Physical Limitations

Inside the musty confines of the Oxnard Channel Islands High football office, two doctors and their assistants examine players in assembly-line fashion. The athletes shuffle from station to station getting their height and weight and blood pressure checked before moving on to an exam room, where the doctors listen to their hearts and conduct cursory checks for other ailments.

Philip Burton, a wide receiver, takes off his shirt as he prepares to undergo the exam that will determine whether he can take the field for his senior season. Thin, with chiseled chest muscles, Burton appears healthy. And he figures that if anything is wrong, he’ll find out soon because the entire process takes only 10 to 15 minutes per player.

“I trust the doctors,� he said.

But what Burton and thousands of other Southern California high school football players who begin practice in the next few days may not realize is that a clean bill of health on a physical form doesn’t assure well-being on the field.

Five football players, ranging from high school to the NFL, have died in recent weeks after being cleared to play. As a result, physicals are under increasing scrutiny, especially at the high school level, where critics say exams are often hastily conducted and, in some cases, by personnel who lack proper training.

Channel Islands players are lucky. One of the doctors conducting their physicals is Luga Podesta, an orthopedic specialist who is a longtime consultant to the Dodgers’ medical staff.

Podesta is as thorough as he can be given the circumstances. Along with Craig Zeman, an orthopedic surgeon, he performs examinations on tables set up in a cramped equipment room, systematically moving along 87 antsy athletes and cheerleaders who would rather be doing practically anything else.

“Even what we do here, these are really just screenings,� Podesta said. “You can’t put enough time in with each kid to do a thorough physical.�

Podesta and Zeman detect heart murmurs in a couple of Channel Islands players who, instead of being cleared to compete, receive referrals to specialists.

But they wonder what happens to athletes at other schools who might not be so closely supervised. They know some kids will go to a health clinic or an urgent-care center--wherever they think it might be easier to receive a rubber stamp on their physical form.

“Kids will physician shop a little to get what they need,� Podesta said. “Our job is to protect them, not to limit what they want to do. We have to know what’s wrong and needs to be treated. Unfortunately, they don’t see it that way sometimes.�

Were he working from his office, Podesta said he would be able to perform more detailed checks on an athlete’s heart, lungs and abdomen--the basics--and talk at greater length with them about their personal and family histories. If he is the player’s personal physician, he will also have a patient’s file to pore over.

Also at his disposal in his office, where he estimates he performs only 2-3% of his physicals, is an X-ray machine and other tools of the trade that don’t come with him for off-site exams.

The bottom line, Podesta said, is that many young athletes don’t get proper pre-participation physicals.

Consider the case of Francisco Rodarte, who was twice cleared to play football for Santa Ana High--and twice prohibited from competition by his family physician.

Rodarte, who is 5 feet 9, weighed 450 pounds in the spring of 2000 but got approval to participate in football practice. It wasn’t until he nearly passed out after a series of wind sprints--�I was sucking wind. I was dizzy. I couldn’t speak,� he recalled--that Santa Ana Coach Jesse Gomez and the school trainer insisted he see his family doctor.

When he did, Rodarte was told his weight posed too great of a health risk, and he was barred from competition. “He was surprised that I survived [the previous] year, the way I was,� Rodarte said of his doctor.

Indeed, the physician’s decision came as no surprise. The same doctor had prohibited him from playing football before his sophomore year. “But I went to a clinic,� Rodarte said, “and they let me play.�

CRUCIAL INDICATORS

Who is allowed to give the physicals, and what they are encouraged to check for, vary from school to school. As a result, family and personal histories--crucial indicators of some potential health problems--are sometimes ignored. And, as was the case with Rodarte, even overt health concerns can be overlooked.

Pauline Altergott, whose sons Trevor and Brett play football for Anaheim Esperanza High, is concerned about the level of care her children would receive if they had their physicals conducted in a group at school. That’s why she insists they visit their pediatric physician.

“I feel more comfortable with the family physician,� Altergott said. “He gives a urine test and spends more time with them.�

Two years ago, a urinalysis--rarely, if ever, conducted in group physicals--detected an abnormally high white blood cell count in Trevor, a defensive end. Trevor’s doctor ordered him to cease workouts for a few weeks and return for a follow-up test, which showed that his cell count had returned to normal.

Pauline Altergott said she feels her children are protected when their physicals are complete.

“If I didn’t,� she said, “we wouldn’t leave the office.�

But even the most exhaustive exams don’t include sophisticated--and costly--tests necessary to detect heart abnormalities.

According to statistics compiled by the University of North Carolina’s Center for Catastrophic Sport Injury Research, of the 13 high school and junior high athletes who died in 2000, three died from injuries sustained during games or practices and two died from heatstroke. The others all died from undiagnosed heart ailments.

Even the best care and equipment can’t guarantee an athlete’s safety. But the heatstroke deaths might be preventable, experts say, if doctors know an athlete’s detailed personal history well enough to warn them that they are especially vulnerable to the heat.

Detecting heart ailments is perhaps most difficult. Hypertrophic cardiomyopathy, a thickening of the heart that afflicts one in 500, has killed without warning seemingly healthy players--among them Fountain Valley High’s Steven “Scotty� Lang, a robust 6-5, 250-pound offensive lineman who died at age 16 in November 1999 after collapsing on the practice field. The condition is treatable but difficult to pinpoint.

Prompted by what they view as inadequate physicals and their own personal tragedies, heart advocacy groups are calling for specialized tests such as echocardiograms to be included as a routine portion of athletic physicals. Most doctors agree that the additional measures could save lives. However, there also are concerns about the cost--tests can run up to $1,000 per player--and the likelihood that hypersensitive tests might result in doctors barring some healthy athletes from playing.

But tragedies don’t always result in immediate health care policy change. The physical form that Fountain Valley uses has not been modified in the wake of Lang’s death almost two years ago, Baron football Coach Eric Johnson said.

Fountain Valley heads into this season with two players who have been cleared to play despite their being diagnosed with heart conditions.

“I don’t like to mess with anything that has to do with the heart almost to the point where I’d not have them play football,� Johnson said, “but it’s not my choice if they’re cleared to play.�

STANDARDS ARE LACKING

From the national to the local level, many high school athletic associations recommend standardized physical forms. Few require them.

The National Federation of State High School Assns., the governing athletic body for all 50 states, suggests using a two-page physical form. Compliance is voluntary.

In California, the CIF requires athletes to undergo an annual physical exam and it recently mailed schools a suggested physical form developed in 1997 by several reputable health organizations. A handful of schools, such as those in the Riverside Unified School District, mandate use of the two-page form.

The Southern Section, which, as the governing body for about 600,000 athletes is the CIF’s largest branch, has no plans to mandate standardized physicals, assistant commissioner Rob Wigod said.

“If schools want to enhance what the state requires, they don’t have to wait for the Southern Section [to act],� said Wigod, who oversees the section’s 405 football programs.

By contrast, the Los Angeles City Section uses a standardized form for its 49 high schools and is in the process of adopting an even more extensive form recommended by the American Academy of Pediatrics that includes thorough family and personal histories.

Podesta used a standardized form developed by the Oxnard Union High School District for his examinations at Channel Islands. It included only a handful of personal history questions and no family history questions.

Podesta said he preferred the form proposed for adoption by the City Section, which he has used while examining players from other school districts who have come to see him at his private practice.

At the vast majority of schools, athletes are given the choice of having their personal physician grant them clearance to play or relying on their schools to arrange a group physical for a nominal fee.

But who is allowed to perform a physical is another variable. For example, some schools allow a chiropractor to clear a player for competition, which concerns Kevin Shannon, a pediatric cardiologist at UCLA.

“Chiropractors are less likely to have the training to do sports physicals [than other health-care physicians],� Shannon said.

Although physicians differ on the specifics of what should be included in a physical, most agree that certain basic requirements must be standard: a family history, a personal history and an examination that includes listening to the heart and checking for other potentially debilitating abnormalities.

“The big issue with physicals is that you want to be sure the athlete is going to be safe on the field and not suffer any major medical maladies,� said Ronald Navarro, team doctor for Wilmington Banning High and chief of orthopedic surgery at Kaiser Permanente in Harbor City. “The family history is one of the important parameters to key you to a further work-up.�

The level of care typically increases as athletes progress into the junior college, college and professional ranks.

At Grossmont College, two doctors--an orthopedic surgeon and a private-care doctor--see football players, according to Allen Richburg, the team doctor. At San Diego State, where Richburg is just one of several team doctors, players are not allowed to have their physicals completed by personnel outside the school.

The level of care is most complete at the pro level. San Diego Charger players, for example, are examined by four doctors--an orthopedic surgeon, an internist, an ophthalmologist and a dentist--and receive electrocardiograms to ensure normal functioning of their hearts. The process, which includes completion of a nine-page physical form, lasts about an hour, said James Collins, the Chargers’ head athletic trainer.

The Chargers’ staff reviews its procedures each year to see whether it wants to make revisions.

LIABILITY ISSUES

When a young athlete dies from a detectable illness, the finger-pointing usually starts with the doctor who cleared the athlete to play. But in many instances that doctor may not be legally liable.

“A doctor is not liable merely because a condition is undiscovered,� said Matt Mitten, a law professor and director of the National Sports Law Institute at Marquette University.

As long as tests that typically discover an illness are performed during the physical, a physician is largely protected from a malpractice suit. “If he conducted the exam and found some warning signs and didn’t follow them up . . . that would be different,� Mitten said.

Gilbert H. Mudge Jr., the doctor who cleared Boston Celtic star Reggie Lewis to play before Lewis died of an abnormal heart rhythm while shooting baskets in 1993, was cleared of any wrongdoing in court, though the matter is on appeal.

The law also normally protects schools and school districts, Mitten said, because of high court costs and the fear that litigation could result in reduced athletic participation.

Despite such legal protections, Mitten says those who oversee athletics should be proactive when it comes to the health and safety of players.

“I advise organizations that preventive law is the way to go,� Mitten said. “Let’s come up with some guidelines and standards that prevent these things from occurring.

“It has to be a collaborative effort between physicians and athletic administrators. It should be a forward-looking process rather than say, ‘Gee, there’s this death, what should have been done?’ �