an interesting article, may be a good read for some
Ask the Doc: Dr. Johnny Benjamin on the pitfalls of medical suspensions
by Dr. Johnny Benjamin on Dec 03, 2008 at 7:05 am ET
Dr. Johnny BenjaminAfter every major mixed-martial-arts event, you probably log on to MMAjunkie.com and read the list of "medical suspensions."
Fighters who suffer knockouts or cuts that require stitches – or more serious injuries like broken bones and muscle tears – often receive medical suspensions, but there's usually the caveat that a fighter can be cleared early by a doctor.
In his latest "Ask the Doc" column, noted combat-sports specialist Dr. Johnny Benjamin discusses the "clearance" process – and some of the glaring problems involved with it.
Q. What does it take to medically clear a fighter to compete? (from Anonymous)
A. On face value this may appear to be a simple question that should produce a simple answer. I agree. The question is straightforward, but the answer probably presents more questions than it answers. Confused yet? Let me explain.
What is "medical clearance," anyway? Well, a doctor must evaluate potential participants and determine if they have any medical issues that should reasonably preclude them from safe participation in a specific upcoming sanctioned event.
Medical clearances for professional combat sports usually include a history and physical examination, blood work (complete blood-cell count, HIV, hepatitis B & C, and coagulation tests PT/PTT), some level of eye exam, and possibly a brain scan depending on whether there has been a history of knockout losses.
Potential problem No. 1
The required elements of medical clearances are dictated by the host state's sanctioning body. Each state is free to decide what is necessary.
Do not assume that all states even have a specific athletic sanctioning body. Some states merely use their DPR divisions (Department of Professional Regulations). This is the same agency that issues licenses for most any public, service-oriented business (doctors, lawyers, pool cleaners, pet groomers, etc.) Some states have no sanctioning body at all.
Therefore, every state that requires a medical clearance has a different form with potentially different criteria. Consequently, the clearances are usually nontransferable.
Here's an example: You were cleared to fight in a specific state this week, but the fight got canceled. Your management team did its job and got you another fight in a bordering state for the next week. Guess what. You will likely be forced to undergo a portion, if not all, of the medical clearance again.
States are not required to share your medical information with other states. (Actually, due to the Health Insurance Portability and Accountability Act, they are probably prohibited from doing so.)
Potential problem No. 2
It's the doctor.
Question: Who picks the doctor who performs the medical clearance?
Answer: The fighter's camp (management and promoter).
Need I say more?
As a doctor, you fail a fighter during his medical clearance, and all hell breaks loose. Not from the state but from the fighter's camp. They rarely address the problem. They just quickly change direction and find a more understanding doctor.
Remember, if this person doesn't fight, for any reason, no one gets paid – not the fighter, not the trainer, not the strength and conditioning coach, not the nutritionist and not the promoter. Well, the promoter will probably be fine because he'll just get rid of you and put another warm body in there (as long as the doctor didn't mess up the main event). After all, the show must go on – and the promoter must get paid.
And what is the background of the doctor who is responsible for the medical-clearance process? The only requirement that I am aware of is a valid medical license. And in some cases, I'm not certain that anyone ever confirms that the medical license is current.
And any specialty of medicine will work. Pediatrics, family practice, OB/GYN, dermatology, radiation oncology. It really doesn't matter. Kinda scary, I agree.
I am not disparaging any specialty of medicine, but just because you may be competent in one area of medicine does not automatically make you qualified to provide medical clearance for combat athletes. (My sister-in-law in Reston, Va., Tammy, is a wonderful OB/GYN. If you have a question regarding your pregnancy, she's the man! But if you need medical clearance for an upcoming bout, I'd humbly suggest that you get a second opinion.)
The morals to this story are numerous.
There should be a computerized, standardized national form and criteria. This standardized process should be required by every state and be transferable. This secure (since it will contain confidential medical info) database would then be accessible to the appropriate sanctioning bodies.
This database will make it easier to verify the licensure of physicians who perform and many times manage these vitally important clearances.
There also should be a greater minimum standard required for physicians who are involved in this process.
Most of all, the fighters must protect themselves. At the beginning and end of the day, it's a business, and money is involved. Money has a funny way of corrupting those who are supposed to have your best interest at heart – and not their own.
Dr. Johnny Benjamin is MMAjunkie.com's medical columnist and consultant and a noted combat-sports specialist. He was also recently appointed to the ABC's medical advisory team and will help review and refine the unified rules of MMA. Dr. Benjamin writes an "Ask the Doc" column every two weeks for MMAjunkie.com. To submit a question for a future column, email him at askthedoc [AT] mmajunkie.com, or share your questions and thoughts in the comments section below. You can find Dr. Benjamin online at
www.drjohnnybenjamin.com, and you can read his other sports-related articles at blog.drjohnnybenjamin.com.