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BITTER MEDICINE EAGER TO HOLD ON TO THEIR VALUABLE SIDELINE PRACTICES, TEAM DOCTORS ALL TOO OFTEN STRIVE TO HELP THE CLUB, NOT HEAL THE PLAYER

Nov. 06, 1995
Nov. 06, 1995

Table of Contents
Nov. 6, 1995

BITTER MEDICINE EAGER TO HOLD ON TO THEIR VALUABLE SIDELINE PRACTICES, TEAM DOCTORS ALL TOO OFTEN STRIVE TO HELP THE CLUB, NOT HEAL THE PLAYER

By Joseph Nocera SPECIAL REPORTING BY Lester Munson AND Mark McClusky

MR. SHAPIRO: Is a rupture or a tear of the anterior cruciate
ligament a serious injury?

This is an article from the Nov. 6, 1995 issue Original Layout

DR. PAPPAS: It is not an injury most athletes would prefer to
have.
--Lawyer Donald Shapiro, questioning Dr. Arthur Pappas
Barrett v. Pappas, U.S. District Court, Worcester, Mass.

On June 4, 1989, late in a game against the Toronto Blue Jays,
Marty Barrett, the second baseman for the Boston Red Sox, hit a
ground ball to third base. Barrett was then 30 years old and had
played six years in the big leagues. Only days before, Boston
had signed him to a three-year contract extension, worth nearly
$3.5 million. As Barrett ran to first, he could see that the
throw was not a good one; Toronto first baseman Fred McGriff had
moved to the foul side of the bag in an awkward attempt to make
the catch while keeping his foot on the base. Fearing a
collision, Barrett reacted to McGriff by darting suddenly toward
the inside part of the base. When he did, he felt his right knee
pop, and he collapsed in pain. Though he didn't know it at the
time, he had just ruptured his anterior cruciate ligament.

Two days later Barrett underwent arthroscopic surgery in
Worcester, Mass., a city some 45 minutes from Boston that is
home to the University of Massachusetts Medical Center.
Worcester is also the location of the practice of Arthur Pappas,
the chairman of the hospital's orthopedic department and the Red
Sox team physician for 18 years. Pappas is also a longtime part
owner of the team. After the operation Pappas, generally
portrayed in the Boston media as an avuncular figure, gave a
short press conference. He reported that Barrett had simply
suffered some torn cartilage in the knee and had stretched a
ligament. Even though the postoperative report that Pappas filed
at the hospital reflected the fact that he had removed much of
what was left of Barrett's ruptured ACL, he made no mention of
this far more serious injury during the press conference.
Instead, his clear implication was that the operation had been
no big deal; in fact, he said Barrett might be able to return to
the lineup right after the All-Star break, a mere five weeks away.

It so happened that Pappas had operated the same day on the
right elbow of Boston outfielder Jim Rice. This procedure had
also gone well, Pappas said at the press conference. "So you
went two for two today?" a reporter quipped. Pappas smiled
smugly. "So far," he replied.

Courtrooms are confining places, and that is especially true of
the U.S. district court in Worcester, temporarily housed as it
is on the sixth floor of a seven-story office building while the
permanent federal court building is being renovated. The waiting
area outside the courtroom is so cramped that even whispered
conversations can be overheard, and inside the courtroom it
doesn't get much better. There are only three rows of benches
for spectators and only one entrance, which means that
opportunities for awkward encounters are not just plentiful but
also practically unavoidable.

Barrett and Pappas know that now. Each learned quickly to sit on
the same spot of the same first-row bench each day, barely 10
feet apart, without so much as acknowledging the other's
presence. They became adept at staring past each other, averting
their glances when their eyes accidentally locked, even for a
millisecond. They mastered the peculiar pas de deux of litigants
as they spent a week and a half this October as legal
adversaries in that cramped Worcester federal courtroom.

Six years and four months after that arthroscopic surgery,
Barrett, now a coach in the San Diego Padre organization, was in
court, seeking close to $4 million in damages from Pappas. His
fundamental allegation was that Pappas had never told him he had
torn his ACL on that June day. Although Pappas denied the
charge, Barrett's suit alleged that this failure to disclose the
true extent of his injury hastened the end of his career. In
taking this lawsuit all the way to its bitter conclusion,
Barrett was raising to the surface the elemental and
subterranean conflicts that plague team doctors in every
big-time college and professional sport.

Barrett is hardly the only former athlete to sue a team doctor
in recent times. Even before his case went to trial, there had
been several trials involving athletes and team doctors this
year alone.

In March former Chicago Bear wide receiver Ron Morris was
awarded $5.3 million by a jury that heard that then team doctor
Christ Pavlatos had botched what should have been a routine
procedure to repair knee cartilage. What's more, in his
desperation to retain his post as the team's physician, Pavlatos
had tried to cover up his error by erasing most of the videotape
of the operation. Three months later a 28-year-old hockey player
named Glen Seabrooke--a former first-round draft choice of the
Philadelphia Flyers who was in his second year with the minor
league Hershey Bears when he was injured--won a $5.5 million
verdict against the Flyers' former team doctor John Gregg (below).

The Seabrooke lawsuit in particular speaks to the central
conundrum for any team doctor: To whom does he owe his
allegiance? Is it the player, who is his patient? Or is it the
team, which pays the doctor, makes the decision about whether to
retain him as team physician and, more often than not, wants the
injured player back on the field as quickly as possible? Last
week this issue was raised anew when L. Fallasha Erwin, an agent
for Washington Bullet forward Chris Webber, said that Webber
would seek an independent medical opinion after he dislocated
his left shoulder for the second time in a year. According to
The Washington Post, Webber felt that the Bullet doctor, Steve
Haas, had not taken seriously Webber's complaints of pain in his
shoulder and had cleared him to play in an exhibition game. A
few days later, in another exhibition game, Webber suffered the
shoulder separation.

Team doctors face torturous ethical dilemmas. Are they supposed
to be getting players ready to play, or are they supposed to be
seeing to it that they heal completely? Should the doctors be
more concerned with the immediate needs of the team or with the
long-term health of players whose careers will be over while
they are still young men? How does a doctor keep from feeling
like a member of the team, which, as former Los Angeles Raider
team internist Robert Huizenga says, "invariably has a subtle
effect on a doctor's decision-making process"? What does a
doctor do when a coach or an owner is pressuring a player to get
back in the lineup--and the player says he's not ready? More to
the point, what does a doctor do in this situation when he knows
that the player is not ready?

MR. SHAPIRO: Dr. Pappas, are you an owner of the Red Sox?

DR. PAPPAS: I am a limited partner of the Red Sox. I have an
investment interest in the Red Sox.

MR. SHAPIRO: So if the team does well, you do well?

DR. PAPPAS: I share in the gains--and in the losses.

No team doctor more starkly illustrates the potential conflicts
inherent in the position than Pappas. The man is no charlatan.
Rather he's a highly respected orthopedic surgeon, now 64 years
old, and one of the handful of surgeons who offer independent
second opinions to professional athletes. Pitcher Dennis
Eckersley, for one, claims that Pappas's work on his arm helped
prolong his career; former National League All-Star pitcher Bob
Tewksbury goes so far as to say that Pappas saved his career.

The income that doctors receive from teams is relatively
insignificant, but they derive enormous benefits, some more
obvious than others, from their association with the clubs. In
New England, for instance, Pappas, who declined to be
interviewed for this story, has long been connected in the
public mind to the Red Sox, giving him a kind of visibility that
other orthopedic surgeons can only dream about. That Pappas's
medical practice has profited from his association with the team
seems undeniable. As one prominent sports agent puts it, "When
the high school quarterback in Framingham hurts his knee, who do
you think his father is going to turn to to do the operation?"

But Pappas, alone among team doctors, has always received
another, more tangible benefit. In the late 1970s, Pappas
obtained about a 5% stake in the Red Sox. Pappas has gotten
something other than visibility and box seats from his interest
in the Sox: He has gotten rich. Today Pappas's stake is probably
worth around $10 million.

Several years ago Boston Globe columnist Dan Shaughnessy called
the relationship between the Red Sox and Pappas "highly unusual
and inappropriate." However much Pappas might pooh-pooh any
suggestion that he has a conflict of interest--something he has
done regularly over the years and continued to do even last
week, just after the Barrett lawsuit was resolved--it seems
clear that Pappas has a direct financial interest in the Red Sox
that could, at least, call into question his medical judgment
about Boston players. Barrett said on the stand that Red Sox
players were intimidated by Pappas, in no small measure because
he was part of management. Since the mid-1980s, a number of
high-profile Boston players, including pitcher Roger Clemens and
outfielder Mike Greenwell, have chosen to have major surgery
performed by other doctors. Phil Plantier, the San Diego
outfielder who played for the Red Sox in the early '90s, once
complained to the Globe that "Pappas failed to explain that the
ulnar nerve surgery he underwent...would take almost a year and
a half to fully heal"--a complaint remarkably similar to
Barrett's.

As far back as 1979 Pappas was accused of allowing a player to
play when he should have been healing, simply because the Red
Sox needed the player in their lineup. This was the charge at
the heart of Barrett's lawsuit, and it is the most common
allegation leveled at team doctors. In '79 the player was
catcher Carlton Fisk, who played the last six weeks of the '78
season with broken ribs. He was in terrible pain, but the Red
Sox were in the middle of a pennant fight, and neither Pappas
nor manager Don Zimmer (nor Fisk, for that matter) suggested
that Fisk do anything but play. The following spring, when Fisk
found himself on the disabled list--as the result of an elbow
problem--he placed at least part of the blame for his sore elbow
on the fact that Pappas had allowed him to play with the broken
ribs.

"When I broke my ribs I should have had two weeks off," Fisk
says, "but [Pappas] said, 'Well, you can't hurt yourself anymore
than what's already been done.' The reason I hurt my elbow is, I
was favoring my ribs when I threw.... I think he should have
indicated the problems that could arise." According to Fisk,
Pappas never did.

The first professional athlete known to have successfully sued a
team doctor was Dick Butkus, the Hall of Fame linebacker of the
Chicago Bears. He did so in 1974, the year after he retired from
football with knees that would never be right again after having
been repeatedly shot up with cortisone and other drugs during
the last two years of his career. The purpose of the drugs was
to deaden the pain in his knees, making it possible for him to
play. What Butkus was alleging was that the team doctor,
Theodore Fox, had put the short-term needs of the team over
Butkus's long-term health. He asked for $1.6 million and settled
for $600,000.

Four years later, in a lawsuit against orthopedist Robert Cook,
the Portland Trail Blazers' team physician, former Blazer center
Bill Walton charged that he had never been told about the
lasting damage being done to his fragile feet while they were
numbed by painkillers injected into them before every game.
Although Walton, now an NBC basketball analyst, is no longer
willing to be interviewed about his lawsuit, he was outspoken at
the time, even after the suit was settled out of court, about
his belief that he had been wronged by Cook.

In the two decades since those groundbreaking lawsuits much has
changed, most of it for the better. Today, some of the most
prominent orthopedic surgeons in the country serve as team
doctors--for example, Stephen O'Brien, an orthopedic surgeon at
the Hospital for Special Surgery in New York, is the orthopedic
specialist for the New York Giants, and Michael Dillingham, the
associate director of Stanford University's Sports Medicine
department, handles the San Francisco 49ers. These are doctors
whose very prominence as surgeons gives them clout with team
officials. According to Leigh Steinberg, the agent who counts
Niner quarterback Steve Young and 23 other NFL quarterbacks
among his clients, Dillingham actually called him after Young's
recent shoulder injury to warn him that Young would probably
want to come back before he was ready.

Another improvement has been the gradual establishment over the
past 15 years of the right to a second opinion--paid for by the
team--if an athlete is dissatisfied with the team doctor's
diagnosis. This second-opinion clause, part of the standard
player contract in all four of the major professional team
sports, is very much a by-product of disputes like Butkus's and
Walton's.

Finally, there is no question that team doctors have become more
cautious about administering steroids, painkillers and other
drugs to athletes. Of course, as Kevin Harrington, a San
Francisco orthopedic surgeon who advises the NFL Players
Association (NFLPA)--and operates on many athletes--points out,
the reason for this is not necessarily a heightened attention to
the Hippocratic oath. "Nowadays there are so damn many
lawsuits," he says, "that the doctors have to be a lot more
careful than they used to be."

Yet team doctors are still placed in the position of having to
answer to two different masters: player and team. And too many
times, they wind up putting the needs of the team ahead of the
needs of the player.

The most obvious, and most shameful, example of this divided
loyalty takes place in pro football after a player retires.
Hundreds of players over the past 15 years, having suffered
debilitating injuries during their playing days, file for
workman's compensation. According to Richard Berthelsen, the
general counsel for the NFLPA, team doctors almost invariably
side against players in arbitration hearings--claiming that
players' injuries are not related to their having played football.

In late 1993 when a reporter for The Washington Post asked Lon
Castle, a respected cardiologist who now works at the North Ohio
Heart Center in Elyria, Ohio--and was the team doctor for the
Cleveland Browns until he left the Cleveland Clinic, which
provides medical care for the Browns--about the workman's
compensation issue, he offered this chilling response: "You
know, this is like the Mafia. You know: 'We're going to shoot
you. It's nothing personal. It's business.'"

There are plenty of indications that both the use of painkillers
and the pressure to get players back on the field have not gone
away. Six weeks ago, for instance, in the first half of a game
against San Francisco, New England Patriot quarterback Drew
Bledsoe suffered a severe separation of his right shoulder. Even
though the injury was serious enough that it would cause him to
miss the next game, Bledsoe sat out only one series and played
the rest of the game in obvious pain. When the press asked
Patriot coach Bill Parcells why he had left Bledsoe in the game,
Parcells's answer was simple: "He was well enough to finish the
game." The Patriots' team doctor, Bert Zarins, did not return
SI's calls, but as Steinberg, Bledsoe's agent, later said, "To
take a 23-year-old quarterback who has been defined as the
franchise and put him in a helpless circumstance doesn't make
much sense."

Huizenga, the former Raider physician, believes that the use of
painkillers and the incessant pressure on players to
play--pressure that the team doctor, as much as the coach, often
applies--still pervade the NFL. He saw it firsthand during the
time he was with the Raiders, between 1983 and '89, and it led
him not only to sever his relationship with the team but also to
write an expose, You're Okay, It's Just a Bruise. The book is a
catalog of medical horrors: defensive lineman Howie Long
complaining of electric jolts of pain up and down his legs--only
to be told by the lead team physician, Robert Rosenfeld, that it
was just a bruise and that he shouldn't worry about it; free
safety Mike Harden being "cleared" to continue playing in a game
in which he had a "quadriplegic episode"; linebacker Jerry
Robinson being given cortisone pills to treat a severe
concussion, a treatment that hadn't been widely prescribed since
World War II. And hanging over it all is the looming specter of
Raider boss Al Davis, forever pushing Rosenfeld--and Huizenga--to
get his players back on the field for the next week's game.

No episode, though, in the sordid medical history of the Raider
franchise can approach the tragedy of Curt Marsh, a guard for
the team from 1981 to '86. After years of playing with an injury
to his right ankle that was repeatedly misdiagnosed, Marsh was
forced last year to have his right leg amputated eight inches
below the knee (SI, Nov. 14, 1994).

After Huizenga's book was published last year, Davis asked
Oakland's team trainer, who had been with the Raiders for more
than 30 years, to publicly denounce the book. When he refused,
Davis fired him.

There is one other troubling development: Teams have recently
begun to put the role of team doctor up for bid, giving it to
whichever clinic or group is willing to put up the most money
(box, page 84). "It's outrageous," says Harrington, the San
Francisco orthopedist. Adds Huizenga, "There were always rumors
of doctors paying the team to be the doctor. Now it's accepted
practice."

MR. SHAPIRO: Mr. Barrett, when you discovered in October 1989
that you no longer had an anterior cruciate ligament, did you
call Dr. Pappas?

MR. BARRETT: Yes

MR. SHAPIRO: What did you say to him?

MR. BARRETT: I said, 'Have you talked to Dr. Steadman? He told
me I had a torn ACL. Why didn't you tell me that?'

MR. SHAPIRO: And how did Dr. Pappas respond?

MR. BARRETT: There was an awkward silence for about 10 seconds.
Then he told me to come in in about two or three weeks to start
rehab.

Not surprisingly, Pappas's ownership role in the Red Sox was a
red flag to Barrett's lawyer, Donald Shapiro. The relationship
gave Shapiro something to sink his teeth into, a way to explain
the inexplicable to a jury. In a fundamental way, it gave him
his case. "If a doctor has a financial interest that is opposed
to the patient's interest," Shapiro said before the verdict,
"then there's an obvious problem. Here, there was no question
that Boston's short-term interest was to get Marty Barrett
playing again."

This was the scenario Shapiro laid out for the jury: The Red
Sox, who had won their division the year before--and would win it
again in 1990--believed strongly that they had a reasonable shot
at a division title in '89. In fact, for most of the season they
were within seven or eight games of first place. But this was
not a team blessed with depth; it needed its veteran starters,
players like Barrett, to stay healthy if it had any hope of
making it to the American League Championship Series.

And that, Shapiro and Barrett contend, is why Pappas never told
Barrett how badly he had been hurt. The team needed him back in
the lineup as quickly as possible--and Pappas knew it. A tear in
the anterior cruciate ligament is among the most serious of
sports injuries. Since the mid-1980s, the standard treatment for
professional athletes with a torn ACL has been to reconstruct it
surgically, but that operation requires a rehabilitation that
can last as long as a year. Clearly, if Barrett had had to
undergo such an operation he would have been lost for the
remainder of the '89 season and quite possibly for the early
part of the '90 season as well.

What's more, Shapiro strongly suggested, because Barrett was not
a superstar the Red Sox viewed him as expendable in the longer
run--which was also something team owner Pappas was likely to
know. Team executives testified during the trial that even
before Barrett's injury they had planned eventually to move
shortstop Jody Reed over to second base (this, in fact, did
happen) and that they knew Barrett's three-year contract would
probably be his last with Boston. That deal included a buyout
clause for $300,000 for the final year, meaning the Red Sox
could jettison Barrett by paying him that amount during the
off-season instead of the full $1.25 million the contract called
for if Barrett started the third season in a Boston uniform.
After Barrett's injury, Shapiro argued, the Red Sox would have
been happy to get another year or two out of him, until Reed
could take over.

Pappas's defense was that he did inform Barrett of the ACL tear
but that the knee was stable enough, even after losing most of
the ACL, to rule out the need for reconstructive surgery and a
lengthy rehabilitation. Instead, Pappas testified, he counseled
a more conservative course of treatment, one that would rely
primarily on a brace to stabilize the knee if necessary and
prevent further injury. Under Shapiro's withering
cross-examination, however, Pappas said he had no notes of any
conversation along those lines. In fact, he could not even
recall the specific conversation in which he told Barrett about
the extent of his injury.

After his surgery Barrett did come back to play the final two
months of the 1989 season. But in a meaningless late-September
game, with Boston out of the race, he slid hard into second
base, trying to break up a double play. Again, he felt pain in
his knee. This time, however, when Barrett visited Pappas, the
physician told him he wouldn't be able to do another
arthroscopic procedure for several weeks; his schedule was too
tight. "You probably tore some more cartilage," Barrett
testified that Pappas told him. So instead, Barrett sought out
John Richard Steadman, a well-known sports orthopedic surgeon,
who quickly diagnosed the injury as an ACL tear. When he
operated, in October 1989, Steadman discovered that Barrett, as
Steadman later stated in his deposition, "had no functional
ACL." It had been removed by Pappas. Barrett was stunned.

But the most damning testimony at the trial came from neither
doctors nor principals. It came from former Red Sox manager Joe
Morgan, who was on the stand for no more than an hour on the
trial's third day. Morgan testified that Pappas came into his
office in late July 1989--after Barrett had been sent to the
club's minor league team in Pawtucket for rehab--and said, "Marty
says he's ready to play." Then, added Morgan, "Dr. Pappas said
to me that by the condition of his knee, he would not have a
long career."

After Morgan's testimony, there wasn't much doubt as to how this
trial was going to turn out. Over the course of the next few
days, Pappas and his wife, Martha, who sat by her husband's side
throughout the trial, became increasingly closemouthed and
stoic, while Barrett grew increasingly upbeat and animated.

Pappas's attorney spent just 2 1/2 days presenting a somewhat
desultory defense--a defense that largely consisted of
downplaying Barrett's abilities as a ballplayer, the implicit
point being that Barrett's career had already begun to go
downhill even before his injury.

When Pappas took the stand to defend himself, he continued to
insist that he had told Barrett the whole truth about his
injury--even if he hadn't announced it to the press--and that it
was Barrett who had failed to follow his advice to wear a brace.
When Shapiro began his cross-examination, one could almost see
Pappas's defense evaporating into thin air. Before it was over
Pappas had been forced to concede that, yes, it was possible
that he had failed to tell Barrett that he had torn his ACL.

And then, late on the afternoon of Oct. 25, after deliberating
for less than four hours, the jury came back with its verdict.
It awarded Barrett $1.7 million, all of it in lost wages. It
wasn't the $4 million Barrett had asked for, but it was a
victory nonetheless. In the courtroom as the verdict was read,
Barrett began crying, wiping away tears of joy and gratitude.
The Pappases simply stared off into space, their expressions
never changing.

Afterward, with a few reporters crowded around them, Shapiro and
Barrett made their victory speeches. "At a minimum," Shapiro
said, "the Red Sox need to evaluate Dr. Pappas's role with the
team." Barrett added, "I think this verdict is a step in the
right direction regarding team doctors and their conflicts of
interest."

Two days later, Pappas told the Boston Herald that he had no
intention of letting go of either his position as team owner or
as team doctor. "No, I'm not going to change," he said. "I see
no reason to change anything nor does anyone else see any reason
to change it."

B/W PHOTO: JOHN BLANDING/BOSTON GLOBE; PHOTO PROCESS BY AMY GUIP Barrett had just signed a new contract and figured to have good years ahead of him when he ruined his knee in '89. [Marty Barrett]B/W PHOTO: NEIL LEIFER; PHOTO PROCESS BY AMY GUIP The Bears paid Butkus $600,000 to compensate for his ravaged knees. [Dick Butkus]B/W PHOTO: BRUCE BENNETT STUDIOS; PHOTO PROCESS BY AMY GUIP Seabrooke was a hot Flyer prospect in '89. [Glen Seabrooke] B/W PHOTO: DAVID L. RYAN/BOSTON GLOBE; PHOTO PROCESS BY AMY GUIP Doctor-owner Pappas has a clear conflict. [Dr. Arthur Pappas]
The purpose of the drugs was to deaden the pain in Butkus's
knees, making it possible for him to play.
The use of painkillers and the pressure to return players to
action have not gone away.
Clubs have recently begun to put the team doctor role up for
bid.
Because Barrett was not a star, the Red Sox viewed him as
expendable.
The doctor never told Barrett how gravely he had been hurt.
In fact, Pappas had removed his ACL.