Book Excerpt: 'Health Liability Will Remake or Break Football'
Spiral of Denial: Muscle Doping in American Football
By Matt Chaney
Four Walls Publishing 2009
The excerpt series for Spiral of Denial culminates during holy Super Bowl week with summaries and conclusions of the book released one year ago
Book excerpt posted February 2, 2010
Safety Issues and Real-World Threats
By 2008, I was impressed American football continued to get away with butchery, even killing. Like me, many former players saw through the football mythology, understood The Spectacle, the power of denial for issues that impacted the health of athletes. Popular sentiment held football as essential for American life, right? Yeah, we older guys heard that. What amazed us in the Post-9/11 world was how America continued to pick up the medical expense for football, to pay for the harm done young players and former athletes in their retirement. There were millions of us. Didn’t America understand mere football profiteers—including the “nonprofit” NCAA and flush athletic departments—continued to pass enormous health-care costs to the public?
Clearly this country didn’t mind footing the bill for stadiums, arenas, and practice facilities, paying billions in construction and renovation along with ongoing maintenance and security. Over the 21st century, the sport-entertainment domain would cost Americans billions just in loan interest and debt service—for capital borrowed and spent within the first decade. What the public didn’t realize, apparently, was the fact we all paid for football’s ravenous consumption of the vital talent commodity, the bodies of players—and for as long as they lived.
Society paid the lion’s share for football casualties, short-term and long-term, in health-care costs and insurance premiums. Costs compounded annually with hundreds of thousands of fresh injuries, leaving many young people with qualified disablements. Medical insurance for colleges and high schools paid some immediate coverage, but school and athletic officials often shifted costs to the injured individuals and their families. Barring death or catastrophic injury, a player assumed full health-care costs once no longer listed on a school’s game roster, whether by choice, graduation, or other medical condition. Future medical coverage and payments related to football were the individual’s burden.
Every year, the nation’s school districts collectively racked up a fortune in injury costs, and college football churned out its enormous medical expenses, incurred at the thousand or so institutions hosting their blood sport. Even major colleges liked to dodge medical expenses. “In fact, the NCAA, which reaps billions from the efforts of ‘student-athletes,’ somehow maintains its status as a nonprofit organization (with all the accompanying tax loopholes),” Wayne M. Barrett wrote for USA Today Magazine. “Yet, the NCAA doesn’t adequately insure its athletes…"
The NFL was hardly better. Barring catastrophic maiming, retirees were responsible for their medical care until death, and many couldn’t afford adequate coverage, especially among generations predating 1977 in the league. The atrocious physical condition of NFL retirees was thoroughly documented, mass orthopedic injuries, and accumulating research focused on concerns such as concussions. The disability and pension issue of NFL retirees blew up in 2006 and would continue for years, apparently, with public sentiment growing against management and the union.
“The richest sports league in America can’t take care of its own,” observed Gwen Knapp, San Francisco Chronicle, citing the case of 1970s lineman Conrad Dobler, in his 50s and facing a myriad of challenges in health and finances along with his wife, a paralysis victim. The league wasn’t any help. “The way Dobler sees it, the NFL often dumps its medical problems on an unsuspecting public, either through social services or higher insurance costs for a player’s future employer,” Knapp wrote. Dobler said, “You see how they get the money for their stadiums. … They’re always saying, ‘Hey, let’s get the public for some more.’ ” Charlie Krueger, former 49ers lineman, said, “Part of the cost of playing football is physical damage. The NFL has been able to get away with monumental monetary advantages without paying for it.”
Surely the general public understood modern football was dangerous as ever. Every American saw vicious collisions of pro and college up close and repeatedly on video, supported by hard data of sizes, speeds, and casualties. Contact death had not occurred for decades in mass-marketed, entertainment football, the 32 NFL franchises and 70 or so big-name schools—each a valued brand name of American football—but disabling injury was common in the variety of shattered bones and ripped knees, tendons, and shoulders. The tragic cases included brain traumas and crippling paralysis, with the latter much less frequent but more publicized. “The health consequences of high-impact sports is not just an issue for old timers. Increasing numbers of present-day players are reckoning with the short- and long-term consequences of concussions and cranial trauma,” wrote Dave Zirin, cultural critic on sport, for The Nation. “This is partly because there is far more research and awareness about concussive injury. But the game is changing: Players today are bigger, stronger and faster then even ten years ago.”
The reality of football destruction and death had been quashed, minimized, disinfected to the extent it rolled by out of sight save for the relative few witnesses to genuine horror. Victims of serious injury and their families endured terrible tragedy of American football. If the game indeed taught positive values to untold young athletes, it should have, because the other side was much darker than commonly portrayed.
The game outright killed 1,006 players during the 77 years through 2007, for example, including at least one girl, and led to deaths of 683 more players, including of heatstroke and cardiac arrest, according to statistics of the National Center for Catastrophic Sports Injury Research, University of North Carolina-Chapel Hill. In addition, the center reported 278 catastrophic incidents classified as cervical-cord injuries, affecting the region of spinal column to brain. Many victims did not recover fully from damages in motor and neural function, and I could vouch for other types of paralysis the center didn't track. In middle age my right foot remained 90 percent “dropped” with paralysis of a nerve shredded at the knee in 1982, sustained playing college football. In the same season, the Catastrophic Injury Center logged 11 cases of cervical-cord injury.
Raw data, stark as it may be, was not the full story, though. To paraphrase the butcher Joseph Stalin, from his staff briefing on fine propaganda, the public viewed 5,000 deaths as a statistic but one victim’s personal story as tragic. Maybe that was why the media routinely reduced football deaths to the few lines of a brief report, and the game and fans demanded it that way.
When I was a newspaper sportswriter, I penned a column titled “A Player Dies Quietly in Football America,” recounting a college player’s collapse in Georgia. The local prep coach complained to my editor. He said I made it difficult to recruit kids to play, and he was correct. I liked the coach, even understood him to a point. He certainly took as much precaution for the heat as possible with his team, while also properly conditioning players for the trying task of competing. My point was the game could never be safe enough, regardless of anyone’s good intent, and that I was a messenger, not a recruiter. Elsewhere, I was agape in seeing researchers, doctors, claim the game could be made “safe” through rules enforcement or technology. Impossible!
Regarding football horror stories, the Stalin rule applied: More detail on victims altered the response. Even the cold, calculated annual report of the Catastrophic Injury Center could chill the blood with its additional notes on cases nationwide. The research encompassed all types of football, pro, college, prep, sandlot, and youth leagues, with financial grants and statistics contributed by the NCAA, the National Federation of State High School Associations, and the American Football Coaches Association. The 2007 report covered football involving about 1.8 million participants, including 1.5 million at junior and senior highs and 75,000 in college football.
In 2007 there were four direct deaths in football, nine indirect deaths, and eight injuries of the cervical cord. Less impersonal details were found in the report’s case descriptions, including the following on non-fatal injuries:
"A 17-year-old high school football player was injured… while being tackled in a game. The helmet of the tackler hit the ball carrier under the facemask and drove his head back. He had a fracture of CV-5 and had surgery… At the present time recovery is incomplete. A 16-year-old… had a collision with a teammate while rushing the passer. He is quadriplegic. A 17-year-old… was hit in the head by the knee of the ball carrier. He was [5-6] and weighed 140 lbs. Recovery is incomplete. A 16-year-old… was a ball carrier fighting for extra yards when he was hit by another tackler from the front. He had surgery and recovery is incomplete. He is presently in a rehabilitation center. … A 16-year-old high school football player was injured… Contact was head-to-head with the tackler. He collapsed after the game… The injury was subdural hematoma with surgery and incomplete recovery. A 17-year-old… was involved in a number of hits during the game and it was not possible to say which hit caused the injury… diagnosed as a bleed in the brain. The player had surgery and was in rehabilitation."
The football year’s four direct fatalities involved collisions, per the definition, and death was not immediate in three cases. Indirect deaths involved various circumstances attributed to football. Case reports by the Catastrophic Injury Center included the following:
"A 14-year-old middle school football player was injured while tackling… was diagnosed with a brain injury. After two weeks in a medically induced coma he died… An 18-year-old high school senior [6-5, 275]… was being tackled at the time of the injury. Contact was made by the helmet of the tackler. Injury was diagnosed as internal, with damage to the spleen and small intestine. The athlete died [a month after injury]. A 13-year-old… was injured while being tackled from behind with a blow to the head. The injury was diagnosed as an acute subdural hematoma. … The athlete died [a day later]. A 25-year-old World Indoor Football League football player was injured… a helmet-to-helmet tackle. He was [6-1] and weighed 180 lbs. … Injury was diagnosed as a brain injury and he was dead on arrival at the hospital. … A 17-year-old collapsed at practice… and died [a week later]. He was running laps at the time and cause of death was heart related. He did not have a physical exam before the season. A 16-year-old… received blunt trauma to the knee during practice… He died of a blood clot that broke loose to the lungs, [a] “pulmonary thrombi emboli.” A 17-year-old… collapsed at practice… and died at the hospital the same day. Cause of death was diagnosed as heatstroke. The player was [6-4] and 290 lbs., and the temperature was 100 degrees. … A 19-year-old college freshman football player collapsed and died during a team workout… He was [5-11] and weighed 210 lbs. He was working with weights at the time, and cause of death was heart related."
Beyond cases of direct and indirect fatalities, at least three more deaths were reported around football in 2007: a 14-year-old with a torn aorta; a 17-year-old who died in his sleep; and a teen player who died playing touch football following a team lifting session, caused by an aortic aneurysm, according to the Catastrophic Injury Center.
I saw several problems affecting the future business of football, including for the vaunted NFL, whose fans consumed anything, and I wasn’t alone. “The fact that the public may not care isn’t the issue and doesn’t change the facts and indications that the NFL is sitting on a powder keg,” observed Sal Marinello, BlogCritics.org columnist and former college football player.
Franchises and doctors had already been sued for abuse of pain-killing pills and shots, a well-publicized discussion for 40 years. In 2008, Patriots offensive tackle Nicholas Kaczur was charged with misdemeanor possession of oxycodone pills, part of a larger investigation, and Giants tackle Shane Olivea said he kicked a painkiller habit after intervention by loved ones. “Seeing my family [gathered] in my living room… seeing how hurt they were and the pain I had caused them was pretty humbling and gut wrenching,” Olivea told reporters. Hero quarterback Brett Favre was documented with a painkiller addiction back in the 1990s, and I thought it impossible for him to continue through the next decade without the stuff. “I don’t think anyone comes with ‘no baggage,’ ” Favre said in 2006. “And I’d be the first to say that I had my share of troubles and addictions…” The next season, Favre endured shoulder and elbow injuries in his throwing arm, saying he could “shoot up and still play.”
The plague of brain concussions was a certifiable legal nightmare for the NFL, given the union’s court defeat by the family of the late Mike Webster. The estate finally prevailed at the U.S. Court of Appeals, Fourth Circuit, a 3-0 decision in December 2006, and collected about $2 million in retroactive disability benefits, interest, and costs. There were more Mike Websters out there. Battered bodies were evident among retirees, garishly displayed at team reunions and other public gatherings, when young and middle-aged men hobbled and jerked about on replacement parts. A few guys motored by wheelchair. “It’s an orthopedic surgeon’s dream,” union official Miki Yaras-Davis said of such a sight in 1995. “[Retirees] all have the crab-like walk, and it’s hard to believe they were once these feared gladiators. Forty-year-old players are having the same problems as 80-year-old men.” In 2002, veteran Raiders lineman Trace Armstrong met many retirees as president of the players association, “and some of these guys don’t look so good,” he said. “Young men, onetime great athletes, but they don’t move around so well.” Armstrong, himself facing retirement, had 16 surgeries by his latter 30s.
The obesity issue of players loomed for the game as a whole. There were already lawsuits, notably for NFL heatstroke fatality Korey Stringer, the enormous Vikings tackle who succumbed in training camp. Research doctors and other medical experts collectively reviewed thousands of football specimens, teens to middle-aged men, and generally concluded risks were apparent, including for cardiac disease leading to complications like enlarged heart syndrome.
Heatstroke continued to kill in football, mainly kids, tragedy unabated despite the game’s horrific record of four deaths in a week during August 2001, including Stringer. Everyone then in football vowed to forever avoid this completely preventable condition, but the promise fell broken. In 2006 five players died of heatstroke, for example, ages 11-17. For cardiac death, meanwhile, researchers corroborated alarming rates of fatalities among athletes, all ages and types.
Grotesquely large physiques of modern football were widely associated with anabolic substances and danger, not surprisingly. Eyesight and common sense constituted enough consideration for the assumption. “Evolved Reality is this: It’s starting to feel like a significant segment of the NFL is on drugs,” observed Chuck Klosterman for ESPN The Magazine. A Chicago physician, Dr. Terry Simpson, saw evidence of malpractice in examining and treating former players of the NFL, damage left by cortisone and xylocaine injections of the past, and he expected disablement rates to increase because of muscle doping and sizes. “Steroids contribute to the overall injury patterns,” Simpson told The New York Daily News.
Active players acted oblivious to muscle drugs, befuddling outsiders as intended. Despite the evidence of a doping epidemic, players would outright deny it, and in turn the public wondered why so many would unite in a flimsy lie. Many retirees were prone to acknowledging a problem, but they didn’t say much. “The guys that we knew… were doing it, we would never say anything about them,” said Bruce Laird, former safety. “It’s just locker room stuff.” Self-acknowledged steroid user Bill Curry, who juiced decades ago as an NFL lineman, believed players and coaches were ashamed of drug abuse. “It’s hard to come clean on it if you did if for a long time. It’s easy to come clean in my little story [of brief use]. That’s like a Sunday School story,” Curry said, adding “no coach can look me in the eye and say, ‘Well, gee, I didn’t know [a player] was doing it.’ ” Curry noted monetary concerns hindered open talk. “Sadly, as in the case of most human experience, it’s going to take maybe a series of disasters that are obvious. … We don’t do anything until there’s a disaster, until everybody feels it. And when everybody feels it, then we’ll do something that’s very, very serious, but not until.”
Money was definitely the impetus for denial by many juicers past and present, along with the league and union administration, according to numerous insiders. Silence or denial was “a self-interest thing,” said former NFL linebacker David Meggyesy, who didn’t use steroids as a player but knew juicers as a union official. “Look, you go to apply for a medical claim or disability, and you can be denied this claim because you used steroids. You know how insurance companies are. For Christ’s sake, any reason you can provide them to not cover you…” In 2004, Giants center Shaun O’Hara echoed Meggyesy as he denied steroid use to inquiring media. “How can we ask someone to insure us if we’re doing something harmful to ourselves? The insurance companies would never do that,” O’Hara said.
Insurance carriers in the U.S. market struggled mightily in the 2000s, with liquid capital always subject to wipeout by global events such as terrorism, war, natural disaster, and collapsing economy. American football felt the heat too, long overdue, despite the nationalistic sport’s appeal to the insurance industry as sort of a loss leader. Football could still acquire coverage for medical and liability, but premium and deductible rates skyrocketed for sports overall during the decade of disaster, as they should have. American football was increasingly exposed and defeated in civil suits—or predisposed to settle—for its inherent hazards and casualties.
Coaches, trainers, and other personnel gambled on, despite knowing they stood legally vulnerable in potential injury situations involving athletes and even fans—especially at the prep and college levels. On the matter of concussions, for example, NFL commissioner Roger Goodell suggested football’s lower levels had more to worry about, and he was correct. For sheer numbers of football participants and lack of resources, fertile litigious conditions existed over unavoidable shortcomings at school districts and colleges, such as inadequate health screening and medical support, and insiders knew it. Kids understood it. Injury “waivers” for football, signed by parents and athletes, were mostly legal ploy anywhere in America. What taxpayers didn’t get, they paid too, especially in the event of an athlete’s death or catastrophic injury, which meant a huge deductible, as high as six figures, and more costs not covered by insurance.
The insurance industry closely monitored the issue of PEDs in American football and had since the 1980s, when carriers began dropping the sport for steroid abuse and injuries reported by media. In 2007, as Texas mandated worthless $6 million random testing for prep sports, one high school required parents of football players to sign a “Steroid Dangers Acknowledgment form.”
Moving forward in the young century, the institutions of insurance, health care, and education were all cash-strapped while the legal peril grew in litigious America. Already, insurers had dropped coverage on numerous hazardous activities at schools and colleges, from rope climbing in PE class to pyramid building by cheerleaders. Football had slid by thus far, likely since it was institutionalized in schools and culture, but this was a money issue, after all. Forces were converging beyond the game’s control, even the all-powerful NFL’s, and it was anyone’s mistake to presume football could roll forward in its present form.
Football reform lay dead ahead for absurd injury and illness—and financial costs—requiring the reversing of drug use and player sizes, particularly for colleges and high schools. The monetary costs alone would mandate change, if not real concern for young people, and the courts, insurance, and health care would carry it out, if football wouldn’t of its own volition. Approaching 2010 in America, with a scary, tough world coming down to roost atop our heads, deflating our formerly insulated cocoon of consumerism and pleasure, the sane choices to make about football began with the athletes, coaches, and officials.
Note: The author files many items beyond works cited for this conclusion passage of book
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Matt Chaney is a journalist, editor, teacher and publisher in Missouri. E-mail him at email@example.com. For more information about his 2009 book Spiral of Denial: Muscle Doping in American Football, visit the home page at www.fourwallspublishing.com.