- The Washington Times - Monday, November 11, 2002

Andrew Bishop almost quit his high-profile post as team physician for the Atlanta Falcons this summer after a decade on the job. Dr. Bishop held a position that thousands of doctors covet, but he wasn't happy, just frustrated, angry and confused.
What nearly drove Dr. Bishop out of the game wasn't the modern-day player, the working hours or his relationship with Falcons ownership. It was insurance.
Malpractice insurance is soaring in cost for every segment of medicine, particularly for physicians who treat professional and major college athletes. A nasty combination of rising salaries for pro athletes, a sharp rise in the number of successful malpractice lawsuits filed by current and former players, and an overall tightening of the insurance industry have sent premiums skyrocketing and some doctors out of the field.
Many physicians who treat pro athletes paid a relatively manageable $50,000 or less per year for malpractice insurance not long ago. They now find those rates soaring to $200,000 per year and beyond.
Doctors serving the sports world typically pay for the insurance out of their own pockets because they usually are not full-time employees of the teams they treat, and the retainers they receive for the work are almost always nominal. The cost of working in pro sports is often recovered in exposure, referral business to the doctor's private practice or personal fulfillment.
But the rising fees and fear of lawsuits have driven dozens of doctors away from pro sports, and those still in are looking for help anywhere they can find it. Some companies and groups, such as the Canadian Medical Protective Association (CMPA), have stopped offering malpractice coverage to doctors treating pro athletes. And for those doctors who can find coverage, the liability limits that usually top out at around $1 million per claim are virtually worthless against athletes earning many times that per year.
"There is a tremendous amount of financial pressure in this field. This is a very clear problem," Dr. Bishop said. He stayed only after the Falcons agreed to fund a supplemental insurance policy for him. "I truly believe that 99.5 percent of the physicians out there working in this area are using good judgment and providing excellent care, world-class care, really. But it is judgment. This is a field where there are very few absolute rights and wrongs. Every patient is different."
This collision of sports medicine and the United State's litigious nature was inevitable, and the sharp rise in insurance fees and stiffening of liability limits stand as only the most glaring fallout. At the heart of the conflict is a fundamental, age-old problem in treating athletes: balancing the short-term desire to return players to action with their long-term medical outlooks.
"It's the built-in problem. That conflict is really unlike any other doctor-patient relationship out there," said Bob Jarvis, a law professor with Nova Southeastern University in Florida who has written on malpractice in sports medicine. "It's taken a while for athletes to really start suing their [team] doctors, but it's definitely happening now, and the insurance industry is responding in kind."
Most recently the conflict came to a head in Pennsylvania, already an expensive state for a physician to practice sports medicine. On Oct. 31, a jury awarded former Philadelphia Flyers defenseman Dave Babych $1.37 million in lost earning and pain-and-suffering damages. Babych said that then-team physician Arthur Bartolozzi deviated from acceptable medical standards when clearing him to play in 1998 despite a broken left foot. Babych also tried to sue Comcast-Spectator, owner of the Flyers, under the same lawsuit, but the company was released as a defendant.
Other recent malpractice lawsuits generating seven-figure awards to players have involved the likes of former Chicago Bears running back Merrill Hoge and former Flyers forward Glen Seabrooke.
"It's often the second- and third-tier players that sue," Jarvis said. "A star player often has their own physician or the clout to dictate when they are and are not playing."
Prior to the Babych suit, Bartolozzi's insurance bills had already soared beyond $200,000 per year given his work with the both the Flyers and Philadelphia Eagles, and his working in one of the most plaintiff-friendly legal venues for malpractice suits. Then when he couldn't get the insurance at all, Bartolozzi stopped working for both teams.
Not only are lead team physicians dropping out of the business, but specialists such as neurosurgeons and cardiologists that work with pro teams on a more informal basis are, too.
"It's not just the head guys. Unfortunately, the specialists that are a key help to us are getting out, too," said Jon Browne, team physician for the Kansas City Chiefs and head of the NFL Physicians Society. "If you have to look over your shoulder every time you see a patient and worry about what kind of exposure you have, that's no way to practice medicine. There's a tremendous domino effect happening, and long-term, we're looking potentially at a real downgrade in the quality of medical care we provide, which nobody wants."
All the doctors interviewed for this article said they have never received direct pressure from a coach or team executive to clear a player to play before the player is medically ready. But nearly all acknowledged feeling some type of indirect pressure.
"These guys all want to play. And although we generally encourage second opinions, that also adds to the pressure," said Nicholas DiNubile, an orthopedic surgeon who works on a consultant basis for the Philadelphia 76ers.
Insurance companies say it is simple market forces and a higher exposure to risk that are fueling their price increases, not malice toward team physicians.
"This is not a knee-jerk reaction of any kind," said Barb Wilson, CMPA spokeswoman. "We've been working on [dropping coverage for team physicians] for a year. They've all known this was coming. Ideally, this will put the [insurance] expense back where it belongs: the employer."
Team physicians in recent years have tried several measures to lessen their exposure to malpractice claims, such as lobbying to be placed on regular team payrolls or having more teams provide supplemental insurance, like what the Falcons did for Dr. Bishop. With only a few such exceptions, the efforts have gone nowhere.
"No [owner] is going to want to employ us full-time because no one wants to share the liability to that degree," Dr. Bishop said.
Some physicians also cannot get supplemental insurance like Dr. Bishop because it is not offered in several states.
NHL Commissioner Gary Bettman said last week that the league was studying the insurance issue but declined to indicate any specific measures it might take to respond.
Despite the gloomy outlook, some physicians working in pro sports plan to stay for the long haul.
"I got a lot from hockey, and I'm trying to give something back and make the game a safer one," said Chip Burke, a Pittsburgh orthopedic surgeon and one of the most influential medical voices in hockey. Dr. Burke presides over the NHL Physicians Society, is the team physician for the Penguins, directs the league's concussion program and was a key figure in the NHL's moving this season back to more-forgiving glass surrounding its rinks.
"This isn't about money or referrals or anything like that. This, for me, is about something bigger."

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