Medical staff exist for player welfare, not for results, despite what Mourinho says

Chelsea’s medical staff have come under fire in the wake of the 2-2 draw with Swansea on the opening day of the English Premier League season. Club doctor Eva Carneiro has been stood down by Jose Mourinho for this weekend’s match against Manchester City – and seemingly for the rest of the season – but Mourinho’s comments and public airing of grievances are grossly out of order, writes Mark Houston.

In stoppage-time on Saturday, while Chelsea were locked at 2-2 with Swansea, Eden Hazard went down following a cynical challenge by Ashley Williams. The Belgian looked in a spot of bother and, after referee Michael Oliver had waved them on – which is an indication that he believed Hazard required treatment – Dr Eva Carneiro and physio Jon Fearn entered the field of play to tend to him.

Hazard was assessed, treated, and left the pitch with the two Chelsea medical staff before play resumed, and shortly after the resumption he was allowed back onto the field. Moments later the match finished in a draw.

“I wasn’t happy with my medical staff because even if you are a medical doctor or secretary on the bench you have to understand the game,” Mourinho said after the game.

“You have to know that you have one player less and if you go to the pitch to assist a player then you must be sure that a player has a serious problem. I was sure that Eden didn’t have a serious problem. He had a knock and was very tired. My medical department left me with eight [out]field players in a counter-attack after a set piece and we were worried we didn’t have enough players left.”

At first glance, it looks like classic Mourinho diversion. His side played poorly. He had his goalkeeper sent off. They drew with a mid-table side at home. Rather than speaking about any of that, he shifts the focus to something else; this time, his medical staff (and an incident which had no bearing on the result). Everyone laps it up, it steals the headlines and it’s a new story everyone is talking about, rather than about the match itself.

Jose Mourinho expresses his frustration.
Jose Mourinho expresses his frustration.

Mourinho notoriously deflects attention away from his players – and it’s safe to assume that this was the purpose. However, publicly calling into question the way medical professionals react and their need to consider how their actions can impact on the result of a match is a step too far, and one which the Premier League and PFA should be addressing.

Jason Burt in the Telegraph wrote one of the very few pieces which looks at the ramifications for the medical professionals in football in the wake of the Mourinho comments – rather than just reporting that Carneiro had, perhaps wrongfully, been demoted in another display of Mourinho’s nasty streak which rears its head from time to time.

“There is a professional responsibility,” explained Michael Davison to Burt in his piece.

Davison is the managing director of Isokinetic Medical Group, a FIFA Medical Centre of Excellence in London, and has vast experience of working with sports bodies – including football clubs.

“There is a moral and ethical duty of care and it is not in their professional code to act in anything but the health and safety of the player. They cannot consider the tactical ramifications if they feel the player needs immediate care. Of course they also can make the judgment of how serious it is. But where managers can influence the medical team entering the field, there can be issues.”

Burt adds: “Davison says that there is also the risk that if the physio or doctor fails to act, and there is a serious problem, they would face the wrath of their own professional bodies such as the General Medical Council.”

And those serious problems do occur on the football pitch. In 2012, during an FA Cup tie between Bolton and Tottenham, Fabrice Muamba collapsed. The former England U21 midfielder lay on the pitch, lifeless, for seven minutes before he was rushed down the tunnel and eventually on to London Chest Hospital, while players from both sides consoled one another – many in tears – with no idea of whether he was dead or alive.

His heart didn’t beat for 78 minutes, he was essentially dead for over an hour, but he was, incredibly, revived by hospital staff – and a heart specialist who happened to be in the crowd that day – before regaining consciousness three days later.

Antonio Puerta and Marc Vivien Foe were involved in similar incidents to Muamba, only they were not able to be revived and are two of the highest profile players to have died while playing a match. In 2015 there have been six recorded cases of professional or semi-professional footballers dying on the pitch due to heart-related conditions or head injuries, including Belgian Gregory Mertens.

Let’s say Muamba plays for Chelsea currently, and his incident occurs in the 93rd minute of a Champions League knockout match instead of happening back in 2012. What if, because of potential repercussions involving their job security because of Mourinho’s stance with the Hazard incident, the club doctor delays entering the pitch, unsure of why the player has gone down and with an important result hanging in the balance? In situations like this, every second can be crucial, and player welfare should always be the number one priority.

There will now be added pressure on Chelsea team doctors, and doubts may creep into their heads as they second-guess whether or not they should enter the field of play to tend to a potentially injured player. A precedent has now been set that if they get it wrong in the eyes of The Special One they may face the axe. Thanks to the treatment of Carneiro, there is a legitimate fear of job loss or demotion if they are too hasty in checking on a player who has gone down. Medical staff are expected to act independently from any coaching or business decisions – the imperative is to ensure player safety. The moment there is any external, unqualified influence on the medical professionals it jeopardises the safety of the players.

And this is why Mourinho’s “I Know Better” attitude and chutzpah towards his staff (“I was sure that Eden didn’t have a serious problem”) is a major issue; and one that a man who is so renowned for being intelligent, meticulous and calculated should really be aware of.

In effect, the Chelsea manager is undermining the process of independent medical assessment and intervention because the result of the match is more important.

Most sports are moving in the other direction. Rugby union, rugby league and AFL have introduced more stringent concussion guidelines at all levels in the hope that tragedies like that of Ben Robinson can be prevented.

Cricket helmet manufacturers have released new designs to provide more protection in the wake of the death of Phillip Hughes, and you can see a very different reaction from fast bowlers when a player is struck by the ball to what we used to.

Football has responded to incidents like those of Foe and Muamba, with the FA making 900 defibrillators available to Premier and Football League clubs to have on standby at English grounds. However, the fact that not one of the Chelsea hierarchy, the Premier League nor the PFA have spoken out against Mourinho’s comments raises doubts about whether football considers player welfare a priority. Mourinho is box office, and often gets away with more than most managers because of his charismatic ways, but he needs to be pulled into line on this occasion.

Christoph Kramer returning to the field in last year’s World Cup Final, despite being clearly concussed following a collision with Ezequial Garay, demonstrates that despite precautions taken in light of incidents like Muamba’s, football is still playing catch up. And Mourinho’s comments and public lambasting of his medical staff – who were only doing their job – only make the issue worse.

UPDATE: Since this article was written statements have been given by the Premier League Doctors’ Group, the Football Medical Association, and the PFA in support of the actions taken by Carneiro and Fearn.

Statement from the Premier League Doctors’ Group:

“Dr Carneiro has universal and total support from her medical colleagues at the Premier League Doctors’ Group. It is also of great concern that at a time when the both the Premier League and the Premier League Doctors’ Group are intensifying efforts to safeguard player welfare, the precedent set by this incident demonstrates that the medical care of players appears to be secondary to the result of the game.

“The Premier League Doctors’ Group considers that removing Dr Carneiro from the Chelsea team bench for their next match is unjust in the extreme. In the publicised incident in last Saturday’s game against Swansea, the Chelsea medical staff were clearly summoned on to the field of play by the match referee to attend to a player. A refusal to run on to the pitch would have breached the duty of care required of the medical team to their patient.

“It is a huge concern that Dr Carneiro has been subjected to unprecedented media scrutiny and a change in her professional role, merely because she adhered to her code of professional conduct and did her job properly.”

Statement from the Football Medical Association:

“If a player sustains or appears to sustain an injury and indicates that he needs assistance it is the duty of the referee to permit medical assessment and evaluation to be provided.

“At that moment, the player becomes a patient of the medical team and it is the duty and obligation of Club medical staff to attend to that patient accordingly and without prejudice to the interests of anyone else including the Club employing them.

“The Football Medical Association fully supports the actions of our members and colleagues in this incident who acted with integrity and professionalism at all times, fully consistent of the rules of the game and in full accordance with that duty of care to their patient. Factors extraneous to the immediate medical needs of the patient (such as the stage and state of the game) cannot be part of their consideration at such time.”

Statement from the PFA:

“The health and safety of our members is of paramount importance and the need, when required, for prompt assessment and treatment is critical in ensuring this.

“The player and the referee are the initial judges as to whether treatment is required and the matter is then the responsibility of the highly qualified and trained medical staff.

“This protocol has worked successfully in past seasons and we can see no justifiable reason to move away from this.”

About Mark Houston 86 Articles
Mark is an editor of The Blog FC and has also contributed to other sport and music sites. He predominantly writes about La Liga but also follows Europe's other top leagues and the local A-League. There's a special place in his heart for bearded deep-lying playmakers and he's a proud member of the Goalkeepers Union.