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Beltran's surgery raises questions


New York Mets center fielder Carlos Beltran, who is entering the sixth season of a $119 million contract, had knee surgery on Wednesday morning. The surgery, which will likely sideline Beltran for the early part of the season, was performed by Dr. Richard Steadman, a prominent orthopedic surgeon not employed by the Mets. The Mets claim that they only gave permission for Beltran to be examined by Steadman and that they asked Beltran to wait on the surgery; Beltran asserts that the Mets granted permission for surgery and then, while the procedure was taking place, changed their mind and asked that he wait. legal expert Michael McCann discusses the potential fallout.

1) Did Beltran need the Mets' permission to see his own doctor?

No. Players can obtain second medical opinions from doctors who are not employed by teams. And it is understandable why they might seek a second opinion. For one, there are many top specialists who are not employed by teams. Steadman certainly qualifies as one. Also, given that team doctors are obviously paid by teams, some players may prefer to visit a doctor who has no connection to the club. Along those lines, teams and players may occasionally have different goals for recovery. Players have their long-term health as a top concern, while teams, which sometimes cannot fully insure players' contracts, are very interested in players performing over the course of their contracts.

Not all second medical opinions are the same, however, and the collective bargaining agreement between Major League Baseball and the Players' Association contains rules on when teams are obligated to pay for second opinions. Article XIII (D) requires that teams provide a list of accepted medical specialists for second opinions; teams are required to pay for the care provided by those specialists. Teams are not required to pay for second opinions by medical specialists who are not on the accepted list. It seems likely that Steadman, who has treated a number of athletes and is considered a pioneer in athletes' knee surgeries, is considered an accepted medical specialist.

2) Did Beltran need the Mets' permission for a surgery performed by his own doctor?

Interestingly, and understandably, the collective bargaining agreement does not expressly resolve how teams and players should reconcile differences in opinions over the appropriate course of a player's treatment and who should perform a particular surgery. Instead, the agreement essentially encourages players and teams to work out their differences in good faith and with an appreciation for reasonableness, taking into consideration the desires of both parties.

One recommendation, as provided in an attachment to the agreement, is that players and teams in disagreement turn to a third physician expert. The attachment also states, clearly, that teams should not force a player to have surgery performed by a team doctor, but should instead designate another physician to perform the surgery.

Given the contradictions in accounts between Beltran and the Mets, it is unclear whether either side satisfied their duties. Still, we know that the Mets have known from some time about Beltran's knee trouble and about his physician-patient relationship with Steadman. Beltran, in fact, was evaluated by Steadman last June. Also, following the completion of the 2009 season, Beltran had three MRIs on his right knee, with the third MRI, conducted on Dec. 10, revealing a worsening osteoarthritis in his knee. Presumably Beltran and the Mets, including the team's own doctors, have been in communication about how to treat the condition. It thus seems unlikely that the Mets were completely caught off-guard that Beltran would have knee surgery, or that the surgery would be performed by Steadman.

On the other hand, if the respective doctors for the Mets and Beltran disagreed as to Beltran's treatment, a third physician expert may have been appropriate. It would be notable if the Mets requested that Beltran see a third physician or if they designated another physician to perform the knee surgery, and if Beltran declined to meet with a third physician or the physician designated to perform the surgery.

3) How can Beltran and the Mets have such different accounts as to what happened?

There are a number of possible explanations, and both could be telling the truth as they see it.

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One possibility is that Beltran and/or the Mets failed to effectively communicate what was being sought and what was being agreed to. For instance, if the Mets agreed that Beltran could "see" Steadman, did they fail to clarify whether "see" meant that Steadman could only evaluate Beltran, or could Steadman also perform surgery? Or if the Mets agreed that Beltran could have "knee surgery" did they agree to any kind of knee surgery, or only certain kinds? Or if Beltran agreed to let the Mets know in advance what he planned to do, how specific was he expected to be and which Mets official was he supposed to tell? Given their apparent confusion, Beltran and the Mets might have benefited by clarifying their agreement in writing, even if parties sometimes avoid putting understandings in writing for fear of those writings later appearing in litigation.

There also may have been differences of opinions among Mets' ownership, front office personnel and medical staff as to best course of action for Beltran. Those differences may have led to conflicting messages to Beltran and his agent, Scott Boras.

On the other hand, perhaps Beltran (or Boras) did not receive permission from the appropriate Mets official or did not inform the right official. Boras, an experienced agent, likely knows which individuals at the Mets possess the authority to grant permission for player healthcare decisions.

4) What about if the surgery was elective, rather than essential?

Neither the collective bargaining agreement nor the uniform player contract distinguishes between elective and essential surgeries. The lack of distinction is probably because what's "elective" and "essential" may be very different from the perspectives of the player and team.

The agreement does distinguish between injuries sustained within the scope of employment from those that were sustained otherwise, with the latter providing fewer protections for players. By all accounts, Beltran's knee injury is baseball related and arose from his employment as a baseball player.

5) What would happen if the Mets withhold payment to Beltran until he returns to the field?

The Mets would need a contractual justification for not paying Beltran. They could claim that Beltran failed to report to work, or that, pursuant to the "loyalty" clause of the standard player contract, Beltran failed to "perform his services hereunder diligently and faithfully... [and] conform to high standards of personal conduct, fair play and good sportsmanship." The Mets could also assert that Beltran failed to satisfy general expectations for working with the team on determining his best course of medical treatment.

In response, Beltran, along with the MLBA, would surely file a grievance. The collective bargaining agreement includes intricate rules for the grievance procedure, including that it be heard by an impartial arbitrator and that either party can request an independent medical expert. The process would likely take weeks. Beltran would argue that that Mets lack the grounds to suspend his payments and that he satisfied expectations for working with the Mets on developing the best treatment for his knee.

A grievance procedure would be a fact-intensive and likely awkward process that may irreparably harm the relationship between Beltran and the Mets. It could also damage the Mets' reputation with other players. Free agents may be less likely to sign with the Mets because of how the team treated Beltran.

6) Is there any way the Mets could try to void Beltran's contract?

The Mets could refer to Section 7(b)(1) of the standard player contract, which empowers a team to terminate a contract if the player "fails, refuses or neglects to conform his personal conduct to the standards of good citizenship and good sportsmanship or to keep himself in first-class physical condition or to obey the club's training rules." While vague, the language has not been used by teams to void contracts of players who have surgery without clear approval from their teams. The Beltran situation, with all of its ambiguity, probably is not going to be the test case.

Section 7(b)(3) similarly empowers teams to terminate a contract if a player "fails, refuses or neglect to render his services hereunder or in any manner materially breach this contract." Though it sounds sweeping, it likely won't help out the Mets.