JULY 4th FAVES MADE HEALTHY
THE SHAM WAR ON SALT
MOMPRENEURSHIP WITH SHANNON MILLER
Is This Your Surgeon?
Are you sure?
Are those ER waiting time signs legit? One-legged pro golfer Ken Green wants a comeback. Why doesnâ€™t the PGA Tour want him? Inside the private-label supplement disaster at Target, Wal-Mart, GNC and Walgreens When a famous restaurant bleeds all over you, what should you expect? PLUS: Meet the HEALTH & WELLNESS MATRIX EMOTIONAL SPIRITUAL
Premier Issue ENVIRONMENTAL
p.11 6 Mompreneurs
Kids at home? Doesn’t mean you can’t build an empire. America’s most decorated gymnast (and mom and cancer survivor) shows you how. BY SHANNON MILLER
24 Stay Off the Green
Five time PGA Tour winner, Ryder Cupper and amputee Ken Green is trying for a comeback. Why is the PGA Tour fighting him? BY DREW NEDERPELT
9 Meatloaf Makeover
Skinny Chef Jennifer Iserloh remakes Momma’s heart-stopping, mouthwatering meatloaf in our monthly Momma’s Recipe Makeover column.
48 The Matrix-thingee
19 French Lick’n Good
21 Bloody Hell
BY KRISTIN CARPENTER
BY DIEGO SANDS
15 Bait & Switch-Blade
42 With Supplements Like These...
The most recent adaptation of French Lick was famous for the birth of Larry Bird until it became famous for the re-birth of the French Lick Resort. How did the middle of nowhere become the center of it all?
Is the doctor sitting across from you today the one who will be cutting into you tomorrow? BY J.C. LOUIS
11 The Salt Crusades
Cardiologist Dr. Mike Fenster takes on the salt demonizers.
40 Signs, Signs, ER Signs
What’s the deal with those ER signs?
When your dining experience at one of the country’s most famous restaurants ends with you and a half-dozen others splattered with a stranger’s blood, where does private enterprise end and public health begin?
When the largest retailers in the country are found selling tainted private-label nutritional supplements, who is to blame?
34 Independently Healthy
Fresh in 15 host Amina AlTai shows you how to keep the wings, burgers and dogs in your 4th menu without the unintended consequences.
Stuff that’s happennin.’
It’s a gray line legally. It’s a black and white line morally. Cover Story, page 15 4
Necessary tiny, tiny print: Health & Wellness Magazine is published with all rights reserved. No part of the publication may be reproduced, stored in a retrieval system, transmitted in any form, by means electronically, mechanically, photocopying, or otherwise, and no article or photography can be printed without the written consent of the publisher. Reproduction in whole or in part without written consent is forbidden. The publisher assumes no responsibility for statements made by advertisers, nor quality or deliverability of products and services advertised. Authors’ opinions do not necessarily represent those of the publisher. All photographs not specifically credited are Creative Commons reprinted with permission.
Premier Issue July 2015 | Health & Wellness Magazine
elcome to the first issue of Health & Wellness Magazine. There are a few things you should know about this magazine, and the first is that we’re delighted you’re here. The second is that this issue took 29 months to come to fruition (which is one of the reasons we’re so glad you’re here!). The third thing you should know is that the second issue will not take 29 months to come to fruition. And the last thing is that we hope you’ll notice this magazine is not like any other health, wellness or fitness related magazine out there. And perhaps it’s like no other magazine at all.
As we are fond of saying at my day job, “The world doesn’t need another outlet for Lulu Lemon tops or Gaiam yoga mats.” And while those are wonderful products, there are all kinds of places you can get them and everyone seemingly already has them. In that same vein, the world doesn’t need another smoothie recipe or article screaming “EIGHT EXERCISES THAT WILL GIVE YOU ABS TO DRIVE HIM NUTS!!” There are plenty of places you can find those. What Health & Wellness Magazine will endeavor to bring each month is content you haven’t seen
before. Will we have recipes? Sure, but we will mainly have smart (sometimes groundbreaking, but always original) exposés on things we believe you’ll find intriguing and at times, very important. One such piece is JC Louis’ cover story on ‘ghost surgeries’ which we commissioned to get to the bottom of how these things happen- namely how you can be operated on by someone other than the person whom you believed was going to do the operating. We think it’s a great piece and an eye-opener. After all, we’re all likely to go under the knife at some point, if we haven’t already done so. We also want to shine a light on things we all take for granted but perhaps need to know more about. Our staff piece on Emergency Room billboards and their legitimacy (page 40) is one such exercise. How many times have you driven by one of those and thought, “Hmm, six minutes seems too good to be true.” Well, now you’ll know. Speaking of shining lights, we’re all about investigative journalism and deep-diving into the arenas of health, wellness, and fitness. In this issue that exposition comes in the form of an article about PGA Tour player Ken Green, who was and is an unbelievably talented golfer, before and after he lost his leg, but has been given a raw deal by the golf tour where he is trying to make a sports comeback that would be one for the history books. You might think that sports (or finance for that
matter, which is coming in future issues) is not health or wellness, but it’s all part and parcel of living a life built on a foundation of wellness.
We’ve got another quasi-investigative piece that tackles public health and what you should expect when you and several of your dining cohorts in and around a restaurant, are bled on. (Can you imagine?!) Unfortunately we didn’t get to the bottom of the policies (that’s a story on its own!) around the country so we will be relying on our readers to help us with that one. This one will be a group effort and we’ll be sure to keep everyone updated on what we find.
Our third investigative piece (told you we liked light-shining) is about the private label supplement debacle that occurred recently at Wal-Mart, Target, Walgreens and GNC. If you haven’t heard about it you need to know about it. What you will also want to know is how this can happen, and what Health & Wellness Magazine is doing to hold those retailers accountable for the millions of supplements they pipe into the marketplace each year.
On the happy, happy upside we’ve got a terrific piece by one of my favorite people, Shannon Miller. In this issue she’s writing about Mompreneurship, and boy, if anyone can pull off multi-tasking (running several businesses, raising a kiddo, defeating cancer), it’s America’s most decorated gymnast, Shannon Miller. Also on the upside for those of you like me who have an affinity for NaCl (salt), cardiologist and super-chef Dr. Michael Fenster reveals that all this salt demonizing might be unwarranted- just in time for your July 4th wingathon! Lastly, thanks again for stopping by. We hope you’ll find more than a few things you like, and if so, we hope you’ll share our magazine with friends and family you care about, as we are sharing it with you.
Drew Nederpelt- Publisher
Yours truly and contributor Shannon Miller who writes about Mompreneurship in this issue. One of my favorite people of all time, Shannon is an inspiration to millions. 5
Shannon Miller, 7-time Olympic Medalist and Mompreneur
Have you ever watched a television program or seen a product on the shelf and thought, “Hey, I thought of that!” Or maybe, “Wow, I should have thought of that!” Oh, the looks I got when I began referring to myself as a “mompreneur.” Mom-a-what? “Mom-pruh-newer,” I’d say slowly with my slight southern drawl. While the term has steadily become accepted by people across the country, many still wonder what makes mompreneurs different from any other entrepreneur. The answer is simple: kids. 6
When a woman has children she not only becomes a mom, she becomes a superhero, a play-date arranger, a cleanerupper, a rule enforcer, a boo-boo kisser, and the list goes on. All of that comes in addition to what she already was prior to the miracle of childbirth. While I had graduated with degrees in marketing and entrepreneurship from the University of Houston and a law degree from Boston College, I had not yet realized what a difference the “mom” part would make in my plan to start a company. You have the day to day challenges combined with the roller coaster of emotions as you plug away
through sport, but I could now open up an entirely new dialogue with women going through the ups and downs of pregnancy. Use your past as a foundation but don’t be afraid of something new.
First write down your goal, then create smaller goals; those that you need to achieve each month, week and day to reach that larger goal. Carry them with you and look at them often.
Step Two: Know Your Target Audience. Is It YOU?
Last Step: Make It Work With Family Life
I kept with fitness but began to bridge into issues of motherhood. Bingo…Pregnancy Fitness! I went to a few production companies to gauge interest. To my dismay they were only interested in the Body After
This is where the “mom” in mompreneurship comes in to play. It’s easy to lose sight of your dream for fear that you might neglect your family. It’s that inner battle of being the best mom you can be while allowing yourself to spread those wings and find out all that you are capable of.
Be bold and always dare to dream. –Shannon at creating something new and exciting. Being a mompreneur will always be scary and tiresome, but with a few tips and tricks, you can also find it to be lucrative and rewarding.
Step One: Look to Your Past and Realize Your Strengths I’ve always been passionate about health and fitness. You have to be when you’re striving to be an Olympic gymnast. After retiring from Olympic competition, I began to really consider what I wanted to do with my life. I was now facing all of these new changes and challenges as a woman that I had never dealt with as a gymnast. However, many of the lessons I learned through sport would prove to serve me well.
My goal: Help women make their health a priority I had just completed my first draft of my initial book Abs To Go when my husband and I discovered we were expecting our first child. Suddenly I wasn’t thinking about health and fitness in the same way. This was a true turning point. I realized, as I did in gymnastics, that sometimes we may think we’re on the best path until we’re shown a brand new avenue. Not only could I rely on the knowledge I had gained
Baby portion. I would hear over and over again that women are only concerned with losing the baby weight; prenatal fitness won’t sell. I wasn’t buying it. If at first you don’t succeed, try and try again. Eventually I found a very smart man (and one that gives a great deal of credit to his savvy wife), he agreed without hesitation to work with me on my Fit Pregnancy and Body After Baby DVD; which are available in Target, Best Buy, and other stores across the nation! Shannon Miller Lifestyle was born. Women are ever changing. We aren’t just about babies or fitness; I had to encompass the idea of health! Most mompreneurs find that THEY are their best customer. We know what’s missing and often times we create a product or service to fill that void without even realizing it! Trust your instincts.
Step Three: Create a Game Plan Creating a game plan is crucial to anything in life: sports, business, family, health… Success doesn’t happen overnight. It takes guts, faith, and a little bit of luck. You have to take baby steps each day to reach your final goal.
Many mompreneurs note that while they may work long hours, they’ve also gained flexibility in their schedule. Most talk about the importance of showing their children that if you have a dream, go for it! Time and again, women were surprised at the wonderful life lessons their children learned by watching them take active steps toward their goals. You’ll have to be disciplined and organized, but you can absolutely find a good balance between work and family. Use Google Calendar to color coordinate when and where you will be for work or home life. Remember to make time to work out and get sleep. If you’re working at home, create boundaries where you have work space to yourself so that you don’t get sidetracked by laundry and dirty dishes. Enlist your kids help. If you have work that they can help you with, let them. They love to be part of the process and will begin to see why you love it! Realize that a four step plan isn’t going to solve all your problems. However, the bumps and bruises along the way strengthen your resolve and help fuel the fire within. You are embarking on a great adventure and no matter where it takes you; you will know that you gave it your all! For more on mompreneurship, health and fitness please join me at: www.shannonmillerlifestyle.com Facebook: Facebook.com/SMLifestyle Twitter: @ShannonMiller96 7 Premier Issue July 2015 | Health & Wellness Magazine
9 Premier Issue July 2015 | Health & Wellness Magazine
A LINE IN THE SALT
No salt, low salt, salt free, heart-healthy salt substitution – any added salt will hurt your constitution; it reads like some bizarre, Seussian tale... ...excepting that we’ve heard it not from the good Dr. Geisel but from the medical community and public health advocates everywhere. We watch as celebrity chefs take the salt elimination cooking challenge to prepare an “improved healthy” cuisine. Self-anointed “experts” through the pulpit of the media, cadge, coax and cajole us to decrease our salt, or more specifically, sodium intake. If that doesn’t work then the specter of heart attacks and strokes is unleashed upon us, along with a dash of fire and brimstone for good measure. It is after all, clearly in our best personal, and
the greater public, interest. The hypothesis is sound and the supporting data is impeccable, right? The theory goes as follows: Salt acts to make us retain fluid. When we retain more fluid it increases our blood pressure (albeit temporarily). Increased blood pressure is hypertension. Hypertension is a risk factor for cardiovascular disease like heart attacks and stroke. Heart attacks and strokes are bad. Therefore, hypertension is bad. Thus, sodium must be bad. A causes B which causes C therefore A causes C. Get rid of A and you get rid of C. Simple basic
arithmetic, no? Reduce sodium intake and you will reduce blood pressure and thus reduce the incidence of stroke and heart attack. Reducing sodium intake is good; simple, effective and undeniably the prevailing conventional wisdom these days.
Except one thing is missing. The data. There is no data that definitively shows that reducing dietary sodium reduces mortality or even significantly reduces cardiovascular morbidity. For over half a century, starting in the 1960s, there has been a vehement and salty exchange just out of public
11 Premier Issue July 2015 | Health & Wellness Magazine
Public health recommendations at global, national, and local levels have been nearly unanimous in asserting that the evidence is incontrovertible that salt consumption should be reduced. earshot involving respected scientists on both sides of this line in the salt. But with the advent of an aggressive public policy to reduce dietary sodium intake for presumed public health benefit and studies emerging suggesting negative consequences to a low sodium diet, well, the clamor of dissension just got cranked up to 11. The public policy on salt was shaken up in 1977 when Senator McGovern released a report entitled “Dietary Goals for the United States” which introduced the first national salt goal. This was set at 3 grams per day. The aforementioned theory of salt-induced hypertension quickly became science fact or urban legend, depending on your take on the data. A report from the Surgeon General issued over a decade later highlighted this disparity. It acknowledged that the policy to restrict salt consumption had been implemented in the absence of studies that proved that a low salt diet might prevent increases in blood pressure. Throughout the decade of the eighties the definitive answer remained elusive. For example, The Framingham Study, a seminal trial following a cadre of Americans from Framingham, Massachusetts since 1948, has yielded many landmark insights into cardiovascular risk, morbidity and mortality. However, the Framingham study failed to find any correlation between sodium and blood pressure. Another study in 1985 of over 8,000 men of Japanese descent found no relationship between sodium consumption and stroke. Halfway around the globe over 7,000 Scottish men were studied and it was found that the “association between sodium and blood pressure is extremely weak.” By the end of the decade in 1990 the Director of Nutrition at the FDA remarked in a newspaper article that “there is no conclusive evidence that salt consumption causes hypertension, it’s only a hypothesis.” Despite this lack of closure, under Mayor Bloomberg in 2008 “the New York City Department of Health coordinated the launch of the national salt reduction initiative, a public-private partnership of more than 85 state and local health authorities and national health organizations that has set voluntary targets to lower salt levels in
packaged and restaurant food.” In 2010, the Institute of Medicine recommended methods of sodium reduction in its report, “Strategies to Reduce Sodium Intake in the United States.” The group had been asked to develop strategies for sodium reduction, not to evaluate whether sodium reduction was of any benefit, which may have been the more important question. Their action plan was based on the presupposition that increased salt consumption caused significant harm. Thomas Frieden, Director of the Centers for Disease Control and Prevention along with other professional organizations like the American Heart Association have moved forward with national campaigns like the Million Hearts Initiative aimed at reducing sodium consumption, based on this report. Programs like this, paid for in part with tax dollars, aim to reduce sodium consumption by 20% despite any solid evidence of a return on that investment. In 2011, some experts involved in a rigorous scientific review of the studies done on salt remarked that it “is surprising that many countries have uncritically adopted sodium restriction, which probably is the largest delusion in the history of preventive medicine.” Despite this call for caution, “public health recommendations at global, national, and local levels have been nearly unanimous in asserting that the evidence is incontrovertible that salt consumption should be reduced.” At the crux of the argument there are fundamentally two questions: • Do low-sodium diets prevent hypertension? • Would a population level decrease in salt consumption save lives? Answering these questions requires an evidence-based approach. Those who feel the current level of evidence is sufficient argue that more data collection will take too much time, cost lives, and that such studies may simply be too expensive. However, it should be noted that over last 45 years while sodium intake has gone up, death from heart disease has continued to decrease. Key tools for the successful implementation of evidencebased approaches include meta-analyses
to identify effects that may not be apparent in individual smaller studies and the use of randomized clinical trials (RCTs) to help eliminate bias. The first meta-analysis involving salt was performed in 1986. It found that lowering sodium intake may reduce blood pressure, particularly in people with preexisting hypertension, but that the effect was extremely small. Subsequent metaanalyses delivered similar results. Advocates for salt reduction believe, as Sir Michael Rawlins, Chair of the National Institute for Health and Clinical Excellence in the United Kingdom notes, that “guidance is based on the best available evidence. The evidence may not, however, be very good and is rarely complete.” These proponents for salt reduction also assume there is no consequence to a low sodium diet. This may not hold true; some amount of sodium is necessary for life. A low sodium diet has some known negative effects. Significantly decreasing the salt in the diet increases renin secretion by the kidneys. Renin is associated with the development of hypertension and can contribute to the development of cardiovascular morbidities and mortality. Decreasing salt intake also increases aldosterone secretion by the adrenal gland. It also increases sympathetic nerve activity and increases insulin resistance (the condition associated with type 2 diabetes). This is not all theoretical, either. In 2011, a European study performed by the European Project on Genes in Hypertension (EPOGH), investigators looked to see if a reduction in salt intake would reduce the number of cardiovascular events. They looked at over 3,500 participants prospectively. They were followed for almost 8 years. Those who ate less salt had the highest risk of dying; those who ate the most salt had the lowest mortality rate. An even larger study was done by Dr. Yusef and his group out of McMaster University in Canada and published in The Journal of the American Medical Association, again in 2011. Over 30,000 people were studied for about four years. They examined low sodium intake (less than 2.3 grams), moderate intake (2.3 to 7 grams) and high (more than 7
What we are learning is that the key may not lie in any absolute amounts, but in the ratios between sodium and potassium. grams). The moderate sodium intake group (which reflects the daily consumption of the average American at 3.4 grams) had the lowest risk of cardiovascular morbidity and mortality. A low level of sodium intake was associated with an increased risk of cardiovascular death and increased risk of hospitalization for heart failure. In addition, the low sodium group had a 2.5% increase in their cholesterol and a 7% increase in their triglyceride levels, changes not seen in the other groups. Yet another meta-analysis examining 167 smaller studies drew similar conclusions. The study author, Niels Graudal of Copenhagen University Hospital in Denmark, concluded that “I can’t really see, if you look at the total evidence, that there is any reason to believe there is a net benefit of decreasing sodium intake in the general population.” Other leading authorities like Dr. Yusef agree and assert that the link between sodium reduction and benefit is, at best, “weak and inconclusive.” Finally, in 2011 two Cochrane reports were released to rub even more salt in the sodium reduction-health benefit theory. Cochrane reports generally consist of metaanalyses and RCTs and are considered a gold standard in delivering reviews of the available data. The first Cochrane review focused on people without hypertension. It found “no strong evidence” that sodium reduction reduced all-cause mortality. The second review also examined persons without hypertension. The report concluded that all available evidence did not permit a determination as to whether a low-salt diet improved or worsened health. However, the authors concluded that “after more than 150 RCTs and 13 population studies without an obvious signal in favor of sodium reduction, another position could be to accept that such a signal may not exist.” What we are learning is that the key may not lie in any absolute amounts, but in the ratios between sodium and potassium; the goal being to achieve a ratio of ≤ 1. An alternative to the hypothesis that any health benefit is a result of sodium reduction is considering that any positive findings may arise because of increased potassium consumption. Sodium and potassium exist in the body in a natural balance. Potassium
is often a component of salt substitutes, fresh fruit, vegetables, legumes, salmon, and chicken. Processing, however, affects this ratio. For example, a 100g (about 3 ½ ounces) serving of fresh pork contains roughly 60 mg of sodium and about 340mg of potassium. But if you industrially process that into the average deli ham you end up with 920mg of sodium and only 240mg of potassium. A study out of Sweden examined ten previous trials looking at data from almost 270,000 people and examining those who suffered strokes. They found that the higher the potassium intake, the less the risk of stroke. Another study examined over 12,000 people for all cause and cardiovascular risk as part of the Third National Health and Nutritional Examination Survey (NHANES III). What they found over a 15 year period was that the highest risk group had a very high ratio of sodium to potassium in their diet. This continues to be an area of intense inquiry. Well, what do we know? We know that treating hypertension with medical therapy saves lives and reduces cardiovascular disease and complications. We know we need salt to live; 70% of our body is salt water. We also know that in the body, sodium exists in a ratio-related balance with potassium. Potassium is another element necessary for proper bodily functioning and is especially important from a cardiovascular perspective. We know that for most normotensive people the sodium intake can vary tremendously from day to day without significant problems-even quintupling the amount of sodium ingested does not affect blood pressure adversely. The longest lived people on earth (and by some accounts the healthiest) are the Japanese, who routinely consume 2-3 times as much salt as the average American (whose salt consumption has been stable over the last 3 decades). We know that the effect of dietary sodium restriction, if any, on blood pressure, appears extremely modest. We know that significant sodium reduction has other potentially negative health consequences. We do not know if salt reduction will result in a health benefit. We do not know the consequences of reducing the salt
content of food. In the 1970s a campaign was initiated to reduce fat consumption among Americans. It has worked and the percentage of fat in the American diet, even saturated fat, has continued to decline. However, people simply ate more and thus obesity and diabetes are on the rise, despite the success of the program in reducing the percentage of fat and saturated fat in the American diet. Any manipulation of a system, whether by addition or subtraction, invokes to some extent The Law of Unintended Consequences, with possibly negative outcomes. Hormone replacement therapy (HRT) for post-menopausal women was based on the extrapolation of the desirable effects these hormones had on blood pressure and cholesterol levels (sound familiar?). It is no longer routinely prescribed today due to the serious increased risks of heart attacks, breast cancer, and strokes associated with this therapy. We cannot simply blame bad policy, especially if it is truly borne of good intentions and scientific ignorance at the time of implementation. Policy, like science, is the purview of humankind and thus subject to our inherent flaws and growing pains. But to implement overarching public policy when good science raises serious concerns is to engage in public folly. I must agree with Bayer and his colleagues in their exacting assessment of the salt debate; that the evidence here forces us to conclude “that the concealment of scientific uncertainty in this case has been a mistake that has served neither the ends of science nor good policy.” As a chef and a cardiologist my business is both food and health. As the British scientist and educator Thomas Huxley commented back in 1860, “My business is to teach my aspirations to conform themselves to fact, not to try and make facts harmonize with my aspirations.” Perhaps it is time for salt to get a fair shake. _____________________________ Dr. Michael Fenster is a cardiologist in Springview, Florida
13 Premier Issue July 2015 | Health & Wellness Magazine
WhenYour Doctor isnâ€™t Your Doctor
By JC Louis An experienced trial lawyer and his well-educated spouse had scheduled their teenage daughter for a routine appendectomy at a prominent hospital in their native Portland, Oregon in 2006. The surgeon whom they selected had purportedly performed hundreds of such laparoscopic routines, sometimes as many as seven a day. Surrounded by his team of white-coated residents at a preoperation meeting, the surgeon explained to the parents that the procedure should last no more than 45 minutes. The risks of bleeding or infection arising from the surgery were real but minimal. The family signed the necessary consent forms and scheduled the surgery.
15 Premier Issue July 2015 | Health & Wellness Magazine
Cover Days later, the nervous couple anxiously awaited the doctor’s update. It had been three hours into what was supposed to be a 45-minute surgery and they were beside themselves with worry. Finally the blood-splattered surgeon emerged to give them what at the time was much needed news, their daughter “will likely survive,” he said. There had been a mishap during surgery and an artery had been lacerated. A vascular surgeon had to be summoned and their daughter would have to continue postoperative recovery at the hospital for a month, but thankfully she was expected to recover fully. The surgeon shared no further details at the time, nor the following weeks despite the parents’ continuous efforts to find out what had actually occurred during the operation. They finally sought help from a personal injury firm in Portland. The attorney representing the family, who spoke to Health & Wellness Magazine on the condition of anonymity, confessed that the case was unusual in his experience specifically in the severity of its outcome as well as the circumstances leading up to it. However, he stresses that the case bears similarities to the course of normal surgical processes that occur every day in teaching hospital throughout the country. Medical records signed by the resident physician and acquired during legal discovery revealed that despite pre-operative assurances that the attending surgeon himself would perform the operation, a surgical resident had performed the critical parts of the operation, and thus the operation itself, albeit under supervision. “Residents are doing surgeries every day, or at least playing a very significant role, depending on the will of the surgeon. When that is not disclosed,” notes the attorney, “you have a ‘ghost surgery.’” This gothic term once referred to operations performed by itinerant surgeons employed by general practitioners who duped their anesthetized patients into believing that they had done the procedure themselves. Today, the term has a different meaning depending on whether used by those in the medical establishment, personal injury lawyers, residents of community or teaching hospitals, as well as patients’
or citizens’ rights advocates. As rare as the cases may seem, the ACLU addressed the issue in a 1989 pamphlet by Boston University medical ethicist George Annas. “Ghost surgery occurs when someone other than the surgeon the patient expects to perform the operation actually performs it. As long as the expected surgeon is present and supervising, this may not be a major issue. However, when a surgical resident or other surgeon unknown to the patient performs the procedure and the attending surgeon is not physically present, an unethical and illegal act is committed that includes fraud on the part of the surgeon and battery on the part of the person who actually performs the procedure.” Ghost surgery has also come to include surgeons who, in the words of noted medical ethicist James Jones, “still delight in the shroud of invisibility that general anesthesia wrapped them in and surreptitiously dealt their operative duties to residents or junior associates without their patients’ knowledge or consent, never neglecting to collect the fees.”
According to guidelines of the American College of Surgeons, “The surgeon may delegate part of the operation to associates or residents under his or her personal direction, because modern surgery is often a team effort. If a resident is to perform the operation and is to provide the continuing care of a patient under the general supervision of the attending surgeon, the patient should have prior knowledge.” The reference to “prior knowledge” informs a huge body of medical practice and literature documenting “informed consent” -- the process by which fully informed patients participate in choices concerning their health care. Specifically, informed consent is the voluntary authorization, by a patient or research subject, with full comprehension of the risks involved, for diagnostic or investigative procedures, and for medical and surgical treatment. The doctrine rests upon the legal and ethical rights the patients have to direct what happens to their bodies. It also rests on the ethical duty of the physician
to inform patients of the benefits, risks and alternatives in health care decisions. “The average patient does not understand how a teaching hospital works,” says Joe Messa, a Philadelphia-based personal injury attorney. “They typically think that the residents are going into the operating room for the purpose of listening or observing. They do not know the resident may be the primary one caring for them or that the resident is handling the procedure from start to finish.” The facts reported by the attorney in the Oregon case show that determining exactly who is handling what in an operating room can be difficult as well as problematic, especially if there are post-operative complications. In that particular case the depositions of the resident and attending surgeon contradicted one another. “I held her hand as she inserted the needle in the abdomen,” says the attorney citing the surgeon’s deposition. “I held her hand as she put in the trocar (a three-edged medical instrument used to introduce ports in the abdomen during surgery). When we saw the bleeding, I took over.” However, the resident’s deposition placed the surgeon on the other side of the operating table. “I did the needle and trocar. He wanted to hold my hand for the needle.” Based on the lacerations to the artery sustained by the patient, the attorney successfully reached a settlement in the case by arguing that the needle had entered the abdomen at the wrong angle and velocity, errors caused by inexperience consistent with the resident’s recounting of events rather than the surgeon’s. No one disputes the essential pedagogical role teaching hospitals play in preparing the next generation of practioners. “Residents need to
gain experience,” notes Steve Levin of the Philadelphiabased law firm Levin Peconti. “But it is the patient’s choice as to whether they wish to be the subject of a teaching exercise. Would a fully informed patient allow herself to be operated on by one attempting to gain experience?” And what if you have that one doctor, as the saying goes, the worst surgeon
r Story that teaching hospitals and state in the world. It has to be the patient in a particular case.” The difference between health boards sometimes prohibit someone. Levin’s question is more than rhetorical, as his firm won a $6.7M jury verdict in 1997 for a case involving birth breech that was handled improperly by a resident who, though purportedly under the supervision of an attending physician, pulled too hard, forcing the baby’s arms over its head. The attending physician jumped in too late to avert permanent nerve damage, leaving the baby with severely stunted body strength and a crippled left arm. “The surgeon overstated his involvement. It was the resident’s case,” noted Levin. “It takes skilled surgeons to extract a baby in breech. But how do you get the experience to become skilled? How do the hospitals and medical schools choose at what level of experience to sanction responsibility for giving treatment?” At the same time,
notes Levin, “who wants to be the patient that helps solve the residents’ learning problems?” The teaching hospital does not hold the power, rightfully or legally, to make that decision. “Only a fully informed patient can allow herself to be operated on by one attempting to gain such experience.”
The medical community is no less sensitive to the thorns of these dilemmas, and is tasked with having to design and maintain standards that can be applied universally across all procedures in differing sub-specialties. The “potential for ‘ghost surgery’ promulgated by wellpublicized anecdotes has resulted in great concern among the lay, political, regulatory, legal and medical communities about who does an operation,” writes Dr. Mininder S. Kocher, Chief of Sports Medicine at Children’s Hospital in Boston. “The legal doctrine of informed consent stems from fundamental principles regarding individual autonomy and the fiduciary doctorpatient relationship,” he says. “In the modern application of informed consent, consent is either expressed or implied by surrounding circumstances. Express consent is usually obtained in writing, but it can be obtained verbally. Implied consent is obtained by the conduct of
expressed and implied consent pushes up against some of the problematic areas that have become the focus of numerous legal actions. Dr. Kocher acknowledges the difficulty in precisely defining the scope of consent. “The issue of ghost surgery depends a bit on definition,” he recently acknowledged. Leaving aside the egregious cases involving outright substitution of surgeons without patient knowledge or permission,” he continues, “The grayer area occurs where other people are involved in an operation -- particularly at a teaching hospital. The issue is that modern surgery is a complex team sport. It takes assistance not only from the resident and fellow community as well as from the technical staff. A surgical operation has many steps, from prepping and positioning the body to the introduction of anesthesia, the initial incision, and the approach to the area of interest, opening in on the specific pathology, the closure of the wound and re-mobilization. The attending surgeon provides adequate supervision across all the key stages.” Dr. Kocher acknowledges that awareness of informed consent is not where it should be. “Some patients still insist that only the attending surgeon be in the room during the operation. As a result, it is necessary that the surgeon and designees be in the paperwork, but this is more than a matter of the patient’s signature. Does the patient really understand what the surgeon will do?” Attorneys who have seen more than their share of contested cases offer straight-forward advice on how patients can protect against the ambiguities of implied consent and the specter of ghost surgeries. “Consumers should never agree that the doctor’s designees can do the surgery,” admonishes Patrick Malone, a Washington-DC based attorney. “Cross out any language on consent forms that allow someone else to do the surgery. The risk is that you will wind up getting surgery from someone who is less skilled and less experienced than the person you selected -- a particular surgeon hired to perform a specific operation. You should insist he or she actually perform the surgery.” Acknowledging
the alteration of consent forms (Shands Hospital at the University of Florida confirmed that patients’ alteration of consent forms is not permitted), Malone maintains that the, “language of consent forms give attending surgeons too much leeway.” He asserts that, where forms provide space for written specifications, patients should record a clear understanding in writing that the doctor performs the major part of the surgery, with assistance on the opening and closing portions delegated to the residents.
In terms of precautions, the ACLU goes even further, counseling patients, “To impress upon the surgeon how important it is that the surgeon personally perform the procedure, limit the written consent to the operation to the specific surgeon, and ask another physician whom the patient trusts to be present during the operation as an observer.”
“People’s lack of knowledge about what questions to ask can severely rush the preamble to a surgery in a crisis situation,” notes the Oregon family attorney. He reports one case where a man took his wife to a country clinic for an elective biopsy of a malignant lung nodule. There was a radiologist attending the procedure. Forty-five minutes after anesthetics was administered, his wife’s heart had stopped and she suffered a stroke and died. The man was led to the hospital chapel. No one discussed what had happened. The man was discouraged from authorizing an autopsy. Had a needle broken through her chest wall puncturing the pulmonary vessel and the aorta? Did the radiologist contribute to the outcome? Was this a ghost surgery? “It is beyond most people’s awareness that these sorts of things go on. That is why it is an excellent idea to have a witness present in the preamble to a surgery, so that there can be no doubt about what representations were made. Right after things go wrong is the best time to find out what went wrong. Who was the Attending Surgeon? Who was assisting? You will find
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out more information when things are hot and before the surgeons are warned into silence by the hospital administration,” points out the Oregon family attorney. A case related by Philadelphiaarea attorney Joe Messa noted above, describes an eye surgeon, whose insistence that the attending surgeon, not the resident, perform the key stage of the operation allegedly went unheeded, resulting in damages, including the loss of one eye and the doctor being prohibited to perform any eye surgeries in the future. “Poor people are less sophisticated and don’t know what questions to ask, but here was a surgeon who knew exactly how the system worked. Consent belongs to the patient. It is given by the patient, not taken by the medical institutors.” The well-established pedagogical role filled by the doctor-resident dynamic conceals an economic underside that is all but invisible to the recipients of their care,” says Steve Levin. “The hospitals cannot bill for operations performed by residents -- unless the residents are acting as the attending surgeons. There are strict rules related to billing that can be skirted by these procedures.” The teaching justification can fuel the economic imperative, wrapped by its guardians in the trust medical doctors have long held by virtue of their standing in our culture. A close friend of attorney Messa, for example, was reportedly training as a neurosurgeon in Philadelphia at Thomas Jefferson University Hospital, a regional spinal cord injury trauma center. While training there under a premier neurosurgeon, he was surprised to find three operating rooms functioning simultaneously with a resident moving from room to room, performing operations. “If you are a big dog at a major teaching institution, you can do whatever you want. Those who have the most surgeries generate the most revenue for themselves and the institution,” notes James Jones. “Faculty with big caseloads may even find themselves seducing overeager residents into doing their routine cases on their own while they do the big ones in another room and bill for them all. When this occurs, we have crossed the line from resident education to ghost surgery.” Personal ties between
physicians can present a classic setting for ghost surgery. Attorney Douglas Ponder of the St. Louis firm Ponder Zimmermann relates a case of a young woman who was seen by her father’s cardiologist after complaining of chest pains. A cardiac cauterization for further diagnosis was scheduled at a time coinciding with the completion of surgical residency by the cardiologist’s brother-in-law. The patient was not informed that the surgery was to be conducted by the brother-in-law. During the operation, the brotherin-law punctured a blood vessel and improperly administered an angioseal which eventually led to severe nerve damage and chronic, life-long neuropathy. Notes the attorney for the Oregon family. “The procedures are not thoroughly disclosed in a way intended to make the average person aware -- who will do the opening, who will do the stitching, who will do the close? There should be an exchange about exactly what is going to happen. ‘This is a training hospital and surgical resident may participate.’ Uninformed patients become more informed about the real risks as well as the alternative.
There are warnings on cigarette packs. There should be disclosure and informed exchange about surgery. Full disclosure is better for the hospitals.” Rising case-loads, soaring health costs and ever more stringent training demands on residents have complicated the traditional doctorresident apprenticeship: residents exchange training for work, including routine bed-care, pre-operative tasks and related as responsibilities. How much and how often such arrangements adversely impact the quality of medical services patients receive remains an open and relevant issue. In busy academic surgical practices, the evidence suggests that patients need to be vigilant that they will receive the services and results that they expect. Informed patients, protected by specific consent spelled out on the institution’s forms or by separate contract, are much more likely to get the outcomes they envisioned. JC Louis covers business, science and medical subjects internationally. He is coauthor of “The Cola Wars,” a corporate history of the Coke-Pepsi rivalry.
By Kristin Carpenter
ot being much of a history buff all I knew about French Lick, Indiana was that it was Larry Bird’s hometown. I came to find out however that French Lick is also home to two of the most historic and award-winning resorts around: the French Lick Springs Hotel and Casino, and the West Baden Springs Hotel. In fact, the West Baden Springs Hotel was dubbed “The Eighth Wonder of The World” in the early 1900s before The Great Depression took its toll and the resorts were left to crumble. Fortunately, local philanthropists Bill and Gail Cook (having founded billion-dollar Cook Medical from their kitchen) came along and invested over $600 million to revitalize the resorts and the community. French Lick Resort is now named the “Best Historic Resort” by Historic Hotels of America and currently the largest employer in Orange County, Indiana with over 1,500 employees. The resort’s spas also boast spots on the list of “Top 270 Best Spas in North America, Caribbean, Hawaii and at Sea” for the past 3 years in a row (I wonder who decided to stop at 270?). And while I wasn’t much of a spakinda-girl, I was really looking forward
to being educated and then converted. Walking into the hotel atrium took my breath away; it was a huge six-story free-span dome, with sunlight streaming in the windows and decorated in gold with plush carpeting and red velvet seating. I felt like I had walked onto the set of The Great Gatsby. The lucky people staying in the rooms that lined the walls of the atrium could open their blinds and look down onto all this luxury. It was amazing. Once I caught my breath and asked directions to the spa, I found myself walking down a long hall of marble with mosaic gold and marble inlays which led to the front door of the spa, thus beginning my indoctrination to spa-girl. Having signed on for the “West Baden Signature Spa Ritual” I was quickly changed into a cushy robe and slippers, ushered into the “Tranquility Room,” which I had all to myself, and sat sipping an orange-infused water while the fireplace crackled and the music soothed. I could feel the knots in my shoulders loosening already.
The first treatment on my agenda was what drew people by the thousands to the resort in the early 1900s - the famous mineral bath. Sheree, my lovely bath-drawer and masseuse for the day, explained that the mineral water comes straight from the ground in French Lick, has 26 different minerals which scientific research has shown to stimulate circulation, increase moisture retention, relieve pain, detoxify, relieve joint discomfort and ease muscle tension that could only have been built up after a day of golf at the world famous Pete Dye Course located just a mile away and part of the French Lick Resort. I was ushered into my own private bath area with a large sunken tub and lots of fluffy towels. I was beginning my transformation to spa-girl. A moment later the door opened and I was almost overwhelmed by the smell. “Sulphur,” Sheree explained, “you’ll get used to it.” The very hot water
19 Premier Issue July 2015 | Health & Wellness Magazine
was grayish with flecks of minerals floating on the surface. Warned that the minerals would tarnish jewelry and could sometimes change hair color (and I’m assuming not the shade of Jennifer Aniston or Cameron Diaz), I shed my jewelry and donned my bathing cap. I then had 25 minutes to languish amongst the minerals, hoping the bath’s amazing curative powers would work their magic. Then it was back to the Tranquility Room (I think we all should designate one room in our home the Tranquility Room!) and more orange-water to rehydrate and wait for Sheree and my massage. As I waited I realized my wrists, which had been hurting from housework earlier in the day, didn’t both me as much. In fact, they felt pretty good! Sheree’s massage-magic then took hold and, relaxed from the bath, loosened muscles I didn’t even know I had. Oh the joy, one hour in lavender aromatherapy heaven with Sheree working every muscle from scalp to toe. And what hands! Then back to the Tranquility Room where Patti administered a fantastic hour-long facial, massaging and moisturizing and herbal wrapping. My face wakes every day now wondering if today will be the day it gets another. When all was said and done and the fluffy robe and slippers were returned I noticed how different I looked from when I had arrived, all wide-eyed and innocent, being a non-spa girl, all the way back then. Walking out into the street a new woman I was determined that my conversion would not wear off, and that having now graduated as a full-fledged spa-girl, I would seek to enjoy my new found education, and maybe even, if time permitted, seek out a spa-MBA with maybe a spadoctorate to follow. Maybe I can then help them round out that list of 270 to 300.
FRENCH LICK RESORT 8670 West State Road 56 - French Lick, Indiana 47432 - Local: +1 (812) 936-9300 - Toll Free: +1 (888) 936-9360 Fax: +1 (812) 936-2100 20
The world is watching, but what will we do?
Of course it was a great step forward that FIFA is starting to undergo closer scrutiny from the world stage, but the human rights disaster unfolding in Qatar, which was awarded the World Cup for 2022 (under how shall we say, ‘dubious’ circumstances), can and should be stopped. Will the world act?
WOULD YOU LIKE THE BLOOD ON THE SIDE, SIR?
At a posh restaurant things go very wrong for several diners when they are splattered with a stranger’s blood. What would you do, and what should be done? And why is there no public health policy for such an occurrence? By Diego Sands
should explain two things before we get too involved. My name is not Diego Sands and the restaurant in question is not named Capatelli’s. For the sake of telling this story, those two details, and only those two, will stand-in for reality. Every other relevant detail in this story is fact. I have changed the name of the establishment in this reporting because the goal is not to cause panic, a public health inquiry, or worse, for the restaurant in question. It is to simply posit the question and get answers about what should happen, or what should you expect to have happen, if something like this ever befalls you. It goes without saying that I pray it does not.
Capatelli’s is world-famous. People from across the globe make pilgrimages to it for their specialty dishes. Alas, despite living a few miles away, I had never been. So that late afternoon when I and my partner and her mother sidled up to the bar for a pre birthday-dinner drink, I was excited and curious. Excited because of the acclaim that came with the name, and curious because upon walking in it did not match what I had envisioned the place would look like. Instead of a laidback, relaxed atmosphere, the bar and the accompanying dining room were much more formalized than I had been expecting. The servers, both male and female, were dressed in waiterly-black and the tablecloths were starch-crisp white. After being shown to our table we ordered a birthday bottle of wine and sat
back to examine a well-appointed menu decades in development. Capatelli’s after all, has been around 100 years. The restaurant was about a third full, perhaps 100 patrons were doing the same as we were; getting ready to feast on their signature offerings and enjoy the company of those sharing the experience.
Not long after we received our wine, an elderly man tottered up to our table with a big smile. He was excitedly talking gibberish that no one at the table could understand. He looked at me and pointed excitedly to my dining partners, two lovely women, and again back at me with a thumbs up and more incoherent mumbling. To me it was simply a welloiled diner on his way to the restroom who had spotted a man with a disproportionate number of beautiful ladies 21
at his table, and as older men are wont to do, thought I was ripe for some good natured ribbing while perhaps endearing himself to one of my dining partners. The ladies and I smiled and nodded and looked at each other as the man flamboyantly flailed on. For his departing flourish, he extended to me a hand, I shook it, and he was off, not to the restroom but to a table 20 feet away, where he seemed to start the entire process over again.
“Do you know him?” came the hurried question from both sides. I thought for a second. Did I know him? So often we come contact with people from all angles and circumstances of living and unfortunately they don’t always get sufficiently cataloged for quick-recollection. I thought hard. The fact that nothing he had spoken resembled English or any other language I had ever heard made it easier for me to come to the conclusion that this was not a long lost relative or friend’s grand-relation, but in fact a com-
Immediately I imagined the worst-case headline: Dying Diseased Old Man Infects Entire Restaurant In Retaliation for Stale Rolls.
pletely innocuous visit from a well-wishing, well-lubricated and excitable diner who happened to be in a similarly festive mood as we.
As we laughed and shook our heads I watched as he made his way, in much the same manner as he had just vacated us, along a middle row of tables - an octogenarian schooner sailing up an aisle at Capatellis’ buoyed by pinot and perhaps the feeling that life was now indeed too short not to spread good cheer wherever he found himself. And then I looked down. On my hand were several drops of blood.
I looked up at my dining partners who were still cooing about the loveable, harmless old man. Then I looked to my partner’s mother, and she too had blood on her, which was bizarre (more bizarre!) because she had not been physically touched by the man. “He left us a little gift,” I said with what I imagine now had to have been a trace of panic.
I showed them my hand. Then I pointed to the mother’s wrist. Their mouths dropped and their eyes bulged. Then they pointed to the white tablecloth next to me which had received its own delivery from the now less-than-harmless old man.
We spent the next dozen seconds looking at each other in astonishment, each trying to process what to make of this bizarre circumstance. Immediately I imagined the worst-case headline: Dying Diseased Old Man Infects Entire Restaurant In Retaliation for Stale Rolls.
But he seemed so happy and excited to know us, I thought. Which was probably how I would go about infecting an entire restaurant if that had been my end-oflife gambit. I realized that sitting around with this man’s blood on my person wasn’t going to get us any closer to the mystery, so I excused myself and began my walk to the restroom to wash. As I walked by the old man docked at another table I made a note to see if the crimson tide was indeed being spread
around world-famous Capatelli’s. And boy did Captain Corpuscle not disappoint. On the back of a gentleman wearing a baby-blue Tommy Bahama shirt was an unmistakable bloody handprint. It was immediately recognizable as something you might see on a crime show with handprints of blood depicting an epic struggle of life and death. Except this time it wasn’t on TV, it was on the back of an unsuspecting middle-aged man eating dinner with his family! I found the restroom a few seconds later, my head still swimming with what was going on at this place dishing out expensive foodstuffs without any knowledge of the attack on its guests. I washed my hands and decided action was needed.
I quickly dried my hands and found the first authority figure I could, which was not difficult because literally outside the restroom door stood a tall square-jawed gentleman with a Secret Service-like earpiece, speaking to a waiter.
“Umm, not sure how to tell you this, but you see that man?” I said, pointing to our sanguine friend sidled up to another table. “Well, he’s walking around your restaurant bleeding on people.” The two looked at me like I had found my way into the Ouzo and overstayed my welcome. I realized at this point some quick proof would be needed to shift their attention from the victim to the perpetrator.
“See the back of that guy’s shirt, with the bloody hand print?” I said, pointing to the back of baby-blue Tommy Bahama who was eating his shrimp cocktail in bloody oblivion. “That elderly gentleman did that. And he’s doing it to everyone in your place.”
At this point, without missing a further beat, Mr. Secret Service sprang into action, immediately reaching down to activate the speaker on his earpiece as the waiter rushed off in another direction. “And you’ll probably want to tell him he has blood all over his back!” I moderately yelled after them over the dining room din as the two disappeared.
I returned to my table to find a flurry of activity (the benefits of far-flung earpiece-wearers no doubt). We were surrounded by scurrying busboys and our waiter, with an ashen-faced manager appearing to determine the state of affairs at the epicenter of the bloodletting.
“Let us move you to this table over here please,” said the manager. The attendent staff ushered us to a table five feet away and quickly went about stripping our previous table of its blood-stained tablecloth and linens. At this point we began to laugh nervously and look at each other incredulously, having just been involved in an all-time great yarn that could only be dealt with by large, forced smiles and repeated head shaking. Our waiter wafted back and we ordered our dinner. A minute later the manager came over and set our minds at ease. “He’s here with his family. He just had a cut on his hand,” he informed us as if the fact that we had been bled on and around by a stranger was assuaged by knowing the identity of his dining partners and what part of his body had been doing the bleeding. He smiled a big managerial smile, and left never to be seen again. And that’s the last we heard of it.
So the problem, as you might have figured out and might in fact be asking yourself right now, is that a stranger came over to our table, a table located in a publicly accommodating facility that
has a license to serve food and drink, mumbled incoherently, bled all over us, bled all over several other people, and then was returned to his “family” somewhere in the same establishment while we were left to resume our meal.
Was the man returned to his family under lock and key? Was he required to be strapped into his chair so he was not free to once again ramble about Capatelli’s bleeding on unsuspecting patrons like his family had already permitted him to do? Did his family know he was not right, or was this considered normal Thursday evening activity? Did the restaurant take precautions to ensure he wouldn’t repeat these transgressions, knowingly or not? Did the family bother looking for him after he was gone from the table for twenty minutes, especially knowing his state of mind? And even if they could understand him, was this the first time he had ever decided to wander around a public place speaking to (let alone bleeding on) people he didn’t know, and did the restaurant find out this information so they could perhaps establish some ground rules for potential future visits by this “family”? Furthermore,
what does it take to be asked to leave Capatelli’s? Obviously not bleeding on a dozen people while they partake in their evening repast. These are all questions we asked County Health Practitioner Diana Scott from the Peoria (Illinois) Health Department on behalf of everyone who might find themselves being bled on by people in public accommodations (while a restaurant or bar is technically private property it is considered a place of “public accommodation” where the public has certain expectations of safety and service) and specifically, restaurants. We asked the State of Illinois (we started with the State and was informed local governments handle restaurant food handling while the State handles wholesale food handling) because this situation did not happen there and Illinois is a progressive (small “p”) state when it comes to public safety and health. Despite the fact that we informed Ms. Scott that this story did NOT take place in Illinois, let alone Peoria, she declined any comment on the story.
“Thank you for your interest in public health. I have no comment on this story,” was her two sentence written reply. Apparently our interest in public health far outstrips Diana Scott’s interest in public health despite that being her job and the tagline on the County’s Public Health logo reading “Prevent. Promote. Protect.”
We reiterated that we weren’t looking for comment as much as we were looking for a link to established policies about local governments’ responsibilities when it comes to public safety matters specifically involving people bleeding on other people in restaurants. Given two months to reply we never received a link nor any documentation governing how restaurants are expected to handle this issue in Peoria, Illinois, or anywhere else. In fact, we contacted several other local governments about this type of situation and strangely none of them were interested in providing us with any advice on what actions we should expect from our local watering and feeding hole. If you know of a public health department willing to help shine some light on policies and procedures governing this type of situation, regardless of State or jurisdiction, please drop us a note.
And if you never need to use this information, count your blessings. If you do, remember not to leave the restaurant without at least getting a free appetizer (unlike Capatelli’s who, though not germane to this story, did not offer to remove even one item from our bill let alone replace our wine which might, in retrospect, have easily received a donation from our tableside visitor).
If you have any information please contact our friends at the Health & Wellness Channel by emailing friends@HWChannel.com
HE TRAILBLAZER & GATOR WRESTLER “I’ll tell you a story that will sum up Ken Green,” says CBS Golf analyst and one of the top golf teachers in the world, Peter Kostis, after giving Ken Green a lesson on a blistering April day in Boca Raton. “Kenny played in the 1985 Masters, and in the Par 3 tournament, which they have every year before the tournament begins, Kenny had his son caddy for him, who was very small, and Ken got reprimanded because conduct like that wasn’t becoming from anyone participating in the Masters. The next year Kenny and Calc (Mark Calcavechia, a Kostis student and good friend of Green on Tour at the time) both qualify for the Masters and on the 16th hole of the Par 3 tournament, as they’re walking off the tee, one of them decides to drop a ball on the edge of the bank and see if he can skip the ball across the water up onto the 16th green. And they both got yelled at for that by the powers that be at Augusta.” Kostis stops to let that sink in. Then begins again as a wry smile spreads across his lips. “These days, two of the biggest, most fun times of practice rounds at Augusta National are the par threes where all the players have their kids caddy for them, and if you don’t try and skip the ball across the water in your practice round at 16, you get booed. So those two guys got yelled at in the mid-80s for what is basically an essential part of the atmosphere of the practice rounds at Augusta today.”
Whether you consider Ken Green to be a trailblazer or simply unwilling or unable to keep his mouth and his actions in keeping with his surroundings, or a combination of both, is likely a matter of several criteria: How well you know Ken Green, your personal views on authority, and also in what era you were born. The people who know him, like his coach of thirty years Peter Kostis, or
talk-show host Maury Povich (another student of Kostis’ who hobnobbed with Green and Calcavechia in the late 80s after his wife, news anchor and journalist Connie Chung, bought Povich a birthday present of Kostis golf lessons), or former Major League Baseball great Larry Walker (whom Green golfs and bowls with regularly), say that Green would give you the shirt off his back, and his pants, shoe, and sock to boot (though you might not have much use for one shoe and sock and a one-legged pant). It’s Green’s apparent lack of self-awareness or perhaps more accurately, selflessness, that caused him to dive into a pond in 2003 to wrestle an alligator, getting the animal to release his beloved dog Nip (who survived the ordeal). And while his lack of consideration for ‘the way things have always been done’ (Masters participants keeping to the straight and narrow, humans fearing alligators, pro golfers requiring two legs) has no doubt helped him win more than a halfdozen professional golf tournaments worldwide, in addition to winning a spot on the 1989 Ryder Cup, these days it seems like his reputation as a “straight shooter” as Golf Digest called him for their cover story in 1988, is wreaking havoc on his attempt at an unprecedented sporting comeback. Typically in an article about a one-legged golfer trying to make a comeback on the PGA Tour, the fact that he’s an amputee, and how that came to be, might be shared in the first couple paragraphs. But just like Ken Green, details about self are set aside for other considerations. Regardless, the story cannot be told without including the tragic circumstances of that night in June 2009. Green and his wife (though she is reported as his girlfriend in much of the media, he and Jeannie, his girlfriend of eleven years, had been married in the Caribbean not long before the accident, says Green), his brother, caddy and best friend Billy, and his constant companion, dog Nip, were returning from a Champions Tour event in Texas when the tire of his motorhome exploded (Green was sleeping in the bedroom while Billy drove), sending the vehicle careening over a small cliff in rural Mississippi. The
crash killed all the occupants but Ken. It left him with severe lacerations to his head, fractured his suborbital bone and almost blinded him, tearing ligaments in his left ankle, knocking his jaw sideways and leaving a bloody gash to the bone on his head measuring ten inches. His right leg was shredded below the knee. After several days in the hospital doctors told him he would require countless surgeries to save the leg and that he would be left dragging it around like the dead appendage it would be. “Cut it off,” he simply said.
The emotional pain from losing what is literally your entire world in one instant would be unbearable if he couldn’t play golf again, thought Green, so the decision to remove his leg was a simple one. “What am I going to do, sit around and watch tapes of my old tournaments, the glory days? That would only lead to one very bad ending. So my choice was to try and get back out and do what I knew how to do, and that was play golf,” he recalls. PAIN INSIDE AND OUT
Six months later, while Green was trying to get some semblance of his life back, his son Hunter died of a drug overdose at college. Green was forced to make a decision, which he says was the most difficult of his life.
“Sitting there in the hospital room I had to make a decision. My life was shattered. I had just lost my wife, my son, my brother (his parents were previously deceased). I felt so alone. Would I be able to start over, or should I just end it and join them?” he says he asked himself. At the end of his time on the PGA Tour he had well-reported bouts with depression and has never been shy about the toll his divorce from his first wife took on him
at the time. But his decision to start over was made. He would rise from the literal ashes of that unbearable June night and try to put his life together, one day at a time. And the one thing he knew more than anything, the one thing that had delivered unto him more satisfaction and confidence than anything else, was professional golf.
“He’s always been a competitor, that’s what endeared him to me back in the day, his competitive spirit. That’s still there, that didn’t get injured in the accident,” said Kostis in 2014. And it was that competitive spirit that Green believed would take his mind from his otherwise debilitating circumstances and give his life meaning once again. He has admitted to seriously considering suicide many times since the accident, but his belief that he can help others in their struggles, regardless of how they are manifest, always wins out. (In the few tournaments that Green has played he always visits local hospitals or along with his significant other Kristin [and the seemingly unending cadre of family friends who travel with him to events], hosts ill children at the home he rents for tournament week). He would rise up and out of bed each day and use his effort at a comeback to gauge how meaningful his life was, and is. Each day would be the start of the rest of his life. Unfortunately, due to forces seemingly conspiring against him, he is losing that battle. DONE BEFORE HE TEES IT UP
“I would love to see him have a chance,” says Kostis. “The fact that sponsors aren’t giving him any exemptions into tournaments is absolutely mind-boggling. And the fact that the PGA Tour is not doing much to help him, at least from my perspective, I find that mind-boggling.” But both of those observations are bang-on, and unfortunately for Green, and possibly for golf itself (see Can Ken Green Save Golf?), time is running out. In 2013, Green wrote to the Montreal Open and received a sponsor’s exemption (sponsors of pro golf events are given freebie spots which they can dole out to those they want at their tournament) to play in that tournament, and although he didn’t need it since he qualified to
play through his medical extension (more about that later), he finished tied for 58, ahead of two dozen other Champions Tour players. But outside of the two Senior PGA Championships he has played in the past two years (he qualifies for the PGA Championship by way of his Ryder Cup Team membership), he has not been able to get into any other Champions Tour tournaments save for Iowa the week after the Senior PGA in the spring of 2014, from which he had to withdraw because of the hills. (Green’s prosthetic is fixed at the heel [at 90 degrees] which makes it incredibly difficult to deal with walking, let alone hitting, on very hilly terrain). “Unfortunately the reputation he developed back in the peak of his playing days, people are unwilling to let go of that, and they’re unwilling to forgive, and today he’s paying the price of that, and it’s a shame, because based on what I saw to-
“He’s always been a competitor, that’s what endeared him to me back in the day, his competitive spirit. That’s still there, that didn’t get injured in the accident,” said Kostis in 2014. day he can hit the ball better than some guys who are already out there,” said Kostis after a 2014 teaching session with a new prosthetic that Green has been working on as part of a joint Department of Defense initiative.
But outside of sponsor’s exemptions (which are very simple; if the sponsor wants you there, you’re in), the Tour has very strict and steadfast rules governing who is eligible to play in tournaments. When Green was injured he was playing on a two-year exemption because of his PGA Tour wins. He had played 10 months of the 24 months at that point. Because that 24-month exemption allowed him unfettered access to play, he was guaranteed to play as many events as he wanted in that 24-month period. After his exemption status was up (the two years), his earned money would be tallied and if he was in the top 30 or 50 on Tour he would gain access to the following year’s tournaments to one degree or another.
But because Green had his accident in month 10 and was incapacitated for the remaining 14 months (and 22 more) of his eligibility, he had to request a medical extension, which is basically a waiver which recognizes there was a legitimate reason for him missing the remainder of his 24-month exemption. In recognizing medical extensions (this type of extension is not automatically granted in order to keep players from simply taking a sabbatical until they feel like playing again) there are three categories; two based on top-30 money lists (one the previous year and one lifetime money1)
1While not the issue here, rankings, eligibility and exemptions determined by past dollar winnings is literally the worst way of organizing such things outside of alphabetical order, and doubly so for players who plied their trade on the PGA Tour in the 80s and early 90s (Ken’s exact time on Tour) before Tiger arrived. Take two toptier tournaments for example, the Colonial in Fort Worth and Arnold Palmer’s tournament at Bay Hill in Orlando. In 1988 the winners of each of those tournaments collected $135,000. Ten year later, after Tiger had burst onto the scene, Colonial paid $360,000 and Bay Hill paid $414,000. So in just those ten years, players from Ken’s generation had to win THREE TIMES MORE TOURNAMENTS just to keep up with the players playing only a few years behind them. Does that seem fair? Jump ahead another ten years to 2008, and both tournaments paid the winner over a million dollars. So now the players’ earnings from the previous generation have been cut by a measure of eight! To what type of democratic organization does that seem just? Exactly none. Lastly, it would be one thing if the money list was used because there was no other option, but there is, and it’s a very simple one. Allocate points (if you want to call them “dollars” feel free) to positions finished. First place= one million points, 70th place = 30,000 points, 150th place= 1,000 points, or whatever those in charge deem just. Or, if that’s too easy (some large organizations believe if it’s too easy there has to be a catch) you could use the World Golf Rankings and week’s spent on them and at what number. A simple (here we go again) way to calculate it would be to multiply the number of weeks at the ranking, add them all up, and the lower the value the better. So easy and so much more valuable. And one thing is for certain: If the current players don’t institute a change to the tracking of player value they’re going to be on the outside looking in in a few years because tournament purses have been stagnant since the late aughts, and with over half a million people leaving the game each year, it won’t be long until we see a slide in purse values (precipitated by TV networks placing less value on the TV rights because of dwindling viewership-after all, if you don’t play golf, you’re much less likely to watch golf). Regardless, keeping track of player value based on wildly fluctuating dollar values is like comparing baseball players based on fans in the stands.
and the third being exemptions based on career wins, which is where Green falls. There are also two types of medical extensions, Major and Minor. Major Medical extensions allow you to qualify at the front of the exempt list while Minor Medical extensions put you at the end of the line when getting into tournaments. As a Minor Medical recipient, Green gets entrée into tournaments only after a select number of qualifying and Major Medical players drop out or don’t show up. The result is that Ken is only eligible for a few tournaments a year based on those criteria. There are however, several problems with the way this is organized. Firstly, if Green had not had his accident, and therefore had not needed to apply for a medical extension, he would have
had an additional 14 months of playing any tournament he wanted. After all, he had earned that exemption by being a prodigious winner on the regular PGA Tour. But because he was forced to miss 36 months after his accident, he had to apply for a medical extension, and in his specific category there is only a Minor Medical extension available, and therefore he (and anyone else whom this might happen to) must wait at the back of the line to get into tournaments. The Tour has these medical extensions for a reason; so players don’t get penalized for the wrong reasons, i.e. reasons that aren’t their fault. Ken Green is being penalized for losing his leg, and that is patently unfair.
FROZEN OUT In 2011, two years after his accident, Green appealed to the Tour to consider implementing a Major Medical extension for his category. They declined. They were comfortable in their decision however because while they felt badly for Green (so they said to his face) they assured him that he would have no problem getting into tournaments through sponsor’s exemptions. To date, since the beginning of his attempt at a comeback, Green has written twenty-five tournament sponsors and directors for an exemption into their tournament. He has been granted access by one. In late 2014, Green pleaded again with the powers of the PGA Tour to do some-
Despite being dealt a blow that would fell most, Green is without a doubt the most humorous and self-deprecating player on the PGA Tour, routinely joking with the galleries about everything from his revamped swing to his pink prosthetic. 27
thing about his not being able to get into tournaments. He found a seemingly sympathetic ear in Jimmy Gabrielsen, Vice President of Player Relations and Administration for the Champions Tour, who suggested that in the next meeting of the Players Advisory Council, he would go around the room and see if the players were willing to speak to sponsors and ask that they allow Green into some tournaments. In an anonymous vote, the decision was made: No.
It’s not unheard of for professional athletes to veto increasing their competition, but for a small group of millionaires to outright bar a one-legged golfer from competing with them seems asinine. Just the impression that a bunch of privileged rich guys all got together behind closed doors and decided not to help this poor man who had his entire family AND his leg ripped from him, is stomach-turning. But the PGA Tour has ironically never been very self-aware (see “Augusta National” and “Shoal Creek” as it relates to blacks and women, for starters). Says scratch-golfer and TV legend Maury Povich, “I find the Senior Tour, over the years, I’ve been told by a lot of quality golfers, has become a closed tour.” If the players want it to remain a “closed tour” by, for, and of, the existing members, that’s one thing, and not entirely surprising. Surely the sponsors can see the folly in that though, especially when it comes to actively and consistently barring access to someone who, literally more than any other golfer who could possibly tee
it up on the Champions, LPGA, or PGA Tours, could provide inspiration to millions around the world. If the sponsors are trying to reach the same 50-plus year-old amateur golfers (who are giving up the game by the millions) by parading the same 50-plus year-old professional golfers around their courses week in and week out, the game will decay faster than Chamber’s Bay greens. Ken Green is giving them an opportunity for something different, something unique, something inspirational. The players obviously don’t want it, and inexplicably, the sponsors seem not to either. At this point Green could go to the courts to help rectify the injustice, but he doesn’t want to, yet. “I’m a team player. If I had wanted to let the courts handle this I would have started that train down the tracks in 2011 when they first said no. But I want to exhaust all other avenues first. I’m trying to be a gentleman about this but I’m not getting any younger,” he says. But when things seem inexplicable you start to look for other reasons things are the way they are. Nefarious reasons. Reasons that no one talks about openly. And in this particular case, the case of Ken Green being shunned from the PGA Tour, a Tour that he contributed mightily to, the reasons are well within sight.
“Whatever Kenny has done in his life, he’s done them for the right reasons. He’s never been malicious, he’s never been vindictive. He’s done some things I know he wishes he hadn’t, but he did them. He’s stood up for freedom of
speech and those things that we’re supposed to have in America. Unfortunately in the controlled environment of the golf world, we don’t really have that freedom, you know?” says Peter Kostis when asked if Ken Green is being treated unfairly by the PGA Tour. And this is coming from someone who is universally regarded as one of the most upstanding and legitimate human beings inside and outside of golf.
With all the defense Green is given you’d think he was Al Czervik to the PGA Tour’s Bushwood Country Club, or even Mitch Cumstein, but he’s not close to being even Ty Webb. Green simply spoke his
“He’s stood up for freedom of speech and those things that we’re supposed to have in America. Unfortunately in the controlled environment of the golf world, we don’t really have that freedom, you know?” says Peter Kostis when asked if Ken Green is being treated unfairly by the PGA Tour. mind in his heyday and was roundly reprimanded for it. That should be all there is to it, but that’s not the case. His estimation is that he’s been fined over 30 times and he’s mentally cataloged fines he’s received when the exact same action from others received nary a peep. (The one he remembers fondly is when he hit a sprinkler-head in anger and was fined, while Arnold Palmer [Green’s biggest
idol] doing the same was ignored, and while Ken Green is not The King, the fact is that golf is not a subjective sportit has rules and those rules, by the very nature of the game, are supposed to be enforced uniformly). He recalls a time in the 90s when he received a call from then, as now, PGA Tour Commissioner Tim Finchem, for wearing bright pants. “He calls me and says the pants that I’m wearing are not professional and that I need to stop,” Green recalls. When asked if he is sure it was the Commissioner himself, Green replies, “Oh yeah, it was Finchy alright.” And that’s when this story gets interesting. THE PING THING
In 1989, golf equipment visionary Karsten Solheim had a serious problem. His PING wedges were in a vast majority of every Tour player’s bag and his PING EYE 2 clubs were the bestselling club in golf. The problem was that would all soon end if things continued as they were.
There are two organizations that collaborate in the development and enforcement of the rules of golf in the United States and around the world. The Royal and Ancient in Scotland, and the United States Golf Association (USGA) in New Jersey. Together these two organizations set the standards for play both for professional and recreational golf. In 1989, the USGA had determined that the PING EYE 2 clubs had what were known as “square grooves,” and that these grooves in fact provided an advantage versus non-square, or V-shaped, grooves. The USGA claimed these grooves were 5/1000s of an inch too wide.
Solheim, an immigrant from Norway and one of the pioneers of golf club design, was panicked. His golden goose was about to get cooked and he was running out of options. The USGA was banning his number one club from professional competition beginning in March of 1990 and for everyone else beginning in 1996. He strongly believed that the USGA’s measurement system was ‘’arbitrary, incon-
sistent, unreliable and not a recognized standard of measurement’’ and so he did what he thought was his only option, he sued the USGA and he sued the PGA Tour (which had agreed with the USGA that the clubs were “bad for the game”). And while the suit against the USGA could be fronted by himself and his company, Karsten Manufacturing Corporation, the suit against the PGA Tour needed the likes of Tour players who were at the time using his clubs. He needed Touring pros involved whom he could count on to support the lawsuit and speak out for the amateurs who used the planet’s best-selling golf clubs. After all, if the pros were barred from playing them, the public would soon dismiss them. At the time, there were three top Tour players on staff (meaning sponsored) with PING, and they were Ken Green, Mark Calcavechia, and Bob Gilder. Calcavechia declined to participate, while Bob Gilder, who was on the downside of his career, agreed to have his name added to the suit. When Green was approached he recalls, “I told him I would do it. I liked Karsten, he was a good man, and what the USGA and the Tour was trying to do was not right. It was arbitrary and Karsten needed some of the Touring pros to stand up and be heard.”
And so Green’s name was the highest profile player on the nine player lawsuit (which included PING) against the PGA Tour. Calcavechia’s decline of participation was, according to Green, because of fear of retribution. While golf competition is a merit-based endeavor, the Tour and the sponsors, who work hand in hand, can affect players receiving sponsor’s exemptions as well as how medi-
Despite rarely being allowed to play, when he does, Green is delighted to see old friends like Peter Jacobsen (center) and Toledo Esteban. (Above: The front cabin of the RV from the accident in 2009).
cal exemptions are handled2, tee times in many tournaments, and who you are paired with for the first two days of tournaments (in a famous line from Sports Illustrated writer Alan Shipnuck’s book Bud, Sweat and Tees, he relates the organizers of the Masters pairing players they didn’t like with Scott Hoch, an irascible hot-tempered sour-puss).
In early 1990, the USGA settled the suit with Solheim and unbelievably conceded that “there was no competitive advantage to a user of the club” and that the issue was merely a technical one based on their math, as Solheim had insisted all along. In return, PING agreed to stop manufacturing the U-shaped grooves with the condition that all pre-1990 Ushaped clubs were grandfathered in. The USGA admitted that they settled the lawsuit in essence because they feared a loss in the courts would weaken their already precarious grasp on global golf control. The New York Times reported in January 1990: “William C. Battle, president of the U.S.G.A., said the compromise was a ‘’reaffirmation of the U.S.G.A. as the sole rule-making body’’ in United States golf. It had been feared by many in golf that a jury verdict against the U.S.G.A. would severely undermine the association’s authority as a rule-making organization.”
That statement speaks volumes about the mentality of these organizations. Instead of adjudicating their position, a position that they had taken unilaterally and stood by steadfastly (until a lawsuit required them to actually provide facts and details), they just caved in and admitted they were actually full of it and that the clubs didn’t actually provide an unfair advantage as they had harrumphed and harangued all along. And not only that, but they claimed their cav-
2 Rob Bolton, from the PGATOUR.com, posted a note on the “2014-2015 PGA TOUR MEDICAL EXTENSIONS” webpage in response to someone confused about Mike Weir’s status on Tour vis a vis his recent medical extension. Mr. Bolton wrote revealingly: “The summary of a very long explanation is that every golfer has his own formula based on recent seasons and current status. And even after that’s plugged in, the final decision rests with the commissioner.” So there are rules, except when there aren’t.
ing was “a reaffirmation of the USGA as the sole rule-making body”! That’s like saying the previous year’s World Series champs successfully defend their title despite calling in sick for this year’s series.
And why did they cave before they actually had to support their claims? The answer is in the President of the USGA’s own words; so they didn’t have the chance of losing the case, and not just losing for the sake of losing this specific case, but “severely undermining the association’s authority as a rule-marking organization.” In the real world, the world where Ken Green and others live, the world where you stand by what you believe in because you believe in it, and you believe that your influence on others and their livelihood should be handled with the utmost respect, thoughtfulness and responsibility, you go forth with such a case because you believe it to be the right thing to do. You don’t give up simply because if you lose it means you don’t get to bully everyone else around until the end of time. At the end of the day, if you lose a case
It would be nice if, when asked to account for very serious issues, the USGA and its golf-governing brethren didn’t behave like 16th Century French Monarchs.
like this, perhaps you shouldn’t have the right to make the rules for everyone else, which of course was expressed by exactly no one at the USGA, the PGA, or in the media. The suggestion that if you do in fact lose this case perhaps means you don’t know what you’re doing and you shouldn’t be solely in charge of the livelihood of professionals and the enjoyment of the masses, was reported by no one. And what does it say about just how little the USGA cares that this horrendous admission gets out into the open that they have their President go on the record and admit that they really didn’t care about losing the case against PING but that they didn’t want to risk losing their control of the very people they caved to
in this instance? At the end of the day the USGA, and later the PGA Tour (which, it needs to be noted, is different from the PGA of America), would be revealed for what they are: a small group of individuals, gathered under a self-proclaimed banner of authority, with the sole goal of maintaining that authority for no other justification than that’s what they want, that’s what they’ve become accustomed to, and that’s the way it’s always been done. And when it comes time to follow through on an attempt to prohibit people and companies from making an honest living, the sole largest consideration in whether they halt their attack is whether, when it’s all over, there’s a chance their authority over everyone else will be weakened. And while five paragraphs might seem like too much piling-on these organizations, it also might be the entire point of this story; self-appointed, century-old institutions (taken together the PGA Tour and the USGA are over 200 years old) with way too much unchecked and unbalanced power and influence might just have outgrown their usefulness. Take for another example the 2015 US Open, administered by the USGA. By all accounts, including typically staid and diplomatic golf legend Gary Player’s, it was held at a crusted husk of a golf course. In unprecedented fashion the USGA was involved in the selection, development, construction and maintenance of the site. The venue was verbally eviscerated by those who participated in the nation’s Open (and those who didn’t) unlike any tournament that has gone before. And the USGA uttered not one word of contrition or mea culpa or even explanation, but was instead steadfast in its defense of the site
and the conditions, predominantly by way of a lock-step chorus-line of Fox onair talent marching forth to denigrate those who might outwardly claim the Emperor has no clothes.
Now, with the firm understanding that whining millionaire golfers should typically be handled as Tom Cruise’s Les Grossman character in Tropic Thunder suggests you handle whining actors (“You take their pants down and you spank their ass”) it would be nice if, when asked to account for very serious issues, the USGA and its golf-governing brethren didn’t behave like 16th Century French Monarchs. Meanwhile, despite the USGA suit being settled, there was still the case of the suit against the PGA Tour, and PING and the players were winning plenty of pre-trial victories, including an injunction filed by the players and PING against the PGA which prohibited the PGA Tour from enforcing their “V-Rule” edict. From the decision of the 9th Circuit Court of Appeals: “…concludes the evidence has shown there is a reasonable chance of success on the merits of Plaintiffs’ claims. Insofar as the conduct of the PGA TOUR, Inc. at the February 28,
1989 Board meeting, it is clear that the vote did not comply with the ByLaws of the PGA Tour, Inc.
The Court concludes there would be irreparable harm to the individual Plaintiffs as well as the corporate Plaintiff if the injunction is not imposed.
The Court has considered evidence of damage to reputation, the fact that the corporate Plaintiff has already lost some of its market share, and that there is a strong likelihood the consuming public emulates the equipment choice of professional golfers. The Court has also considered conflicting evidence as to the harm which may or may not be suffered by the individual Plaintiffs and concludes that irreparable harm will inure if the injunction is not imposed.
IT IS HEREBY ORDERED that the defendants PGA Tour, Inc., its officers, agents, servants, employees and attorneys and those persons in active concert or participation with them who receive actual notice of the order by personal service or otherwise are preliminarily enjoined, pending
the outcome on the merits from prohibiting the use of U-groove irons by enforcing, enacting or implementing the so-called PGA Tour V™-Rule adopted by its TOUR Tournament Policy Board at its meetings on February 28, 1989 and December 5, 1989, or otherwise, and from enacting, adopting or implementing any other regulation, rule or resolution which would have the same effect or nullify the effect of this Preliminary Injunction.”
This ground-breaking decision was appealed by the PGA Tour and they lost again- the Plaintiffs were walloping the Evil Empire. And so, on the eve of the trial that would determine who was finally right and who was wrong, the PGA Tour offered to settle the case by agreeing to abide by the settlement reached in the USGA case. The players and PING agreed and the authoritarian collapse was complete. BELOW: Green always makes a point of visiting hospitals or hosting terminal and sick children at the home he rents for the one tournament he is guaranteed to get into every year: the Senior PGA. Below he visited with two kids who wanted to meet the man who wasn’t letting a little disability get in his way, at the 2014 tournament in Michigan.
Green says he felt vindicated by all the pro-plaintiff decisions leading up the settlement, as well as by the admission by the USGA that playing the PING clubs was not an advantage. “We were in the right and we were standing up to a bully. The only reason, in my mind, that the Tour was even in this fight was because Karsten was not of the old-guard, the established golf-industrial-complex. Ask yourself who complained that the clubs, when measured, were five one-thousands of an inch off from an arbitrary measurement to begin with. Ask yourself who had that kind of equipment. Yes, the other club manufacturers. And the fact that the USGA even admitted that the grooves didn’t help improve play just goes to show you that the decision to ban the clubs was old-school fear-mongering and turf-protecting at its worst,” says Green twenty-five years later. And while that would seem to be a victory for Ken Green and his merry band of anti-establishment “free-speechers,” as Kostis would call him, the fallout would come fast and last for the rest of Ken Green’s life. Because while the case against the establishment may have been won, there was one man who represented the establishment as an attorney for the Defense, and who, according to Green, was involved in every single one of the gambits and moves by the PGA Tour during that lawsuit. This man would go on to play a very big role in every single professional golfer’s life for the next twenty-one years, up to and including today. And the name of that man is Commissioner of the PGA Tour, Tim Finchem.
days, but also for making his post-accident life a very tough slog.
“I get there are rules, and I follow the rules and appreciate the rules, but sometimes the rules need to be looked at and adjusted like everything else. The PGA Tour amends rules all the time. Ask Phil Mickelson about PING wedges in 2010. Ask Adam Scott about long putters today. But the rules not changing (the addition of a Major Medical extension in Category Three, ed.) doesn’t take into consideration the cold shoulder I’ve received from the tournament organizers and sponsors whom I would bet anything have been told by the Tour that I’m persona-non-grata,” says Green. Coming from anyone else, those words would have the distinct and unpleasant odor of paranoia and self-pity. From Ken Green, they carry considerable weight. They carry that weight because those who don’t go by the name Ken Green echo them. People like Peter Kostis, who has nothing to gain, in fact much to lose, by speaking out about his disbelief that
Green can’t get into more than a single tournament through a sponsor’s exemption in three years despite having more wins and US Ryder Cup inclusions than the majority of the field on any given weekend. Read that again: Ken Green has more wins and has been on the United States Ryder Cup team more times than at least half of all Champions Tour players on any given weekend. And he can’t get into a tournament. And there’s Maury Povich, who doesn’t say that the Tour seems to have become a closed ecosystem because Ken tells him that, it’s because Maury is a famous, successful, jet-setting, golf-loving celebrity who rubs elbows with others in the same boat who have the inside scoop. And finally, go to the source. Just look at the Tour players, who voted not to change the career wins category to include a Major Medical extension because they believed beyond a doubt that Ken Green would get sponsor’s exemptions at every turn. And he’s received one in three years.
THE OFFICE OF THE COMMISSIONER
Ken Green estimates that most of his fines (not including the phone calls and written locker-room warnings about loud pants and having a beer with Arnold Palmer inside the ropes at the Masters) came during his time on Tour right after the settlement of the PING lawsuit and during the first few years of Tim Finchem taking the helm at the Tour (Finchem took over as Commissioner of the PGA Tour in 1994). He has no love lost for the man he feels is responsible for not only coming down on him at every opportunity during his PGA Tour
Green with his 1989 Ryder Cup bag. His Ryder Cup participation is the only thing that allows him to be guaranteed to play one tournament a year- the PGA of America’s Senior PGA Championship, as the organization also oversees the Ryder Cup every four years.
Ken Green has an incredible, heartwrenching and yet inspirational story, one that no other player on any Tour can lay claim to. And yet when he asks tournament organizers to be allowed to play in even the lowliest tournaments… crickets.
Green has never had a problem pointing out that the Emperor, no matter where he is found, has no clothes. He lent his name to a lawsuit that claimed that much about the PGA Tour in the early 90s when he was at the top of his game and when others feared repercussions from on high. Today that honesty, candor and selflessness is keeping him from what would be an attempt at one of the greatest comebacks in American sports history. And those who know him know this isn’t some ill-conceived pipedream or publicity stunt. Those in the know know he can still play with the best of them. “We’ve talked about this (his comeback) a lot,” says Kostis. “I think this new prosthetic is huge, he’s made a lot of progress and I think with a few more tweaks I think he’ll be able to compete. Will he be able to win? Probably not, but I don’t think that’s his goal.”
Kostis says that Green’s short game and his putting is still at the top of the pro game. He compared his short game second only to that of Spanish short-game impresario Seve Ballesteros, who died of cancer in 2009. “In terms of quality, his short-game is almost equal to Seve’s,” says Kostis. Green is still as dangerous as they come on the golf course, but he can’t compete if he can’t tee it up.
or the weekends after that.” Says Green, “I want to be out there as an inspiration to people and to kids to never give up, to never stop trying and to never get too down on yourself. If anyone on this planet had reason to give up, it was me. My life, my livelihood, my wife, my son, my future—all gone in the blink of an eye. My self-esteem, everything that told me I was Ken Green, was blown apart all at once. If I can get back up and hobble around and compete on the Champions Tour like I know I can, can you imagine what that will do for people, for kids, for adults?” Green is not looking for a free pass into 20 tournaments a year. He thinks he can play seven or eight and that will allow him to keep his game sharp and show people what he can do, which will in turn show them what they can do. Everyone close to him and in the know believes he can do it. He believes he can do it.
And maybe that’s the problem. Maybe Ken Green scares people. He beat 20plus players with two legs at a Champions Tour event in 2013 on a single peg. Perhaps they’re worried that if they let him into tournaments he’ll not only charm the crowd (he’s undoubtedly one of the most fan-endearing players on any Tour, making self-denigrating wisecracks about his prosthetic and his game as he flails off-balance walking courses
like the treacherous Pete Dye course this year, as well as an unrivaled pro-am partner) but challenge, or obliterate, the status quo. Speaking of French Lick, site of the Senior PGA Championship this year, despite cliff-like conditions [remember his fixed ankle], Green finished tied with another 5-time PGA Tour winner, and USA Network golf analyst, Jim Gallagher, Jr., who is two years Green’s junior and has two healthy legs supporting his torso, and ahead of 10 other players as well. He is just the person to put a scare into the staid and established senior golf world consisting of players like Colin Montgomery and Bernhard Langer. And to them that’s scarier than an 8 on the scorecard. After all, if you’ve ever been on a driving range at a Champions Tour event, the word ‘reverence’ doesn’t begin to describe the attitude expected from onlookers, the media and even organizers. Ken Green doesn’t do reverence. “Nobody knows that my prosthetic was developed in coordination with the United States Department of Defense. I’m the only one using it right now, sort of putting it through its paces for the military. I bet that would be a great story, and I bet that would be something that everyone at every tournament would like to know and learn more about. But I can’t tell them because I won’t be there this
BELOW: Promotional piece for the docu-series being shot by the Health & Wellness Channel chronicling Green’s arduous attempt at a comeback.
“Nobody knows that my prosthetic was developed in coordination with the DoD. I’m the only one using it right now, sort of putting it through its paces for the military. I bet that would be a great story that everyone at every tournament would like to know and learn more about. But I can’t tell them because I won’t be there this weekend, or next weekend, 33
weekend, or next weekend, or the weekends after that,” says Green, his voice trailing off and his eyes welling up. You don’t have to scratch very deep to generate tears from Ken Green, they’re always right there, just below the surface.
Says Peter Kostis, “I hate clichés, but I’m going to use one now: Kenny wears his emotions on his sleeve. You always know what you’re getting with him. I think he’s gotten a bad rap over the years. There are times when he acted poorly, no question about it, and he regrets having done that, but he was honest. He never did the right things for the wrong reasons,
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he always tried to do the right things for the right reasons, and sometimes he did the wrong things, but he did them for the right reasons. If he had taken a deep breath once in a while and thought about what was about to come out of his mouth, it probably wouldn’t have come out of his mouth. But Kenny’s a good guy, and that’s my final answer.” It’s never been more clear that the sporting world is populated with some bad people who do bad things and most of the time get away with it until the straw breaks the camel’s back (or it’s caught on video). From Lance Armstrong to the ar-
mada of NFL players being perp-walked what seems like daily, the celebrification and subsequent fall from grace of our athletes has reached pandemic proportions. What we need more than anything right now is the story of a flawed person who says it like it is, stands up for what he believes, and refuses to give up when everything in his life says he should. What does it say about us that we would leave that man to rot on the trash-heap where we have discarded the others who are not worthy of shining his single shoe? What does it say about us when there’s still time to do something about it and we choose to remain silent?
meba o c s ’ n e K
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SIGN THE PETITION! Let’s help Ken get back on the fairways and greens and give him a chance at his own personal comeback and to show people the world over that anything’s possible if you try and never give up. Go to change.org and search “Ken Green” to sign the petition asking the PGA Tour to reconsider implimenting a Major Medical extension in the Career Wins category. Let’s make up for lost time and support the act of overcoming. If not us, who?
were, they would have done something about it. The last thing they want is an indictment of their high-margin private label supplement line, especially when they’ve been paying for something they’re apparently not getting. No buyer in their right mind at these retailers would condone telling their private label supplier, “Just put a bunch of crap in there and we’ll call it St. John’s Wort.”
WITH SUPPLEMENTS LIKE THESE, WHO NEEDS DISEASE?
hen the largest retailers in the country are caught selling fillers as the real deal, the entire store brand business is in desperate need of an overhaul.
Earlier this year, the NY Attorney General sent letters to four of the largest retailers in the Western Hemisphere: Wal-Mart, Target, GNC and Walgreens, informing them that 79% of their storebrand herbal supplements either did not contain the natural ingredients that were claimed on the packaging, or contained harmful ingredients to people with certain allergies
“Contamination, substitution and falsely labeling herbal products constitute deceptive business practices and, more importantly, present considerable health risks for consumers,” said the letters. The Attorney General told them to caeseand-desist selling the products. Harvard Medical School assistant professor Pieter Cohen, who is an expert on supplement safety, told the New York Times that “if this data is accurate, then it is an unbelievably devastating indictment of the industry.” The problem is that none of these companies actually manufacture their ownlabeled product, they are all manufactured in third-party factories. And to be honest, if companies like Wal-Mart, Target and GNC were aware that their storebrands were not what they claimed they
So those retailers rely on their private label co-packers to manufacture their products for them, which lets them off the hook, to an extent. When retailers choose their vendors for their store brands they typically have a ‘bake-off’ where the vendors all submit samples and pricing in an attempt to win the business. The problem is that the samples that are sent are almost exclusively hand-picked and custom curated just for these types of competitions. By and large the buyers at these retailers are aware that the samples they’re receiving are hand-picked and not indicative of what the consumer can expect on a day-to-day basis, but, the thinking goes, since everyone is cheating, it’s a level playing field. And at the end of the day, especially with supplements, what rules the store brands roost is pricing.
The laser-sharp focus on price over quality is where the train goes off the tracks, and at the end of the day, it’s the retailers who decide where to aim that laser. But since the competition is really all about price, the vendors are forced to go as low as they possibly can, which means dirt cheap. Most larger store brand manufacturing companies (and national brands) use the big-box and club business as a way to drive costs down on their own buying, not really caring too much about making money on the actual sales to the big retailers themselves. But the sales people who make the deals are not the ones who govern what goes into the bottles on a daily basis. Typically the sales and the internal buying departments have their own budgets. The sales person has their budget to hit and the
manufacturing department has their budget to hit, and, as we have likely seen with these four instances, the manufacturing end of the deal decided to cut corners because their pricing was squeezed. It’s also quite possible that the same manufacturer supplies supplements to all four of these retailers. We have written to these companies to ask for the suppliers involved in these recalls and we will pass along what we find out. The laser-sharp focus on price over quality is where the train goes off the tracks, and at the end of the day, it’s the retailers who decide where to aim that laser. But retailers know how the game is played, and they should (and do) expect their ‘vendor-partners’ to play a little fast and loose with quality when they are put under such incredible pressure to deliver breathtakingly low pricing. So responsible retailers do shelf audits of their products and any vendors found to be taking unexplained liberties are summarily dismissed and lose that business, often for a long time or as long as that buyer is on the desk.
What’s clear is that Wal-Mart, Walgreens, GNC and Target don’t do shelf audits of their supplement line, at least not seriously. So we have, in addition to asking these four retailers for the name of their supplement supplier, also asked them to institute blind, shelf audit, third-party testing of their supplement lines and to report those findings publicly no fewer than four times per year. If they choose not to do this voluntarily Health & Wellness Magazine has put them on notice that we will be doing the auditing ourselves and will absolutely release the information publicly. We hope that not only will this ensure that the actual manufacturer is aware that someone is checking up on them, but the retailer will now be forced to pay closer attention to what their vendors are selling them. At the end of the day, these retailers have their name on the bottle, and if that’s not enough to get them concerned about what they’re feeding their shoppers (which apparently it isn’t) then perhaps we can help rectify that unfortunate situation.
SIGNS, SIGNS, EVERYWHERE THE ER SIGNS
ive years ago the Emergency Room wait-time billboard was newsworthy. Today you can’t drive through the exurbs without seeing the ubiquitous manmade poplars festooning the countryside (except in Vermont and Hawaii where billboards are illegal). And while it would seem that Emergency Room wait times posted at the side of commuter highways would seem about as useful as ads for cheeseburgers at the entrance of the cardiac ward, the marketing potential is not lost on institutions that are in a dogfight for customers.
A company spokesman for HCA, a hospital consortium in South Florida, told Ad Age Magazine, that after putting up the billboards, all 12 of its South Florida hospital ERs saw “significant increases in the number of patients.” So you can’t argue with the results.
“There’s been that stigma back in the day that people would die in the waiting room or waiting for ER services and having quicker wait times would be that differentiator for us,” says Jessica Schmidt, Vice President of Brown Parker Demarinis, an ad agency in Delray Beach Florida that handles HCA’s billboards. “When you’re scared you want to see a doctor quickly,” she says. And while not all hospitals believe in what some, like Dr. David Soria, chief of emergency medicine at Wellington Regional Medical Center and reported in a 2012 Sun-Sentinel article, term as “a gimmick,” there is no ques-
tion they get people’s attention. But in order for them to achieve what they’re trying to achieve, that is to convince you that the institution that you wish to trust your health and wellbeing to is actually a finely run institution dedicated to taking care of you better than anyone else, you have to believe what they’re telling, or more accurately, selling you, on their billboard. “Consumers are definitely skeptical about what (the times) mean. I think a lot of our clients have really gotten back to the idea that let’s be truthful and honest about what that (time) means. And it no longer means the first time you see someone, it actually means, not all the times, but lots of times, means when you’re seeing medical care,” says Schmidt.
A recent study found that those waiting times however, were incorrect by an average of 29 minutes.
If you do an unscientific study, like we did, of listed wait times in your town, you will find that rarely will an ER wait time be listed higher than 20 minutes, with many in the single digits or mid-teens. In fact, in a moderately more scientific survey, we visited websites which reported wait times and found no wait time higher than fifteen minutes. The reason for this is obvious but not encouraging. Firstly, once you put up a field-engulfing billboard with a digital counter on it, it’s not like you can just hide it when the ER gets busy. And secondly, nobody wants to list a 45-minute wait time for all the world to see- that’s just doing your competition’s job for them. So it’s no surprise that the marketing department’s brilliant idea has led to some fudging, or more accurately, some bandaid-ing, of the actual wait times. “It’s something that is very hard to put your arms around, very hard to police and very hard to validate,” says Soria.
When you think of the appeal however, it’s actually counter-intuitive, or it should be. Would you go to a restaurant that continually advertised how empty it was? The suggestion that your waiting area is full of crickets and no patients actually being a good thing perhaps indicts the entire premise of the ER wait-time billboards, and maybe even the hospital system itself. The fact that we as consumers of medical treatment interpret that a patientless ER means good instead of bad would seem that we cannot bring ourselves to believe that consumers actually make choices on quality, instead of speed. This, of course, is the fault of those ER’s that promote their ER wait times day in and day out, and of course our culture that demands it now and in 38 different flavors. Another problem is that the posted wait times are rolling averages (that include patients brought in by ambulance) collated over several hours and updated every thirty or sixty minutes. Patients who then check the billboard on the way to the ER after slicing their finger in the bagel-cutter might be disappointed that the time posted on the billboard is well below the actual time they waited in line to see someone and might make the (possibly incorrect) inference that that hospital is of low quality. The also might take their more expensive and more elective future requirements elsewhere, creating the exact opposite reaction the ER billboards are intended to create.
The most significant medical problem these signs can pose however is leading you to hospitals that might not be ideally suited for your particular needs. If you’re experiencing chest pains it would stand to reason that you might head to the hospital you’ve routinely noticed has the lowest wait times, regardless of whether you know it has a cardiac department. Most patients also understand that life threatening issues will be moved to the front of the line, but again, when the counter reads “44-minutes,” how far away is the front? At the end of the day consumers need to become familiar with their surrounding hospitals, especially if they have children. Most Americans live near no more than one or two convenient hospitals in the first place so the time to become familiar with each is not only simple but necessary. And if you really have a serious medical emergency the paramed-
ics are going to be the ones to determine where you end up, not some pixelated placard eighty feet in the air that you ogle to pass the time during your daily commute.
(h/t NY Mag)