Sunday, March 27, 2011


For team doctors, a tight spot

As medical staffs try to serve injured players and owners, conflict is the name of the game

Jacoby Ellsbury was injured in a collision early last season and missed most of the year with rib injuries. He publicly complained that he was “playing with five broken ribs I didn’t know about,’’ although the Red Sox medical staff defended its care.Jacoby Ellsbury was injured in a collision early last season and missed most of the year with rib injuries. He publicly complained that he was “playing with five broken ribs I didn’t know about,’’ although the Red Sox medical staff defended its care. (Orlin Wagner/ Associated Press/ File 2010)

Globe Staff / March 27, 2011

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His client’s career in the balance, Adrian Gonzalez’s agent needed a question answered last winter as he pursued a lucrative long-term contract extension with the Red Sox: Could Gonzalez trust the team’s doctors?
John Boggs had heard about disputes between the Sox medical staff and most notably Jacoby Ellsbury, Curt Schilling, and Jason Bay. He needed to know whose side the Sox doctors were on — the owners who pay them or the players whose careers could hinge on their care.
In an age when baseball stars command a king’s ransom and team doctors serve both the players and club owners, their triangular relationship has turned the company physician’s office into an arena ripe for high-stakes conflicts. Concerns about the competing loyalties of team doctors have spurred an increasing number of major league players to try to protect their livelihoods by seeking second opinions from independent physicians not employed by their clubs, according to sports medicine specialists.
The issue has rarely mattered more to the Sox, as they prepare for Opening Day Friday, after a 2010 season marred by debilitating injuries.
“It’s a business, baby,’’ said Dr. Craig D. Morgan, a consultant for the Kansas City Royals who has provided second opinions for many major leaguers, including Schilling. “The player is like a racehorse. The team wants to get its investment out of him, and when an injury occurs, the question becomes, ‘Is the treatment going to make him produce for us or not?’ ’’
Players beware, said Morgan and some independent specialists.
“There are plenty of team doctors who are the best at certain things and support the player’s interests,’’ Morgan said. “There are plenty of others I wouldn’t send my dog to, and I love my dog.’’
Morgan was not speaking specifically of Boston’s team physicians, who are generally well-respected by Sox players and specialists unaffiliated with the franchise. In terms of providing care and avoiding conflicts of interest, “there are discrepancies around the league,’’ said Dr. Richard Steadman, a renowned knee surgeon who has operated on many major leaguers. “But I think the doctors in Boston are great.’’
Boggs was concerned enough that he monitored every step of an exhaustive physical Sox doctors conducted in December on Gonzalez.
“I came away from it with the utmost confidence in the staff,’’ Boggs said. “That will remain solid until something dissuades me from it.’’
Ellsbury’s confidence was shaken last year, when he missed 144 games with rib injuries. He publicly complained that, while he was under the care of the Sox medical staff, he was “playing with five broken ribs I didn’t know about.’’
Sox medical director Dr. Thomas J. Gill denied in an interview that his staff committed any error in Ellsbury’s case. Gill said he has never placed the team’s interests over a player’s. Nor has the Sox front office ever tried to influence his recommendations for baseball or business purposes, he said.




“I know in the past there may have been a perception of an inherent conflict of interest because of the feeling that a physician retained by the team might have the team’s best interests at heart,’’ said Gill, who also serves as medical director of the Patriots and team physician for the Bruins in addition to his private practice.
“But as long as I’ve been a team physician, there has never been a conflict of interest for one simple reason: Whether you’re the CEO of Gillette, a laborer on the street, or a professional athlete, we treat every patient absolutely the same way.’’
Other baseball physicians said they shared Gill’s commitment to equal care but questioned its practicality. Treating players who represent million-dollar assets to a team may take on greater urgency in the heat of a pennant race, they suggested.
“Regardless of what anybody says about treating everybody the same, it’s not the same,’’ said Dr. William J. Morgan, a former member of the Sox medical team for 18 years, who is not related to Dr. Craig Morgan. “In private practice, for example, we have a lot of pressure from the health care industry to be careful about spending on diagnostic techniques. In professional baseball, we are more aggressive diagnostically because so much is riding on us quickly making the proper decisions to get players back in the game.’’

Conflicting opinions
The Sox became notorious in the 1990s for fostering a possible conflict of interest by employing a team owner, Arthur M. Pappas, as the club’s physician. Players frequently complained about their treatment — “Our doctors are killing us,’’ Nomar Garciaparra famously uttered in 1999 — and second baseman Marty Barrett won a $1.7 million lawsuit against Pappas in 1995 for misdiagnosing a knee injury.
William Morgan, who served as the team’s primary physician for several years before Pappas retired as medical director in 2004, was revered by Sox players and gained international acclaim for his role in the experimental ankle treatment in 2004 that enabled Schilling to help carry the franchise to its first world championship in 86 years. Morgan was replaced after the ’04 season by Gill, chief of the sports medicine division at Massachusetts General Hospital.
Gill’s affiliation with Mass. General and its network of specialists was seen as a key reason the Sox replaced Morgan, whose primary affiliation was with Caritas Christi Health Care through St. Elizabeth’s Medical Center.
“I was frequently operating in a triage situation, working outside the system at times,’’ said Morgan, who voluntarily surrendered his medical license in 2009 and began a sabbatical for private health reasons. “The current medical team has the advantage of having an extraordinary team of specialists they can refer to.’

Any edge in treating injuries helps the Sox, whose estimated value ($912 million, according to Forbes) exceeds the gross national product of some countries. In 2004, for instance, Morgan’s radical surgery on Schilling’s ankle helped to make the difference between a lost season and a world championship.
Four years later, however, a shoulder injury placed Schilling at odds with the Sox. In Dr. Craig Morgan’s view, the case became a classic example of a front office influencing a team doctor’s recommendation.
The Sox, who had signed Schilling to a one-year, $8 million contract for 2008, favored a rehabilitation plan to treat a tendon injury in Schilling’s shoulder. The team hoped Schilling would pitch again by the All-Star break.
Schilling and Dr. Craig Morgan, serving as Schilling’s personal doctor, said they had a better idea. Morgan operated on Schilling’s shoulder in 1995 after the pitcher claimed the Phillies medical team misdiagnosed him. In 2008, the doctor recommended Schilling undergo a pioneering surgery known as biceps tenodesis. Under their plan, they said, Schilling would pitch again by midseason.
The Sox opposed Morgan’s recommendation partly because there was no record of a major leaguer successfully returning from such an operation.
To resolve the issue, the Sox and Schilling solicited a third opinion, from Dr. David W. Altchek, the Mets team doctor, who agreed with Gill’s recommendation.
At that, Schilling continued rehabbing. But the shoulder failed to heal, and Schilling underwent the surgery in June 2008, ending his season. He never pitched again, retiring the following March at age 42, but Morgan said the operation succeeded and would have enabled Schilling to return to the mound in 2009.
Morgan asserted in a recent interview that Sox management gave too much weight to its baseball investment in Schilling. The former pitcher declined to comment.
“There were 8 million reasons why the Red Sox wanted to take the approach they did,’’ Morgan said. “I don’t fault them for that, but they were wrong.’’
Sox general manager Theo Epstein defended the team’s handling of the case.
“It’s the medical staff’s priority — and responsibility — to do its absolute best to provide a safe return for an injured player while also ensuring his long-term health,’’ Epstein said. “Oftentimes, that requires a conservative approach focused on rehabilitation rather than surgery. Other times, when a proven surgery is clearly the best option, we endorse a surgical approach.’’

‘Your career is at stake’
Baseball’s collective bargaining agreement permits players to seek second opinions — and sometimes third opinions — from mutually approved physicians. The club pays the costs, including transportation and lodging.
The basic agreement also gives the commissioner the authority to prevent teams from forcing players to undergo surgery by team-affiliated physicians against their wishes.

Many agents said players would be foolish not to fully exercise their contractual rights.
“So much is on the line that there is a certain level of skepticism you bring to the table when you’re representing the interests of the player with team doctors,’’ said Lisa Masteralexis, a professor of sports law at the University of Massachusetts Amherst.
Masteralexis and her husband, James, represent a number of players, including former Sox pitcher Manny Delcarmen, now with the Mariners. She said players should never hesitate to seek independent advice.
Other agents agree. “I always send players for second opinions because misdiagnoses happen all the time,’’ said Rick Thurman, who clashed with the Sox in 1999 over the team’s treatment of pitcher Tom Gordon.
As for Bay, he was past the point of second opinions when he entered free agency in 2009. The same was true of Pedro Martinez five years earlier. In each case, the Sox medical team provided an evaluation to ownership citing a greater risk of signing the player to a long-term contract because of the chance of future injuries. The Sox signed neither player.
Bay said at the time that he “absolutely did not agree’’ with Gill’s evaluation. Martinez also insisted his physical condition was sound. Yet both players experienced injuries and declining production after leaving Boston.
Gill likened himself to “an insurance assessor’’ in forecasting future performances based on medical evaluations.
“We saved the team millions and millions of dollars over the years on players we didn’t end up signing,’’ he said.
The competing pressures on team doctors have prompted several former Sox players to caution young players to protect their interests. They included pitchers Brian Rose and Butch Henry, who complained in the 1990s about their treatment by the Sox medical staff.
“I put my faith in the team and lost a lot because of it,’’ said Rose, who asserted the Sox misdiagnosed and mistreated a serious elbow injury. “It’s OK to have the faith, but you always need to look out for yourself. Your career is at stake.’’
A number of players, including former White Sox slugger Frank Thomas, have successfully sued teams over allegations they received improper care. What’s more, courts generally have ruled that team doctors must act in the best long-term interests of players rather than the club’s short-term needs.
Regardless, Gill said, he needs no additional motivation to provide the best care. He said he recognizes how futile his job might become if he were perceived by Sox players as allowing ownership to influence his treatment plans.
“It would only take one incident for me to completely lose the clubhouse,’’ he said. “It all comes down to trust.’’
Bob Hohler can be reached at hohler@globe.com. 
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