Posts Tagged ‘NFL’

Super Games, Super Pains

Tuesday, February 7th, 2012

I watched the Superbowl with a group of friends on a 60″ High Definition TV, sipping a few beers and compulsively downing munchies. My team lost (but to my mind, second place in a league of 32 teams is not all that bad – kind of a silver medal). I find the organized mayhem of football fascinating, as if J. S. Bach were being performed by a deranged, full contact orchestra. A number of years ago, my then 4 year old daughter Julia called the game “all fall down.” She was right in more ways than she knew.
We have been following two tracks in the saga of the NFL: the workers comp claims filed by former players in California (where benefits are easier to secure) and the lawsuits alleging that the league knowingly hid the effects of repeated concussions, resulting in dementia and other serious medical issues among retired players. While there are numerous lawsuits filed across the country, there is a movement to consolidate several of them into one big federal case, under Senior Judge Anita Brody in Philadelphia.
The stories of diminished mental capacity that have emerged over the last few years are disturbing – easily reaching the threshold where all of us who view the sport must question our complicity. For decades, the football mentality has been to keep the best players on the field, regardless of (future) consequences.
Touchdown Tony Dorsett
One of the parties to the lawsuits is the former Dallas Cowboy running back, Tony Dorsett. He was a smooth, electric runner on the field, but the mask of his helmet and pads only served to make invisible his considerable pain and suffering:

Dorsett’s had surgery on both his knees, and problems with his left arm and right wrist. He says then-Cowboys coach Tom Landry once told him he could play despite a broken bone in his back. Not even the flak jacket Dorsett says he wore beneath his jersey could bring relief, the injury so painful that “tears would just start flowing out of my eyes, profusely and uncontrollably” during practices.
“They would see me and just point to the training room. ‘Go to the training room, get some ice and heat and come on back out here,'” Dorsett says.

That, indeed, was (and to some extent, still is) the coaching mantra: “Suck it up and get back out there!”
Presumption versus Denial
For many years, the NFL denied any relationship between the violence on the field and the subsequent mental traumas of former players. Much like the company doctors who once denied that smoking caused cancer, the league’s doctors insisted that there was no demonstrable relationship between multiple concussions and dementia.
The systematic denial has ended, but the implications for hundreds of retired players are still not clear. I envision that they will eventually reach a settlement, where the league accepts responsibility for virtually any and all mental incapacity in its retirees. Much like the cancer and heart attack presumptions granted to public sector firefighters and police, the league would presume that mental disabilities among retirees are work related, with the burden of proof on a given owner to show that they are not.
While any such settlement will involved the commitment of millions of dollars, the league is so wildly popular, only a small percentage of gross income will be required.
Appetite for Sport
In the meantime, we face half a year without football. Come fall, there will be a Thursday night game every week, along with the full Sunday menu. To be sure, the players don’t like the short week of preparation that Thursday games entail; they will lack the usual full week to recover from the bumps and bruises of the prior Sunday game. Oh, well, the public’s appetite for America’s Game is nearly insatiable. The players will just have to suck it up and get back out there…

NFL and Dementia: A Changing of the Guard

Wednesday, May 4th, 2011

Last month we blogged the suicide of Dave Duerson, a former NFL star who killed himself at the age of 50. In order to preserve his brain for study, he took the unusual step of shooting himself in the chest. He suspected – and the subsequent autopsy confirmed – that he suffered from chronic traumatic encephalopathy, a degenerative and incurable disease that is linked to memory loss, depression and dementia. A definitive diagnosis is available only through an autopsy.
Among the many ironies surrounding this sad tale is the fact that Duerson sat on the six person NFL committee that reviewed claims for medical benefits submitted by retired players. Duerson was known for his harsh line on these claims, apparently voting to deny benefits in many cases (the votes of individual committee members were not recorded). He even testified before a Senate subcommittee in 2007, supporting the NFL’s position that there was no definitive relationship between repeated concussions and subsequent dementia.
The days of denial appear to be over. Dr. Ira Casson, who represented the “prove it” mentality of the NFL, is no longer actively involved. The medical evidence is accumulating; while some refuse to connect the dots, it’s increasingly clear that repeated brain trauma (concussion) is often directly related to a precipitous decline in brain function in the post-gridiron years.
Old Game, New Order
The NFL is trying to improve the safety of its players. The new rules limiting return to the playing field after a concussion are taking root. Helmet to helmet hits are being penalized with increasing financial severity. But even as the league tries to limit future exposures, the fate of retired players looms large. There will be increasing numbers of claims for disability, including workers comp where applicable, by players who face a substantially diminished burden of proof to connect dementia to playing field (“workplace”) exposures.
It is painful to contemplate the agony of Dave Duerson’s final days. Confronted with the incontrovertible evidence of his own demise, he must have realized how wrong he had been in taking the company line on dementia. He knew what his own autopsy would reveal: a brain damaged by chronic traumatic encephalopathy, caused by repeated trauma. His choosing to shoot himself in the chest was a farewell gesture, not only to his own life, but to the beliefs that had led him to take a hard line with his former colleagues. A loyal member of the “old guard,” he ended his life with the unmistakable and moving embrace of the new order.

A Bullet to the Heart

Tuesday, March 1st, 2011

Dave Duerson was a star safety in the NFL. He used his head in the way that aggressive defensive backs often do – as a battering ram to bring an opponent down, maybe even jar the ball loose. He was articulate, generous and in his post-football life, successful. So it saddened many of his friends and colleagues to learn that he had committed suicide last month. But even in this last, desperate act there was a method to the madness: he shot himself in the chest, so that his brain would be left intact. He was convinced that the downward spiral of his life over the past few years was due to football-related brain damage – chronic traumatic encephalopathy. He texted his ex-wife just before he shot himself, requesting that his brain be given to the NFL brain bank. Just in case she did not get the message, he left a written note with the same instructions.
We have blogged the issue of concussions in the NFL and their potential for long-term brain damage. As this prior blog pointed out, a changing of the NFL’s medical guard indicates that the league finally appears willing to confront the issue head on (so to speak). They no longer systematically deny a connection between concussions on the field and severe cognitive problems after football careers come to an end.
Over the past few years, Duerson was in a downward spiral. He lost his business to bankruptcy. He (uncharacteristically) assaulted his wife, who soon felt compelled to end their marriage. While his friends did not see major changes in his behavior, he talked openly of his fears of dementia. He suffered short-term memory loss, blurred vision and pain on the left side of his brain. He looked into the future and despaired at what he saw coming. At the time of his death, Duerson was only 50.
Suicide as Political Act
Duerson’s last gesture was an explicitly political act. He was convinced that his life problems – and the rapidly diminishing quality of that life – were directly connected to his years as a football player. So he not only decided to end his life, he made sure that suicide would leave his brain intact for research. The NFL has been (belatedly) collecting the brains of deceased players willing to donate them, to try and determine the impact of repeated violent collisions on aging. At this point, there is not much doubt of the causal connection – not in every individual who played the game, but surely in a significant percentage who suffered from multiple concussions.
With this connection medically proven, the burden falls on the NFL to improve player safety. That will not be easy. This past season, a number of players – most notably the Steelers linebacker James Harrison– complained about the newly implemented fines for helmut to helmut hits, defined as:

“using any part of a players helmet (including the top/crown and forehead/hairline parts) or facemask to butt, spear, or ram an opponent violently or unnecessarily; although such violent or unnecessary use of the helmet is impermissible against any opponent, game officials will give special attention in administering this rule to protect those players who are in virtually defenseless postures…”

Duerson the player would have agreed with Harrison about the rule. Duerson the retiree would have supported it. Experience is an exacting and often cruel teacher. As Duerson’s sad demise demonstrates, what we choose to ignore in the prime of life may give birth to demons that haunt us as we age.

Thanksgiving Cavalcade Of Risk, social media, pigeon poop & more

Wednesday, November 17th, 2010

For your biweekly risk roundup, check out the Thanksgiving Cavalcade Of Risk posted by Louise at Colorado Health Insurance Insider. Louise always does a great job curating the carnivals.
Is claim frequency on the upswing? – At Comp Time, Roberto Ceniceros says that claims data gathered by Liberty Mutual Group shows frequency trending up.
Another extension for Medicare Secondary Payer requirementsNational Underwriter reports that The Centers for Medicare and Medicaid Services has agreed to delay certain mandatory reporting requirements for workers’ compensation cases under the Medicare Secondary Payer law until January 2012. These requirements had previously been extended to January 2011. The exemption is for liability claims that do not involve on-going medical responsibility, according to officials at the American Insurance Association.
Wheelchair checklist – at Complex Care Blog, Zack Craft offers checklist for wheelchair accessibility in the home for adjusters, nurse case managers and others who are involved in managing the care of injured workers. It’s intended to be used as a starting point for a review at the onset of a claim to to ensure the claimant’s needs are met and to minimize costs and legal issues over the life of the claim.
10 years of preventing needlestick injuries – Over at The Pump Handle, Liz Borkowski informs us that it is the 10th anniversary of the Needlestick Safety and Prevention Act. Her post includes links to current standards as well as an update of progress since the act’s passage.
Collision course At Today’s Workplace, Roger Bybee has posted a great article on an issue that is heating up: NFL Collision: Management Control vs. Player Safety. He tackles the issue of chronic brain injuries vs an industry with a culture that has touted its violent collisions as a feature. One interesting aspect that Bybee points out is that as advanced helmets got harder, the collisions became more dangerous, not less.
Cool tool of the week – If you’ve been frustrated that you can never access American Medical Association studies, research, and news directly, there’s some good news. Last week, the AMA announced it will open its 10 years of American Medical News archives to the general public. They say: “It represents a rich resource on issues confronting physicians and trends in medicine. Content includes in-depth reporting on the business and regulatory sides of health care, practice management and hot issues in public health and patient care.”
Pigeon poop safety – We admit that pigeon poop is a safety hazard we have never given much thought to, but that doesn’t mean it’s not an important issue. Safety Daily Advisor recommends proper personal protective equipment to protect workers from exposure to serious conditions, including histoplasmosis and cryptococcosis.
Florida’s Sinkhole Belt – OK, it’s not comp-related – at least not so far, but Emily Holbrook of Risk Management Monitor has a fascinating post on how Florida sinkhole claims are skyrocketing. “According to a new state report, for the years 2006 through 2010, sinkhole claims have cost Florida property insurers $1.4 billion — a number that could reach $2 billion by the end of this year.” She links to the state report and a video clip that offer more info about this problem which is one of the state’s major premium cost drivers. Yikes. (We confess that we have been inordinately fascinated with sinkholes since seeing reports of this Guatemalan monster last spring.)
Tweet this – Claire Wilkinson of III’s Insurance Industry Blog posts about a recent research report that notes a big uptick in Fortune-500 insurers who are using Twitter – up from 13 in 2009 to 20 in 2010. That’s either a sign that Twitter is here to stay or that it has jumped the shark, you be the judge. If you aren’t on Twitter yet, what are you waiting for? The following video is more than a year old so already outdated, but it is elucidating about the speed of change in the way we are communicating.

All Hallows Eve Edition of Health Wonk Review and other noteworthy news

Thursday, October 28th, 2010

The pre-election season used to be dubbed the silly season, but this year it might better be termed the scary season – things are getting pretty acrimonious. Following up on the scary theme, Meredith Hughes, Allison Levy, and Sam Wainwright of New Health Dialogue Blog team up to bring you Health Wonk Review: All Hallows Eve Edition. It’s an entertaining and substantive issue, and the last issue before the election.
And in other news of note:
Joe Paduda of Managed Care Matters tackles the issue of physician dispensed drugs in work comp and explains how repackaged drugs can add to costs by an alarming magnitude. In 2007, California closed this loophole that allowed repackaged drugs to go “off the grid” in terms of existing pricing controls, and other states are now looking at this issue. Joe’s post compiles research and explains why this is an issue you should know and care about.
Roberto Ceniceros of Comp Time looks at the NFL’s recent focus on helmet-to-helmet hits. He links to a press release from the NFL Players Association, which makes the point that player safety extends beyond the field, calling on the league to “call on the league to end “nasty litigation against nearly 300 players’ workers compensation cases and stop saying ‘no’ to the disability benefits of NFL legends.”
Yvonne Guibert of Complex Care Blog discusses obesity and comorbidities and the impact on claims costs. She offers research and resources to help employers grapple with this issue. The current issue of Human Resource Executive also carries a good article on how obesity adds to healthcare costs, along with some approaches that employers are taking to mitigate the problem.
For all practical purposes, Texas is the only state in the union that allows employers to opt out of mandatory workers comp coverage. Peter Rousmaniere takes a look at how the opt-out option has affected employers in the current issue of Risk and Insurance. And on the topic of opting out, see Good News for Texas Non-subscribers, Bad News for Excess Carrier, a post by Michael Fox of Jottings By An Employer’s Lawyer.
Advanced Safety and Health News Blog discusses and links to federal OSHA’s recently issued special evaluation of state-run OSHA programs. “The reports provide detailed findings and recommendations on the operations of state-run OSHA programs in 25 states and territories. The review was initiated after a 2009 special OSHA report on Nevada’s program, identified serious operational deficiencies in that state.”
Judge Tom of the eponymous blog schools us on Oklahoma’s law on recreational injuries and workers comp. In 2005, the law was tightened to exclude any injuries that stem from recreational and social activities, even those occurring on the employer’s premises. He notes: “The larger, unanswered question is whether employers no longer have tort immunity for injuries sustained at recreational and social functions such as Christmas parties, company sponsored sports leagues, the Orcutt basketball pick-up game, attendance at charitable events to name a few.”
Short takes
Weekly Toll: Death in the American Workplace
High Unemployment Rate a Drag on Workers’ Compensation Insurers
Health care group spends $4 million on safety, saves $14 million
Specialist and primary care pay per hour
FedEx to Pay $2.3 Million Over Independent Contractors

Flighty Health Wonk Review and sundry other news blurbs

Thursday, August 5th, 2010

Jaan Sidorov has an air travel themed Health Wonk Review posted over at Disease Management Care Blog, which he calls “frequent flyer miles for your brain.” There’s a roundup of assorted news on the health care policy front ranging from a post on the growth of MinuteClinics to a look at hospital quality surveys. Get your dose of the news from some of the brightest braniacs in the health policy blogosphere.
Here are a few other health-care related news items we noted in our travels: Katharine Van Tassel of HealthLawProfBlog posts the disturbing news revealed via a survey that 36% of responding physicians don’t believe in reporting impaired colleagues. And at Managed Care Matters, Joe Paduda talks about the results of a Kaiser Health Tracking Poll that demonstrates the power of mis-information: “Half of seniors (50%) say the [heathcare reform] law will cut benefits that were previously provided to all people on Medicare, and more than a third (36%) incorrectly believe the law will “allow a government panel to make decisions about end-of-life care for people on Medicare.”
The Weekly Toll – If you haven’t visited in awhile, stop by The Weekly Toll to read about US workers who died on the job this past week. Many seasonal hazards are represented with a high toll of tractor and farming-related fatalities and construction-related deaths in this week’s grim list. And the list does not include the 8 employees of Hartford Distributors who were killed by a coworker.
Whistleblowers – Michael Fox of Jottings By An Employer’s Lawyer tell us that the difference between cloth and leather gloves is just over $1 million in his post about a Maine court’s ruling in favor of a whistleblower who was terminated after making complaints about safety and working conditions. Maine courts aren’t the only ones who are taking a dim view of retaliation against employees who report safety problems: at Today’s Workplace, Mike Hall posts that OSHA takes whistleblowers seriously and has established a website to offer a Whistleblower Protection Program.
Teen workers – Elizabeth Cooney writes about young employees who face injury or even death on the job in an article in the Boston Globe. Teens often are employed in some of the most dangerous jobs and have little in the way of training, as evidenced by the fact that the nonfatal injury rate for 15- to 17-year-olds in the United States was 5.2 per 100 full-time equivalent workers per year, double the rate for adults 25 and older. She discusses research from the state’s Teens at Work initiative, which revealed that of “208 teens under age 18 who had been injured at work from 2003 through 2007, about half said they had no safety training. About 15 percent said there was no supervisor on site when they were hurt. Almost a quarter said they had no work permit.”
Remarkable storyChrissy gets a new face from Work Comp Complex Care: “…her story of recovery is incredible on several levels – for the medical technology involved; for the reminder that dedicated health care professionals have the power to make a huge difference in a patient’s quality of life; and for the grace and attitude of the woman who suffered a devastating, life-changing injury and did not let it defeat her.”
Protecting football players – In Hitless or Witless?, Skip Rozin of WSJ.com discusses new NFL safeguards to protect football players from serious head injuries. Long overdue, and more is needed. The biggest hurdle will be overcoming the culture. As Rozin puts it “One of the biggest obstacles here is the athletes’ code of playing hurt.”
Nursing shifts – A new study from the University of Maryland-Baltimore reveals that long shifts pose health hazards for nurses – and may increase the risk to patients, as well. Study authors said that “the most common problems with an overemphasis on 12-hour shifts are needle-stick injuries, musculoskeletal disorders, drowsy driving, and other health breakdowns related to sleep deprivation.”
Legal briefs – In South Carolina, the court ruled that free living quarters offered as inducement for employment are considered wages. In a case involving horseplay, an Iowa court ruled in favor of a butt-shaking employee on appeal. A Washington court found that a fitness for duty test did not violate the ADA.
OSHA – Dwayne Towles of Advanced Safety Health News Blog warns employers that OSHA is scrutinizing safety incentive programs and may be asking for any written policies or details of any contests or promotions. They are looking for programs that might discourage employees from reporting injuries. Towles offers his thoughts for how to handle matters should OSHA come calling. And while on the topic of OSHA visits, SafetyNewsAlert offers additional suggestions in prepping for an inspection: top 10 dos and don’ts for OSHA inspections from 2 OSHA inspectors.

Concussions: A Softening in the NFL’s School of Hard Knocks

Tuesday, December 1st, 2009

Hines Ward is the epitome of the NFL tough guy. As a wide receiver for the Pittsburgh Steelers, he is known for his flamboyant personality and his ability to give and take ferocious hits. He was the most valuable player in Superbowl XL. In his pursuit of athletic excellence, he is a gambler. No, he is not betting on games. He is betting with his own life.
In the course of his football career, Ward has suffered numerous concussions. But he continues playing. He has even lied about his symptoms, so that the doctors would allow him to keep playing.
In this regard, Ward is part of the mainstream culture of professional athletics. Play today, pay (perhaps) tomorrow.
Until recently, the NFL was complicit in allowing players like Ward to gamble away their futures in the interest of the next game. The league’s leading advisor on concussions, Dr. Ira Casson, routinely dismissed every outside study finding links to dementia and other cognitive decline, including three papers published by the University of North Carolina’s Center for the Study of Retired Athletes.
The NFL is in the midst of a major change of policy regarding concussions. Dr. Casson has resigned. The league is requiring teams to have an independent consulting neurologist examine players with concussions. They have finally acknowledged what has been obvious for years: repeated concussions, especially when occuring over a relatively short period of time, can have a devastating effect on the brains of athletes. Well, duh!
Roethlisberger Sits, Ward Frets
Hines Ward came face to face with the new, more cautious NFL this past weekend, when star quarterback Ben Roethlisberger sat out a crucial game against the Baltimore Ravens. He suffered a concussion the prior week, when his head collided with the knee of an opposing player. Even though he practiced with the team all week, Big Ben suffered from recurring headaches toward the end of the week. At the last minute, the coach kept him from the game and substituted a relatively inexperienced quarterback. The Steelers lost.
After the game, Ward said the Steelers players were split 50-50 on whether Roethlisberger should have played. Ward added that, “these games, you don’t get back.”
“I understand what the league is doing,” he said. “I don’t judge another man.”
He went on to say: “We needed him out there. We wanted him out there. This is the biggest game of the year. We lost and we kind of dug ourselves a hole. Me being a competitor, I just wish we would’ve had all our weapons out there. It’s frustrating.”
Paradigm Shift: Sudden or Gradual?
The NFL will never be for sissies. Nonetheless, the policy shift on concussions is long overdue and most welcome. However, it may not be easy to enforce. Players like Ward may soon learn to remain silent on critical symptoms (dizziness, headache). They may avoid talking to the team doctors so they can stay in the game. These old school tough guys might even call out teammates who choose a more cautious route. As the legendary coach Vince Lombardi supposedly said: “Winning isn’t everything. It’s the only thing.”
Well, not quite. There are many things in life that are a lot more important than winning. Just ask one of the many retired NFL players with Parkinson’s or dementia.
In the conventional workplace we tend to fret about people with minor injuries, who may resist returning to work even though it is safe to do so. In professional sports, it’s usually the opposite: athletes will do almost anything to get back into the game, even jeapordize their future health. Just as we could use a little more of a “get me back in the game” attitude from reticent employees, we need to recognize that concussions require time to heal. Toughness is fine in its place, but let’s not be stupid about it. A game is just a game, a job is just a job. Neither is worth a single life.

Docs and Jocks: Exclusive Remedy for a Pro Football Player

Wednesday, April 13th, 2005

I set out this morning to blog the general status of “exclusive remedy” in the workers comp system, but I’ve been distracted by a specific case which involves an injury to a professional athlete. I will return to the more general ramifications of “exclusive remedy” in a few days.
Greg Lotysz was a lineman for the New York Jets. In July of 2000 he sustained an injury to the anterior ligament of his left knee while blocking another player during pre-season practice . Pursuant to his NFL Player contract and the players’s Collective Bargaining Agreement, he received care from the Jets’ Medical Department. Lotysz underwent surgery and post-surgery rehabilitation under the care of the Jets’ physicians. A post-surgical infection resulted in permanent damage to his knee, which in turn brought a premature end to his football career.
No Malpractice Here
Lotysz tried to sue the team doctors for $10 million in damages, but in December of 2002 an appeals court in New York ruled against him. The court found that the doctors were employees of the Jets, that their medical services were made available to plaintiff as a consequence of his employment and that their services were not available to members of the general public. In other words, the court viewed the team doctors as co-workers of the same employer, so tort liability was not available as a remedy. You cannot sue your employer and you cannot sue co-workers for work-related injuries. Comp was the “exclusive remedy” for the injured player. It’s interesting to note that the unions for all the major pro-sports leagues (NFL, NBA, NHL and MLB) filed a friends-of-the-court brief in Lotysz’s behalf, arguing that team doctors are actually independent contractors. (You can view a detailed case study of Lotysz’s story here.)
The fact that Lotysz’s claim falls under the workers compensation system is not all bad. While he cannot sue the doctors for malpractice, he is eligible for indemnity benefits (admittedly chump change compared to a professional lineman’s salary) and for lifetime medical benefits for any treatments related to the injury (given the apparent permanency of his disability, this could turn out to be a significant benefit).
It is important to note that hospitals and similar medical facilities that treat both the public and their own employees may not find the courts so receptive to the “exclusive remedy” approach. For the most part, when hospitals treat their own employees for work related injuries, they become a third party vendor. If employees are unhappy with the treatment, they usually have the option of pursuing tort remedies. The main difference, I would guess, is that the hospitals routinely treat the public, while the “team doctors” have a more limited practice.
Docs and Jocks
The Lotysz opinion is binding only in New York. It’s possible that under similar circumstances other states will conclude that team doctors are indeed third parties and thus liable to lawsuits for malpractice. In the world of professional athletics, the medical profession is intricately involved in what from time to time may be ambiguous circumstances. With such enormous sums of money at stake, owners may pressure doctors to rush star athletes back onto the field. Permanent damage may result. Under these circumstances the player will certainly want to pursue a tort remedy. Whether this option is available to the athlete remains a state by state situation.