In the wake of the recent flap regarding outside-of-the-club knee surgery conducted on Mets center fielder Carlos Beltran, one reporter sought the answer to this question:
Many agents ask why Major League Baseball and the Players Association cannot agree upon an independent board of doctors that can be consulted for independent opinions.
But a reading of the Basic Agreement shows that a matter of an independent committee could not be considered an issue. There's already a Safety and Health Advisory Committee made up of an equal number of members appointed by MLB and the Players Association. Article XIII-A(1) of the current Basic Agreement signed on Dec. 26, 2006, clearly defines the goal of this committee:
"To deal with emergency safety and health problems as they arise, and attempt to find solutions, and engage in review of planning for maintenance of safe and healthful working conditions for Players."
There are also ample codicils and supporting letters documenting a player's right to receive second medical opinions by doctors on a list pre-cleared by the clubs and this committee (the Players Association, obviously, representing the players), and even third opinions by doctors not on that list selected by the individual player and approved by the club.
The reason this procedure exists is to head off club physicians, who may have the best interest of the club in mind, rather than the long-term welfare of the player. In many cases, a club physician's job simply may be perceived as trying to patch up a player so that he can quickly get back on the field.
In Attachment 35, included in the Basic Agreement, Don Fehr, the former executive director of the Players Association, writes in a letter format:
"While the Club has the right to designate the doctors and hospital when a Player is undergoing surgery for an employment related injury, the Clubs understand the importance of a Player being comfortable with the physician performing any such surgery. As a result, the Office of the Commissioner will continue to advise Clubs they should take a Player's reasonable preference into account when designating doctors to perform surgery.
"As part of this commitment, the Office of the Commissioner will advise the Clubs that in no event should they force a Player to have surgery performed by the Club physician, but should instead in any case in which a player has objected to the surgery being performed by the Club physician, designate another physician to perform the surgery."
The Basic Agreement is a public document available via MLB.com on the Players Association Web site. A link for the Basic Agreement is on the left side near the top of the home page, the first listing under an easily readable title: MLBPA Player Resources.
As far as Beltran is concerned, the Mets may have an argument that has nothing to do with the committee: a player's right to second and third medical opinions or the right for a player to have surgery performed by an outside surgeon.
Mets physicians were aware of Beltran's right knee problems, but club officials may not have been given the right to approve the procedure by an outside physician. The right of that selection and permission is the crux of the issue and is stipulated in the Basic Agreement under Article XIII-D, Second Medical Opinions.
Fehr wrote in his accompanying letter: "A Club has the right ... to designate the doctors and hospitals furnishing medical care and hospital services to a Player for injuries sustained in the course and within the scope of his employment. ... The Parties have had a disagreement regarding Club and Player rights when a second medical opinion doctor and a Club physician disagree on the appropriate course of treatment. Without attempting to resolve this disagreement, the Parties will continue to avoid disputes ... urging their constituents to agree on a qualified third party expert ... who would resolve the dispute."
Mets assistant general manager John Ricco said earlier this month that Beltran had permission to seek a second opinion from Dr. John Steadman, a knee specialist in Colorado, who also examined Beltran's right knee last summer when he missed most of the season because of injuries. Steadman recommended surgery to remove cartilage fragments and shaving bone spurs that caused continued inflammation.
"We told the agent for the player that we wanted to have the ability to discuss the diagnosis and possibly have a third opinion because of the nature of this injury," Ricco said during a conference call. "We wanted to have the opportunity to digest the information, the diagnosis, and unfortunately we were never afforded the opportunity to do that."
The statement seems to support the proposition that Dr. David Altchek, a respected orthopedic surgeon and the Mets' medical director, didn't agree with Steadman that Beltran needed surgery. Thus, a third-party opinion should have been sought.
Scott Boras, Beltran's agent, said they had permission from the Mets for Beltran to undergo the surgery. The center fielder is not expected to resume baseball activities until 12 weeks after the Jan. 13 procedure, meaning he will miss at least the first month of Spring Training.
"I have done nothing but follow the directions of my doctors," Beltran said in a statement following Ricco's comments. "Any accusations that I ignored or defied the team's wishes are simply false. No one from the team raised any issue until after I was already in surgery. I do not know what else I could have done."
Since the Safety and Health Advisory Committee was created to make non-binding recommendations to preclude such problems, the resolution of any post-surgery dispute would be for the Mets to file a grievance under the normal process spelled out by the Basic Agreement. They have yet to do so.
What would be at stake is "reasonable medical expenses," including travel costs incurred by Beltran to have the surgery, plus any followup appointments that are stipulated to be paid by the team, and perhaps pay for the three months after what might be concluded as surgery unauthorized by the Mets.
Globally, a possible grievance and the incident would seem to have little ripple effect on the way clubs or players handle injuries and procedures as long as they follow the process detailed in the current Basic Agreement, which will expire on Dec. 19, 2011. Negotiations between the Players Union and MLB are set to begin next year and it wouldn't be surprising if further safeguards are placed in an already intricate medical system that exists between MLB and the Players Association.
Because of the possibility of a grievance, Michael Weiner, the new executive director of the Union, declined when asked to speak about any general medical issues, including expanding the scope of the already existing Safety and Health Advisory Committee.
Rob Manfred, MLB's executive vice president of labor relations and human resources, didn't return a phone call.
With preparations for collective bargaining already in full swing, current general managers for the 30 clubs have been asked not to publicly discuss any of the pending issues, including medical. For the first time, the GMs have now been included in the pre-collective bargaining process, having attended the last Owners' Meetings in the Phoenix area. Commissioner Bud Selig said they will be invited as well to the May meeting in New York.
But at least one former GM said he likes the system the way it is.
"We never had any of those medical issues when I was with the Padres," said Kevin Towers, who was San Diego's GM for 14 years from 1995-2009. "We had a great relationship with the doctors at Scripps Clinic in La Jolla. The players trusted them and you can't replace the history that the players have with those doctors from the time they're in the Minor League system on up to the Majors.
"To me, that's really important. These doctors, who are associated with the ballclub, know these players better than anyone. As long as the players remain comfortable with them and feel that they're working in their best interest, that's the best result for everyone."
Because of that trust, Tony Gwynn, a Hall of Famer who spent his entire 20-year career with the Padres, and who had numerous surgeries on his knee, feet and neck, never sought an outside opinion.
"I was very happy with the medical team," said Gwynn, whose career ended in 2001. "I had doctors there I could trust, who I built relationships with and knew how I operated. I wanted to play. I'd do everything I could so I could play. I loved our doctors with the Padres. I always thought they had my best interest in mind as well as the interest of the club."
