June 4, 2012
In Hockey Enforcer’s Descent, a Flood of Prescription Drugs
By JOHN BRANCH
In his final three seasons playing in the National Hockey League, before dying last year at 28 of an accidental overdose of narcotic painkillers and alcohol, Derek Boogaard received more than 100 prescriptions for thousands of pills from more than a dozen team doctors for the Minnesota Wild and the Rangers.
A trove of documents, compiled by Boogaard’s father, offer a rare prescription-by-prescription history of the care given to a prominent, physically ailing athlete who struggled with addiction to some of the very drugs the team doctors were providing.
The scores of prescriptions came before and after Boogaard’s entry into the league’s substance-abuse program in September 2009 for an addiction to painkillers and sleeping pills.
Among the findings:
¶ In a six-month stretch from October 2008 to April 2009, while playing 51 games, Boogaard received at least 25 prescriptions for the painkillers hydrocodone or oxycodone, a total of 622 pills, from 10 doctors — eight team doctors of the Wild, an oral surgeon in Minneapolis and a doctor for another N.H.L. team.
¶ In the fall of 2010, an official for the Rangers, Boogaard’s new team, was notified of Boogaard’s recurring abuse of narcotic pain pills. Nonetheless, a Rangers team dentist soon wrote the first of five prescriptions for hydrocodone for Boogaard after he sustained an injury.
¶ Another Rangers doctor, although aware that Boogaard also had been addicted to sleeping pills in the past, wrote nearly 10 prescriptions for Ambien during Boogaard’s lone season with the team.
The records reveal the ease with which Boogaard received prescription drugs — often shortly after sending a text message to a team doctor’s cellphone and without a notation made in team medical files. They also show the breadth of the drugs being prescribed, from flu medications and decongestants to antidepressants and anti-anxiety pills.
Most striking, though, are the narcotic painkillers and sleeping pills, which Boogaard had a history of abusing.
“To see him have all that access to those doctors and all those prescriptions, that is mind boggling,” said Dr. Louis Baxter Sr., the executive medical director of the Professional Assistance Program of New Jersey and immediate past president of the American Society of Addiction Medicine. “He had such easy access to prescription medicines.”
The records paint an incomplete picture. They do not show what Boogaard told doctors or the degree to which he may have misled them. They do not indicate what the doctors knew, if anything, about Boogaard’s pursuit of drugs bought illicitly on his own. They do not reflect whether the doctors knew what other doctors were diagnosing or prescribing.
But, at the least, the records raise questions for hockey and professional sports of all kinds.
Do team doctors communicate with one another about the care they are giving or the drugs they are prescribing? Do they demand to see a player before writing a new prescription? Are team medical records monitored and complete? How much information is shared among doctors, team officials and administrators of programs like the N.H.L.’s Substance Abuse and Behavioral Health Program? Can a hockey player, especially one paid to inflict and to absorb pain, continue a career with an addiction to painkillers? And what role does the league play in all this?
The N.H.L., teams, team doctors and substance-abuse program directors involved in Boogaard’s care all declined to discuss any of that.
The league, the Wild and the Rangers were given specific examples of the care that Boogaard received. Each released two-sentence written statements defending the care and citing the guidance of the league’s Substance Abuse and Behavioral Health Program.
None of the doctors mentioned in this article would comment. Neither would Dr. Brian Shaw or Dr. David Lewis, co-directors of the Substance Abuse and Behavioral Health Program that they founded in 1996 through the N.H.L. and its players association. They took on oversight of Boogaard’s care after he was placed in rehabilitation in 2009. Dr. Lewis is a psychiatrist on the staff of the Canyon, a rehabilitation center in Malibu, Calif. Dr. Shaw is a psychologist based in Toronto.
Little is known about their program, even within the N.H.L.’s league offices. The league, saying that privacy is paramount, has said that it does not know at any one time which players are enrolled in the program. Requests to interview the directors, even about the general parameters of their program or their ability to oversee three leagues with more than 1,500 athletes, have been routinely denied.
A Player Needing Help
Derek Boogaard was an unlikely N.H.L. star. When he was a boy, his limited hockey skills were offset by his size and his willingness to use his fists. Raised in small-town Saskatchewan, he grew into a feared 6-foot-8 brawler.
He became one of the most popular players for the Wild before signing with the Rangers for $1.6 million a season. It was a rare sum for an enforcer, someone whose role is like that of a playground bodyguard — to intimidate, and occasionally beat up, opposing players, whether to settle a simmering dispute or to excite the crowd.
In six N.H.L. seasons, Boogaard scored 3 goals and was assessed 589 minutes in penalties.
His life was explored in a three-part series in The New York Times in December.
After Boogaard died on May 13, 2011, his family donated his brain to researchers at Boston University. In October, the family learned that Derek had chronic traumatic encephalopathy, or C.T.E., a brain disease caused by repeated blows to the head. For now, it can only be diagnosed posthumously, but some of the symptoms include memory loss, impulsivity and addictive behavior.
But Boogaard’s father, Len, wanted to know more. He has been a member of the Royal Canadian Mounted Police for most of 30 years, much of it as a small-town street cop. He set out on a hunt for documentation of his son’s life and the care he received as things went from bad to worse to unthinkable in Derek’s final years.
He requested and received Derek’s medical records from the Wild. The Rangers initially refused, but Boogaard eventually received them through the players association. He asked for records from the private practices of team doctors, too, and received them from most.
It seems certain that the records received were not complete. Many were missing pages. One practice’s file did not include a particular doctor who cared for Boogaard extensively. A dentist sent X-rays with no explanation.
Len Boogaard also obtained pharmacy records for his son through various drugstore chains. They provided store-by-store accounts of Derek Boogaard’s prescriptions, with dates, doctors, medications and dosages. After discovering the four-digit number used to identify Derek Boogaard to the drug-testing lab used by the N.H.L.’s substance-abuse program, Len Boogaard was sent his son’s drug-test results. He obtained a stack of notes from Derek’s stays at two California rehabilitation clinics.
He had hundreds of pages of Derek’s cellphone records. He organized the phone numbers of doctors and substance-abuse program officials to determine Derek’s day-by-day contacts with them. He had Derek’s bank and credit-card records, showing everything from fast-food purchases to binges of ATM withdrawals totaling thousands of dollars, believed to be used when Derek bought more painkillers from dealers.
Len Boogaard knows that his son supplemented his drug habit with purchases of pills from dealers in Minneapolis; New York; and Regina, Saskatchewan. But he has found no sign of abuse until injuries sustained in fights were followed by steady streams of pills provided by team doctors.
“Derek was an addict,” Len Boogaard said. “But why was he an addict? Everyone said he had ‘off-ice’ issues. No, it was hockey.”
At 7:11 p.m. on the date Derek Boogaard died, about an hour after the Minneapolis police say he was given at least one Percocet (oxycodone and acetaminophen) pill by his brother Aaron, Derek called Dan Cronin, a counselor for the league substance-abuse program, phone records show. The call lasted a minute. Boogaard and Cronin then exchanged seven texts over a 12-minute period. Boogaard went barhopping with friends and Aaron that night. Aaron and another brother found Derek’s dead body in his apartment the next afternoon.
Len Boogaard later contacted Cronin to ask about the nature of the exchange, wondering what his son’s last messages were to the counselor helping oversee his care. Cronin, in an e-mail, cited “privacy rules” and declined to answer Len Boogaard’s questions. He declined to answer questions from The Times, too.
Dr. Lewis and Dr. Shaw, co-directors of the program, referred all questions to the league and its players association. The N.H.L. provided a written statement: “Under the auspices of the NHL/NHLPA Substance Abuse and Behavioral Health Program, an NHL player receives individualized — and confidential — medical treatment, care and counseling. Based on what we know, Derek Boogaard at all times received medical treatment, care and counseling that was deemed appropriate for the specifics of his situation.”
The players association declined to comment. The Wild and the Rangers responded with short, written statements.
“The Minnesota Wild treated Derek’s medical status in accordance with the NHL/NHLPA Substance Abuse and Behavioral Health Program as we do with all our players,” the Wild wrote. “Due to patient-doctor confidentiality, the team is not able to comment further.”
It was pointed out to the Wild that most of the team’s care being questioned by Boogaard’s father came before Boogaard entered the program. The Wild stood by its statement.
The Rangers wrote: “We are confident that the medical professionals who treated Derek acted in a professional and responsible manner and in accordance with their best medical judgment. They took extraordinary steps to coordinate the medication prescribed for him with the professionals in charge of the NHL-NHLPA Substance Abuse and Behavioral Health Program.”
The Times shared Len Boogaard’s research with several outside experts in the drug and addiction fields. Most were reluctant to comment on Boogaard’s precise care without knowing the specifics of his injuries and the corresponding advice and counseling he may or may not have received.
But they took note of the persistently high dosages of medications Boogaard was prescribed, and the seeming lack of a primary doctor overseeing his care.
Baxter, from the American Society of Addiction Medicine, cited a three-step process for addicts: detoxification, rehabilitation and continuing care.
“Continuing care is probably the most important part,” Baxter said. “And it looks like he didn’t have much of that.”
Boogaard’s case provides a window into a world usually shuttered to outsiders. Like most major professional sports teams, the Wild and the Rangers have many doctors — eight for the Wild, seven for the Rangers — from orthopedic surgeons to dentists.
Team doctors are rarely seen by fans or journalists, but their decisions can determine everything from who plays in the next game to the long-term direction of lucrative careers.
The doctors presumably want to provide top-notch care, and might have been chosen by the teams based on strong reputations. But their unusual role suggests an inherent tension in their work. Players, accustomed to pain and concerned about contracts, want to play.
Teams, with fortunes riding on wins and losses, are eager for their top players to perform. The doctors usually have private practices, which they often market by boasting of their team affiliations.
Team doctors often want to help athletes return to competition, so “the tendency is to overtreat,” said Dr. Jane Ballantyne, a professor of anesthesiology and pain medicine at the University of Washington. She also noted that because the famous athletes have access to virtually any doctor they want, they often receive whatever treatment they want.
Gregory J. Davis, professor of pathology and lab medicine at the University of Kentucky, and an assistant state medical examiner for the Commonwealth of Kentucky, said he saw no “smoking guns” in the list of prescriptions. But he had plenty of questions.
“What does leap off the page is that this is a guy who is in desperate need of some help,” Davis said.
There were few signs of trouble during Boogaard’s first few seasons with the Wild, beginning in 2005, when he quickly established himself as a leading enforcer.
Documents show a marked shift after Oct. 16, 2008, when Boogaard lost a tooth during a fight with Florida’s Wade Belak. While it is unknown what drugs Boogaard received in South Florida that night, he was given a prescription for hydrocodone (often known by the brand name Vicodin) several days later by a Wild team dentist.
That was the start of a 33-day stretch when Boogaard received at least 195 hydrocodone pills from six doctors, records show. He received pharmacy prescriptions for most, but records indicate that some were dispensed directly from doctors, including the Wild medical director Sheldon Burns, a family practitioner who is also medical director for the N.B.A.’s Minnesota Timberwolves and a team physician for the Minnesota Vikings of the National Football League.
The hydrocodone prescriptions provided more narcotic painkillers in about a month than Boogaard had in his first three N.H.L. seasons combined, records show. And injuries and prescriptions kept coming.
Burns and Dr. Dan Peterson, who share a practice in Edina, Minn., prescribed 110 more hydrocodone pills from Dec. 4 to Jan. 1, records show. In April, with his season over, Boogaard had operations a week apart on his nose and shoulder.
During a 26-day period that month, Boogaard received prescriptions for 150 oxycodone (usually sold under brand names OxyContin or Percocet) and 70 hydrocodone pills from four doctors — the surgeons, plus Burns and Peterson.
“The problem with athletes is that they do get multiple injuries and therefore are given multiple courses of opiates,” said Dr. Ballantyne, the pain expert from the University of Washington. “A single course of opiates might be O.K. for normal people who only get injured once in a blue moon, but when injuries are frequent, it can easily turn into chronic treatment instead of just acute treatment. And athletes are at high risk of developing addiction because of their risk-taking personalities.”
The painkiller prescriptions stopped during the 2009 summer off-season. By then, Boogaard had found illicit sources for pain pills from street dealers, according to his family and friends.
Dr. Peterson and Dr. Burns continued to prescribe Ambien — five times, 30 pills each, over about three months of the off-season. Ambien, with a recommended dosage of one 10-milligram pill a day, is considered a short-term solution to sleeping problems, usually limited to a few weeks. The drug’s warning label notes that it can impair coordination and exacerbate depression, which Boogaard showed signs of having. It also says that overdoses can be fatal.
By fall, it was clear to those close to him that Boogaard had a drug problem, and the Wild caught on, too. During training camp in September, he was quietly placed in the league’s substance-abuse program, assigned to a live-in rehabilitation clinic in Malibu, Calif., because of an addiction to narcotic painkillers and sleeping pills.
Publicly, the Wild reported that Boogaard was taking time off to recover from a concussion.
On Oct. 9, 2009, when he rejoined the Wild as the team was on a West Coast trip, Boogaard signed a one-page document describing an “aftercare” program. The form was also signed by Dr. Shaw and Dr. Lewis of the league’s substance-abuse program, and Cronin, the alcohol and substance-abuse counselor.
The sheet directed Boogaard to abstain from any medications, including alcohol, “not specifically approved by Program Doctors or prescribed by Minnesota Wild Team Physicians.” Among other things, it said Boogaard must attend three “12 step” meetings a week and keep in “regular contact” with program officials. He would be randomly drug tested. It is unclear how much of any of that Boogaard did.
On Oct. 21, in the Wild’s first home game after Boogaard’s return, Boogaard badly beat Colorado’s David Koci in a fight.
Team doctors seem mostly to have stopped prescribing narcotic painkillers and sleeping pills during the 2009-10 season, after Boogaard’s rehabilitation assignment. Most of Boogaard’s prescriptions were for Trazodone, an antidepressant, and Tramadol, a different type of painkiller. Another prescription, in March, was for acetaminophen and codeine.
Highlighting the difficulty of treating a player subjected to continual pain without the use of powerful pain pills, Boogaard also received at least eight injections of Ketrolac Tromethamine, commonly known as Toradol, including six in a 10-day stretch of January 2010 after a shoulder injury. He often received acupuncture as a painkiller substitute, too.
Boogaard’s contract expired at the end of the season. The Wild made little attempt to re-sign him. But he was still only 28, with a lingering reputation for being among the toughest men in the league.
On July 1, 2010, Boogaard signed a four-year, $6.5 million contract with the Rangers.
The Rangers knew about Boogaard’s addiction problems. Doug Risebrough, a senior official with the Rangers, had spent about a decade as the general manager of the Wild. He drafted Boogaard in 2001 and instructed coaches to turn him into a big-league enforcer.
When Boogaard was sent to rehabilitation in September 2009, he called Risebrough, who had been fired by the Wild months earlier. In June 2010, now working for the Rangers’ front office, Risebrough met with Boogaard for a couple of hours, Len Boogaard said.
Once signed by the Rangers, however, Boogaard did not make a good impression. He reported to training camp overweight, slow and lethargic. Boogaard quickly clashed with the team’s demanding coach, John Tortorella.
In October, Derek’s brother Aaron told their father that Derek had been abusing pain pills with increasing regularity late in the summer. Derek demanded that Aaron mail to New York a large stash that Derek had left behind in Minneapolis. Aaron refused.
Len Boogaard sent an e-mail to the Rangers on Oct. 13, 2010, requesting a conversation with Risebrough. Risebrough called the next day. Len Boogaard said he told Risebrough about Derek’s renewed drug problem.
Two days later, Derek called his father and, according to Len Boogaard, complained that General Manager Glen Sather had called him into his office, demanding the truth and threatening to trade him. Derek, apparently unaware that it was his father who had notified the Rangers, did not explain why Sather was upset, and Len Boogaard did not press him. The Rangers were on top of it, he thought.
Derek Boogaard continued to play and fight. And he increasingly received prescriptions for drugs that the Rangers knew he had previously abused.
On Oct. 21, 2010, a punch from Toronto’s Colton Orr broke a three-tooth bridge in Boogaard’s mouth. Three days later, Boogaard hurt his hand in a fight with Boston’s Shawn Thornton.
On Oct. 26, a Rangers dentist, Dr. Joseph V. Esposito, citing an “emergency,” prescribed 20 hydrocodone pills, the first of five prescriptions written over several weeks, totaling 64 pills.
It appears that decision might have come in consultation with the league’s substance-abuse program. On the evening of that first hydrocodone prescription, Boogaard spoke briefly with Dr. Shaw and Cronin.
Outside experts noted the difficulty of treating a painkiller addict for ongoing pain. Some suggested that one way to treat people addicted to painkillers was to use other longer-term drugs, such as methadone, for chronic pain, as part of maintenance therapy that includes steady counseling. Cutting off all pain medications, they said, can lead to severe relapses in some patients.
On Nov. 16, two days after Boogaard had his nose broken by Edmonton’s Steve McIntyre, Boogaard received another hydrocodone prescription from Dr. Esposito, who shares a practice in Hartsdale, N.Y., with another Rangers team dentist. Boogaard also received a prescription from another Rangers team doctor, Andrew Feldman, the director of sports medicine at St. Vincent Medical Center, for 40 pills of Tramadol, a mild narcotic. It is unclear if Dr. Esposito and Dr. Feldman knew of each other’s prescriptions.
“The doctor who prescribed Tramadol was probably thinking it’s better than hydrocodone, but it’s still addictive,” said Dr. Ballantyne, the University of Washington pain expert.
Those appear to be the extent of painkillers prescribed by Rangers doctors. But Boogaard, as he had in Minnesota, found illicit dealers, his family and friends said, especially after his season ended Dec. 9. That was when he sustained a concussion in a fight with Ottawa’s Matt Carkner.
Boogaard never played again. Publicly, the Rangers said Boogaard was struggling with postconcussion syndrome, but that was only part of the story.
Over the succeeding months, Boogaard continued to be prescribed medication — particularly Ambien, about a dozen times. By several accounts, Boogaard drifted through wild mood swings and erratic behavior — breaking down in tears one day, buying expensive toys like night-vision goggles the next. Bored and lonely, he was sending and receiving more than 10,000 text messages a month in early 2011.
Among those he communicated with were Cronin and Dr. Shaw, hundreds of times. Boogaard was subjected to at least 19 drug tests during his season with the Rangers, most of which showed him testing positive — initially for antihistamines and decongestants, then Xanax, an antianxiety medication. By spring, Boogaard was testing positive for hydrocodone and other narcotic painkillers.
It is unclear what ramifications, if any, there were for testing positive on more than a dozen drug tests. But Boogaard was not sent to rehabilitation until he struggled to stand up on the ice in front of coaches and teammates during a skating session in early April.
On Dec. 1 and 4, Boogaard tested positive for Xanax, although there is no record of it being prescribed to him. On Dec. 16, Dr. Ronald Weissman, a team doctor and cardiologist based in White Plains, prescribed 20 pills of Xanax. Records show he did it after consultation with Dr. Lewis, the substance-abuse program co-director.
Dr. Weissman’s notes also say that Boogaard, on Dec. 14, complained of “chronic insomnia.” Dr. Weissman wrote that he previously spoke with Dr. Lewis about Boogaard’s past abuse of Ambien. He prescribed Restoril, another sleeping medication.
But early on Dec. 24, having just landed in Minneapolis for Christmas, Boogaard texted the Wild’s Dr. Peterson. Later that day he had a prescription for 30 Zolpidem, the generic version of Ambien — one of at least four such prescriptions that Dr. Peterson wrote for Boogaard after Boogaard joined the Rangers.
On Jan. 6, 2011, Dr. Weissman prescribed Boogaard five pills of Ambien. While it is unknown what sort of guidance, if any, Dr. Weissman received from the substance-abuse directors, it was the first of nine Ambien prescriptions, the latter ones for 30 pills, that Dr. Weissman wrote for Boogaard over three months.
Len Boogaard said he saw one of those Ambien bottles when he visited Derek in January. Dated the day before, and labeled with Dr. Weissman’s name, the bottle contained only 10 of the 14 prescribed pills. A day later, six more were gone. On the third day, the bottle was empty, Len Boogaard said.
On the fourth day, a man came to collect a urine sample from Boogaard. Boogaard knew about the timing of the test several days ahead of time. The results came back negative.
At that point, however, the drug tests did not check for Ambien/Zolpidem, the records show, despite Boogaard’s past addiction problems with the sleeping drug. It was not added to the list of drugs to test for until April, the drug tests show.
Later in January, another doctor, a neurologist keeping tabs of Boogaard’s postconcussion symptoms, prescribed 30 pills of Zolpidem. Dr. Peterson, the Wild team doctor, prescribed 30 more on Feb. 2, when Boogaard was in Minnesota. And Dr. Weissman of the Rangers began increasing his dosages to 30 pills every week or two.
A friend reported seeing Boogaard in March crushing and snorting Ambien. By March, friends and family said, Boogaard was spending thousands of dollars on pain pills from a man on Long Island. He kept pills in Ziploc bags and plastic Easter eggs he sometimes carried in his pockets.
By then, Boogaard had tested positive several times for opiates like oxycodone. In early April, Boogaard flopped on the ice during a skating session and was confronted by an assistant. Within days, Boogaard was in California for another extended stay in substance-abuse rehabilitation, his second in about 18 months.
On May 12, granted a second long leave of absence from the rehabilitation facility, Authentic Recovery Center in Los Angeles, Boogaard returned to Minnesota. He went out with friends and his brother Aaron. A day later, Aaron and Ryan Boogaard, Derek’s other younger brother, found Boogaard dead of an overdose on the bed of his Minneapolis apartment.
Len Boogaard has considered lawsuits. But he said that taking the N.H.L. and those with ties to it to court could take a financial and time commitment that he could not afford. He cited the example of Steve Moore, a Colorado Avalanche player attacked on the ice by Vancouver’s Todd Bertuzzi in 2004. A long-awaited trial is scheduled to begin later this year.
“It’s not the money,” Len Boogaard said. “But in eight years, how many more players are going to go through something like what Derek did?”