The Patient Was…

The patient was not actually under my direct and personal care, but we intersected in an unusual way.

He was a renowned, world class, iconic athlete, who held records, and owned championship rings and trophies. He was generally recognized as an “ambassador” for sport and its impact on society.

In his thirties, he was still competing at peak form.

On one occasion, however, while running during a heated competition, he felt a pressure-like pain in his chest. He went to the sidelines, sat down, medical attention was summoned, and he was transported to the hospital for evaluation.

After a few days in the hospital he was released and, although he remained on “active” status in his sport, he did not compete any more that year. The problem that eventually brought him to my attention arose when it was time to issue him a new insurance policy for the following year of competition.  

Insuring celebrities, including athletes, has a long history. Some celebrities have insured themselves or their particular body parts for large sums on money, often as publicity stunts. Actresses, for example, have insured their legs and breasts; and an Australian cricket player is reported to have insured his moustache for almost $400,000 during his playing days.

Athletes’ salaries have grown dramatically, and their earnings, including from commercial endorsements and other business opportunities, have skyrocketed. Tiger Woods’ total earnings reportedly crossed the one billion dollar mark in 2009. Since athletes regularly risk career-ending injuries, the financial implications for both insured and insurer are huge. Insuring the life, health, and earning potential of athletes has become more complex.

When the time came to issue new insurance for the recently hospitalized athlete, the insurance company who had previously insured him declined to do so. This presented a big problem for a lot of people, because many others depended on this individual and his ability to compete, win, endorse, and earn. These other people  —  we’ll call them “Team Athlete”  —  insisted that the insurance company issue a new policy, but the company resisted because the risk, in their view, was too high.

The medical record showed that when the athlete was admitted to the hospital with chest pain, his electrocardiogram (EKG) was abnormal. An EKG measures the electrical activity within the heart; these electric signals are detected by small recording electrodes placed on both arms and both lower legs, and across the chest.  

The EKG showed a pattern recognized by physicians as indicating reduced blood flow to part of the heart muscle. After a few days in the hospital, the EKG reverted back to normal, suggesting that the heart muscle had not been permanently damaged. Blood tests showed that that assumption was correct: There was no heart damage. But with blood flow limited, the potential for damage under conditions of physical exertion was obviously there.

The financial implications for both the patient and “Team Athlete” were great. And the financial risk for the insurer was also great.

To help resolve the issue, a well known and highly respected cardiologist was asked to review the records. He was hired by “Team Athlete” with the remit to find a “benign” explanation for the abnormal EKG that had shown the potential damage to the patient’s heart. His explanation was that because the athlete was unusually tall –   and he was well above average height for an American male  —  the recording electrodes on his arms and legs were so far apart that they distorted the electric signals.

At this time, I was serving as a so-called Senior Premium Examiner for the insurance company that was involved. They had never heard of such an explanation for an abnormal EKG and, frankly, neither had I. But the cardiologist who had submitted the report was an expert, and the amounts of money involved were high. If the company did insure the athlete, the premium payments they received would be high, and they were assured of other insurance contracts by “Team Athlete.” But if they had to pay out the principal because of injury to the insured, it would cost them a lot.

The company asked me to review the records, especially the electrocardiogram, and to render an opinion.

The records were as reported. On admission to hospital, the EKG showed clear abnormality suggesting limited blood flow to heart muscle. A few days later, the EKG was normal.

My opinion, submitted to the company, said that I had never seen or heard of an abnormal EKG reverting to normal based simply on a patient’s height or the distance between the recording electrodes on his arms and legs. But I would accept it as possible  —  IF they could assure me that the patient had shrunk six inches between the time of his admission and discharge from the hospital.

I never heard back from the company about this case, and don’t know their ultimate decision about insuring the athlete. But I do know that he never competed again professionally.