asking, at what point will the level of care slip to a point where professional teams have no choice but to address the problem of insurance? It’s clear that someone will always be willing to step in and replace any team doctor who has to resign, but how far down will teams be willing to watch their quality of care slip before they take action?
“Until the league and the players association addresses this, I think you’re going to find many, many very good, qualified doctors refusing to treat these guys,” Bishop said. “I think if they want to have seriously qualified physicians, they’re going to have to listen to us.”
Bishop was hopeful that a short-term solution was going to be negotiated with the Falcons prior to the season with the team buying additional malpractice insurance beyond what Bishop currently carries. “But when it comes down to dollars and cents, I really don’t know whether they’ll do it or not,” he said.
Even if Bishop stays with the Falcons this season, though, he only sees three long-term fixes for team doctors: one, have physicians become employees of their respective leagues; two, have physicians become employees of the players association; or three, have a panel of qualified doctors who understand the demands of team doctors serve as a litigation qualifying board for any player thinking about suing.
Jon Browne, MD, team doctor for the Kansas City Chiefs and president of the NFL Physicians Society, has attempted to speak with the league on several recent occasions to attempt to broker a deal that would indemnify team doctors, but had been unable to reach an agreement through the first half of the preseason.
If he doesn’t, physicians like Bishop probably will not be able to afford to survive in the NFL.
“If they’re going to hold physicians liable and paint this horrible picture of what you do to a jury, it is going to be very hard for us,” Bishop said. “There are some things that players, 10 or 15 years from now, they’ll realize that they are worse off because they played with this injury or had a certain treatment. But that’s the tradeoff for them to continue in the business. We battle those dual concerns constantly. And right now, it’s very murky about how we are supposed to be treating these guys.”
To this point, the public hasn’t shown much interest in the plight of team doctors and the potential for substandard care for high-level athletes. And as long as players are able to return to action quickly, they probably won’t.
But, as Bartolozzi pointed out, when the NFL postseason rolls around and a player is held out of action by the team physician because of fear of a lawsuit, ambivalence will quickly disappear.
“No doctor is going to be willing to take any risks,” Bartolozzi said. “In the past, doctors would work hard to get a player back into the game without compromising their safety. In the playoffs or the Super Bowl, a player might receive an injection in order to play. Now, a player will have to be out the obligatory 4-to-6 weeks because liability is too great.”
by Scott Kober
September 2002, from Orthopaedics Today
Ask nearly any orthopedic surgeon serving as team doctor for a professional sports team why they do it and they will likely tell you about the prestige and the perks and the wonderful camaraderie with their colleagues. Historically, the money involved has never really been much of an issue.
But suddenly, the money has become the big issue in team physician care. And it’s leading a whole gaggle of orthopedic surgeons to question whether they can afford to remain involved in one of the glamorous posts in sports medicine.
“This training camp, unfortunately, I have written my resignation letter,” said Andrew Bishop, MD, who has been the team doctor for the Atlanta Falcons for the last nine years. “I’ve told the team that I will not go into the regular season as their doctor unless something changes. Doctors have a long history of screaming and yelling and then quietly going along after it’s all over. But eventually we’re going to have to take a stand and act on what we say. That’s what I’m doing right now.”
A pair of recent lawsuits filed by players in the National Football League against team doctors, both seeking millions of dollars from juries, have served as the call to action amongst orthopedic surgeons who have, in the past, been willing to ignore their personal financial exposure.
Philadelphia Eagles team doctor Arthur R. Bartolozzi, MD, was forced to resign his post with the team and came within hours of temporarily shutting down his entire practice on Aug. 20 because of the skyrocketing malpractice costs in Pennsylvania.
For most team physicians, however, it’s not the cost of malpractice coverage that is scaring them. Most frightening are the costs beyond what malpractice insurance can provide.
In many states, doctors can only obtain malpractice insurance up to $1 million per individual occurrence and $3 million for group coverage. Neither figure approaches what team doctors are finding they’ll need to protect themselves against professional athletes seeking multimillion dollar jury verdicts.
“To me, the frightening thing with this is that players, especially at the end of their careers, are looking for their last big payday,” Bishop said. “These guys have made lots of money so they’re looking anywhere they can. There is rarely a guy who leaves the league without some type of injury. And if they’re going to hold doctors responsible for their injuries and be able to have juries compensate them for what they perceive their income to have been, that’s a frightening concept. You’re talking millions and millions of dollars.”
Two recent cases in Florida have made team doctors in every professional sport familiar with that sort of costly vocabulary.
The first involved Jeff Novak, an offensive lineman for the Jacksonville Jaguars in the 1990s. Novak was a starter for the Jaguars fighting to protect his position during training camp in 1998, when on July 28 he injured his knee during a team practice.
After the pain persisted for several days, Novak went to see team physician Stephen Lucie, MD, on Aug. 3. Lucie was with the Jaguars from 1995-2001.
Lucie drained blood and fluid from Novak’s knee, later testifying that he “had a patient who was in a lot of pain who was having trouble walking around and wanted relief; the best way to provide relief was to remove this pressure and drain the hematoma.”
Novak returned to practice two days after the surgery, but on Sept. 10, he was back in the operating room. This time, Lucie treated him for staph and E-coli infections, as well as bleeding episodes. After two operations, Novak played in three more games. He was not offered a new contract by Jacksonville following the season and retired.
Novak eventually sued Lucie, who was an employee of the Jacksonville Orthopedic Institute and not the NFL’s Jaguars, for medical malpractice.
Novak’s case was finally heard this summer and a jury awarded him $5.35 million for pain and suffering, as well as lost potential income from pro football. A circuit court judge eventually overturned the ruling, claiming that Novak had not proven that he had received negligent medical treatment.
Still, the message of financial vulnerability sounded to team doctors everywhere. Immediately following the jury’s ruling, the Jacksonville subspecialists formerly used by the team sent a letter to the Jaguars’ management stating that they would refuse to see injured players as patients in the future.
The second high-profile case involving an NFL player and his team doctor was filed in Miami in June. There, former Miami Dolphins wide receiver O.J. McDuffie has charged former team physician John Uribe, current team physician Dan Kanell and radiologist Michael Thorpe for malpractice and gross negligence stemming from a 1999 toe injury which McDuffie is claiming led to the end of his playing career.
McDuffie is reportedly seeking upwards of $10 million in damages.
“If I were a partner of somebody who got sued for $5 million and they took some of my money, I would tell them to reconsider taking care of these professional athletes because if this is what is going to happen, then the risk-gain value is not that high for us,” said John Bergfeld, MD, who has been caring for the Cleveland Browns since the mid-1970s. “It’s nice to take care of the team, it’s good publicity, it’s a fun job, but it’s not so much fun that it might cost you $2.5 million. Doctors in private practice, if they can’t get enough insurance to cover it, then it’s not worth doing.”
Brokering a deal, however, with professional leagues and individual teams has proven in the past to be difficult.
In recent years, team physician organizations in the four major U.S. sports have tried to reach agreements that would make team doctors employees of the league and eliminate their personal financial exposure, but they have been met with significant resistance. David Apple, MD, who worked with the Atlanta Hawks for nearly 25 years, said that when a group of NBA physicians approached the league in the late 1980s requesting that the league provide malpractice coverage beyond insurers’ limits, “the league wouldn’t touch it.”
Chip Burke, III, MD, president of the NHL Physicians Society, reported a similar experience.
“We’ve tried to address it in the NHL for years, asking to get extra coverage, asking for the teams to employ us so we fall under workers’ comp, but obviously, the league and the teams don’t want to take on the responsibility for the actions of the doctors,” Burke said. “And in some ways, you can’t blame them because their point would be that if a case of malpractice does occur, why should we as team or the league be responsible?”
But then, surgeons are asking, at what point will the level of care slip to a point where professional teams have no choice but to address the problem of insurance? It’s clear that someone will always be willing to step in and replace any team doctor who has to resign, but how far down will teams be willing to watch their quality of care slip before they take action?
“Until the league and the players association addresses this, I think you’re going to find many, many very good, qualified doctors refusing to treat these guys,” Bishop said. “I think if they want to have seriously qualified physicians, they’re going to have to listen to us.”
Bishop was hopeful that a short-term solution was going to be negotiated with the Falcons prior to the season with the team buying additional malpractice insurance beyond what Bishop currently carries. “But when it comes down to dollars and cents, I really don’t know whether they’ll do it or not,” he said.
Even if Bishop stays with the Falcons this season, though, he only sees three long-term fixes for team doctors: one, have physicians become employees of their respective leagues; two, have physicians become employees of the players association; or three, have a panel of qualified doctors who understand the demands of team doctors serve as a litigation qualifying board for any player thinking about suing.
Jon Browne, MD, team doctor for the Kansas City Chiefs and president of the NFL Physicians Society, has attempted to speak with the league on several recent occasions to attempt to broker a deal that would indemnify team doctors, but had been unable to reach an agreement through the first half of the preseason.
If he doesn’t, physicians like Bishop probably will not be able to afford to survive in the NFL.
“If they’re going to hold physicians liable and paint this horrible picture of what you do to a jury, it is going to be very hard for us,” Bishop said. “There are some things that players, 10 or 15 years from now, they’ll realize that they are worse off because they played with this injury or had a certain treatment. But that’s the tradeoff for them to continue in the business. We battle those dual concerns constantly. And right now, it’s very murky about how we are supposed to be treating these guys.”
To this point, the public hasn’t shown much interest in the plight of team doctors and the potential for substandard care for high-level athletes. And as long as players are able to return to action quickly, they probably won’t.
But, as Bartolozzi pointed out, when the NFL postseason rolls around and a player is held out of action by the team physician because of fear of a lawsuit, ambivalence will quickly disappear.
“No doctor is going to be willing to take any risks,” Bartolozzi said. “In the past, doctors would work hard to get a player back into the game without compromising their safety. In the playoffs or the Super Bowl, a player might receive an injection in order to play. Now, a player will have to be out the obligatory 4-to-6 weeks because liability is too great.”