Antonio Brown's Outburst And Troublesome Return-To-Play Culture

On Sunday, Tampa Bay Buccaneers wide receiver Antonio Brown made an abrupt exit from a game against the New York Jets. Brown removed his jersey and football gear before running off the sidelines in the middle of the game and leaving MetLife Stadium entirely.

Reports that followed the incident indicate Brown may have had a legitimate reason to not reenter the game: he was injured. “What he told the staff, from what I understand, is that he was not going into the game because, in his mind, he did not feel he was healthy,” NFL Network’s Ian Rapoport said on Monday. “The response then from the offensive coaches and from Bruce Arians was, ‘If you are not gonna go into the game when we tell you to go into the game, then you cannot be here.’ At that point, they threw him off the sidelines and then cut him from the team.”

However, Bucs head coach Bruce Arians shared a different version of the story. “I don't know that he was (injured),” Arians said Monday. “It was pretty obvious what happened. He left the field and that was it. We had a conversation and he left the field.” Without revealing what words were exchanged during said conversation, Arians claimed that Brown refused to return to the game when he was asked to play in the second half so he cut him from the team.

While Brown has made headlines in the past for various reasons, this time his actions may actually draw more attention to a long-standing practice in the NFL: the return to play culture.

Former Seattle Seahawks team physician, Pierce Scranton, opined that as a result of pressure from team management, “[t]he conventional doctor-patient relationship is nonexistent [in sports medicine], and the trust naturally fostered by such a relationship is consciously undermined by the organization.” As another former team physician stated, “There is no loyalty except to winning. In the NFL, owners and coaches can treat employees in ways that would immediately provoke a successful lawsuit in any other business.”

Since its inception, the NFL and its member clubs that comprise the league have realized that keeping their best players on the field increases the odds of winning a championship and ensures strong attendance at games and the best possible TV ratings. Just last year, the NFL signed long-term agreements with media partners Amazon, CBS, ESPN/ABC, FOX and NBC to distribute NFL games across television and digital platforms. Its new media rights deal, which runs through the 2033 season, will give the NFL total earnings of a whopping $113 billion. As a result of the significant profits flowing from television deals, the NFL has created a return to play culture that prioritizes profit over players’ health and safety.

The NFL has used their inherent authority to compel all NFL players and participants to follow the policies, rules, and regulations the NFL has enacted and imposed. The NFL-NFLPA Collective Bargaining Agreement (“CBA”) contains a number of provisions that directly depict the authority of the NFL as it relates to players’ health and safety. They are mainly found in Article 39, which concerns the dynamic of health care professionals paid by teams to treat players. Interestingly, Article 39 dictates that the “primary duty” of an NFL team physician in providing medical care is “not to the club but instead to the player-patient.” In addition, teams must use their “best efforts” to ensure that players are “provided with medical care consistent with professional standards for the industry.”

Pursuing the best interests of the patient is the central hallmark of health care and it is reflected in laws, regulations and professional licensing requirements like the Hippocratic oath, which obligates doctors to provide ethical care to their patients and not harm those patients. However, in the context of sports, the best interests of the coaches and owners of the team often take priority over the player-patient. Per the CBA, the Head Team Physician has the exclusive and final authority to determine whether a player is cleared to return to participation in football activities. But when a health care professional is employed by an NFL team, they are constantly threatened by the possibility of losing their job if they deviate from the requests of coaches or owners. All too often, this prompts team doctors to misrepresent the severity of injuries or conceal life-or-death medical information all to obey team management’s demands to get the player back on the field as quickly as possible.

For instance, leading up to Sunday’s game, Brown did not practice on Thursday and Friday due to an ankle injury. He was also listed as questionable for Sunday’s game. The same lingering ankle injury had also caused him to miss multiple games this season. With that said, it is apparent that the Tampa Bay Buccaneers organization and its doctors, trainers, and coaches were aware that Brown was struggling with a painful injury. However, Brown on the sidelines in Week 17 does not provide the organization any benefits, but deliberately ignoring and actively concealing medical information so Brown stays on the field will. If head coach Arians told the team doctor he needs Brown on the field by Sunday, he will do everything in his power to ensure that happens – or risk losing his job.

Despite the NFL claiming teams must use their “best efforts” to ensure that players are “provided with medical care consistent with professional standards for the industry,” that is clearly not the case. In fact, former head coach Tom Coughlin admitted in a deposition for a medical malpractice lawsuit that he “can and will exert as much pressure on the player and the doctors to get the player [back] on the field.” Another former player reported that he was watching nearby as a teammate was getting evaluated by a team doctor and overheard a disturbing statement: “If you were a normal person, we might do things a little differently, but you’re a football player,” the team doctor said.

Players also have the collectively bargained right to seek a second medical opinion and, provided a player satisfies Article 39 procedural requirements in seeking such an opinion, the team can be obligated to pay for the medical services rendered by that outside physician. But, the language of the CBA is carefully crafted to exert more control, as it includes that the player still must consult the team physician prior to seeking a second opinion. Later on, the player must ensure that the team physician be “furnished promptly” with a report that details the outside physician’s views on diagnosis, examination and recommended course of treatment. A player can also elect to pursue the recommendation of the second opinion over the opinion offered by the team physician, but only after consulting with the team physician and giving “due consideration” to his or her recommendations.

Rick Stroud of the Tampa Bay Times reported Wednesday that Brown visited with a “top surgeon” outside the team, and that the evaluation (including an MRI) confirmed that he has “serious pain.” The belief, per Stroud, is that Brown “probably should’ve never been on the field to begin with on Sunday.” If Brown is still on the Bucs roster, Article 39 of the CBA requires him to give the team doctor a full report detailing the outside physician’s opinion. Not only that, but he must then meet with the team doctor to discuss his or her recommendations before pursuing the second opinion.

The way these pertinent sections of the CBA are written give team doctors complete control over the player’s health and safety by significantly influencing the player’s decisions, even when that player receives a second opinion. The team physician is able to ignore, minimize, dispute, and actively suppress any second opinion due to the immediate trust players place in their hands as both members of the team, and more importantly, as their doctor. Ordinary everyday people trust doctors. Professional football players trust them the same, if not more. However, player injuries pose a serious business problem for the NFL and its member clubs.

The aftermath of Antonio Brown’s exit is a developing story, but seemingly provides insight into the return-to-play culture and thorny dynamic of health care professionals paid by teams to treat players. According to the Tampa Bay Times, an official statement from Brown will be released soon, and will echo that despite Brown’s high threshold for pain, it’s believed he should not have been on the field Sunday.

Stephanie Weissenburger is an Associate at Geragos & Geragos. You can find her on Twitter @SWeissenburger_ and Instagram @Steph_ExplainsItAll