By Stuart Ratzan
In the National Football League, the players are in supreme physical condition, but the system in place to treat player injuries is unhealthy. Team doctors, hired by and beholden to the teams, are in a position where it can be difficult to put their patients’ – the players’ – interests first. The players are the ones who suffer for this conflict of interest, sometimes with long-term health effects and sometimes through shortened playing careers.
Not only are team doctors under enormous pressure to keep players playing, the players themselves are under pressure to stay on the field, both from their teams and from their peers. The entire system promotes ignoring or downplaying injuries.
Doctors are hired by the teams. It’s an entrée to a life of fame and fortune, making it a highly coveted position, one most team doctors are not eager to risk losing. Since team doctors can feel obligated to the team more than the player who is their patient, the temptations for compromised medical care are great.
The Case of O.J. McDuffie
O.J. McDuffie was a star wide receiver for the Miami Dolphins. In the first half of the New England Patriots game on November 21, 1999, Mr. McDuffie was tackled near the goal line. The play caused a hyperextension of Mr. McDuffie’s left big toe. He felt a “pop” inside the toe joint. He came out of the game, was examined on the sideline, taped, and sent back in. On the ensuing play, he felt another “pop,” and came out of the game. Dr. John W. Uribe, head team doctor for the Miami Dolphins, took Mr. McDuffie into the locker room, injected the toe to numb the pain, re-taped the toe, and sent Mr. McDuffie back in the game without diagnosing the cause of the two “pops.” Mr. McDuffie played the remainder of the football game.
The next day, Mr. McDuffie underwent the first of two MRIs performed on his left foot. Dr. Uribe admitted that he reached a diagnosis of completely ruptured ligaments in Mr. McDuffie’s toe, based on his independent review of Mr. McDuffie’s MRI films taken immediately after the injury and repeated a little over two weeks later. Despite making this diagnosis, Dr. Uribe never told Mr. McDuffie of this diagnosis, nor did he tell anyone else on the Dolphins medical staff, including trainers and other physicians. When one of the other physicians questioned Dr. Uribe about a concerning area on the MRI picture suggestive of ligament rupture, Dr. Uribe instructed him that the findings were “not significant”.
Dr. Uribe never referred Mr. McDuffie to a foot and ankle specialist, despite the fact that Dr. Uribe has never done the type of surgery that was needed and despite the fact that foot and ankle specialists are experts in treating this exact type of injury.
Dr. Uribe encouraged Mr. McDuffie to continue to practice and play football. In fact, with regard to Mr. McDuffie’s MRI, Dr. Uribe told Mr. McDuffie that he would “heal without incident,” have a “complete recovery,” and that he should continue with “activities as tolerated.”
Dr. Uribe injected Mr. McDuffie’s toe so that he could continue to play in each of the remaining four games. Dr Uribe never ordered, and Mr. McDuffie never received, non-weight bearing, long term immobilization in a walking boot or a cast.
Mr. McDuffie never learned of the diagnosis of ligament ruptures until after the season was over. When Jimmie Johnson resigned as head coach on Jan 16, 2000, Dr. Uribe left his position and Dr. Dan Kannell took over as head team doctor.
On Jan. 18, 2000 Dr. Kannell ordered a referral of Mr. McDuffie to a foot and ankle specialist.
Feb. 2, 2000 the foot and ankle specialist examined Mr. McDuffie and reviewed his x-rays and MRIs. On that same day the foot and ankle specialist delivered the diagnosis of ruptured toe ligaments to Mr. McDuffie for the first time. Also on Feb. 2, 2000, the specialist recommended surgery.
After receiving a second opinion from another foot and ankle specialist who again made the diagnosis of ruptured ligaments and also recommended surgery, Mr. McDuffie underwent surgery to repair the ruptured ligaments in his toe on Feb. 16, 2000.
The ruptured ligaments comprised the main stabilizing force for the big toe joint in Mr. McDuffie’s left foot.
Mr. McDuffie practiced and played with the ruptured ligaments through the end of the 1999/2000 season. Irreversible joint surface damage occurred when the unstable joint was stressed by Mr. McDuffie’s football activities as well as his activities of daily life. Although the post-season surgery was able to repair the ligaments, it could not repair the irreversible damage to the joint surfaces. The surgery was too late.
The post-traumatic repetitive arthritis that had taken hold in Mr. McDuffie’s toe joint was irreversible and would progress to the point where it ended his career,
Non weight bearing, long-term immobilization in a walking boot or cast, and/or earlier surgery in November or December, 1999, before the joint surfaces were irreversibly damaged, would have prevented the arthritic destruction of the toe joint. Long-term immobilization in a walking boot or cast and/or surgery were and are the standard of care for treating a Grade 3, complete rupture of the toe ligaments, the injury Mr. McDuffie sustained in this case. This was corroborated by the relevant, authoritative textbook chapter from that time frame.
OJ McDuffie played sparingly in 11 games in the 2000/2001 season, with only 14 catches, and was placed on injured reserve the following season. He was officially released from the Dolphins in February 2002.
Mr. McDuffie sued Dr. Uribe for negligence and malpractice in 2002. On May 6, 2010, the jury found negligence on the part of Defendant John W. Uribe, M.D. which was a legal cause of loss, injury or damage to Otis J. McDuffie. The jury awarded damages for lost earnings or loss of earnings capacity for 2001-2004 in the amount of $10 million. The jury also awarded compensation for physical impairment, disfigurement, mental anguish, disability, inconvenience, loss of capacity for enjoyment of life or pain and suffering in the amounts of $750,000 for the past and $750,000 for the future. The total damages were $11.5 million.
Implications for the NFL
In his testimony during the trial, NFL Hall of Fame player Dan Marino said, “You’re supposed to play hurt, but you’re not supposed to play injured. We rely on team doctors to tell us the difference.” In too many cases, such as the case of O.J. McDuffie, that trust in team doctors is misplaced. One of the key implications of this case for the future treatment of NFL players is that the player would be well served to get a second opinion, from a specialist, on significant injuries.
This case may also have an impact in future potential litigation. Following Mr. McDuffie’s example, players may be more willing to hold team doctors accountable. This in turn may put more pressure on the current system, where team doctors are beholden to the team, and may not be able to stand up to the pressure to keep players on the field, even when that is not what’s best for the patient.
O.J. McDuffie v. John W. Uribe, M.D., Circuit Court for the Eleventh Judicial Circuit in and for Miami-Dade County, Florida, Case Number 02-14638 CA 8. Attorneys of record for plaintiff: Stuart Ratzan, Ratzan & Rubio, P.A., Miami, Fla.; Herman Russomanno, Robert Borrello, Russomanno & Borrello, P.A., Miami, Fla. For defendant: Charles Hartz, George, Hartz & Lundeen, P.A., Miami, Fla.
Stuart Ratzan, managing shareholder of Ratzan & Rubio in Miami, Fla., has successfully tried and resolved many of Florida’s most significant catastrophic injury and wrongful death cases. He can be reached at stuart@ratzanrubio.com.
