Before he took to the court last Monday night, every piece of publicly available information suggested that Kevin Durant wasn’t ready to start a professional basketball game, let alone play in the NBA Finals, after suffering what his team, the Golden State Warriors, called a calf injury. For four weeks, Durant hadn’t been on a basketball court. Three days before Game 5 of the Finals against the Toronto Raptors, Durant went through a practice that reportedly “didn’t go well on any level.” These sound like the type of details that typically foreshadow a player being on the bench in street clothes, or at least being kept on a minutes restriction.
Neither of those things happened, and by now you know what followed as a result. You know that Durant started last Monday’s game, sat for only two minutes and 20 seconds of the first quarter, and then made it through two minutes and 11 seconds in the second quarter before rupturing his Achilles tendon while trying to get past Serge Ibaka. Next came Warriors general manager Bob Myers’s tears after the game, and the inevitable blame game rabbit hole that consumed the discourse surrounding the injury.
But in that search for a person to blame, a critical detail was glossed over—a chance to address the very real concerns that date back decades about how team doctors operate and where their loyalties lie. In Durant’s case, that means examining why so many reporters are still giving the Warriors the benefit of the doubt, and the benefit of parroting what the Warriors say in print, while ignoring the huge conflicts of interest that team doctors carry with them.
The ethics of what a doctor is supposed to do and the goals of a doctor employed by a sports team are inevitably in conflict at some point. This is mostly due to pressure coming from multiple sources, as attorney Scott Polsky lays out in a 1998 law review article, Winning Medicine: Professional Sports Team Doctors’ Conflict Of Interest. First is pressure from the business side of a team—which is what the franchise essentially is, a business. A team’s medical staff is part of a system that can influence wins and losses just as surely as coaches and executives are, and their success or failure in their role naturally influences the franchise’s bottom line. As University of Washington law professor Steve P. Calandrillo puts it in a 2005 publication on sports medicine conflicts:
The fact that physicians are employees of the team whose athletes they treat creates conflict of interest that are difficult, if not impossible, to satisfy ethically. When a team hires a medical provider, the purpose of that employment relationship is to further the interests of the sports franchise.
The second pressure Polsky notes comes from the patients themselves. These are athletes whose professional reputation and financial prospects will be greatly affected by whether or not they return to action, and there are powerful incentives for them to get back out there as soon as possible. The third problem for team-employed medical professionals boils down to being caught between the ethical choice of caring for the health of their player-patients while also maintaining their professional relationship with management, which can fire team doctors if they make too many rulings the team’s leadership doesn’t like. All this means that, at any given moment, a team doctor isn’t just keeping the best interest of the player in mind. They also must keep the best interests of the franchise in mind, and by association their own professional concerns.
These pressures can be difficult to handle, and create a complicated tangle of moral dilemmas for team doctors. Some of those doctors have reconsidered their professional approach and become advocates against problematic norms in the industry. Former Red Sox physician Dr. Arthur Pappas went another route.
In August of 1978, Boston Red Sox catcher Carlton Fisk crashed into the stands while chasing a pop foul late. When he evaluated Fisk after the game, Pappas told Fisk that the impact gave him a broken rib. That was the bad news, but the doctor had good news, too: Fisk would not have to worry about the injury affecting his availability for a team that was deep in a heated pennant race. This was because, according to Pappas, Fisk couldn’t “hurt [himself] anymore than what’s already been done.” Fisk took that medical advice and kept playing.
Years later, teammates would recall that time and say Fisk was a shell of his former self. Red Sox pitcher Bill Lee later told Sports Illustrated that he “looked into [Fisk’s] eyes. He looked like a raccoon. You could see he was playing in pain and it was just sapping his body. His eyes were sunk back in his head, with dark rings around them.” The damage went beyond the catcher’s appearance. Fisk’s injury and the pain from his damaged ribs forced him to adopt a new throwing technique that put more pressure on his elbow. This eventually led to an elbow injury that put him on the disabled list to start the 1979 season and caused his numbers to drop off across the board. Fisk and the Red Sox lost the AL East divisional tiebreaker to the Yankees, 5-4.
Fisk would later claim that Pappas never mentioned the potential risks of not seeking treatment on his damaged ribs, or what the decision might mean for him in the long term. Outside of sports, what Pappas did could be seen as medical malpractice, but because this was sports, things were seen a bit differently. From the team’s perspective, Pappas kept one of the greatest offensive catchers of the era on the field when his team needed him there. Pappas also had a much more literal stake in the team’s success than the average team doctor—an approximately 5 percent ownership stake in the team to be exact.
In an ideal world, what happened with Fisk and Pappas would be an isolated, cautionary tale of what happens when one doctor decided to toss ethics aside in pursuit of a short-term goal. But this is not that world, and as it happens 1978 wasn’t the last time that Pappas made dangerous medical decisions for what look like cynical reasons. In 1995, former Boston second baseman Marty Barrett sued the physician after Pappas not only allowed the player to return just five weeks after rupturing his ACL, but also failed to tell Barrett that he had removed much of what was left of the compromised ligament. It wasn’t until an arthroscopic surgery in 1989 that another doctor discovered that Barrett didn’t have a working ACL in his knee. The jury sided with Barrett, and ordered Pappas to pay the player $1.7 million, according to the Chicago Tribune.
(Pappas died in 2016, receiving positive obituaries in the Boston area media. And he had at least one defender, Red Sox great Carl Yastrzemski, who gave Pappas credit for keeping him healthy.)
Where Pappas is concerned, there’s a very specific cynicism in play that revolves around his investment in the team. But a team doctor doesn’t need a direct financial stake in the team to give players bad advice.
These cynical clearances aren’t always obvious, although the obvious ones make for harrowing examples. Take former Raider team internist Robert Huizenga, who recalled in his book, You’re Okay, It’s Just a Bruise: A Doctor’s Sideline Secrets About Pro Football’s Most Outrageous Team, that he had to have an “underground system of second opinions” so that players could get real medical advice on the various injuries they experienced. According to Huizenga, the system was finally busted when, after telling safety Mike Harden to get a second opinion on pain that team physician Robert Rosenfeld diagnosed as “OK—nothing to worry about,” the neurosurgeon to which Huizenga had referred Harden called Rosenfeld instead. X-rays of Harden’s spine showed that it was not, in fact, not OK, but a severe spinal defect that potentially required neurosurgery. Though Harden had suffered a quadriplegic episode on the field, Huizenga recalled that Rosenfeld was mostly irate that one of his staff members went behind his back.
(Rosenfeld died in 1994, before Huizenga’s book came out and before reporting in various outlets would outline what multiple players said about Rosenfeld. The Raiders, when contacted by Shelley Smith back in 1994 for a story in SI, wouldn’t comment.)
One of the more blatant examples of this sort of thing in the modern era happened when the Carolina Panthers decided to send quarterback Cam Newton back onto the field despite him showing some pretty clear signs of being hurt after taking a hit to the head. There’s no smoking gun, here, and no coach or executive telling Newton that he should tough it out, and the NFL ended up clearing the Panthers of violating any concussion protocol. But given that this was a star quarterback returning to a playoff came, it’s not like Carolina staff was physically restraining him as he sought to return to the field.
Sure, things have gotten better from the days when Bill Walton says he wasn’t told about the potential long-term damage he was doing to his foot while playing through pain, or when Dick Butkus’s recalls his knees getting constantly shot up with cortisone. Advances in medical science have helped, and every sports team having more watchful eyes on the game at all times certainly is a benefit.
But all those beneficial changes do not erase the conflict of interest that exists across all sports. This is true in MLB, where Marvin Miller’s campaign to unionize the fuck out of baseball led to one of the more player-friendly CBAs in sports. It’s also true in the notably more feudal NFL, where the final say on whether a player-patient has a concussion is taken out of the hands of a third-party medical professional. In every sports league, everywhere, you’ll find team doctors ignoring medical ethics, whether at the behest of a controlling team owner or out of some false sense of personal responsibility to make sure the team is in the best position to win. Even in the NBA.
Kevin Durant’s injury came under the care of Rick Celebrini, who has a doctorate in rehabilitation sciences and whom the Warriors added as the team’s director of sports medicine and performance this past summer amid much praise. The features on Celebrini when he joined the team were hymns to his history of finding the best medical path to help a player reach the next level. The Mercury News said he’d be able to prolong the career longevity of each star; CBS San Francisco hinted that he is, in a retrospectively ironic echo of Durant, the team’s real MVP. These glowing write ups could explain, at least in part, why the reporting and commentary on Durant’s injury seems so keen to accept the team as a reliable source of unbiased information. In this report from ESPN’s Rachel Nichols after Game 5, the medical advice attributed to Steve Kerr about Durant’s injury sounds eerily similar to what Pappas told Fisk nearly 40 years ago—“the doctors told us that he couldn’t get more hurt.”
Let’s leave aside the questionable idea that an injury could ever plateau in terms of its severity, although I suppose an injury can’t get any worse if it kills you. Let’s also leave aside the conflict of interest from Nichols’s source, for the time being. That this argument continues to be used in discussing Durant’s injury is jarring and strange. And yet, after Durant suffered one of the worst injuries a basketball player can experience, while playing an NBA Finals game on a leg that was known to be injured, and mere weeks away from going through the closest thing to a true free market a player with his services could experience, much of the commentary surrounding the team’s handling of the injury was bizarrely positive.
The NBA has done an excellent job building up goodwill and trust among fans, and it’s that willingness to take teams in good faith that let the Warriors get the benefit of the doubt in this scenario. Imagine how different the response would be if such an injury happened in a league that was more notoriously reckless with player safety. An NFL player doesn’t even need to be rushed back from an injury to draw the ire of fans and players alike toward a team during a player’s contract year. Just ask Earl Thomas III.
But that goodwill shouldn’t spare the NBA and its teams from scrutiny, especially after an incident like this. Just because one league is trying to screw former players out of settlements owed from years of doing nothing about concussions, doesn’t mean that other leagues’ medical clearances are golden. The same conflict of interests that exists for doctors in MLB and the NFL exist in the NBA, too.
This isn’t to say that doctors necessarily need to prevent players from stepping onto their field of play if they aren’t 100 percent healthy; the patients should have a say there, too. Nor is it saying that those defending the Warriors or the broader status quo are dismissing player safety out of hand. But it’s worth re-examining the starting point for all the discussion surrounding Durant’s injury, and especially the doctors who have been the main sources for those stories. It’s natural that reporters might see their work, in this case, as being about filling in the gaps of what the Warriors, Kerr, and Myers haven’t said. To do that, it would help to begin with some healthy skepticism, and a dose of context, about who is providing the information in the first place.
Clarification: This post has been updated to better reflect Rick Celebrini’s doctorate degree in rehabilitation sciences.