Kevin Anderson, Maryland’s athletic director at the time, sent a memo to Loh dated May 19, 2017, that spelled out the changes the athletic department aimed to make in its management of athlete injuries and illnesses, calling for the school to establish an independent medical care model. The memo, which was obtained by The Washington Post, also called for athletic trainers to report to the University of Maryland School of Medicine in Baltimore and to be autonomous from any influence by the school’s athletic department.
“This relationship also better aligns resources and expertise under one umbrella aimed at improving patient care, staff education and clinical research in the care of athletic conditions and injuries,” the memo read.
Loh rejected the proposal last August because he did not want to allow medical personnel decisions to be made by another institution, according to the three people who had direct knowledge of Anderson’s proposal and Loh’s response. They spoke on the condition of anonymity because they were not authorized to speak about the matter.
In an emailed statement, Maryland spokeswoman Katie Lawson did not directly address Loh’s decision not to adopt the proposal but said the school already uses physicians from the medical school to help treat athletes and supervise athletic trainers. Because the trainers remained university employees, “we retained the ability to make necessary personnel decisions,” she said, “as we did recently in placing members of our athletic training staff on administrative leave.”
Under Maryland’s organizational flow chart, most of the sports-medicine operations are housed in the athletic department. Valerie Cothran, from the Baltimore-based medical school, serves in a supervisory role, along with Steve Nordwall, an assistant athletic director. Nordwall, who was placed on administrative leave Saturday, in turn reports to David Klossner, the associate athletic director of sports performance. Both Nordwall and Klossner report to Cothran.
Lawson said the school is able to avoid any conflicts of interest by relying on physicians outside the athletic department to supervise the training staff.
“Consistent with best practices, our coaches do not have direct responsibility for the hiring or supervision of any member of the sports medicine staff,” she said.
To take medical care out of the hands of athletic department officials and remove any potential conflicts of interest, the NCAA adopted a measure in 2016 that called on schools to “establish an administrative structure that provides independent medical care.” Greater autonomy empowers medical personnel, including athletic trainers, to make health and safety decisions detached from the influence of coaches, athletic department officials or competitive concerns, sports medical professionals say.
While many schools still use a traditional athletic department model, others have shifted some responsibilities to their associated medical schools and hospitals — including fellow Big Ten schools Michigan, Northwestern, Iowa and Ohio State — and reported good results. Tory Lindley, Northwestern’s head athletic trainer, said having a separate campus entity oversee sports medicine is now the “gold standard.”
“Knowing that independent autonomy exists in our independent situation at Northwestern, which is the one I can speak most intimately to, is great,” said Lindley, who is also president of the National Athletics Trainers’ Association.
McNair suffered exertional heatstroke at a May 29 team workout and died 15 days later. The school admitted it made major mistakes in administering medical care to the 19-year-old offensive lineman. School officials pointed a finger at the athletic training staff and said McNair was never diagnosed or treated for heatstroke while under the school’s care that day.
It remains unclear whether an independent model would have saved McNair’s life, but the rejected proposal has prompted more questions about how the University of Maryland administers medical services for its athletes.
“You cannot draw a line between organizational structure and the death of student-athlete Jordan McNair,” Andy Pollak, department chair for the medical school's orthopedics department, said in a statement issued Friday morning, a day after this story was initially published. “We share in the commitment to make sure a tragedy like this one never happens again, and we extend our condolences to Jordan’s family. We can and will work with the university to implement changes that improve the environment and conditions where student-athletes compete and how athletic trainers provide care.”
Anderson went on sabbatical last October and eventually resigned. “I have moved on, and I have no comment,” he said Thursday.
A spokesman for the Maryland School of Medicine did not respond to a request for comment.
A campus reels
The University of Maryland, which is based in College Park, has found itself reeling in the wake of McNair’s death and reports over the past week that an abusive culture within the football program may have contributed to it. The controversy has prompted two external investigations, led to the resignation of a strength and conditioning coach and prompted the university to place three others on administrative leave, including the team’s head coach, DJ Durkin. The University System of Maryland’s board of regents is expected to take up the matter at a special meeting Friday morning.
School officials met and apologized to the family Tuesday, admitting to major lapses in the care McNair received May 29.
In their first public comments since their son’s death, McNair’s parents spoke on ABC’s “Good Morning America” and to ESPN on Thursday.
“That was my reaction: ‘Really?’ ” Tonya Wilson, McNair’s mother, told ESPN, when asked about the school’s revelations. “I mean, I’m not in the medical field, and . . . first thing you should do, take his vitals. Check his temperature. I didn’t understand. I didn’t understand. Why not?”
Loh said in a news conference Tuesday that the school accepts “legal and moral responsibility,” while Damon Evans, the school’s recently promoted athletic director, added that McNair “did not receive appropriate medical care, and mistakes were made by some of our athletic training personnel.” The training staff’s emergency response plan — which lists Cothran as an attending team physician — was not followed; trainers did not take McNair’s temperature or give him cold-water immersion treatment.
“The care we provided was not consistent with best practices,” Evans said Tuesday.
The proposal put before Loh was specifically designed to better align the school’s sports medicine operation “with the NCAA’s best practice recommendation,” according to the memo sent to Loh, but it almost immediately faced pushback from school administration, according to emails obtained by The Post.
The proposal gained traction in the fall of 2016, in part as a response to NCAA guidelines made that year that recommended member schools institute an independent medical care model. Athletic department officials initially wanted the change to coincide with the launch of a new sports medicine program based at the Baltimore campus in July 2017.
As they considered a change that would shift oversight of the operation to the medical school, Maryland officials were in contact with other schools that carry similar models, according to the three people with knowledge of the situation.
“This new organization structure will directly align athletic trainer licensure oversight with their supervising physician,” the memo read.
Michele Eastman, Loh’s chief of staff, said in a May 30, 2017, email that was addressed to Anderson: “I just read the memo and do not understand WHY you are moving this (outsourcing it?) to UMB. In addition, I don’t know what the move means.”
The school did not make Loh or Eastman available for comment.
The College Park campus and the medical school in Baltimore are separate within the Maryland university system. The College Park school is one of the few flagship universities that doesn’t have its own medical school and the only one in the Big Ten. The relationship between the schools has been the subject of much debate over the years. In 2011, regents of the Maryland university system rejected a measure to merge the schools, and in recent years state lawmakers and school administrators have regularly debated the merits of a union.
According to two people familiar with the situation, Eastman wrote in an Aug. 29, 2017, email to Anderson, Evans and Klossner: “I have spoken to Dr. Loh and he will not concede hiring or firing to another institution.”
The NCAA’s constitution leaves it up to schools to establish their preferred medical structure, but in 2014 the governing body for college athletics issued recommended guidelines to its member schools to encourage the independence of medical providers. While the guidelines do not call for medical care to be removed entirely from an athletic department, they do urge independence and autonomy.
The recommendation was added to the NCAA’s bylaws in 2016.
In a statement Thursday, an NCAA spokeswoman noted that the organization “has published clear guidelines to aid in the prevention and treatment of heat illness and we expect universities to provide an athletic culture that protects and fosters student-athlete well-being and safety.
“The University of Maryland has taken responsibility for its failures in the care leading up to Jordan’s tragic death and offered steps to ensure this does not happen again,” she said. “We believe all of our universities should take this opportunity to assure they are prepared to avoid these types of tragedies.”
As Maryland considered overhauling its model, school officials visited or studied similar-sized programs that already had reassigned some of their sports medicine services to the school’s medical schools or affiliated hospitals, including Ohio State, Iowa and the University of Pittsburgh.
At schools such as Pitt, Northwestern and Michigan, for example, athletic trainers are still technically employed by the athletic department, but the various team doctors are employed by the affiliated university hospitals, and athletic department officials are supposed to be at least a step removed from medical decisions.
“It’s a great feeling to know that, and it’s an attractive thing for my staff of 20 to have when they are facing those situations on a day-to-day basis sport-by-sport,” Northwestern’s Lindley said.
Chad Asplund, president of American Medical Society for Sports Medicine, said that built-in autonomy could help remove potential conflicts of interest and limit any undue influence a lower-level staffer might feel.
“The coach may need a player for a big game, but they have an injury where it’s not safe. If you report directly to the football staff or someone in athletics, you might worry about being fired if you pull a kid out,” Asplund said. “You may feel coerced to playing a kid even if he’s not healthy.”
Even at schools where medical staff might not technically report to the athletic department, those around the sport say, the chain of command can look one way on paper and differently on the practice field.
“It’s seldom when an athletic trainer doesn’t feel like he or she doesn’t report to the head coach,” said Gerry DiNardo, a former college football coach who serves as an analyst for the Big Ten Network. “It seldom is that a head coach doesn’t think that the trainer doesn’t report to him. That’s the real world. That’s the culture. The flow chart will maybe say something else. But the reality of it . . . is that the trainer works for and reports to the head coach.”
Jesse Dougherty and Emily Giambalvo contributed to this report.