Bitter Medicine

The Seabrooke lawsuit in particular speaks to the central conundrum for any team doctor: To whom does he owe his allegiance? Is it the player, who is his patient? Or is it the team, which pays the doctor, makes the decision about whether to retain him as team physician and, more often than not, wants the injured player back on the field as quickly as possible? Last week this issue was raised anew when L. Fallasha Erwin, an agent for Washington Bullet forward Chris Webber, said that Webber would seek an independent medical opinion after he dislocated his left shoulder for the second time in a year. According to The Washington Post, Webber felt that the Bullet doctor, Steve Haas, had not taken seriously Webber's complaints of pain in his shoulder and had cleared him to play in an exhibition game. A few days later, in another exhibition game, Webber suffered the shoulder separation.

Team doctors face torturous ethical dilemmas. Are they supposed to be getting players ready to play, or are they supposed to be seeing to it that they heal completely? Should the doctors be more concerned with the immediate needs of the team or with the long-term health of players whose careers will be over while they are still young men? How does a doctor keep from feeling like a member of the team, which, as former Los Angeles Raider team internist Robert Huizenga says, "invariably has a subtle effect on a doctor's decision-making process"? What does a doctor do when a coach or an owner is pressuring a player to get back in the lineup—and the player says he's not ready? More to the point, what does a doctor do in this situation when he knows that the player is not ready?

Mr. SHAPIRO: Dr. Pappas, are you an owner of the Red Sox?

DR. PAPPAS: I am a limited partner of the Red Sox. I have an investment interest in the Red Sox.

Mr. SHAPIRO: So if the team does well, you do well?

DR. PAPPAS: I share in the gains—and in the losses.

No team doctor more starkly illustrates the potential conflicts inherent in the position than Pappas. The man is no charlatan. Rather he's a highly respected orthopedic surgeon, now 64 years old, and one of the handful of surgeons who offer independent second opinions to professional athletes. Pitcher Dennis Eckersley, for one, claims that Pappas's work on his arm helped prolong his career; former National League All-Star pitcher Bob Tewksbury goes so far as to say that Pappas saved his career.

The income that doctors receive from teams is relatively insignificant, but they derive enormous benefits, some more obvious than others, from their association with the clubs. In New England, for instance, Pappas, who declined to be interviewed for this story, has long been connected in the public mind to the Red Sox, giving him a kind of visibility that other orthopedic surgeons can only dream about. That Pappas's medical practice has profited from his association with the team seems undeniable. As one prominent sports agent puts it, "When the high school quarterback in Framingham hurls his knee, who do you think his father is going to turn to to do the operation?"

But Pappas, alone among team doctors, has always received another, more tangible benefit. In the late 1970s, Pappas obtained about a 5% stake in the Red Sox. Pappas has gotten something other than visibility and box seats from his interest in the Sox: He has gotten rich. Today Pappas's stake is probably worth around $10 million.

Several years ago Boston Globe columnist Dan Shaughnessy called the relationship between the Red Sox and Pappas "highly unusual and inappropriate." However much Pappas might pooh-pooh any suggestion that he has a conflict of interest—something he has done regularly over the years and continued to do even last week, just after the Barrett lawsuit was resolved—it seems clear that Pappas has a direct financial interest in the Red Sox that could, at least, call into question his medical judgment about Boston players. Barrett said on the stand that Red Sox players were intimidated by Pappas, in no small measure because he was part of management. Since the mid-1980s, a number of high-profile Boston players, including pitcher Roger Clemens and outfielder Mike Greenwell, have chosen to have major surgery performed by other doctors. Phil Plantier, the San Diego outfielder who played for the Red Sox in the early '90s, once complained to the Globe that "Pappas failed to explain that the ulnar nerve surgery he underwent...would take almost a year and a half to fully heal"—a complaint remarkably similar to Barrett's.