Giving 'Em Fitz: A not-so-healthy conflict

Let's say you're in the business of buying and selling rare luxury cars.

To keep these sensitive, multimillion-dollar vehicles running smoothly, you need a world-class mechanic. The kid who does oil changes at the local Sunoco won't do.

So how do you find such an invaluable asset?

Do you seek out the advice of an automotive consultant? Place an advertisement on websites that specialize in fine automobiles? Contact engineers at Mercedes, BMW, Lexus?

No, you offer the prestigious position to anyone willing to pay you lots of money.

While that might sound outlandish in the world of high-priced automobiles, it's usually how it works in professional and big-time college sports.

The care and careers of the world's best athletes, the most compelling and critical figures in billion-dollar enterprises, are often put in the hands of the highest bidder.

In this marketing-mad environment, medical practices pay franchises a million dollars or more annually to act as team doctors. In most cases, the services they provide are free.

What these physician groups get in return, of course, is the not-insignificant ability to promote themselves as the beloved home team's "official and exclusive medical provider."

These doctors might be the best in town. They could also be sports fans with stethoscopes, happy to pay for access to their idols. There's no guarantee they aren't quacks.

"The purchasing power of these groups," William O. Roberts, president of the American College of Sports Medicine, told the New York Times in 2004, "doesn't necessarily reflect their abilities."

More problematic is that when it comes to medical conflicts involving players, it's difficult to envision a scenario in which these physicians aren't more beholden to teams than athletes.

Somehow I don't think this is what Hippocrates had in mind when he was drawing up his oath in ancient Greece.

This interaction between wealthy athletes and doctors whose loyalties lie with the team might be the most volatile issue in sports today.

The strange relationship has been at the heart of the concussion crisis. Just this month, a lawsuit filed by eight former NFL players alleged team medical personnel had wantonly administered dangerous drugs that led to their subsequent addiction.

It's an issue that surfaces every time a Cliff Lee is shut down weeks after complaining of elbow discomfort, or when a Ryan Howard is given a risky cortisone shot and then breaks down.

These conflicts arise far more often than we know. It's only the major injuries and disabled-list transactions that make the headlines. But day-to-day medical treatment - both widely accepted measures and under-the-trainer's-table solutions - is the grease that keeps the sports machine functioning.

When all else fails, a trip to the DL or corrective surgery might be the prudent course of action. But if either is possibly going to prevent a team from reaching the postseason, they might be options the two parties can't agree upon.

Whether a player's money is guaranteed or not, it's a complex and - as the recent spate of medical-related lawsuits reveals - risky dance. Owners don't want to see their investments sidelined. Players don't want to see their fortunes, livelihoods, and long-term health jeopardized.

So what's the team physician's role in resolving these disputes?

The Hippocratic oath demands that he place a patient's interests above all others. But on whose side do you think a doctor whose professional future is linked with the team's success is likely to land?

M. Gregg Bloche, a physician-attorney who is also a law professor at Georgetown, has long researched this inherent conflict. He believes that, despite all the job-related gains professional athletes have made in recent decades, the balance of power continues to reside with the club.

"The overall picture is of a contractual environment that runs roughshod over players' rights to make their own medical decisions, doctors' ethical duty of undivided loyalty to their patients, and players' rights to medical privacy," said Bloche, the author of The Hippocratic Myth.

Most collective-bargaining agreements, he noted, restrict players from seeking the advice of outside physicians without the team's consent.

Baseball's, for example, mandates that the club has "the right to designate the doctors and hospitals furnishing such medical and hospital services." NBA teams can demand the medical records from any outside physician a player has seen if that treatment is deemed to affect his "ability to play skilled basketball."

In those cases in which players are permitted to seek second opinions, the club isn't bound to abide by them.

In 2007, for example, Curt Schilling signed a one-year deal with the Boston Red Sox that paid him $8 million and offered $3 million more in incentives.

The 41-year-old pitcher's well-worn right shoulder contained torn tendons, which his personal physician described as looking like "strands of pasta." That physician and another independent doctor Schilling visited recommended surgery.

The Red Sox, however, knowing Schilling probably didn't have many bullets left in that valuable right arm, disagreed. The team told him it preferred more conservative measures and suggested he rehab the shoulder instead.

And, by the way, if Schilling balked, his contract could be voided.

"He didn't have any alternative other than throw $8 million away," said Schilling's physician, Craig Morgan, a Wilmington orthopedist.

In many ways, the problem is an insoluble one.

The best interests of teams and players frequently don't mesh.

But sports franchises can always develop, sign, or trade for new players.

An athlete, for all his natural gifts, can't regenerate a knee, can't revive a career that's been lost to questionable medical decisions, can't retrieve a memory that has vanished in the fog of war.

"Obviously, we were grown adults and we had a choice," retired NFL lineman Kyle Turley said after the filing of the lawsuit this month. "But when a team doctor is saying this will take the pain away, you trust them."

@philafitz