Medical staff battles nothing new

FORT MYERS, Fla. -- Allegations that a former Boston Red Sox athletic trainer was illicitly injecting players with the legal pain-killer Toradol appear to be just the latest indicator of what one team source described as "open warfare" between various factions of the team's previous medical staff.

The friction that existed for years between former medical director Dr. Thomas Gill and trainer Mike Reinold spilled over into the clubhouse, multiple sources told ESPNBoston.com. Reinold was originally hired as athletic trainer but was given expanded authority until his dismissal after last season. Players took sides not only on Toradol, but other issues.

Outfielder Jacoby Ellsbury in 2010 publicly challenged Gill over what he contended was a botched diagnosis of his fractured ribs, while former Red Sox pitcher Jonathan Papelbon said he informed then-general manager Theo Epstein and then-manager Terry Francona he would no longer allow Reinold to work on him.

"My thing is that [Reinold] thought he knew everything about everything," Papelbon said. "You couldn't tell him anything. I don't know of any players who thought he was a good trainer."

Several players have told ESPNBoston.com that they also refused treatment from Reinold. Pitcher Jon Lester, meanwhile, said he "loved" Reinold. The Red Sox, a team source said, were reluctant to sever ties with Reinold because of his close relationship with the starting pitching staff, including Lester and former Sox pitcher Josh Beckett.

"I loved Mike,'' Lester said this week. "I think you got to take Pap's personality. Pap's got a strong personality. Mike's got a strong personality. Any time you're with somebody from February to the end of October you're going to butt heads.

"Mike can come across as a know-it-all, but I never had any problem with him. I know Josh didn't have a problem with Mike, but I know some guys did. I had a great relationship with Mike. Very smart guy. His track record speaks volumes. I like all the stuff that he did. I liked the fact when we implemented new things, he sat there and explained them to me.

"I had a good relationship with him. I still do. I still talk with him."

A number of Red Sox players, including Ellsbury and former infielder Jed Lowrie, also expressed dissatisfaction to team management over Gill's care, according to sources.

The rift in the medical staff also divided the front office, according to multiple sources. Principal owner John W. Henry championed Gill, who as his personal orthopedist twice operated on Henry's shoulder. Henry is also a trustee at Massachusetts General Hospital, where Gill is on staff. The baseball operations staff, meanwhile, backed Reinold. At one point, Epstein fired Gill and tried to transfer his duties to team internist Dr. Larry Ronan and Reinold, but was immediately overruled by Henry.

But the situation became so "toxic" between not only Gill and Reinold but with other members of the medical staff, a source said, that Henry did not stand in the way when Gill was not retained as medical director after the 2011 season. That followed a meeting in which Gill, according to multiple sources, demanded that Reinold be fired.

"I'd rather not characterize it, except to say there was a discussion about it and a mutual resolution was achieved," Red Sox CEO Larry Lucchino said Thursday about that meeting.

The team also fired Scott Waugh -- whom a source said had been at odds with Reinold -- as physical therapist, Greg Barajas as assistant trainer, and David Page as strength and conditioning coach after the 2011 season. Reinold was also given a reduced title, named to replace Waugh as physical therapist, although former manager Bobby Valentine would complain privately last summer that Reinold exerted undue influence over when injured players could return to the field.

On March 8, 2012, MLB issued a directive to all clubs outlining the proper uses of Toradol, stating that only a physician was allowed to administer the anti-inflammatory drug and warning of potential side effects. Shortly thereafter, according to sources, MLB received a complaint that Reinold had been injecting Red Sox players with Toradol. There are conflicting accounts of who contacted MLB.

The league subsequently launched an investigation of the Red Sox that found the team in compliance with the practices as outlined in the memo, and did not take any disciplinary action against the club, the sources said. The MLB investigation, a source said, was complicated by the deep divisions within the medical staff, but added "it was not in dispute" that Reinold previously engaged in the practice prior to the 2012 season.

Papelbon said last week that he and other players were regularly injected with Toradol by Reinold, and Lester said this week that while he was primarily injected by physicians, Reinold injected him on occasion.

Reinold maintains that any Toradol injections he administered were at the instructions of a doctor, and he did nothing illegal.

"Every medical treatment I provided was under the direction, authority and knowledge of a team physician and appropriately documented,'' he told Yahoo! Sports. "Any suggestion to the contrary would be false."

Reinold declined to comment when reached by ESPNBoston.com.

Lucchino on Thursday acknowledged the MLB investigation.

"I think the allegations related to that subject and then they did an investigation and then they closed it,'' Lucchino said. "They don't want us commenting on their investigation."

Asked if Reinold's departure was a result of the investigation, Lucchino said: "I'm not going to get into that sort of personnel [decision]. Considering he was not brought back should be sufficient enough."

The Red Sox have missed the playoffs the last three years, and in each of those years, injuries have played a significant role. In 2010, the team placed 19 players on the disabled list for a loss of 1,018 games. In 2011, it was 18 players and 803 games lost, and last year, 27 players were placed on the DL in 34 stints that cost the club 1,495 games, the equivalent of more than nine seasons.

"Many of our injuries have been of the traumatic kind, collisions on the field, that I don't think any medical person could prevent," GM Ben Cherington told ESPNBoston.com late last year. "But if there's ever a situation where we're missing any time that doesn't have to be missed or if there's an injury that maybe could have been prevented, we have to look at that, too. The goals here are not to look back and sort of figure out, 'Because of this, we're doing this,' but to look forward and try to set up a structure that incorporates the best practices within those specialties with a group of people that will be fully dedicated to the players and the players will trust and they'll have the players' best interests in mind."

Last November, the club promoted Dr. Larry Ronan, who had been its chief internist since 2005, to the position of medical director.

"We're trying to finish off a restructuring that really started last winter and get to a system that appropriately captures the different specialties in the medical realm," Cherington said at the time of Ronan's appointment. "We went 60 or 70 yards down the field last winter, and now we're trying to get it in the end zone."

While the regular use of Toradol is said to be a common practice in baseball, especially by starting pitchers -- Lester said he used it "quite a bit" and Curt Schilling told Yahoo! Sports he was injected before every start for years -- not every team sanctions the practice. Papelbon said when the Phillies gave him a physical before signing a free agent contract after the 2011 season, the team's medical staff advised him that it did not allow Toradol use.

Cherington said this week that the Red Sox are undertaking a review of the club's policy on Toradol, and Lester said the medical staff talked to the pitchers earlier this week about it.

The issue of Toradol took on added relevance for the Red Sox last June when pitcher Clay Buchholz spent three days in intensive care and lost three to four pints of blood after the lining of his esophagus became inflamed. That condition, known as esophagitis, is a known side effect of Toradol. Buchholz acknowledged to ESPN last June that he had used Toradol on occasion, but that doctors were not able with certainty to establish a direct connection between Toradol and his condition.

Buchholz was on the disabled list for 20 games.

Toradol, though legal in MLB and other sports, has raised concerns among medical experts about the effects of longtime use. In December 2011, a lawsuit was filed by a dozen retired NFL players who said the league and its teams repeatedly and indiscriminately administered the drug before and during games, thus worsening injuries like concussions.

That lawsuit, a baseball source said, prompted MLB to issue its memo on Toradol last March.

Last September, an NFL physician society task force provided a series of recommendations regarding the use of Toradol, including that it only should be administered by a team physician, and it should be limited to use on players listed on the team's injury report. It also said it should be given in the lowest effective dose and should not be used for more than five days.

Armond Armstead, a former USC football player who recently signed with the New England Patriots, alleged in a lawsuit against the school that Toradol led to his heart attack, at age 20.

Lester maintained that he took Toradol in much smaller dosages than NFL players.

"It's good they're looking into it," Lester said. "As players, though, we just think it's a bigger Advil, a stronger Advil. But I think it's nice to know our organization cares about us long term and wants to nip this thing in the bud."