The recent concussion developments involving, in particular, Michael Vick of the Philadelphia Eagles and Jahvid Best of the Detroit Lions have reminded even the most football-centric journalists of a distressing truth: there are no independent neurologists – independent of the National Football League teams of these injured players, that is – assisting, much less being given final authority, in return-to-play decisions. Certainly not within games.
(The Eagles asserted that an “independent neurologist” cleared Vick before the game against the New York Giants, but refuse to name him or her. As for the “dirt in the eye” and “wind knocked out of him” incident last Sunday in the game against the Washington Redskins … forget about it.)
But there’s an even more fundamental NFL medical issue that is well known but not widely or clearly reported: a number of team physicians, or the institutions employing them, have tangled financial relationships with their clubs. These call into question their ability to provide down-the-middle player diagnoses and return-to-play advice.
For example, the University of Pittsburgh Medical Center is a corporate sponsor of the Pittsburgh Steelers, in addition to being its preferred health care and sports medicine provider. (UPMC has the same relationships with Pitt sports teams, but those are intra-institutional and more intuitive.)
NFL spokesman Greg Aiello told me that sponsorships do not compromise medical care. “League policy is that team hospital, medical facility or physician group sponsorship cannot involve a commitment to provide medical services by team physicians.” Aiello also pointed out that Article 39 of the new collective bargaining agreement with the NFL Players Association details “Players’ Right to Medical Care and Treatment,” stating: “The cost of medical services rendered by Club physicians will be the responsibility of the respective Clubs, but each Club physicians’ primary duty in providing player medical care shall be not to the Club but instead to the player-patient.”
The CBA does seem to attempt to tighten the principle that a team physician’s primary duty is the care of the player, regardless of contractual relationships with teams outside the four corners of the medical-services contract itself. As a pro football beat writer put it to me, “All players are allowed to choose their own surgeons for surgeries, but clearly teams like when players use the teams’ docs.”
The NFL’s position is that there is no linkage between sponsorship contracts and medical services. But as the breaches of the league’s professed new culture of “concussion awareness” and extra caution reach farcical levels – and I am far from the only one saying as much – it is worth underscoring that the NFL’s heavily-lawyered verbiage of doctor independence, and true Hippocratic independence, are not one and the same.
More on this theme as we move along.