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What Still Ails Penn State
David Epstein
May 20, 2013
AT A TIME WHEN FOOTBALL SAFETY HAS NEVER BEEN MORE SCRUTINIZED, CHANGES IN THE UNIVERSITY'S ONCE-EXEMPLARY MEDICAL CARE BELIE PROMISES TO REIN IN THE ATHLETIC DEPARTMENT AND OPERATE TRANSPARENTLY
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May 20, 2013

What Still Ails Penn State

AT A TIME WHEN FOOTBALL SAFETY HAS NEVER BEEN MORE SCRUTINIZED, CHANGES IN THE UNIVERSITY'S ONCE-EXEMPLARY MEDICAL CARE BELIE PROMISES TO REIN IN THE ATHLETIC DEPARTMENT AND OPERATE TRANSPARENTLY

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One recently graduated player told SI that injuries were commonplace at Penn State practice. He wondered: What will happen in the future when there's a serious injury—an open fracture, for example—and no surgeon nearby? Because Lynch doesn't have operating privileges in State College, the answer is that either the player will have to be transported to Hershey, or, if an operation is required urgently, a surgeon in State College who does not see the team regularly will handle it.

According to trustee sources, Joyner's rationale for the change was cost savings. With decreased donations to athletics following the Sandusky scandal, a decline in football club-seat and suite renewals, and increased operating expenses, an athletic department that has perennially been one of the few in the country that is self-sustaining is approaching the red. During 2010--11 the athletic department reported a surplus of $14.8 million dollars. For '11--12, that plummeted to $863,000. "It's less good care," says Pellegrini, "in exchange for saving a few bucks."

Even before the removal of Sebastianelli, health care for the football team underwent a decided shift starting last season. "The change has been overnight," says one Penn State sports medicine professional, "from a physician-driven model with the athletic trainer there to assist, to an athletic-trainer-driven model."

In February 2012, before the start of his first season and while Sebastianelli was still the team's orthopedic surgeon, Joyner announced the hiring of Penn State alum Tim Bream as athletic trainer—and head of athletic training for the university—replacing George Salvaterra, who had been in the position since 1985.

Bream told The Patriot News that Joyner initiated the process—the two were on the U.S. team's medical staff at the '92 Olympics. Bream came to Penn State after 15 years with the Chicago Bears. Penn State players who spoke with SI expressed reverence for Bream's NFL experience. Multiple staff members also told SI that Bream goes beyond what is typical to provide athletic training instruction to undergraduate kinesiology students and graduate assistants.

But according to current and former Penn State staff members and players, Bream has engaged in practices his predecessor did not. Three sources involved in health care for Penn State athletics who spoke with SI on the condition of anonymity say they saw Bream—who does not have a medical degree—giving players the anti-inflammatory drug Voltaren without a prescription or a physician's approval. Two of those three also say Bream gave a player the prescription drug Bentyl for diarrhea, when the drug is actually meant to treat irritable bowel syndrome. Those sources as well as team sources told SI that they saw Bream engaging in other procedures requiring special certification or a medical license. These include using an X-ray machine, administering an inhaler to a player who does not have asthma and lancing a boil on a player's neck. (A Penn State spokesman told SI that Bream would not be available for comment and declined to clarify whether Bream had X-ray certification.)

The university asked attorney Michael Mustokoff to investigate a number of these allegations involving Bream, including that he dispensed prescription drugs and operated an X-ray machine. Mustokoff's bio page on the website of his law firm, Duane Morris LLP, notes that he has been a lead attorney "in a number of highly publicized cases" and is "currently representing Penn State University in criminal proceedings arising from the criminal prosecution of Gerald Sandusky and others." Mustokoff's conclusion regarding Bream was relayed to trustees at a private meeting in March. "We were told that [the dispensing of drugs] did happen, but that they were misunderstandings," says a source who was present at the meeting. "We were told he thought he had a doctor's approval." (Mustokoff did not respond to a voice mail from SI.)

In a statement e-mailed to SI, Joyner said, "The legal team's report concluded there was no credible or substantial evidence to support the allegations or rumors, and there was no wrongdoing or violation of any professional standards. The report also concluded that none of the physicians who supervise the head trainer had made or documented any contemporaneous complaints to anyone or discussed with the trainer any concerns about overstepping bounds of care."

The practice of NCAA athletic trainers' dispensing prescription drugs is not uncommon: A 2003 study in the Journal of Athletic Training found that 55.9% of trainers do it. Nevertheless, it is contrary to NCAA and National Athletic Trainers' Association guidelines, and to state and federal laws.

Salvaterra says that he used to assist a physician in lancing boils, but that he would never do the minor surgical procedure on his own, "because a boil is a staph infection, and it could turn into MRSA"—a strain of staph that resists common antibiotics and can be fatal. According to Pennsylvania law, athletic trainers should not conduct invasive procedures. Some medical staff members have taken to calling Bream "Dr. Tim" behind his back.

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