NFL, DEA spar

Af­ter con­tentious meet­ing in 2011, league ‘chose to ig­nore’ DEA guide­lines

The Washington Post - - FRONT PAGE - BY RICK MAESE

League’s med­i­cal per­son­nel took four years to im­ple­ment pre­scrip­tion drug guide­lines af­ter meet­ing with agency of­fi­cial.

On a cold day in Fe­bru­ary 2011, doc­tors and ath­letic train­ers from the NFL’s 32 teams gath­ered at a ho­tel ball­room in down­town Indianapolis. Un­der scru­tiny for its han­dling of pre­scrip­tion drugs, the league had in­vited the Drug En­force­ment Ad­min­is­tra­tion, and an of­fi­cial named Joseph T. Ran­nazz­isi made the trip from Wash­ing­ton armed with more than 80 slides of charts, pho­to­graphs and bul­let points about fed­eral laws that gov­ern how the doc­tors can med­i­cate pro­fes­sional foot­ball play­ers suf­fer­ing from pain and in­juries.

The pre­sen­ta­tion was called “NFL Physi­cians Brief­ing: Obli­ga­tions and Re­spon­si­bil­i­ties un­der the Con­trolled Sub­stances Act and Code of Fed­eral Reg­u­la­tions.” It did not un­fold as planned.

The NFL doc­tors grew de­fen­sive, then an­gry, ac­cord­ing to par­tic­i­pants in the room, as Ran­nazz­isi lec­tured them on their du­ties and re­spon­si­bil­i­ties in the con­text of the opi­oid epi­demic that was sweep­ing the coun­try. The doc­tors felt they were be­ing com­pared to pill push­ers, and the meet­ing be­came con­fronta­tional. “He was treat­ing every­one like a crim­i­nal,” said one doc­tor in at­ten­dance.

The teams’ med­i­cal per­son­nel were un­happy with the DEA of­fi­cial’s tone, his mes­sage and the laws he was out­lin­ing. Groans, cat­calls and even some boos filled the ho­tel ball­room at times.

“I’d done hundreds of pre­sen­ta­tions,” Ran­nazz­isi said in a re­cent in­ter­view. “I’d never ex­pe­ri­enced that be­fore.”

“It was about as con­tentious as you can imag­ine a pro­fes­sional meet­ing get­ting,” an­other par­tic­i­pant said.

Af­ter the meet­ing ended, the doc­tors re­turned to their teams and con­tin­ued ad­min­is­ter­ing pow­er­ful painkillers and anti-in­flam­ma­to­ries in ways that of­ten

counter to fed­eral guide­lines. It would be four years un­til the NFL fully in­sti­tuted rules and prac­tices that ad­dressed the DEA’s con­cerns over the way teams travel with pain med­i­ca­tions, store them at their prac­tice fa­cil­i­ties and ad­min­is­ter them on the road.

The is­sues Ran­nazz­isi warned team doc­tors about would be­come the heart of a DEA investigation into the NFL’s pre­scrip­tion drug prac­tices and the crux of a law­suit in­volv­ing more than 1,800 former play­ers who say teams im­prop­erly med­i­cated them dur­ing their play­ing ca­reers. The law­suit paints a cava­lier at­ti­tude within the NFL about the quan­ti­ties of drugs dis­trib­uted to play­ers and al­leges teams were reck­less in the way they han­dled, stored and trans­ported med­i­ca­tions, fail­ing to main­tain proper records and al­low­ing non­li­censed per­son­nel, such as team train­ers, to dole out pre­scrip­tion drugs.

One trainer, for ex­am­ple, said his team was at a “com­pet­i­tive dis­ad­van­tage” be­cause it wasn’t us­ing a pow­er­ful anti-in­flam­ma­tory called To­radol like other teams at the time, ac­cord­ing to a court fil­ing. The former play­ers cited doc­u­ments ob­tained in dis­cov­ery that showed in one cal­en­dar year the av­er­age team pre­scribed nearly 5,777 doses of non­s­teroidal anti-in­flam­ma­tory drugs and 2,213 doses of con­trolled med­i­ca­tions to its play­ers.

The 2011 Indianapolis meet­ing marked a flash point for the NFL in which team med­i­cal per­son­nel were ad­vised of the fed­eral laws they later would be ac­cused of vi­o­lat­ing. Those in the Indianapolis ball­room say the doc­tors were par­tic­u­larly frus­trated to learn they couldn’t travel with pre­scrip­tion-strength med­i­ca­tions across state lines to road games, as they had for years.

At one point, Ran­nazz­isi said, a doc­tor raised his hand and asked why the pres­i­dent is able to travel with drugs aboard Air Force One. The DEA of­fi­cial ex­plained that Air Force One is a mil­i­tary plane and statutes al­low ex­emp­tions for mil­i­tary air­craft to move drugs around the coun­try.

“I’m think­ing as I’m say­ing this, ‘ This is sur­real,’ ” Ran­nazz­isi re­called. “So he says, ‘ The mil­i­tary is ex­empt? Well, think of our play­ers as war­riors ev­ery Sun­day on the field of bat­tle.’ I was stunned.”

Cit­ing pend­ing lit­i­ga­tion, a spokes­woman for the NFL Physi­cians So­ci­ety de­clined to com­ment. The NFL de­liv­ered a re­sponse Thurs­day to an in­quiry from four Demo­cratic mem­bers of the House En­ergy and Com­merce Com­mit­tee and cited the meet­ing, say­ing that team doc­tors pre­vi­ously had been told by the DEA that they were in com­pli­ance with fed­eral law.

“It rep­re­sented a sig­nif­i­cant de­par­ture from the way that team physi­cians in all sports had been prac­tic­ing medicine for decades,” Dennis Cur­ran, the NFL’s se­nior vice pres­i­dent and gen­eral coun­sel, wrote the law­mak­ers. “Much of this ad­vice con­tra­dicted writ­ten and oral ad­vice that DEA agents had pro­vided to in­di­vid­ual teams over time.”

The 2011 meet­ing fol­lowed un­re­lated DEA in­ves­ti­ga­tions into team drug prac­tices in San Diego and New Or­leans. The DEA had briefed league per­son­nel at least three times in the pre­vi­ous year, and NFL of­fi­cials felt a pre­sen­ta­tion might bring all 32 of the teams up to date on the fed­eral laws that reg­u­late pre­scrip­tion drugs. In a re­cent in­ter­view, Ran­nazz­isi said he wanted the doc­tors to un­der­stand, “you can’t just do what­ever you want to do.”

“And the funny thing was, I was there to help them. I wasn’t look­ing to take ac­tion against any­body,” he said. “I wanted them to un­der­stand if they were do­ing what I think they were do­ing — if they were just hand­ing out drugs to play­ers — they weren’t do­ing the play­ers a ser­vice as pa­tients.”

‘ The law is the law’

Mid­way through the pre­sen­ta­tion tai­lored for the NFL, Ran­nazz­isi shared a slide of “Fre­quently Asked Ques­tions,” which high­lighted many of the po­ten­tial prob­lem ar­eas the DEA had iden­ti­fied, in­clud­ing: Is it a vi­o­la­tion to keep con­trolled sub­stances at an un­reg­is­tered lo­ca­tion? Is it a vi­o­la­tion if I travel with con­trolled sub­stances? Is it a vi­o­la­tion to is­sue a pre­scrip­tion for a con­trolled sub­stance in a state that I am not reg­is­tered in?

“But ba­si­cally, every­one got so [an­gry], they didn’t buy into it. The mes­sage was lost,” said a doc­tor who was in the room. “The league un­der­stood the mes­sage be­cause they’d had other meet­ings with the DEA, but the league chose to ig­nore it.”

At the time, Ran­nazz­isi was the deputy as­sis­tant ad­min­is­tra­tor at the DEA, head­ing up the Of­fice of Di­ver­sion Con­trol. He re­tired from the DEA in 2015, hav­ing de­liv­ered hundreds of pre­sen­ta­tions and tes­ti­fy­ing be­fore Congress nearly three dozen times.

As part of his pre­sen­ta­tion, Ran­nazz­isi told the team doc­tors about the na­tional opi­oid epi­dem­ran and he ex­plained that in Florida, pain clin­ics were rak­ing in mil­lions of dol­lars by lib­er­ally pre­scrib­ing ad­dic­tive painkillers.

“He was lump­ing all of the NFL doc­tors with the pain fac­tory doc­tors,” said one team doc­tor who at­tended the meet­ing. “. . . The whole thing went over like a lead bal­loon.”

Late in the meet­ing, Ran­nazz­isi said, a doc­tor from the Dal­las Cow­boys com­plained that fed­eral statutes don’t take into ac­count the chal­lenges posed by pro­fes­sional sports teams that travel out of state for games.

“I told him, ‘ The law is the law,’ ” Ran­nazz­isi said. “He said, ‘Well, my owner knows mem­bers of Congress, and he’ll get the law changed.’ ”

In March, The Wash­ing­ton Post pub­lished details of the former play­ers’ court fil­ing in their law­suit against the NFL’s 32 teams that al­leges in­stances in which team and league of­fi­cials were made aware of abuses and likely vi­o­la­tions of fed­eral law. In most cases, the teams were ei­ther slow to re­spond or ig­nored the reg­u­la­tions en­tirely, the play­ers said.

The day af­ter the ar­ti­cle ap­peared, Rep. Pete Ses­sions (RTex.) in­tro­duced a bill in Congress that es­sen­tially would al­low pro­fes­sional sports teams to travel for up to 72 hours with un­lim­ited amounts of pre­scrip­tion drugs. They could ad­min­is­ter those drugs on road trips as long as they kept proper records.

“I be­lieve this is an ex­tremely im­por­tant is­sue for all doc­tors, sports doc­tors in par­tic­u­lar, and this bill will pro­vide them with the op­por­tu­nity to pro­vide their ath­letes and pa­tients with much­needed med­i­cal care un­der the author­ity of the DEA,” Ses­sions said.

Ses­sions in­tro­duced a sim­i­lar mea­sure in De­cem­ber 2011, nine months af­ter the heated DEA meet­ing with NFL doc­tors in Indianapolis, and an­other in July 2015. Nei­ther got out of com­mit­tee. Ses­sions’s of­fice said the Cow­boys’ long­time team doc­tor, Daniel Cooper, first brought the is­sue to the con­gress­man’s at­ten­tion.

Ses­sions’s dis­trict in­cludes parts of Dal­las and sub­urbs to the north and northwest of the city. Even though nei­ther the Cow­boys’ head­quar­ters nor their sta­dium is based in the con­gress­man’s dis­trict, the team has taken a re­cent in­ter­est in help­ing Ses­sions keep his of­fice.

Cam­paign fi­nance re­ports show that the Cow­boys never do­nated to the 11-term con­gress­man be­fore his most re­cent re­elec­tion bid in 2016. That’s when the fam­ily of Cow­boys owner Jerry Jones be­came ac­tive donors. The most an in­di­vid­ual can con­trib­ute to a can­di­date in an elec­tion cy­cle is $2,700. Within a two-day pe­riod in De­cem­ber 2015, Ses­sions re­ceived that ex­act amount from Jones, his wife, all three of his chil­dren, each of his chil­dren’s spouses and four of Jones’s grand­chil­dren — a to­tal of $32,400.

Ses­sions also re­ceived $5,000 from the NFL last year, in ad­di­tion to a $1,500 do­na­tion in 2012. Cooper has made three do­na­tions to Ses­sions, to­tal­ing $2,000, but none since 2007. He sent a let­ter to Ses­sions in Jan­uary 2012, ac­cord­ing to a court fil­ing, urg­ing for a change in the law.

A spokesman for the Cow­boys de­clined to com­ment. Ses­sions’s of­fice did not re­spond to ques­tions about Jones’s cam­paign conic, tri­b­u­tions or pos­si­ble in­flu­ence on the pro­posed bill.

Other law­mak­ers had a markedly dif­fer­ent re­sponse to the claims out­lined in the ex-play­ers’ law­suit. Four House Democrats reached out to the NFL and the DEA, de­mand­ing an­swers to ques­tions about the use of pre­scrip­tion med­i­ca­tions in pro­fes­sional foot­ball and the way the NFL and the DEA have in­ves­ti­gated the mat­ter.

“Th­ese al­le­ga­tions sug­gest a trou­bling lack of re­spect for the laws gov­ern­ing the han­dling of con­trolled sub­stances, and raise ques­tions about the league’s ded­i­ca­tion to the health and safety of its play­ers,” the law­mak­ers, all mem­bers of the House En­ergy and Com­merce Com­mit­tee, said in a let­ter to NFL Com­mis­sioner Roger Good­ell.

‘All in com­pli­ance’

In 2010, the league’s drug prac­tices be­gan draw­ing in­creased scru­tiny from fed­eral au­thor­i­ties. The DEA of­fice in San Diego in­ves­ti­gated the pro sports teams there af­ter a Charg­ers player was found with 100 doses of Vi­codin in his pos­ses­sion dur­ing a traf­fic stop. At the same time, the DEA’s New Or­leans of­fice was look­ing into the Saints re­gard­ing the theft of con­trolled sub­stances. An At­lanta Fal­cons in­ter­nal memo that same year, re­vealed in the re­cent court fil­ing, stated: “We were also un­der the radar of the DEA be­cause of the large amount of con­trolled sub­stances or­dered.”

In Au­gust 2010, a group of team doc­tors joined El­liott Pell­man, the league’s former med­i­cal ad­viser, in Wash­ing­ton to meet with the DEA. Ran­nazz­isi gave a pre­sen­ta­tion sim­i­lar to the one he would de­liver six months later in Indianapolis.

The ex-play­ers’ law­suits filed in 2014 and 2015 drew the at­ten­tion of Depart­ment of Jus­tice, par­tic­u­larly the U.S. At­tor­ney’s Of­fice for the South­ern Dis­trict in New York. Later in 2015, the DEA ac­knowl­edged the ex­is­tence of a wide­spread investigation and said agents had in­ter­viewed NFL team doc­tors in mul­ti­ple lo­ca­tions. Ran­nazz­isi’s slide show from the Indianapolis meet­ing was shared with in­ves­ti­ga­tors, who also were briefed on what tran­spired in the ho­tel ball­room.

In Novem­ber 2014, the DEA con­ducted sur­prise in­spec­tions of NFL teams in three cities to see whether they were still trav­el­ing with con­trolled sub­stances. None were found, ac­cord­ing to the former ex-play­ers’ com­plaint in the law­suit, be­cause “the clubs were tipped off by a DEA em­ployee in ad­vance of the raids.”

Any case against the NFL teams or their doc­tors car­ried in­her­ent com­pli­ca­tions.

“Th­ese doc­tors are all in­de­pen­dently li­censed and reg­is­tered, so they’re the ones with the obli­ga­tions, not the sports teams,” said Larry Cote, who for­merly worked as as­so­ciate chief coun­sel for the DEA’s di­ver­sion sec­tion. “That’s where the DEA and the U.S. At­tor­ney’s Of­fice have prob­lems bridg­ing that gap and hold­ing sports teams li­able when it’s re­ally the obli­ga­tions of the doc­tors.”

While some doc­tors might con­tend any in­frac­tions were rel­a­tively mi­nor, Cote said that record-keep­ing vi­o­la­tions can some­times be in­dica­tive of larger prob­lems.

“When you’re talk­ing about trav­el­ing with the drugs, when you’re talk­ing about ad­min­is­ter­ing the drugs in states where most of­ten the doc­tors aren’t li­censed and when you’re talk­ing about train­ers hav­ing un­fet­tered ac­cess to the drugs, that’s where you’re get­ting into se­ri­ous vi­o­la­tions and po­ten­tial for di­ver­sion mis­use,” said Cote, an at­tor­ney at Wash­ing­ton-based Quar­les & Brady who spe­cial­izes in com­pli­ance and en­force­ment is­sues re­lated to the Con­trolled Sub­stances Act.

The league had long dis­cussed the idea of al­low­ing lo­cal doc­tors to pre­scribe and dis­trib­ute drugs to vis­it­ing teams, but some teams scoffed at the idea, fear­ful it would in­crease the risk of in­jury and put them at a com­pet­i­tive dis­ad­van­tage be­cause med­i­cal in­for­ma­tion would be shared. A hand­ful of teams pi­loted the pro­gram the next year. Four years later, in 2015, the NFL’s “vis­it­ing team med­i­cal li­ai­son pro­gram” went into ef­fect, and since then team physi­cians aren’t sup­posed to ad­min­is­ter pre­scrip­tion med­i­ca­tion at road games. The league says all of its teams are in com­pli­ance with the Con­trolled Sub­stances Act.

“I would say some of the changes were im­me­di­ate, but it took some time to get it done,” said a per­son fa­mil­iar with the meet­ing and the league’s poli­cies and pro­ce­dures in this area.

In a re­sponse to ques­tions about the Indianapolis pre­sen­ta­tion, a DEA spokesman said “dur­ing the meet­ing a num­ber of is­sues per­tain­ing to the trans­porta­tion and dis­pen­sa­tion of con­trolled sub­stances were dis­cussed.

“DEA has since learned that the league has taken steps to ad­dress the is­sues dis­cussed,” the spokesman said.

HARAZ N. GHANBARI/ASSOCIATED PRESS

Then-DEA of­fi­cial Joseph T. Ran­nazz­isi out­lined fed­eral laws gov­ern­ing the trans­port and ad­min­is­tra­tion of pre­scrip­tion drugs.

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