|Outside the Lines: |
Do No Harm
Here's the transcript from Show 129 of weekly Outside The Lines - Do No Harm
ANNOUNCER- September 15, 2002.
TOM COUGHLIN, JAGUARS HEAD COACH (1995-PRESENT)- Let's face it. I'm a football coach. I'm just like any other football coach. I like the players to be on the field.
BOB LEY, HOST- Jeff Novak was one of those players. His NFL career was ended, he says, by medical malpractice by the team doctor.
JEFF NOVAK, JAGUARS OFFENSIVE LINEMAN (1995-'98)- The doctor clears you to practice and clears you to work. You go out there and you work, and if you don't, you're going to be in trouble.
LEY- But on this team, the team doctor was heard to say...
JOHN JURKOVIC, JAGUARS DEFENSIVE TACKLE (1996-'98)- If you were a normal person, we might do things a little bit differently, but you guys are football players.
LEY- Doctors who are supposed to have the last word with coaches on player injuries.
COUGHLIN- You're darn right, I want them out of the training room and on the field. But unreasonably? No.
JURKOVIC- The doctor says, "Listen, this guy can't practice," well, that's gold. That's it. That's biblical verse. It should not be challenged. And unfortunately, I think, a lot of times it is challenged.
LEY- Today on Outside The Lines -- Are NFL players getting the best available medical care?
Some time in the next few hours, if it has not happened already, Curtis Martin of the Jets, Keenan McCardell of the Buccaneers, Sam Adams of the Raiders, numerous injured players around the NFL will be evaluated by their team doctors and a decision reached as to whether they'll be playing today.
Now, how such a decision is reached, with whose interest is paramount, is a question that has bedeviled medicine in the NFL for years. Pete Gent, the former Cowboy receiver who wrote the novel "North Dallas 40" to this day calls sports doctors "carpenters, with the ethics of carpenters."
Now, physicians take an oath to do no harm. Players are paid to play. Coaches are hired to win. And the collision of all those interests is illustrated this morning in the story of a former Jacksonville Jaguar who believes his career was ended by a doctor's actions. There are some graphic medical images in the story. It is reported by ESPN.com's Tom Farrey.
TOM FARREY, ESPN CORRESPONDENT- Jeff Novak seemed born to play football, born to strap on a helmet and dish out pain, born to take the pain, born the son of an injury-wracked player. Jack Novak was drafted by the Green Bay Packers and Vince Lombardi in 1961.
NOVAK- My father's always had a -- you know, a -- it's always been one of his phrases, Lombardi's "You got to pay the price."
FARREY- So Jeff Novak paid the price through five NFL seasons filled with the usual assortment of joint and muscle ailments. But it was an injury that seemed nothing more than a bruise that he says eventually ended his career.
It was late July 1998, Camp Coughlin, as Jaguar players call the grueling training camps of head coach Tom Coughlin. Novak was competing for the starting center job when a teammate's helmet slammed into his right shin.
NOVAK- I instantly just had a big hematoma or a big bruise on my shin.
FARREY- The injury was documented in a series of photos, some taken by Novak, some taken by the team.
NOVAK- After two or three days, essentially what happened is that I kept getting hit and kept getting kicked in the same place, and it just kept getting bigger and bigger, not as really a hematoma anymore, just the whole calf and shin began to swell.
FARREY- For help, Novak turned to team doctor Stephen Lucie of Jacksonville Orthopedics, one of the official medical providers of the Jaguars.
DR. R. STEPHEN LUCIE, JAGUARS TEAM DOCTOR (1995-2000)- He was having trouble just walking around, and he came in and said, "Doc, you've got to do something to relieve this. I mean, this leg's gotten a lot worse. It's really hurting." And so we performed a minor surgical procedure called an "incision and drainage."
FARREY- Former Jacksonville receiver Keenan McCardell, now with Tampa Bay, was in the training room and witnessed the procedure.
KEENAN MCCARDELL, JAGUARS WIDE RECEIVER (1996-2001)- The doctor numbs him with novocain with the needle, and he just takes a scalpel and cuts into his leg, you know, and then they just start pushing the bruise's blood out. It looked like grape jelly. It's, like, "Is this really happening right here in the training room?"
FARREY- You operated in an unsterile environment.
LUCIE- We operated at the treatment room in Alltel Stadium, which has been defined as a training room, and it's certainly not.
FARREY- But it was a sterile environment? I mean, you had your -- you had your watch on. I saw your hair in the picture. Players were in the room.
LUCIE- It was a -- it was -- it's designed to do a similar surgical procedures as physicians all over the country do in their offices or in emergency rooms.
FARREY- Lucie left the one-inch hole open to heal naturally.
MCCARDELL- It was a big hole. You could see clear to his bone, almost.
NOVAK- But what was interesting to me is that -- that he kept me -- he told me I was going to have to stay off the field because he didn't want it to get infected. And then that changed 48 hours later. I had the same opening, the same hole in my leg, but the worry about it getting dirty and infected was no longer there.
FARREY- Jeff Novak was going out there with a wound that you knew could get infected and could be aggravated by continuing to practice.
LUCIE- But we didn't -- if we'd have thought that, for sure, sending him back out there, it was going to make it worse, we would have obviously never sent him back out there. There was a small risk of infection with draining the hematoma. There was a small risk of infection with letting him continue to play.
FARREY- A few days later, Jeff Novak woke up in a pool of blood. His leg was not healing. Still, the next day he was cleared to play in the rain and mud of a pre-season game at Charlotte. After the game, at the airport, teammates noticed more blood seeping from his cowboy boot.
NOVAK- I took the boot off and poured it out and hopped off the bus. And I was standing on the tarmac of the airport, because our buses pull up to the -- right on the runway. And in the minute or so that I was standing there, another big pool of blood formed. And Brian DeMarco, who's an Italian kid from up north, you know, he's hollering, you know, "I've seen gunshots that didn't bleed this bad. Somebody get over here! Somebody get over here!"
FARREY- At this point, are you saying to yourself, "We have a situation here?"
FARREY- Lucie rushed Novak to a hospital for emergency surgery, where his leg was stapled shut. But Novak's trust in his team doctor had run out. When little black dots showed up around his wound a month later, he went to a doctor not connected to the Jaguars. That doctor found E. coli and staph infections. Novak saw limited action later in 1998, but that would turn out to be his final NFL season.
He later sued Lucie and Jacksonville Orthopedics for malpractice, claiming his leg never fully recovered. The suit went to trial this summer, a year-and-a-half after Lucie resigned saying he wanted to spend more time with his family.
MCCARDELL- A lot of the guys thought of going out and getting second opinions, going out getting surgeries outside of the team doctor.
FARREY- And how did Tom Coughlin feel about players getting second opinions?
MCCARDELL- He didn't like that. I mean, you know, he would ask a player why.
FARREY- Coaches are supposed to have no influence over medical matters. Officially, that's the domain of doctors. But some players told ESPN that Tom Coughlin's influence was unmistakable. They say he seemed to call the shots on whether players played injured.
MCCARDELL- It seemed like he -- it was kind of hard for Dr. Lucie to say, "No, Tom. He needs to sit out."
FARREY- Did you have a hard time standing up to Tom Coughlin?
LUCIE- No. Tom Coughlin is a tough but very fair coach, and our relationships with Tom were very good.
MCCARDELL- He's a doctor, you know? He's supposed to say, "Hey, he can't practice," you know? But I think, you know, Tom would kind of push him a little bit to get that player out there.
FARREY- How hard do you push players to play with injury?
COUGHLIN- Let's face it. I'm a football coach. I'm just like any other football coach. I like the players to be on the field. You're darn right, I want them out of the training room and on the field. But unreasonably? No. And the medical people always have the last word.
FARREY- Keenan McCardell said that it seemed like Dr. Lucie had a tough time saying no to you. Was that the case?
COUGHLIN- Not true. No. I don't remember Keenan being in any meetings between Dr. Lucie, Mike Ryan and myself.
FARREY- Mike Ryan is Jacksonville's head trainer. Outside The Lines requested an interview with Ryan, but the team declined. One former Jaguar player says Ryan, at times, seemed to overrule Lucie.
JOHN JURKOVIC, JAGUARS DEFENSIVE TACKLE (1996-'98)- There were a number of times when I played out there where I was told I wasn't going to practice. I had Dr. Lucie tell me I wasn't going to practice. And then all of a sudden, the head trainer, Mike Ryan, would come over, and he says, "No, put your equipment on and go out there and do what you can do." And if the doctor says, "Listen, this guy can't practice," well, that's gold. That's it. That's biblical verse. It should not be challenged. And unfortunately, I think, a lot of times it is challenged.
FARREY- Former Jaguars say there was a double standard for stars and marginal players. In a video deposition prior to the Novak trial, All-Pro tackle Tony Boselli said he was allowed to sit out practice that summer due to an ankle injury, while Novak a month later was cleared to practice with his injured shin. He and other teammates found that odd.
TONY BOSELLI, JAGUARS OFFENSIVE TACKLE, (1995-2001)- Without a doubt, it was definitely questioned why he was out there at all after he got hurt, and then he had a hole in his leg, and he's out there practicing in the heat of summer, two a days and everything else. So it was definitely questioned. And it had gotten to the point where guys said this is ridiculous that he's out there.
FARREY- Boselli, now with the Texans, says he got reprimanded by Ryan for questioning Novak's care.
BOSELLI- It was a subject that was not to be talked about or wasn't to be brought up in the training room or around -- you just -- it was a very heated topic, to say the least.
MCCARDELL- You got to have that -- the cojones, as they say, to say, "Hey, I'm not practicing," you know? And you have to stand strong. I mean, if you didn't stand strong, I mean, they just kind of wither you away and get you out there.
FARREY- Is it reasonable to expect that a player is going to sit himself down and make the decision not to play?
LUCIE- I think the ultimate responsibility for the player going on the field is the player's. He knows his body best.
FARREY- What if you just said, "Look, I am not going out there today?"
NOVAK- I think that, without a question, that you'd get nailed with a big fine from your team. I mean, you're expected to work. It's kind of -- you know, the doctor clears you to practice or clears you to work, you go out there and you work. And if you don't, you're going to be in trouble. You can't make that call.
LEY- Jeff Novak, his leg infected, confronted that pressure. When his career ended, he sued Dr. Stephen Lucie for malpractice. Now, later I'll be speaking with former Miami Dolphin O.J. McDuffie, who also believes his career ended because of medical treatment, and with the physician who heads the organization of NFL doctors.
But next, what Jeff Novak believes is the financial conflict of interest that produces the medical care he received. And when we come back, we'll see what a jury of his peers decided after a two-week trial against the doctor that he says ended his NFL career.
FARREY- In July, former Jaguars offensive lineman Jeff Novak finally got his day in court with former team doctor Stephen Lucie, whom he sued for malpractice. Still, he has some sympathy for the plight of NFL physicians.
NOVAK- I think it's probably the toughest environment a doctor can have in the whole world, to properly diagnose and take care of patients. You got players that are worried about losing their jobs. You got coaches that are worried about losing football games. You got physicians that get tied up in wanting the team to win, as well.
FARREY- All of which makes the relationship between players and team doctors a fragile one. In 2000, the year Novak filed his lawsuit, the NFL Players Union conducted a survey -- 37 percent of Jaguars players rated their medical staff as "fair" or "poor." Only five teams gave their doctors lower ratings.
HAROLD HENDERSON, NFL EXECUTIVE VP OF LABOR RELATIONS- On some teams, a large number of the players believed that they don't have the very best medical care that's available to them. We believe that throughout the league, it's our standard to have the very best. We are discussing ways in which that perception can be addressed.
FARREY- Players say one way to regain their trust is for teams to stop doing marketing deals with the same companies that provide their medical care. In the Jaguars' case, Lucie's group, Jacksonville Orthopedics, was part of a three-company group that won the right to service the team after it began play in 1995. In turn, Jacksonville Orthopedics gets to advertise itself as the team's official doctors. And its partner, Baptist Hospital, is one of the team's biggest sponsors. Novak sees those relationships as a conflict of interest.
NOVAK- It's tough, as well, for a team to sit back and say, "We went out and got the best medical care available for our players," when, in fact, you know, the medicine was sold like a billboard at the stadium.
LUCIE- We've never paid to be their doctor. We were selected on the basis of our merit and our other accomplishments in the field of sports medicine. And I have never felt that our care has at all been compromised by any type of marketing relationship.
FARREY- The NFL says it stands behind the half dozen or so teams that have marketing deals with their medical service providers.
HENDERSON- It's short-sighted to jump to conclusions and make assumptions about how that relationship may affect the quality of the medical care without looking a little more closely at it.
NOVAK- I'm sure they evaluated the doctors and did histories and all those things. But ultimately, there was a whole lot of physicians that were not eligible to even try to get that job because they didn't have the money, even though they may have been a better physician, and I think that, in and of itself, is an absolute travesty.
LEY- Jeff Novak's testimony convinced a jury. On July 19th, he was awarded a $5.35 million judgment. But 12 days after that, Novak's trial judge overruled the jury verdict, saying that no negligence had been proven. In late August, the two sides reached a resolution of the case, presumably involving a financial settlement.
To discuss the ethics of NFL medicine, we welcome O.J. McDuffie. He spent his entire nine-year NFL career with the Miami Dolphins, retiring officially three weeks ago as the team's fourth all-time leading receiver. He is suing the former and the present Miami team doctors over the treatment of a toe injury that effectively ended his career. This morning, he's in State College, Pennsylvania.
Dr. Elliot Pellman is chairman of the New York Jets medical department and past president of the NFL Physicians Society. He is in East Rutherford, New Jersey.
Good morning, gentlemen. O.J. let me begin with you. We have some tape of your toe injury. What happened with your toe injury to convince you that the team doctors have a conflict of interest?
O.J. MCDUFFIE, MIAMI DOLPHINS WIDE RECEIVER (1993-2001)- Well, originally, Bob, when I hurt my toe, they told me after my first MRI that I had a serious injury, you know, and if I played on it, it'd -- quote, unquote -- "jeopardize my ability to play football again." When I take that back to -- you know, to the training room away from the doctor's office, I tell them that, you know, I can't play for the rest of the season, I got to get something done with my toe, you know, they told me to hold on a second, just relax, you know?
So I go a couple weeks and don't practice, don't do anything. They're trying to get me ready to play. Four days later, ten days later, I get another MRI, they tell me it's not a torn tendon anymore. You know, the first MRI wasn't a very good one. So the second one was a lot better because the hospital had better facilities and a better machine. So I don't practice at all. I just get shot up every game and go out there and play.
End of the season comes around, go to another doctor -- torn tendon from the beginning. So that's why I feel that, you know, at the beginning, that they lied to me about what was wrong with my foot, got me out there on the field and effectively ended my career.
LEY- Well, Dr. Pellman, you've heard the results of that union survey from 2000. A significant number of players rated their medical care as fair or poor. Why do players have that impression?
DR. ELLIOT PELLMAN, CHAIRMAN, NY JETS MEDICAL DEPARTMENT- Well, first, I wouldn't say that a significant amount. I would say that there were some. The majority of teams I was -- I saw that survey thought that their care was good, and many felt their care was excellent. I think that it is a problem...
PELLMAN- ... of communication. I think that the business relationships that you describe, the relationships between the physicians and teams, there has to be better communication. Most importantly, there has to be better communication to the players.
LEY- Well, I -- O.J., when the doctor mentioned "excellent," you took issue with that word.
MCDUFFIE- Definitely. I would disagree. I definitely don't feel that my teammates felt that our care was excellent at any point, you know? It might have been excellent at the beginning of my career there, but recently, it's been pretty poor.
MCDUFFIE- And I'm sure a lot of my teammates agree.
PELLMAN- But O.J., I certainly cannot comment upon specifically the Miami Dolphins.
PELLMAN- But I can talk, certainly, for the New York Jets. I was confident that the survey and our -- certainly, our results on that survey, and many of the other teams in the league. What's gone on in -- with two teams and two specific cases regarding the thousands that have been taken care of by both those teams and certainly through the NFL is no reason to damn the entire NFL medical care. The medical care in the NFL is certainly seen as a role model throughout the country. Many of the team physicians are considered the leaders in their community, chairmen of departments, chief of staffs...
LEY- Should they be, Doctor...
PELLMAN- ... lecturers...
LEY- Should they be team employees? Should team physicians be employed directly by the team?
PELLMAN- Well, I...
MCDUFFIE- I definitely don't think so. I definitely don't think so. Then it's really going to be a problem. If they're working for the team, they're really not going to have the players' best interests at heart.
LEY- Dr. Pellman, you're chairman of...
LEY- ... the Jets medical department, then, right?
PELLMAN- Correct. And I guess I disagree with what O.J. said. I think that as any physician, my priority is absolutely the care of my patients, and those are the players. I have worked for many coaches, as Jet fans know out there, over the years. I've been with the team now for 16 years. And no coach has ever influenced me one way or another in terms of deciding whether players should return to play or the type of medical care they should receive. And though there are specific cases cited, the majority of physicians feel very strongly about that. Our ethics and our careers are based upon the care that we give to our patients.
LEY- Who should make the...
MCDUFFIE- I think a lot of doctors risk that, though. A lot of doctors -- we need to clone you, then, Dr. Pellman, because that's not -- a lot of doctors don't feel that way.
PELLMAN- Well, you know...
MCDUFFIE- A lot of doctors, you know...
PELLMAN- Well, O.J....
MCDUFFIE- Go ahead. I'm sorry.
PELLMAN- That's OK. I -- unfortunately, you had a bad experience and a bad outcome playing for the Miami Dolphins, but that is one team out of 32 teams in the National Football League.
MCDUFFIE- But I'm sure it's not -- I'm sure it's not an isolated situation. I'm guaranteeing it's not.
LEY- At least five teams, I think, the figure was 40 percent rated it fair or poor, so you can take issue with the word "significant," but there were a number of teams where there were players seemingly not too happy with their medical care.
PELLMAN- But was that on the basis of their medical care or on the level of communication? Was that on the perception that there were business relationships, so therefore they did not trust the physicians, even though those business relationships probably did not impact on their care? Or was that on the basis, again, of their medical care? There are issues regarding -- with that survey, how long players had to wait to obtain diagnostic testing, that had nothing to do with their medical care.
And remember, their medical care transcends the team physicians. There is a medical staff. There are head trainers. There are team physicians. It is truly medical departments from team to team, and the quality probably does vary from team to team.
LEY- One of the things that came out in the trial, in Tom Farrey's report, was that there are seemingly -- at least in this case, people felt a double standard for medical care between stars and the more anonymous players. O.J., have you experienced -- have you seen anything like that?
MCDUFFIE- You see that a lot of times. You know, a lot of guys, you know, might come up with a little hamstring pull that are stars, and you know, they're going to --they're going to rest them. They're not going to play them until they're healthy. But you be a second-stringer, you know, guys just on special teams, and you're going to get out there on the field taped up and stretched up and ready to go. They're going to have you get out there and try it every single time.
PELLMAN- But what -- O.J., but what about the fact that players are a partner in that relationship, as well? What about the fact that there are players...
MCDUFFIE- Well, if you tell me I can get out there and play on that, I'm not going to --it's not going to affect me, you know...
PELLMAN- I understand.
MCDUFFIE- ... I'm going to go out there and try to go.
PELLMAN- Well, I'll give you an example...
MCDUFFIE- So I mean, we trust -- we trust the doctors...
PELLMAN- Well, but...
MCDUFFIE- ... and the trust is always -- you know, it's not a good thing anymore, I don't believe.
PELLMAN- Well, I understand, but I -- there are also experiences that I've had in which players fight you and don't want to take your advice. There was a well-documented episode that I had with my good friend, Boomer Esiason, when I told him that he should not return to play because of a concussion that he had, and he, you know, punched me and smacked me around a little bit in the press for that, but I did not allow him to go back and play.
I think, ultimately, the physician makes the decision, and if the physician allows someone else to influence that decision, whether or not it is a player or a coach or a general manager, then that physician is wrong.
LEY- O.J., in one sentence, how could this get better? And what would you do to improve? Quickly.
MCDUFFIE- I'll tell you what we need to do is have the players go see specialists outside the organization immediately. You know, a lot of doctors are -- you know, might be good at knees or maybe a foot, but you know, don't send a guy that has an Achilles problem to a doctor who only does shoulders.
LEY- All right, gentlemen...
MCDUFFIE- So I think that everybody should always get second and third opinions every single time.
LEY- Thank you so much, O.J. McDuffie and Dr. Elliot Pellman. Thank you, gentlemen, for joining us this morning. We appreciate it.
PELLMAN- You're welcome.
LEY- Next up, we'll have your reaction to last week's story about the Patriots fan who had his season tickets revoked by the team.
Our story last week of the Patriots season ticket holder who had his seats revoked after offering the tickets on an internet auction site -- well, that brought emotional reactions on both sides of the issue to our inbox. From a viewer this past week, "The punishment does not fit the crime. A warning letter would have been sufficient. Shame on the Patriots." And from South Boston, always the home of the pithy observation, "This guy has had tickets for 18 years and didn't know you are not allowed to scalp them? I hope they laugh him out of court," end quote.
Online, you can check us out. OTLWeekly is the keyword at ESPN.com for our transcripts and streaming video. Our email address for your thoughts on today's topic, "Do No Harm," address it to firstname.lastname@example.org. And thanks for being in touch.