League of Denial Page 15
Still, it was a devastating defeat for the Bears and, by extension, the NFL. It put the teams, its doctors, and the league on notice. Fogel suddenly found himself getting calls from lawyers around the country. They represented not only football players but athletes from other sports as well. The NFL’s mushrooming crisis now had legal implications.
The league, of course, was aware of the lawsuit. An indication of its concern came late in the case, when Munsell’s lawyers produced a new witness. According to a letter filed with the court, this witness, in contrast to the leading concussion experts in the country, would testify that “at all times Dr. Munsell acted within the standard of care” for the National Football League. At all times—the letter emphasized that point repeatedly. Munsell’s treatment met the standard of care for the NFL from the moment Merril Hoge heard the ocean in Kansas City. His treatment met the standard of care for the NFL when Hoge was allowed to take the field a week later without Munsell or any other doctor examining him. Munsell’s treatment met the standard of care for the NFL right up to the moment five weeks later when Hoge bent down to make a block and his world went black, ending his career.
It turned out that Munsell’s lawyers produced this expert witness too late, and so he was not allowed to appear in court in support of the Bears’ team doctor. But Fogel always wondered how the witness suddenly materialized. “I just got the sense, you know, some of this went to another level.”
The witness’s name was Elliot Pellman. He was the head of the NFL’s Mild Traumatic Brain Injury Committee.
PART TWO
DENIAL
7
GALEN OF PERGAMON
Even though they were on opposite sides of Merril Hoge’s lawsuit, Mark Lovell and Elliot Pellman knew each other well. One day back in 1994, Pellman had called Lovell in Pittsburgh, identifying himself as the chairman of the NFL’s Mild Traumatic Brain Injury Committee. Pellman explained that the new entity had been created by Commissioner Paul Tagliabue to study concussions. He told Lovell he was familiar with his new concussion test—of course he would have been, since that test had been used to end Hoge’s career—and invited him to participate in the committee’s first meeting in February 1995 at the NFL Combine in Indianapolis.
As skeptical as Tagliabue was about the NFL’s concussion problem (“a pack journalism issue”), the MTBI committee was a logical response to a mushrooming public relations crisis. The retirements of Toon and Hoge, Troy Aikman’s erased memory after the 1993 NFC Championship Game, and the spate of head injuries league-wide had left fans with a growing impression that the entire sport was concussed. The Mild Traumatic Brain Injury Committee—some researchers said the name itself suggested the NFL’s benign view of the problem—promised to take a scientific approach to concussions and come up with a series of measures to make the game safer than ever.
Lovell traveled to his first meeting of the MTBI committee with the trepidation befitting a novice entering the seat of power. He had started baselining the Steelers just two years earlier and was still unfamiliar with the world of pro sports. His innate shyness didn’t help. Accompanied by the Steelers’ doctor, Tony Yates, Lovell put on his best suit for the occasion. “What are you trying to do, embarrass me?” said Yates. When they walked into the hotel conference room where the first meeting was held, the dozen men who greeted Lovell were a picture of casualness in both manner and dress; some wore sweat suits emblazoned with their team’s logo, as if they had just come off the sidelines. “I’m the only guy wearing a suit,” Lovell recalled of the moment. “I feel like a jerk.” Most of the men seemed to know one another, but Lovell didn’t recognize any of them, nor did they seem to have any clue who he was. He suspected that they probably had no idea what a neuropsychologist was, much less how one might treat a concussion.
Lovell, of course, was involved in some of the most cutting-edge research in the emerging science of head trauma—he was one of Steinberg’s people who believed the world was round. With the NFL’s power and resources, he imagined he would be joining a veritable dream team of concussion experts to attack the problem. In fact, there were very few. The contemporary researchers whose studies were reshaping the entire conception of what a concussion was—men such as Jeff Barth, Julian Bailes, Joe Maroon, and Barry Jordan—were nowhere to be found. Instead, Tagliabue’s concussion committee was made up almost entirely of NFL insiders. Nearly half the members were team doctors, the same men who had been sending players back on the field for years. There were two trainers, a consulting engineer, and an equipment manager. The committee did have one neurologist, Ira Casson, who had studied boxers and had made the fateful recommendation to Al Toon that he retire, and a neurosurgeon, Hank Feuer (pronounced FOY-er), who had done an internship at Indiana Medical School at the same time Maroon was there and worked for the Colts. Reflecting years later on his status as the committee’s lone neurosurgeon, Feuer, measuring his words, said: “That was always, to me, ah, I just thought it’s an interesting committee. The best way I could put it.” The MTBI committee’s epidemiologist—the man charged with analyzing much of the committee’s research—was John Powell, the number cruncher behind the NFL’s claim that concussions had held steady at one every three or four games.
The most perplexing choice was Tagliabue’s handpicked chairman: Pellman. With the endorsement of the powerful commissioner, Pellman had instantly become one of the most influential concussion researchers in the country, yet he had not produced a single piece of scientific literature on the subject. This almost certainly was due in part to his medical specialty, rheumatology, which deals primarily with bone and joint disorders such as arthritis. Pellman was genial and stout, a balding man, then 41, routinely described by colleagues as “a good administrator.” Through his contacts with the NFL, Pellman came to work as a top medical adviser with other leagues, including the NHL and Major League Baseball. One executive who worked closely with Pellman described him as a kind of medical “concierge” whose primary responsibilities were to administer flu shots and recommend specialists. “If an individual employee has a bad back, Elliot is great in New York about getting you in to see the best back guy,” the executive said. He described Pellman as “honestly, a nice man” and suggested he was kept around because of his pleasantness.
The most complete professional biography of Pellman would be assembled years later by the New York Times after the newspaper discovered in 2005 that he had exaggerated his credentials in a biography he sent to the House Committee on Government Reform. This came as Pellman testified before the committee, offering effusive praise of baseball’s steroids policy, the same policy that had done nothing to prevent Barry Bonds from shattering the career home run record. Pellman had claimed in his biography, which he circulated widely, that he obtained his medical degree from the State University of New York at Stony Brook. In reality, Pellman had attended medical school in Guadalajara, Mexico, and received his medical degree from the New York State Department of Education. Pellman also reported that he was an associate clinical professor at the Albert Einstein College of Medicine, when, in fact, he was an assistant clinical professor, an honorary position held by thousands of doctors, and didn’t teach at the school. He told the Times the errors were minor. “In a way, I thank you,” he said, “because those discrepancies are not important enough to be there, and they have all been fixed.” Pellman explained he had enrolled at the Universidad Autónoma de Guadalajara, which had lower admissions standards, because he received poor grades as an undergraduate biology major at NYU. He attributed his poor academic record to his complicated life at the time, including his father’s death and a busy schedule working in his family’s flower shop in the Bronx and as a cab driver. Pellman blamed the errors on his secretary and the New York Jets, where he had worked as team doctor since 1988. “So SUNY said he didn’t get an MD from there?” Jets vice president Ron Colangelo told the Times. “Oh my goodness, oh my goodness gracious.”
When Pellman first came to
the NFL, he was practicing rheumatology at Long Island Jewish Medical Center. As the Jets’ doctor, he had treated Al Toon after the concussion that ended Toon’s career. When Pellman went to look for a neuropsychologist to test Toon’s brain function, he approached a colleague, Bill Barr. “I don’t know who any neuropsychologists are; I’ve never worked with one,” Pellman said, according to Barr, who recounted the conversation to ESPN’s Peter Keating. “But somebody said Al Toon should see a neuropsychologist, so I asked around and I’m calling you.” As the NFL slowly began to adopt neuropsychological testing to diagnose concussions, Pellman brought on Barr to work with the Jets. Occasionally, the two men—along with Casson, another colleague at Long Island Jewish—would appear at coaching clinics to talk about concussions. Barr was struck by how ignorant Pellman seemed of all previous research. By then, Barth, Lovell, and others had been publishing for years. “During these lectures, Pellman’s saying things like, ‘Nothing has ever been done on concussions or mild brain injury and we’re starting from scratch,’ ” Barr, who had moved on to New York University, said in an interview for this book. “I had been trained in evaluating MTBI, and I knew the literature. But he acted like nothing had ever been published on this before 1995.”
Elliot Pellman’s views on concussions were perfectly aligned with the NFL doctrine at the time, as articulated by Tagliabue and the NFL’s PR machine. When he spoke publicly, he seemed to suggest that they were a routine part of the game and not a major concern. In 1994, the year the MTBI committee was formed, he told Sports Illustrated that “concussions are part of the profession, an occupational risk.” A football player, he told the magazine, is “like a steelworker who goes up 100 stories, or a soldier.” In 1999, by siding with Munsell, the Bears’ doctor in the Hoge case, Pellman—himself an NFL doctor and by then the head of scientific research for the league—had endorsed a treatment model that most leading concussion researchers would have equated with bloodletting and the application of leeches: allowing a severely concussed athlete who had no idea where he was to return to play without even a cursory exam. The same year, Pellman repeated the statistics the league had now floated for a decade—just one concussion every three games—and suggested that injuries to high-profile players such as Toon, Hoge, Aikman, and Steve Young had created a “mirage” that led people to “think the injuries have increased though they’ve really been there all the time.”
Pellman seemed to practice what he preached. Former players described how, as the Jets’ doctor, he often allowed concussed athletes back on the field. During a 1999 playoff game against the Jacksonville Jaguars, tight end Kyle Brady reached back for a pass from Vinny Testaverde and was knocked unconscious by a helmet-to-helmet hit. Dazed and nauseous, Brady was helped to the sideline, where Pellman and the medical staff examined him. Suddenly, out of the fog, Brady heard the booming voice of Jets head coach Bill Parcells: “Is he gonna be all right? When’s he gonna get back in there?”
“You know, in a classic Parcells kind of way,” recalled Brady, chuckling as he described the memory to ESPN’s John Barr. “I’m not sure if it was a question. It might have been a command.” Brady returned for the next offensive series, still woozy, his teammates telling him where to go. Asked if there was any basis for clearing him, Brady replied: “No. None.” But he said he was just as eager as Parcells to see himself back on the field. “At that point, you’re kind of like a slobbering dog,” Brady said.
Kevin Mawae, who played center for the Jets for eight seasons, said he liked Pellman immensely, respected him “as a man,” and even trusted him as his family physician. But he said it was clear in the Jets’ locker room that Pellman served multiple masters. Pellman had cofounded a Long Island health care network, ProHEALTH Care Associates, which worked with multiple New York sports teams, including the Jets. The building was filled with memorabilia. “There’s definitely some influential weight that goes with being a team doctor, and there’s a conflict of interest because they work for the team,” said Mawae. As more information about Pellman surfaced—his résumé embellishment, the overlapping relationship between the Jets and his private practice, his brain research for the NFL despite his total lack of qualifications—Mawae began to hear “jokes in the locker room about Pellman’s status with the NFL and things like that.”
One running joke involved a three-word code—“Red Brick Broadway”—that Pellman had players recite to determine if they were able to play after a concussion. According to Mawae, “The three words were always the same. He would leave you and come back before the next series, and you’d go, ‘Red Brick Broadway. I’m ready to go.’ ” In 2003, Pellman would face pointed questions about his treatment of a wide receiver, Wayne Chrebet, who was allowed to reenter a close game against the Giants after being knocked out for several minutes. “This is very important for your career,” Pellman reportedly said before sending him back in. Chrebet was never the same and retired in 2005.
But players such as Mawae and Brady said such incidents were common. On one occasion, Mawae said, he suffered the same injury as Chrebet: He took a knee to the head and blacked out. “Next thing I know I’m laying prostrate on the ground,” he said. “The first realization was, ‘Wow I just got knocked out.’ ” After performing a “systems check,” Pellman and the Jets’ medical staff allowed Mawae to return for the next series, but “my teammates were telling me that I was making calls that weren’t even in our playbook.”
Reflecting on Pellman’s selection as the NFL’s top medical adviser and leading expert on concussions, Mawae said: “If you’re gonna get a doctor that’s a yes man, then it makes it easy for you.” He regarded Pellman as a pawn. “Pellman’s just a small part in this,” Mawae said. “The bigger part is it’s a multibillion-dollar industry that cannot afford something such as this.”
In North Carolina, Kevin Guskiewicz was beginning to perform his own concussion studies, each with results more ominous than the one that preceded it. He watched the development of the NFL’s new concussion committee with incredulity and amazement. Guskiewicz, of course, loved football—the Steelers, after all, had paid his way through grad school while he worked as an assistant trainer—but he felt that the NFL’s new committee had willfully excluded the most respected researchers, especially those whose research indicated the potential for long-term problems. “Quite frankly it was comical the way in which that original committee was pulled together; comical is probably the nicest way I could describe it,” he said. “It seemed like they were cherry-picking anyone who seemed to be dabbling in this topic who was local in the New York area.” Guskiewicz found the choice of Pellman (“a rheumatologist!”) “bizarre.” He wondered: “Who looked at the résumés of these individuals?”
“I’m trying to think of an analogy here: like in an airport when there’s a major breach of security,” said Guskiewicz. He thought the NFL’s approach to the concussion problem was essentially: “Let’s pick these folks, that will be the solution, ignore the problem, and it will all go away.”
Lovell was part of the committee, but he too wondered how Pellman, with his limited neurological background, could possibly have landed the job. Pellman offered one explanation when he later wrote about the MTBI committee’s formation: “On the basis of my experience with Mr. Toon, I was invited to the Commissioner’s office to offer my limited insight into this problem. The Commissioner and I realized that we had more questions than answers. Was this a new problem or just an often misdiagnosed or unrecognized one? Was the premature retirement of these men a statistical anomaly or the beginning of an epidemic? I was asked to mount an effort to answer these questions.”
Multiple sources, however, said Pellman had been Tagliabue’s personal physician and they believed that was at least part of the reason he was named chairman.
“That’s my understanding,” said Lovell, a member of the committee from its inception.
In a statement to ESPN, Tagliabue acknowledged he was treated by Pellman but said that t
he first time he saw him as a patient was October 1997—three years after the formation of the MTBI committee. “No personal medical care had anything to do with Dr. Pellman’s appointment to the committee in 1994,” Tagliabue wrote, adding that Pellman got the job “based on his experience in sports medicine, his work with the Jets that included Al Toon’s concussion-related retirement … and recommendations from Jets ownership and management.”
The committee didn’t publish its first research until October 2003—six years after Tagliabue became one of Pellman’s patients. Pellman would continue as one of the commissioner’s personal doctors until 2006.
Pellman, as promised, started from scratch. The MTBI committee began its work by spending months establishing an official NFL definition of a concussion. The lack of a consensus definition “has plagued the study of mild head injury in general and concussive injuries in athletes in particular,” the committee wrote in an internal status report circulated in 1996. The new league definition was broad: “any traumatically induced alteration of brain function.” That included a long list of symptoms: blackouts, wooziness, amnesia, headaches, vertigo, memory loss, personality change, lethargy, and so on. All constituted an NFL concussion, “or, as we quickly decided, the more academically appropriate term, mild traumatic brain injury,” Pellman wrote.
The committee used that definition as the starting point for an epidemiological study it called the NFL Mild Brain Injury Surveillance Study, a system to monitor concussions across the league. The MTBI committee distributed forms to medical personnel from all 30 teams with instructions to keep up-to-date records every week. “A major obstacle to head injury research is the unavailability of willing test subjects,” said one memo prepared by a bioengineering firm contracted to participate in the study. “The NFL has graciously sponsored a research program offering its players as those living subjects.”