The NFL owes Jalen Hurts, and all of us, more than haughty dismissiveness New York Times (Online) Michael Silver Imagine medically evaluating an employee on an off-site work assignment, subjecting him to well-documented risk factors that could exacerbate the condition — and then having his symptoms worsen to the point where they are potentially life-threatening. Then imagine proclaiming to the world that you are in no way culpable, and that any suggestion that you could possibly have handled the situation differently is an affront to logic and decency. Throw in a touch of indignant condescension, and voila: You are the National Football League. On Tuesday in New York, NFL chief medical officer Dr. Allen Sills held a news conference at the league owners' meetings, during which he vigorously defended the Philadelphia Eagles' decision to let quarterback Jalen Hurts play with a superficial blood clot in an Oct. 11 game against the Jacksonville Jaguars in London. Hurts, 28, has since been diagnosed with deep vein thrombosis with bilateral pulmonary emboli — blood clots in both lungs — and is expected to miss the remainder of the season. Now the NFL, whose medical officials were in the loop when Hurts' initial blood clot was discovered the night before the game, is in full cover-your-ass mode. That's a curious strategy, given the dots that qualified physicians might connect, made worse by the assertion that none of us — even experts in the field — are qualified to question any of it. “If you're not sitting in that room with that patient and you don't have all the data, if you are speculating as a physician on what should have been done, you are unprofessional and unethical in doing that,” Sills said. Coming from a league that paid $765 million to settle a class-action lawsuit after being accused of having concealed evidence of the dangers of head trauma for decades, that's quite a bold statement. On Tuesday, I spoke with three experienced trauma doctors who questioned the way the Eagles and the NFL, in consultation with medical professionals in London, handled Hurts' injury. One of them, Dr. James Horowitz, said it was reasonable to suspect that playing in a football game and taking a seven-hour flight after the game could contribute to a pulmonary emboli, which can be fatal. (According to a statement by Hurts' agent, Nicole Lynn, he is being treated with blood thinners and expected to recover.) “I would point to trauma plus the flight — that's the first teaching point in Virchow's Triad ,” said Horowitz, the director of critical care cardiology at NYU Langone Health. “It's what a medical student would learn in residency.” The triad consists of three broad categories that contribute to blood clots, and “all of those things can be caused by either air travel or trauma,” Horowitz said. “It's just common sense.” However, when it comes to the NFL, common sense sometimes takes a back seat to another pressure point: the relentless push to play. This pressure typically comes from players, who desperately want to be there for their teammates and to do what's best for their careers, and from teams, who employ doctors conditioned to the prevailing ethos. Sills vehemently stated on Tuesday that team physicians want to put the patient first, insisting that any assertion otherwise is “nonsense.” Is it? While we don't know yet what happened with Hurts, the reality is that NFL teams want their best players on the field. If team doctors consistently err on the side of caution, they could be at risk of being replaced by a peers more aligned with the team's on-field needs. As Pro Football Talk's Mike Florio has repeatedly pointed out, if the motivations of team physicians were unassailable, there'd be no need for Unaffiliated Neurotrauma Consultants, independent physicians who work with the league's game-day medical teams to help spot and evaluate concussions and other potential brain injuries. Three UNCs are assigned to every game. The program, established in conjunction with the NFL Players Association, began more than a decade ago in the wake of the aforementioned class-action lawsuit and amid intense public pressure. On Tuesday night, the NFLPA pushed back on the league's finding that Hurts' situation was “handled appropriately,” issuing a statement that read, in part, “Before conclusions are drawn about how this situation was handled, there must be a full investigation into what occurred.” The collective bargaining agreement gives the union the right to launch such an investigation, via its joint Accountability and Care Committee with the league. On Wednesday, NFL commissioner Roger Goodell said the league would “welcome (an investigation). That's part of our processes.” That should be in everyone's interest, especially given the murkiness surrounding the situation. We haven't gotten the whole story from the Eagles, who absurdly and unfairly trotted out coach Nick Sirianni Monday as the sole organizational voice on the matter. General manager Howie Roseman, one of the league's most powerful executives, should have been the one being grilled by reporters about how the Hurts situation was handled. The perspective of Jeffrey Lurie, who has a strong track record as one of the best and most empathic owners in major professional sports, would also be helpful. Until we get all the answers, it is completely fair to wonder what the Eagles and the NFL were thinking when they allowed Hurts to play in the game and to fly home afterward. For even if Hurts was pushing hard to play, and even if doctors signed off on the decision, the team and league had an obligation to protect the quarterback from himself. According to Horowitz, who has extensive experience in the field, an ultrasound's finding of a superficial blood clot in his calf doesn't necessarily call for blood thinners. Sometimes, the treatment is as simple as elevating the affected area and placing a warm compress on it. However, other factors — experiencing pain, or having just taken a lengthy flight from Philadelphia to London, for example — could be viewed as potential risks. “The teaching is that superficial thrombosis shouldn't require blood thinners and should not lead to bigger problems,” Horowitz said. “It's a gray area. But if pain is progressing, that's a concern. If the clot is significant enough that a 28-year-old guy is complaining, that's also instructive. “Major trauma or a long flight can certainly exacerbate the clot. So can movement. Every time your leg pumps, your muscles are flexing, and they can compress the veins. There's a theoretical risk that if you walk it can pry loose. If the activity is very vigorous, it's a higher risk. “I think what is in the teaching is what is safe for the average person. I don't think there's any data to support anything involving someone playing a (professional) football game.” There is little debate that Hurts was likely to experience vigorous movement and impact-related trauma in the game against the Jaguars, which lasted three hours and 42 minutes. It would be one thing if the Eagles and NFL had ignored those risk factors, but nothing came of it. In this case, Hurts' condition obviously worsened, something that apparently wasn't addressed until days after the initial ultrasound in London. The fact that it took that long to do additional testing is yet another perplexing layer to this situation, reinforcing the need for an investigation. The scary thing is, the outcome could have been even worse. Pulmonary emboli have been responsible for some grave situations involving notable athletes, including Serena Williams, Chris Bosh and Victor Wembanyama. Williams had life-threatening pulmonary emboli in 2011 (after cutting her foot and undergoing surgery) and 2017 (after an emergency C-section); she has said she was “on my death bed at one point, quite literally.” Wembanyama, who was shut down in February of his second season after a deep vein thrombosis diagnosis, called the experience, and the accompanying risk of recurrence, “life changing.” Bosh, who retired from the NBA at 31 because of recurring clots, has continued to battle the condition; after another episode this past February, he said he was “lucky to be alive.” Hurts, too, is fortunate — and so are the Eagles and the NFL. Yet the league, with Sills as its public face, isn't acting humbled or grateful. Instead, on Tuesday, we got vague platitudes that reeked of defensiveness and dismissiveness. If the NFL truly acted in the best interest of Hurts, one of its most decorated and well-known players, an investigation should substantiate that. The league and the Eagles should have nothing to hide. Anything short of full transparency, to borrow from Sills, would be unprofessional and unethical.