Insider | Notes
Is NFL medical care good enough?
That's a question the NFL Players Association wants to help answer with standardized care for all 32 teams. As it is now, each team decides its own, with some actually handing out the work to the best bidder.
The NFLPA and league representatives sit down each year and discuss medical treatment issues. But recent developments -- including the filing of lawsuits by three former players and the widow of late Minnesota Vikings tackle Korey Stringer -- have shed new light on the way players are treated.
That, the NFLPA hopes, will be the impetus for change.
"The issue of quality of care and standardization of care at the facility by the trainer and the medical staff has been a topic of discussion," said Doug Allen, the NFLPA's assistant executive director. "I would expect that issue to be resolved sooner rather than later. There are ongoing discussions about medical issues that have taken place. That's not something we're waiting to talk about."
Says Dr. Robert Huizenga, former team doctor for the Raiders, who wrote a controversial book about working for them titled You're Okay, It's Just a Bruise: "People just want a team that wins. Nobody is going to boycott the Super Bowl based on the poor medical practices.
"That's not what football is about. Fans want a winner. They don't care about that stuff. If they're so concerned with the players' health, why aren't doctors involved with the rules committees? They give it lip service. There are a lot of things they can do to make it safer."
Catalyst for change
The lawsuits could have a major impact on reshaping the process. The first of these trials took place this past summer in Jacksonville.
The case pitted former Jaguars lineman Jeff Novak against former Jaguars team doctor Stephen Lucie (not Novak vs. the team, because workman's compensation laws protected the Jags). As the team doctor, Lucie was an independent contractor, not a team employee.
Novak won a jury verdict only to have it overturned by the judge, and it's believed the two sides then settled, since that decision was not appealed. Novak was initially awarded $5.3 million by the jury, but neither side has commented on any settlement, or possible figure, after the judge's decision.
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| Former Dolphins receiver O.J. McDuffie is challenging the team's medical treatment in court. (Getty Images) |
A backup New York Jets offensive lineman has also filed a motion to sue.
Another case involves the high-profile death of Stringer last year from "heat-related illness." His wife, Kelci, filed a wrongful death suit against the Vikings, coaches and medical staff. She is seeking more than $100 million in damages.
Both the NFLPA and the league office will be closely watching as these cases wind through the legal system, and the way the NFL handles its medical situation could change because of the outcomes, or the information coming from them.
"We are certainly watching what takes place there," Allen said. "But as far as the specifics of those cases, I'd rather not get into that."
Greg Aiello, the NFL's vice president of public relations, said the league office is also going to monitor the cases and is in constant dialogue with the NFLPA about ways to improve medical care.
"We realize the medical issues are very important issues," Aiello said. "The discussions (between the league and the NFLPA) have been ongoing and are part of the (Collective Bargaining Agreement)."
The Novak case is one that had been in the works for two years.
A 'bruise gone bad'
A lineman with the team from 1995-1998, Novak filed the case in 1999 against Lucie and his employer, Jacksonville Orthopaedic Institute -- a company that won a bidding war to be the "official" medical provider for the Jaguars.
The basis of the suit was Novak claimed the poor medical treatment of a bone bruise eventually led to infection and ultimately his early retirement.
His is a story of a bruise gone bad, including grisly details of how he contends his treatment went wrong.
According to the suit, Novak took a helmet to the lower part of his right leg. He missed one day of practice and then was back on the field.
After several days, the wound was swollen, according to Novak. Lucie then evacuated the hematoma and "milked, squeezed and scraped" the area with his hands in the team's locker room. This created a big, bleeding hole, Novak said.
After a day of rest, Novak was back on the field, even though he says his socks were soaked with blood every day he was on the field.
The day before the team's first preseason game against Carolina, Novak woke up from a nap to see a pool of blood, two feet in diameter, at his feet. The wound was re-bandaged, Novak said, and he was cleared to play. He did, three quarters.
"There's no way he should have played," former teammate John Jurkovic said. "They put him in a lot of danger."
After the game, while sitting on the team bus on the tarmac of the Charlotte airport, a teammate noticed a pool of blood at Novak's feet. Novak and teammates said he then actually dumped blood from his boot.
Instead of going to the hospital in Charlotte, Novak flew home with the team and was taken to the hospital upon arrival. An arteriogram was performed, as well as surgery to clean and sterilize the wound, causing a bigger hole.
"They told me I lost a lot of blood," Novak said. "It was something that could have led to me dying."
He didn't die, but his career did.
He developed a staph infection and E. coli in the leg. Novak would put the NFL uniform on again three more games after returning six weeks later. At the end of the season, he was placed on IR with a back injury suffered while lifting weights.
He never played again. Novak retired in 1999 and claims the leg infection -- not the back injury -- is the reason he did. He says he's now forced to wear a circulatory stocking to improve the blood flow in his leg and his life might never be normal again.
All, he says, because a simple bone bruise suffered during a training camp practice -- an injury Novak says was made far worse by the poor treatment -- never properly healed. That's why he took this fight to courts.
Who's accountable?
After a trial that included testimony from teammates, doctors and even Jaguars coach Tom Coughlin, Novak was awarded the $5.35 million by a jury, but the judge subsequently rejected the decision. Any monetary settlement has been kept confidential.
"I'm more interested in people and doctors around the league realizing that if you're going to take a chance with players' lives, you may have to answer for it in a court of law," Novak said before the trial. "That interests me more than having somebody come up and offering me X amount of dollars. For me, it's much deeper than that. I've taken care of my family's future by being frugal. This is based more on what's right and wrong than about money. It's about quality of life."
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| The lawsuit involving the late Korey Stringer could have big impact on NFL medical care. (Getty Images) |
The two players are no longer in the NFL, and while they were, they weren't superstars. But the outcome of these cases could go a long way in determining how teams handle medical treatment. Stringer's case will be a far more high-profile courtroom drama -- if it makes it that far.
"Some doctors simply do not put the players' best interests at heart," Huizenga said.
The increase in litigation could lead to these doctors walking away from their duties with teams. Most do it only for the exposure, with the financial rewards usually minimal compared to their normal practices.
"The doctors have a lot of pressure on them," Falcons coach Dan Reeves said. "These lawsuits have added more pressure. A lot of these guys don't do it for the money. They do it for the love of being around the game. That could lead to some walking away."
To play or not
This litigation could also shed light on two areas that have long concerned players:
- Being forced out onto the field by coaches when injured.
- The right to seek second opinions outside the team doctors.
"There are a lot of gray areas," said Oakland Raiders defensive end Trace Armstrong, president of the NFLPA. "That's where problems occur."
Players are sometimes classified as "limited" in terms of what they can do on the practice field. A lot of teams use that classification, which means a player can do some things, but not others.
One phrase trainers and doctors use is "see what you can do." It's a gray area, which leads to players pressing to take part, which can lead to further injuries.
Instead of "out" or "in," a player is on the field taking part in some of the drills. But players push hard -- it's the nature of the game -- and that's where trouble can occur. They want to be on field, especially with the chance to lose out on a $1 million a year job.
Peer and coach pressure can also be a problem.
Say you're a player with little job security, and a missed practice means you could be out of work.
Do you practice even though you know you shouldn't? Shouldn't the doctor be the one to stand up and rule a player out? What about a coach pushing a doctor to let a player practice?
"You should not leave it up to the guy," former NFL player Don Davey said. "You should take their input, but I'm not a doctor. I don't know this stuff. Doctors should tell you that you shouldn't play or practice. He should take responsibility. But he's the team doctor, and his No. 1 loyalty is to the team.
"Given the chance, most guys will practice. Most of the time, guys want to be out there. There has to be somebody with final authority. It has to be the doctor. I'm a smart guy, but I need somebody else's input, and it shouldn't be the coach."
Former 49ers coach and general manager Bill Walsh, who's now a consultant with the team, agrees.
"You've got to have somebody who's independent enough to make independent decisions and then you've got to be willing to go with those decisions," he said. "Some owners and general managers can have a lot of influence on the doctor."
Huizenga said it happened to him several times when he was with the Raiders.
"There is a lot of pressure from coaches on the doctors to get players on the field," said Huizenga. "It may not always be in the best interest, but that's part of the NFL."
Added Novak: "It's a real easy out for the medical staff to label you 'limited.' What that means to a player is a doctor says you're hurt, but you're not injured. It's this: Let's see how much pain he can take."
Pressure to practice
Novak said Jaguars coach Tom Coughlin often pressured players to do more when they were limited, a claim vehemently denied by Coughlin.
"If you're not Tony Boselli or Tony Brackens, Tom's calling you, 'Sick, lame and lazy,'" Novak said. "You knew he was going to pressure you if you were not out there."
"No, I never forced a player on the field," Coughlin said this summer. "I always consulted with the doctor on what is right and wrong for the player. Am I like every coach who wants to see players practice? Of course I am. But I would not endanger a player by overruling the doctor."
"Limited" status is something that concerns the NFLPA -- if it is abused. It can put undue pressure on the player to practice when the trainer or doctor should be making those decisions. "In" or "out" would be an easy solution.
"There are some benefits to limited status because it lets a player test it out," Armstrong said. "My problem is when a player does not make an informed decision because he's getting incomplete and inaccurate advice from the training staff. That's when you get trouble."
In Pittsburgh, coach Bill Cowher uses the "limited" tag, but said it usually means a player can take part in some drills but may not have contact. Some players say a limited day can start that way, but as the practice moves along, they can be coerced to take part in the more physical drills.
"The players can only take part in some drills if the doctor allows him to do some," Cowher said. "They must get clearance first. We never feel like we've had a situation where we've forced a player to come back quicker than he should have. What good is an injured player? They'll be tentative anyway."
Players, though, want to play. They don't want the label of being injured. The idea that they're malingerers follows them from team to team. So sometimes they push through, risking further injury.
"When I'm hurt and not on the field, I don't feel pressure from the coach to play, but I do put it on myself," Tampa Bay running back Michael Pittman said. "I've never been forced to play with an injury."
"It's a delicate balance," said Jurkovic, who is now working in radio in Chicago. "A player wants to play. He wants to be on the field even if he's a little banged up. A doctor should take the uncertainty away.
"'Do what you can do.' ... What does that mean? If I had to play a football game that day, I could, but I'm still hurting. If I had to climb Mount Everest, I could. It's not a matter of doing what you can do. It's a matter of what you should be doing. They put it on your shoulders, 'Be tough. Go out and practice.'
"Players will do it because they don't want to get the moniker they are soft."
Most coaches insist they never force players onto the field.
"You don't force people to play," Reeves said. "You let the doctors make the decision with information from the player. It's true years ago you were scared to death that you would lose your job if you didn't practice, but that's not the case anymore I don't think. There's not that kind of pressure.
"I treat my players as if they were my kids. I wouldn't force my kids out on the field if they were injured. And I won't do that to my players. I can't look at Mike Vick and say he doesn't have a sore arm if he says he does. He's the only one who knows how he feels."
Some coaches, though, are fearful of players that milk injuries. Which players are just trying to coast through the week?
"You know how some guys are, so you have to be careful with them," Saints coach Jim Haslett said. "You really have to know your players to have a good understanding about their injuries."
Haslett is one coach who says he makes decisions on whether a player can play by taking what the doctor says, talking to the player and then making a final verdict.
And thus lies some of the problem -- coaches superseding the advice of the medical staff or browbeating the doctor into becoming nothing more than a puppet. Several ex-Jaguars say Coughlin is one coach that had too much influence over the medical staff, both doctors and trainer Mike Ryan.
"Mike would never intervene on a player's behalf," Jurkovic said. "He was browbeaten. Coughlin controlled him. That's who has no spine. He's a puppet. Coughlin brings him into his office, and Mike started -----ing his pants."
Things got so bad in Jacksonville that some players actually starting referring to the training staff as "the maiming staff."
Ryan would not comment when reached, since Coughlin does not allow his assistants or training staff to speak with the media unless approved by him.
It is clear, though, the player-trainer and player-doctor relationships have to be of trust, relationships that can't be hindered by a pushy coach.
"You have to trust the people that work for you, the people that know the medical stuff better than you," Reeves said. "A coach shouldn't be making those decisions."
"Our medical staff does a great job," Cowher said. "And we rely on them for all the information. You can't overrule their decisions."
Second opinions
Players have the right to seek a second opinion by virtue of the collective bargaining agreement.
Since 1984, they were free to go outside team doctors if they felt they needed to do so. The NFLPA even provides physicians on a regional basis that players can see. Despite those rights, some players feel they are discouraged from getting a second opinion.
They say coaches want everything kept inside the building, a way to control the flow of information. And what good does it do to go outside when these teams supposedly have the best medical care they can get?
That's what some players say they get from coaches when a second opinion is broached.
"Any time you allow the player to have the choice, the team can pressure him in some way to make the choice it wants," former running back Robert Smith said before his retirement.
"My bottom line is, hell, you don't take a Ferrari to Jiffy Lube. Make sure you do what you can to make sure you know who the best are, and go see the best when you can. Why wouldn't you? Why wouldn't that be the logical thing to do?"
"You're at the mercy of the team about second opinions," Huizenga said. "Even the A-list player feels a large amount of pressure from the front office and coaches. They don't want to alienate management."
Armstrong said the second opinion issue is one the NFLPA is strongly seeking to amend.
They want some sort of penalty if a team discourages a player from seeking a second opinion. There has been talk any decision would be part of the next CBA, but Allen said the hope is the issue will be addressed much sooner.
"The player has every right to a second opinion," Armstrong said. "But what often happens is he faces resistance or perceived resistance from the training staff or the team doctor or the coach. Some players end up not pursuing it because it puts them in bad light with management. So often times they'll avoid it.
"Nobody is immune to that kind of pressure, either. Often times a guy you would think would be bulletproof isn't. For every team, that pressure is different. At some places it could be a position coach, the trainer or a team doctor. Often times players encounter resistance from a couple of different people. Ultimately, the player's body is his responsibility."
Cowher said the Steelers encourage their players to get second opinions. Haslett, Coughlin and Reeves said the same thing. In fact, the majority of coaches asked say they also willingly let their players seek second opinions.
But is that just lip service? Many times, those second opinions are at the request of an agent, which can rub teams the wrong way. If a player asks, those coaches say he's free to get one.
"We certainly don't discourage it," Cowher said. "I'm a former player. I know what players have to go through."
"If my guys want it, why would I stop it or pressure them not to?" Haslett said. "It's their right. But a lot of times I just think it's an agent making a power play."
Novak is one who said he felt undue pressure from the Jaguars to stay inside the team's medical hierarchy for his treatment; Pittman said he has never encountered any problems with getting a second opinion -- which he has done a couple of times.
It's this disparity from team to team that has the NFLPA pushing for league-wide conformity.
"I think that would be a good thing," Cowher said. "When it's different from team to team, you open yourself up to criticism. Why don't you do that here when we do it that way at my last team? If you have a standard way of doing things, where everyone agrees the way it should be done, there won't be as many problems."
"How would that work?" Haslett asked. "That would be tough to do."
Jeff Novak might have never been forced to turn to the courts had his medical troubles been taken outside the building. When he eventually went to get a second opinion outside the team, it was too late. The treatment had done too much damage, he said. His career was soon over.
And so he fought to right what he feels was a major wrong.
Life after football
A year after the hole in his leg ended his career, Novak asked his oldest son, Cade, if he wanted to play Pop Warner football.
"If you play football, you get holes in your leg, Daddy," Cade said.
"He was terrified," Novak said. "I had to convince him it was OK."
Cade did eventually play flag football, and Novak loved to spend those two hours on his feet watching his son enjoy the game he once made a living playing. It is pure, simple fun, the way Novak used to view football before his injury.
But the pain of standing on his feet quickly jars Novak back to the reality of football at its worst, when a simple bruise could have cost him his life and cost him the rest of his career.
"I haven't soured on football as a whole, just on how they handled him as a person," said his wife, Kim. "They cost him his career. They took that from him. And he's paying for it every day. The medical care wasn't right."
The question remains league-wide: Will it ever be?
