Monday Morning MD: Common for medical staff to get the blame

Whenever something goes wrong, the blame game is started. We look for whom to blame with the league concussion issues. When injuries pop up, the same thing often happens. The New York Giants medical staff has taken some heat over the years for leading the league in injuries. Now the Buffalo Bills and Pittsburgh Steelers medical staffs are being questioned. It would be entirely unfair to place blame on anyone without a thorough analysis of the particular injuries. Certainly the Bills defense has taken four hits already this year, but are they the fault of the medical staff? Indeed Buffalo’s first and second round draft picks have been injured. Shaq Lawson aggravated a pre-existing shoulder injury and had surgery. Reggie Ragland tore his ACL. IK Enemkpali has now met the same fate. Manny Lawson injured his pec, but at least his season is not over. The medical staff doesn’t cause injuries. There is some evidence of effectiveness in soccer of ACL prevention exercises in young players, but it has not been proven in football. Clearly traumatic ligament tears are not the fault of the medical staff. ACL tears are rarely partial and it was too much to hope for that Ragland’s season could be saved. We don’t know the dynamics of the Bills decision to draft Shaq Lawson given his shoulder issues. In my 2016 draft medical guide, I indicated that Lawson had a labral tear and would need shoulder surgery. If this was obvious to someone who didn’t examine Lawson, it is unfathomable that the Bills medical staff didn’t know it. The question is what stock management placed in the medical assessment and what played into the decision to initially risk playing with the injury. In my time in the NFL, my club has drafted players with poor medical grades based on perceived value. Just because a player with medical risk was drafted high doesn’t mean the team didn’t know about the problem. In Pittsburgh there are questions about Ladarius Green and his headaches. Some are asking if the Steelers bungled the $20 million free agent signing. The replacement for retired Heath Miller has yet to practice and also is coming off ankle surgery. Some fans question why the Steelers medical staff would allow Green to be signed and whether they should have been able to predict his lack of availability. I know the Steelers to have a top quality medical staff that has been involved in the leadership of the Pro Football Athletic Trainers Society and NFL Physicians Society. There is no way they did not have access to Green’s medical records as all 32 teams are on the same electronic medical records system. It is highly unlikely the medical team “missed” the ankle injury or lingering signs related to previous concussions with the Chargers. To suggest his previous team did not properly document headaches or concussion symptoms would be extremely hard to believe. First, this was not a trade and there would be no benefit to a club to downplay medical findings. Second, the penalties for inaccurate medical records go way beyond any potential NFL fine or discipline. Falsifying, altering or purposely under reporting medical findings could result in state Medical Board action and/or civil litigation with career threatening implications for a medical provider. This is why I say the new NFL penalties for violations of medical protocol will have little affect. Word has come out that Green reportedly never told the Steelers about his headaches when he was signed. This makes it near impossible that the medical staff is to blame. It is possible the player was not having headaches when signed or under reported symptoms to the team. To blame his previous club for allowing Green to play through headaches would be saying the independent and unaffiliated neuro consultants were in error. Unfortunately due to HIPAA privacy laws, the team physicians involved cannot come out and tell their side of the story in New York, Buffalo or Pittsburgh. This leaves their roles up to speculation and any public accusations or implications cannot be refuted by the medical staff. The Jaguars are poised to simultaneously add three first-round talents to their defense, but does their medical staff get any credit? Last year’s first pick Dante Fowler tore his ACL early in offseason but has rehabbed well. Jalen Ramsey had a post draft injury this year with knee surgery and has made a quick recovery. Clearly the Jaguars medical staff had some input in the evaluation for top of draft talent Myles Jack and his early second round selection despite medical concerns. I don’t hear any kudos coming to the Jaguars medical staff now that Fowler is back, Ramsey dodged a bullet and Jack seems to be performing well. The blame game is one reason I started my media efforts. Most medical staffs are not allowed by their team to speak out and federal law prohibits the disclosure of private medical information. I am not here to defend anyone. I only try to provide an insider’s prospective of what may be happening. Injuries always affect teams. So far it seems the injury bug has hit the Bills defense several times, and fortune has smiled on the Jaguars defense so far. In some ways, medical staffs are like long snappers. It seems when something goes wrong they get the blame, but when it goes right, the credit is given elsewhere.
Dr. David Chao
Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

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