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What Still Ails Penn State

May 20, 2013
May 20, 2013

Table of Contents
May 20, 2013

GOLF PLUS
LEADING OFF
THE MAIL
NBA PLAYOFFS
SPECIAL REPORT
  • AT A TIME WHEN FOOTBALL SAFETY HAS NEVER BEEN MORE SCRUTINIZED, CHANGES IN THE UNIVERSITY'S ONCE-EXEMPLARY MEDICAL CARE BELIE PROMISES TO REIN IN THE ATHLETIC DEPARTMENT AND OPERATE TRANSPARENTLY

FORTUNATE FIFTY
MATT HARVEY
Departments

What Still Ails Penn State

AT A TIME WHEN FOOTBALL SAFETY HAS NEVER BEEN MORE SCRUTINIZED, CHANGES IN THE UNIVERSITY'S ONCE-EXEMPLARY MEDICAL CARE BELIE PROMISES TO REIN IN THE ATHLETIC DEPARTMENT AND OPERATE TRANSPARENTLY

IN A SEPTEMBER 2004 game at Wisconsin, Penn State junior quarterback Michael Robinson faked an option left and shuffled back a few steps to gaze downfield. With no receivers open, he pulled the ball down and spun—his chin connecting with the crown of defensive end Erasmus James's helmet. Then: darkness.

This is an article from the May 20, 2013 issue

The crowd of 82,179 at Camp Randall Stadium went silent. Robinson had barely regained consciousness a couple of minutes later when he began to panic: "I gotta get a real job now!" he cried out. Then something calmed him. "I just remember Sebas's face," Robinson says, using the players' nickname (pronounced SEE-bass) for Wayne Sebastianelli, the longtime director of athletic medicine and orthopedic surgeon--head physician for the football team. "When you're down on the field in front of so many people, you just want to see a familiar face."

Sebastianelli knew Robinson well, having attended almost every Nittany Lions practice since 1992. That was the year the university created a position for a full-time orthopedic surgeon at the urging of coach Joe Paterno, and Sebastianelli had become part of the football family. Sebastianelli was always on call; Robinson even remembers seeing him working with Paterno's wife, Sue, to rehab her hip at 4:30 a.m.

"Sebas just spoke with a respect that made you trust him," Robinson says. "He was there all the time and he knew how to talk to athletes." That Saturday in Madison, Robinson was strapped to a body board and taken away in an ambulance. He stayed overnight at the University of Wisconsin Hospital before returning to State College. Within a few days he felt well enough to take the neurocognitive ImPACT test to assess whether his brain had returned to normal functioning. Surprisingly, Robinson scored better than his baseline on several measures.

But based on his expertise—for a decade, Sebastianelli had been a co-author on studies of concussion recovery—he told Robinson that he could not play the next game, against Minnesota, or the one after that, against Purdue. Sebastianelli ordered that the quarterback's helmet be taken out of his locker. Robinson pleaded. He argued. He asked why he had even taken the ImPACT test if passing it didn't allow him to play. When none of that worked, the 6'2", 225-pound Robinson stood up, angrily, in Sebastianelli's office in the football building.

Recalls Robinson, "Sebas said, 'You want to throw down? Let's do it. You might beat me up, but you're not going back on the field.... Maybe at another university, or maybe when you get to the league, but I can't let you go out there.' " Such a firm stance was not unusual. According to former team staff members, Sebastianelli would respond to coaches who insisted that an injured player was ready to return with: "And where did you get your medical degree?"

Now a fullback for the Seahawks, Robinson is grateful Sebastianelli held his ground, and he has become one of the legion of former Nittany Lions in the NFL who continue to call Sebastianelli for medical advice. But recently Robinson joined a more problematic roster: former players and members of the Penn State football family dismayed that Sebastianelli was relieved of his duties as orthopedic surgeon--head physician as part of an abrupt shift in the school's health-care program for football—a shift that will provide less on-site coverage. Instead of having an orthopedic surgeon who attends every practice, the university now employs a primary care physician in State College and an orthopedic consultant who commutes about two hours each way from Hershey, Pa., at least once a week.

At a time when health and safety issues have rattled football to its core, some members of the Penn State community can't fathom why one of the country's highest-profile and most-scrutinized programs would do anything that might lessen athletic health care. "It was one of the things that sold you about Penn State," says the parent of a player who asked not to be identified. "That whole medical coverage at every practice. How is this change [made] with our kids in mind?"

Beyond that, many are troubled by the circumstances surrounding the change, which they attribute to David Joyner, the controversial new athletic director. A member of the board of trustees at the time of his appointment, Joyner had no experience in college athletic administration and has a contentious history with Sebastianelli. In the wake of the Jerry Sandusky scandal—the longtime assistant football coach was found guilty of 45 counts of sexual abuse, and the school was fined $60 million by the NCAA and placed on five years' probation—Penn State president Rodney Erickson acknowledged that "the nation's eyes are upon us," vowing to "ensure proper governance" of athletics and making a "commitment to transparency." The school even set up a website, Toward a More Open University.

Erickson's appointing a university trustee as AD and the ouster of Sebastianelli—which was done summarily, without reference to performance issues and based on the recommendation of Bill O'Brien, who had just finished his first year as football coach—appear squarely at odds with those aims. "Here we are trying to change our image and approach administrative changes with clarity and openness," says Mac Evarts, former dean of Penn State's College of Medicine and a current professor of orthopedics at the university, "and we have another example of a decision being driven by athletics."

Before 1992, Penn State employed an orthopedic surgeon who drove from Hershey, the site of Penn State's main medical campus, once or twice a week. The distance and limited hours meant that many injured players wound up in the offices and on the operating tables of State College private practitioners. Says Vincent Pellegrini, then chair of the department of orthopedics, "It was a B system on a good day, and a C on a bad day."

To improve student-athlete health care, in '92 the university started an unusually progressive sports medicine program in which doctors appointed to the college of medicine faculty would tend to varsity teams. A director of athletic medicine would head the program and report not to coaches or to the athletic director, but to the dean of the College of Medicine and to the chair of the department of orthopedics. That doctor would serve as orthopedic surgeon--head physician for the football team and, along with a primary care physician, attend practice daily. While he would work closely with the AD, "we felt it was very important to separate the athletics from the medical care," says Evarts, who was head of the national search committee convened to fill the position.

One orthopedic surgeon wanted the position badly: David Joyner, an All-America offensive lineman and wrestler at Penn State in the 1970s. Joyner served as the head physician to the U.S. team at the '92 Winter Olympics and that year also founded Joyner Sports Medicine Institute (JSI), which developed 19 physical therapy centers in eight states. "He approached me about the job personally," Evarts says of Joyner. "I told him it wasn't possible because he wasn't going to be a full-time academic" and maintain a private practice. (Through a Penn State spokesman, Joyner declined to speak directly to SI for this story.)

Instead, the search committee chose Sebastianelli, who had played football at Rochester and was an assistant professor there as well as a surgeon at two Rochester hospitals, to be the director of athletic medicine and orthopedic surgeon--head physician for the football team. According to Pellegrini, the decision to bring in an outsider did not sit well with Joyner. Once he was passed over, Pellegrini says, "Joyner had friends and connections in State College for whom he advocated. As objective as I can be, Joyner didn't have the credentials to be the team doctor full time. He hadn't done a sports medicine fellowship.... He was not excited about having a full-time faculty member in State College take care of the teams, but it was done to elevate the care for the athletes. Over the ensuing decade, Penn State had a model program for sports medicine."

According to current and former Penn State staff members, administrators, former players and longtime colleagues and friends of both Joyner and Sebastianelli, the decision began a rivalry of sorts between the two doctors. (Sebastianelli declined to comment about Joyner to SI. Through a university spokesman, Joyner said, "It's terribly unfortunate some want to make baseless accusations.... The vast majority of Penn Staters want the focus to be on our dedicated student-athletes, as it should be.") "Joyner kept trying to work behind the scenes to become the sports medicine doctor at Penn State," Evarts says. When he couldn't get the in-house job, adds Pellegrini, "he wanted more involvement with the teams as a private practitioner. And I have to tell you, now he's taken advantage of what had been a long-standing, very competitive relationship with Sebastianelli."

In the mid-1990s, when Joyner's sons, Andy and Matt, played football for the Nittany Lions, their former teammates and members of the team staff say their father would give them jsi T-shirts that they would hand out to other players. "His sons would tell guys on the team that [Joyner] could operate on them," recalls one former staff member. Multiple former players and staff members told SI that they recalled Joyner and Sebastianelli having heated words over whether Joyner was trying to lure football players away from the university medical system.

The following year Joyner sold JSI to NovaCare. In 2000 he became a Penn State trustee and joined a practice called the University Orthopedics Center, in which another trustee, former Nittany Lions linebacker Paul Suhey, was a partner. Soon thereafter, Joyner helped start a company that operated fitness centers. That business failed, and by 2005 Joyner was more than $1 million in debt to Community Banks, according to court records.

For help with his debt Joyner turned to his friend and former Penn State wrestling teammate Ira Lubert, a real estate investor who has served two stints as a university trustee. According to Dauphin County property records, Lubert purchased Joyner's house and allowed him to keep living there. Joyner ultimately satisfied his financial obligations by selling several other properties. According to interviews with trustees, Lubert is widely considered to be an exceptionally influential voice on the 32-member board. (Lubert did not respond to a message seeking comment.)

In November 2011, athletic director Tim Curley was placed on administrative leave after being charged with perjury related to the Sandusky case. (Curley has yet to go to trial.) He was succeeded by Mark Sherburne, who had been an associate AD for 11 years. Sherburne served for only 10 days before he was replaced as acting AD by Joyner, who then vacated his seat on the board.

Joyner's official appointment in January 2012, at a salary of $396,000, raised eyebrows. "You have to ask yourself how a member of the board of trustees was hired as AD without a national search," says Brandon Short, a former Penn State captain and Giants linebacker, a member of Penn State's Letterman's Club and now president of a business finance company based in Dubai. (Erickson has said there will be a national search for a permanent AD starting on June 30, 2014, the day Erickson says he will retire as president.)

In November 2012 the Pennsylvania auditor general issued a special report, Recommendations for Governance Reform at the Pennsylvania State University After the Child Sex Abuse Scandal. Chapter 5 was titled: "Insiders moving back and forth between board and staff." The chapter specifically cites Joyner's transition from trustee to AD—made without a waiting period—as an example that conveys "a public message that influential insiders are running the university, and that objectivity and independent thinking are compromised."

On Jan. 25, 2013, after 20 years of service—but just four days after "acting" was dropped from Joyner's athletic director title—Sebastianelli was ordered to clear out his office in the football building by the end of the day. "It's a decision that I don't agree with, but it's something I have to work with," the 55-year-old Sebastianelli says. Athletic department officials escorted him out of the facility. (Philip Bosha, the team's primary care doctor, who worked under Sebastianelli, was also informed that he would be replaced but was given several weeks to transition.) Sebastianelli would retain the title of director of athletic medicine, but his work with the football team was over.

The sudden departure of the longtime orthopedic surgeon--head physician caused confusion among athletes, according to Penn State players and staff members. Several athletes say they were told that Sebastianelli had retired or resigned. Football players showed up at the hospital wondering if Sebastianelli could still remove their surgical sutures.

Joyner began to approach Penn State doctors about filling Sebastianelli's position with the football team. According to sources familiar with that process, the Penn State medical community was stunned by the abrupt removal of Sebastianelli, and several doctors declined offers to succeed him.

No official announcement regarding Sebastianelli was made at the time, and school personnel involved in internal discussions say that Penn State officials began to explore how they would justify, in the absence of performance issues, the removal of a longtime doctor with an endowed professorship. According to two people with knowledge of those discussions, Joyner's perceived dislike for Sebastianelli is widely enough known in State College that Penn State officials worked on talking points in case reporters asked whether Joyner was settling a personal score.

The news came out in the Centre Daily Times a month later: Sebastianelli was being replaced by Peter Seidenberg as head physician and by Scott Lynch—like Joyner and Lubert, a former Penn State wrestler— as orthopedic surgeon. Lynch is based in Hershey and will attend every game and meet weekly with injured players. The university released a statement to the paper about the shake-up, saying that the "change in physicians was made after a review of procedures and personnel by Coach Bill O'Brien and is part of an ongoing reorganization of the football staff."

"Scott Lynch is a wonderful doctor, but he's based in Hershey and has a full-time practice there," Pellegrini says. "I can't imagine Bill O'Brien will be happy with the coverage he'll get with a person running back and forth."

In an interview with SI, O'Brien said that he made year-end recommendations for improvements to the football team that included changing medical personnel. (Joyner, he said, approved and implemented the changes and chose the new doctors.) O'Brien said that he is happy with the changes and that Lynch was at most of the 15 spring practices that occurred over five weeks. "I believe that Dr. Lynch will be there just about every day in the fall," he said. A medical schedule Penn State gave to SI indicates that, during the week, Lynch will be expected to be present only on Wednesdays.

Asked to address this apparent contradiction, O'Brien said, "At the end of the day, I believe in a primary care physician being here every day, that's something I believe in, and that's one of the recommendations I made." Penn State, though, already had a primary care physician—Philip Bosha—present at every practice. "That's what I believe in," O'Brien said, "which is what we have, and which is what we had."

An athletic department staff member takes issue with the idea that coaches and ADs are making medical personnel decisions, saying, "How ironic is it that after everything that happened a year and a half ago, that the program is much more like an NFL program [in which doctors are picked by the team] than it ever was before."

One recently graduated player told SI that injuries were commonplace at Penn State practice. He wondered: What will happen in the future when there's a serious injury—an open fracture, for example—and no surgeon nearby? Because Lynch doesn't have operating privileges in State College, the answer is that either the player will have to be transported to Hershey, or, if an operation is required urgently, a surgeon in State College who does not see the team regularly will handle it.

According to trustee sources, Joyner's rationale for the change was cost savings. With decreased donations to athletics following the Sandusky scandal, a decline in football club-seat and suite renewals, and increased operating expenses, an athletic department that has perennially been one of the few in the country that is self-sustaining is approaching the red. During 2010--11 the athletic department reported a surplus of $14.8 million dollars. For '11--12, that plummeted to $863,000. "It's less good care," says Pellegrini, "in exchange for saving a few bucks."

Even before the removal of Sebastianelli, health care for the football team underwent a decided shift starting last season. "The change has been overnight," says one Penn State sports medicine professional, "from a physician-driven model with the athletic trainer there to assist, to an athletic-trainer-driven model."

In February 2012, before the start of his first season and while Sebastianelli was still the team's orthopedic surgeon, Joyner announced the hiring of Penn State alum Tim Bream as athletic trainer—and head of athletic training for the university—replacing George Salvaterra, who had been in the position since 1985.

Bream told The Patriot News that Joyner initiated the process—the two were on the U.S. team's medical staff at the '92 Olympics. Bream came to Penn State after 15 years with the Chicago Bears. Penn State players who spoke with SI expressed reverence for Bream's NFL experience. Multiple staff members also told SI that Bream goes beyond what is typical to provide athletic training instruction to undergraduate kinesiology students and graduate assistants.

But according to current and former Penn State staff members and players, Bream has engaged in practices his predecessor did not. Three sources involved in health care for Penn State athletics who spoke with SI on the condition of anonymity say they saw Bream—who does not have a medical degree—giving players the anti-inflammatory drug Voltaren without a prescription or a physician's approval. Two of those three also say Bream gave a player the prescription drug Bentyl for diarrhea, when the drug is actually meant to treat irritable bowel syndrome. Those sources as well as team sources told SI that they saw Bream engaging in other procedures requiring special certification or a medical license. These include using an X-ray machine, administering an inhaler to a player who does not have asthma and lancing a boil on a player's neck. (A Penn State spokesman told SI that Bream would not be available for comment and declined to clarify whether Bream had X-ray certification.)

The university asked attorney Michael Mustokoff to investigate a number of these allegations involving Bream, including that he dispensed prescription drugs and operated an X-ray machine. Mustokoff's bio page on the website of his law firm, Duane Morris LLP, notes that he has been a lead attorney "in a number of highly publicized cases" and is "currently representing Penn State University in criminal proceedings arising from the criminal prosecution of Gerald Sandusky and others." Mustokoff's conclusion regarding Bream was relayed to trustees at a private meeting in March. "We were told that [the dispensing of drugs] did happen, but that they were misunderstandings," says a source who was present at the meeting. "We were told he thought he had a doctor's approval." (Mustokoff did not respond to a voice mail from SI.)

In a statement e-mailed to SI, Joyner said, "The legal team's report concluded there was no credible or substantial evidence to support the allegations or rumors, and there was no wrongdoing or violation of any professional standards. The report also concluded that none of the physicians who supervise the head trainer had made or documented any contemporaneous complaints to anyone or discussed with the trainer any concerns about overstepping bounds of care."

The practice of NCAA athletic trainers' dispensing prescription drugs is not uncommon: A 2003 study in the Journal of Athletic Training found that 55.9% of trainers do it. Nevertheless, it is contrary to NCAA and National Athletic Trainers' Association guidelines, and to state and federal laws.

Salvaterra says that he used to assist a physician in lancing boils, but that he would never do the minor surgical procedure on his own, "because a boil is a staph infection, and it could turn into MRSA"—a strain of staph that resists common antibiotics and can be fatal. According to Pennsylvania law, athletic trainers should not conduct invasive procedures. Some medical staff members have taken to calling Bream "Dr. Tim" behind his back.

Bream has also ordered medical braces for athletes, according to multiple sources, a task at Penn State previously left to physicians or at least done with physician approval. And several university medical sources say that beginning last season, Bream told physicians to stop talking with the parents of players. What's more, Bream said that they should not spend as much time in the athletic training room, and that they aren't needed on many of the occasions when they used to show up, including at some morning conditioning sessions in winter.

In February, walk-on wide receiver Garrett Lerner says he was being treated by Bream with an electrical-stimulation, or "stim," machine. According to Lerner the contact pads for the machine were worn down and did not stick well to his hirsute legs. "Tim said he just wrapped it anyway because he figured the ice and the ACE bandage would keep it down. But it didn't stick," Lerner says. "The electricity ended up arcing onto my leg." Lerner, who left the team in March due to an unrelated injury, ended up with two severe burns—quarter- and dime-sized—on his right leg.

Stim burns occur on rare occasions. The greater problem in Lerner's case, he says, was that later in the week, when his leg became painful, no physician was in the athletic training room to examine him, and the athletic trainers decided simply to keep the burns covered. Lerner insists that the athletic training staff took good care of him, but he was not seen by a doctor for several days, by which point his leg had become infected. He tweeted, "Third degree burns on my leg from the stim machine ... awesome."

Lerner was actually sent to Sebastianelli, who had just been ousted as team physician, by a concerned doctor who learned of the injury. Lerner says that subsequently Seidenberg, the team's new physician, advised him not to go outside of Penn State to see a specialist. (Seidenberg did not respond to an e-mail from SI.) Lerner's mother objected and took him to Lehigh Valley Hospital, where doctors contemplated skin grafts to repair what had become "craters in my leg," as Lerner puts it. Ultimately, he was treated with antibiotic ointment, and it was two months before his skin started to regrow. "Tim said it was a freak accident," Lerner says.

For many at Penn State, the enduring image of Sebastianelli is from 2000, when he knelt beside Adam Taliaferro. The freshman cornerback—now a Penn State trustee—had just exploded the fifth cervical vertebra in his neck and bruised his spinal cord with a head-down hit on an Ohio State running back's knee. Sebastianelli quickly aligned Taliaferro's spine and ordered the paramedics to call ahead to Ohio State University Wexner Medical Center to prepare a shot of the steroid methylprednisolone.

Most who suffer Taliaferro's injury never walk again, but all of the emergency treatment that day happened in the right way and at the right time. In nine days Taliaferro began to regain movement, and Sebastianelli flew every week to the Magee Rehabilitation Hospital in Philadelphia to be by his side. "He's a guy that became part of my family," Taliaferro says. "If it wasn't for him, I wouldn't be walking today." Which is why Taliaferro was "very concerned" when he learned that Sebastianelli would be replaced. "I'm trying to figure out what's going on," Taliaferro told SI.

Taliaferro's father was more direct. "They're putting b.s. out there about, Well, this is Coach's decision," Andre Taliaferro says. "Even if it was Coach's decision, that's wrong. You don't ask the doctor to make coaching decisions."

"Clearly, this is not what the skeptics and critics want out of Penn State," Evarts says. "It's not what one would like to see happen to correct some of the problems that existed."

Pellegrini sees a major conflict of interest: A return to the pre-1992 football medicine model, he says, may reopen opportunities for local private doctors to work with players, including Joyner and his former partners. "He has a business conflict of interest and a personal conflict of interest," says Pellegrini, now chair of orthopedic surgery at the Medical University of South Carolina. "My own opinion is that he's not an honorable guy in this situation."

That website dedicated to transparency, explicitly intended to quell the outcry from a scandal centered in the athletic department? The only information about Joyner, who assumed such a critical position at such a crucial time under such controversial circumstances, is a copy of the memorandum of understanding that named him acting athletic director.

Follow @SIDavidEpstein

"You have to ask yourself how a member of the board of trustees was hired as AD without a national search," says Brandon Short, a football captain in 1998 and '99.
After 20 years of service—but just four days after Joyner assumed the full title of AD—Sebastianelli was ordered to clear out his office.

SI.COM

For more about Penn State football 18 months after the biggest scandal in the history of college sports, go to SI.com/mag

ILLUSTRATIONILLUSTRATION by GUY STAUBERSIMON BRUTY/SPORTS ILLUSTRATED (STADIUM); JOE HERMITT/THE PATRIOT-NEWS (JOYNER, SEBASTIANELLI)DOCTOR'S ORDER Joyner (far left), an orthopedic surgeon who wanted the job that went to Sebastianelli (near left), went from the board of trustees to AD despite a lack of college athletic administrative experience.PHOTORON SCHEFFLER/US PRESSWIREKNOCK OUT After Robinson (12) suffered a concussion against Wisconsin, Sebastianelli (in ambulance) had the freedom to put the QB's full recovery ahead of football considerations.PHOTOMORRY GASH/AP[See caption above]TWO PHOTOSJOE HERMITT/THE PATRIOT-NEWSDEFENSIVE POSITION Taliaferro (above and right), who was nearly paralyzed on the field in 2000, believes Sebastianelli (near right) is a major reason he's able to walk and considers the doctor a family member.PHOTOJOE HERMITT/THE PATRIOT-NEWSCOACH'S DECISION Sebastianelli (right, in 2006) was hired after Paterno made the case that the team needed a full-time orthopedic surgeon at every practice rather than a part-time consultant.