"Intercollegiate athletics programs shall be conducted in a manner designed to protect and enhance the physical and educational well-being of student-athletes." - 2012-13 NCAA Division I Manual
The National Collegiate Athletics Association Division I manual includes more than 400 pages of mandates for its member schools.
But there is less than a page regarding healthcare for athletes.
Instead, there's a half-page list of healthcare services that institutions may finance should they choose. Athletic departments (with the exception of those in California, where specific legislation has been passed) don't have to publish their healthcare policies in writing, leaving players to rely solely on the promises of recruiters.
In other words, after an incoming student signs a letter of intent binding him or her to a university, many schools have no contractual obligation to treat injuries or strains that result from playing for that college.
Some schools, maybe even most, provide exceptional care for their athletes. But there's little way to know who does and who doesn't—and these sparse guidelines can leave some student-athletes dangerously exposed.
Off Louisiana Highway 16, down a dirt road, and another dirt road, to where the road ends, Stanley Doughty sat with his family inside the doublewide mobile home he grew up in. It was April 28, 2007, and the bayou weather had already grown hot and humid. Doughty—all 325 pounds of him—lounged on the left side of the couch with his father, Hollis, on the right, and his mother, Sandra, in the recliner: their usual arrangement. The silver Sanyo television was set to ESPN, where NFL commissioner Roger Goodell was calling the names of the 255 players picked in that year's draft.
For Doughty, a promising defensive tackle who had just finished his junior year at the University of South Carolina, it was a tense moment. He had forfeited his final year of college in hopes of going pro, and now he was waiting to hear his fate.
Initially, the news seemed bad: Goodell never announced Doughty's name. Disappointed, the family turned off the television and walked several houses down to Doughty's grandmother's for a late-afternoon barbecue with family.
But about 10 minutes later, Doughty's phone rang. He can't remember exactly who it was. All he knows is that the voice on the other side of the line was from the Kansas City Chiefs and told him, "Stanley, we want you to come be a part of our organization." Now 29, Doughty doesn't speak in feelings. Everything is a fact, a business transaction. His father, though, is a bit more open. "It was an emotional moment," Hollis Doughty says. "It was emotional for all of us."
Doughty and his two siblings grew up in poverty. He never could afford to purchase his own gear, not even cleats. Most of his classmates from high school didn't go on to college—the same would have been true of Doughty if he hadn't earned a football scholarship. And while he felt fortunate to be at South Carolina, he says college brought its own difficulties. As one of just a small number of black students on campus, Doughty felt isolated. He also struggled academically, overwhelmed by a curriculum that bore little resemblance to the education offered at his rural high school. He didn't always make the best choices, but he pushed through. When he left for the draft, Doughty was only 12 credits shy of a degree. And when the Chiefs called, it seemed like his perseverance had finally paid off.
Within two weeks, Doughty was in Kansas City, Missouri, and had signed a two-year, $400,000 contract. He had his own locker with his name printed above, a new helmet, and a new uniform. He even had a new number, 71. He took a picture to send home to his parents. It showed a beaming Doughty standing next to his new locker while wearing a bright red Chiefs hat.
Doughty immediately began training with the team and undergoing the mandatory testing all new players submit to. When the doctors asked if he'd ever had any serious injuries, he answered no, thinking that since he'd been cleared to play in college there was nothing wrong. But then the Chiefs' head athletic trainer called Doughty off the field and into his office. The veteran trainer got right to the point: Doughty's X-rays revealed that he was playing with a cervical spine injury. One hit in the wrong place could leave him paralyzed for life. That meant Doughty couldn't play football for the Chiefs—or for anyone else, ever again.
The next day Doughty was on a plane headed back south, with questions on his mind. He thought back to the injuries he suffered while playing at South Carolina. There were two that immediately came to mind. The first was a helmet-to-helmet collision during a 2004 practice. The impact had left Doughty temporarily paralyzed and with a tingling sensation in his arms and neck that would never go away. He was taken to a neurosurgeon, who gave Doughty a diagnosis of mild congenital stenosis—a narrowing of the spine near the base of the neck that occurs at birth—but gave him the go-ahead to keep playing.
A year later, South Carolina traveled to Knoxville for an ESPN-televised, late October game against Tennessee. Doughty started on defense. With less than three minutes left in the first quarter, he lined up on his own 1-yard line. Arian Foster, who now plays for the Houston Texans, ran the ball into the end zone, barreling into Doughty and leaving him momentarily unable to move, similar to what happened after his previous 2004 hit. But this time team doctors didn't take him for a MRI. Doughty says he rested in the locker room for five minutes and then finished the game. South Carolina won. "I was young," Doughty says. "I thought they knew what was good for me. I just listened to 'em. I trusted 'em"
The Chiefs' surgeon and several after him have additionally diagnosed in Doughty an acquired spinal injury—the sort that often occurs from a sudden, traumatic blow to the spine, such as a helmet-to-helmet collision, like the two Doughty suffered. Records also show that Doughty's spine had become more deformed between the time of his first examination and that done by the Chiefs, which could mean that he had further injured himself during the second hit against Tennessee or another unrecognized play. He'd need surgery to prevent his symptoms, limited use of his right arm and a burning sensation, from worsening.
Now Doughty felt blindsided again. Had his doctors at South Carolina misled him? Ignored his injuries? At 23, he had no job, no college degree, and no insurance. What was he going to do? After the injury was found, the Chiefs terminated his contract. Would the university pay for the surgery he needed?
The answer to the last question would be no.
Upon joining a Division I team, every participant must have insurance and undergo a medical examination before playing. But when it comes to protecting players, who generate billions of dollars every year, from having to pay unanticipated medical bills or ensuring they receive superior, impartial healthcare, there are no official NCAA provisions in place.
Thus, when a player is injured, nothing prevents the athletic director from refusing to pay related medical bills—which sometimes keep coming for years. Even for those with private insurance, some policies don't cover varsity sports injuries, have high deductibles, or refuse to pay the entire amount due. In such situations, the remaining costs fall to the athlete (many schools, though, do pay those bills).
The NCAA has a catastrophic injury fund that kicks in when personal deductibles exceed $90,000. Doughty's surgery would cost around $20,000. According to Ramogi Huma, president of the National College Players Association, schools are more likely to help cover costs if the player is high-profile and the injury is severe or public, such as the one Louisville's Kevin Ware suffered when he broke his leg during a 2013 March Madness game. Or when running back Marcus Lattimore twisted his knee almost 180 degrees during a televised game last year.
There is also no provision in the Division I Manual to prohibit a coach from revoking a scholarship the year after a recruit gets hurt. For those from poor families and without coverage through a parent, this means that a young man or young woman can be enlisted on the promise of an education, get injured on the field, and lose his or her only source of medical insurance precisely when he or she needs it most. "There is no doubt there are horror stories out there about schools terminating scholarships," says Warren Zola, assistant dean for graduate programs in the Carroll School of Management at Boston College and a sports business expert. "It comes down to the ethos of particular schools."
There is no provision in the Division I Manual to prohibit a coach from revoking a scholarship after a recruit gets hurt. So in some cases, a young athlete can be enlisted on the promise of an education, get injured on the field, and lose his or her only source of medical insurance precisely when he or she needs it most.
Many from low-income families are completely dependent on the school's healthcare system, which in some cases means being cared for solely by team doctors and trainers—many of whom may feel pressure to keep a team's healthcare costs low or to get an injured player back on the field. Several lawyers experienced in college sports point out that the relationship between athletes and team doctors is unique because the university, not the patient, does the hiring. Doughty wasn't encouraged to seek out care by an impartial physician, and it didn't cross his mind to. "I put everything in their hands and trusted them," Doughty says. "They said I would be taken care of."
The NCAA reports there are 20,718 college football injuries a year, with 841 of those spinal injuries. The National Center for Catastrophic Sports Injury Research has recorded a steady rise in the number of football players who have permanent disability due to cervical cord and brain injuries.
Players with professional potential have the option to purchase Student-Athlete Disability Insurance through the NCAA, which guards against potential financial loses from career-ending damages. As a recent Atlantic article by Kevin Fixler explains, however, most individuals with these policies won't be able to cash in on them. The disability insurance only covers those who can never play their sport again and has resulted in fewer than a dozen successful claims in more than 20 years. With treatment and rehab, most can return, although it may not be to the same level as before the injury.
Knee injuries are generally less debilitating, but with around 4,000 incidences per year, they're the most common in college football and cost roughly $11,000 to repair. A competitor who gets hurt, then, can easily rack up thousands of dollars worth of medical costs. "Their situation is very vulnerable," says Ellen Staurowsky, a sports management professor at Drexel University who has researched various aspects of the college sports business.
It's impossible to know how many Doughtys are out there, although conversations with experts, retired coaches, and athletic trainers suggest there are many more. Officials won't release medical information because of privacy laws, and no one keeps track of what happens to players once they are off the squad. So these young men and women can fall completely off the grid. "This is a very difficult area to get specific data," Staurowsky says. "So we don't know what kinds of injuries are out there. I don't think there is any way to fully capture the problem."
For Doughty, the interest started trickling in late junior year—recruiters calling his high school coach, letters arriving from schools that wanted the wide-set defensive tackle behind their scrimmage lines. The teenage boy even got to go inside Nick Saban's house during a visit to the University of Alabama. But it was the recruiter South Carolina sent to the Doughtys' home on dusty G Lane that sealed the deal. The middle-aged man sat on the loveseat, against the front wall and across from the only window in the room, and told the 17-year-old and his parents this would be the best decision of his life.
Sandra Doughty, who was reluctant to send her son so far away, recalls how the recruiter kept saying if anything happened, they would take care of him, and they would call immediately. "We were so sure they were going to have his back 100 percent," she says.
That's what the Division I football sales pitch is meant to do: gain trust. It starts when a coach narrows in on a high school player and decides he wants him on the team. But he's not the only coach searching for talented young men to stock his roster in hopes of building a winning and lucrative program, and, ultimately, securing his job for another year. There are hundreds of recruiters on the prowl, all competing to convince a small number of top players to choose their school.
How is this accomplished? By sitting in the boy's living room and telling his parents that for the next four years their son will be in good hands. By forming a bond, and bringing the boy to campus. By convincing him this is the best decision for his future. Some may imply that the boy's scholarship will cover the entire tenure of his education—even if doesn't. Some, as in what the Doughtys say was their case, may promise that if anything happens the university will take care of it. "Of course I believed them," Sandra Doughty says.