Dr Akshai Mansingh Unplugged

Jamaican physician Dr. Akshai Mansingh, a member of the West Indies Cricket Board's (WICB) medical panel found himself in the eye of the storm surrounding the cutting of Marlon Samuels from the World Cup squad.

It was Dr. Mansingh's recommendations in a medical report, the WICB explained, that forced the selectors to make the decision to drop the batsman and replace him with Ryan Hinds for the World Cup. In this interview with CaribbeanCricket.com editor-in-chief Ryan Naraine, Dr. Mansingh talks about his involvement in the Marlon Samuels episode... (Update: Adds Dr Mansingh's press release at the end of the interview).

RYAN NARAINE: Have you seen the reports from the two U.S. doctors that examined Marlon? If you have, are there any significant differences from the diagnosis you gave?

DR AKSHAI MANSINGH: I saw the reports and they say basically said the same thing. They have identified a problem with the knee. They agree that it's a longstanding problem and that in the future, it is very likely that he'll need surgery. That is basically exactly what I said in my report (to the WICB). They both said he needed constant monitoring and that he must refrain from high impact activities.

All the major points are very similar in the reports. The only significant difference is one of time scale (for the surgery). We all suggested clearly that Marlon can go to the World Cup but he'll require special training and monitoring while there...I suggested the surgery be done earlier (after the World Cup). The other doctors are recommending surgery a year or two down the road.

RN: What exactly do you mean when you caution against high-impact activities?

AM:It basically means he must avoid routine heavy duty training. It has to be substituted by other activities like swimming, soft-terrain activities. Jogging on grassy fields instead of a hard courts to minimize the impact on the knee. We all recommended that for him during the World Cup.

RN: Can you give us a timeline of how this whole episode unfolded?

AM: Last week was the first time Marlon complained of pain and swelling in the knee since his return from India and Bangladesh. It was significant enough to suggest that he may need further surgery (the same surgery that the other doctors have suggested as a possibility). For the first time, when I looked at the MRI scans, I saw an indication of deterioration from last year to now. I then suggested in my report to the board that he alter his training to enable him to get through the World Cup and I warned that, although he may break down at any time, he should seek an assessment immediately after the World Cup.

I suggested it be done by Dr Ansley Allen in New York City, who has examined many of our players in the past. While on tour, I suggested in the report to (manager Ricky) Skerritt that he have constant monitoring.

I want to make it clear that I explicitly expressed the view that, with these training modifications, he would be able to complete the World Cup competition. If there was anything implicit, perhaps he could have been rested from some matches if he were having any trouble.

RN: Would you concede that maybe some of the terminology of your report could have set off alarm bells with the selectors? I'm referring to your statement that you were surprised at the size of the defect (in the knee)...

AM: I stated that this was the first time I had seen any films on Marlon's knee. In the past, I had only seen the reports from the surgery that was done in Sharjah (last year). It was the first MRI film I had seen and indeed, on it, the defect was quite large. I expressed that in the report.

Regarding the use of alarming words, there may be some words that may be perceived as alarming, but if one would bother to complete the sentences (in the leaks of my report), those words would be understood...

RN: Are you saying that selective quotes were taken out of the report and put out in the public domain?

AM: Yes, alarming words were taken out of the report, without completing the sentence. In fact, if the complete sentences were released, the context would have been different.

RN: But, those 'selective quotes' were actually put out there in a WICB press release...

AM: It's not my policy to discuss the contents of medical reports. However, I do feel that these words were taken out and used by the WICB to paint an inaccurate picture of my report. In all my reports in the past to the board, I've expressed the best and worst case scenarios and my personal view or assessment. In this report, I have stated that Marlon could break down at any time (worst case) but I also said that, with special attention, he could complete the World Cup and be assessed thereafter.

RN: How did you learn that, based on your report, Marlon was dropped from the side? And what was your immediate reaction?

AM: I learned immediately after Marlon was informed. I'm not going to go into a blow-by-blow of how I got the news. My immediate reaction was one of surprise. It was very shocking because, in every previous medical assessment (of severity), I have always been contacted by the selectors to further discuss the course of action. In this case, where I had explicitly stated that Marlon could go to the World Cup, albeit with some risk to his knee, the decision was made without consultation.

I can tell you this was the first time ever that a decision was made without follow-up consultations. In fact, on previous occasions, we have had meetings that lasted for four hours to decide whether a player can survive a tour. We had the situation with (Brian) Lara's groin strain prior to going to Sri Lanka and there were numerous phone conference calls and hours of meetings to deliberate whether selectors should or should not pick him.

That's why it came as quite a shock that Marlon was dropped and nobody called to follow up with me.

RN: Were any meetings held at all with the selectors during this entire situation?

AM: I would rather not comment on that. Perhaps you should ask the West Indies Cricket Board.

RN: Was any contact made before the selectors' decision to cut Marlon?

AM: No, none at all.

RN: Was any contact made with you after the WICB issued the press release announcing he was dropped?

AM: No, up until then, no one contacted me.

RN: Was any contact made between the time of the (selectors') decision and the WICB announcement?

AM: I'd rather not comment on that. That's something you'll have to get from the West Indies Cricket Board.

RN: But, that answer suggests that there was a meeting before the WICB press release...

I'd rather the board confirm or deny that.

RN: Marlon is on record as saying he feels better now than when he was in India. Did he complain of pain during that tour?

AM: I didn't hear Marlon's statement about his situation on tour. Maybe he was referring to the fact that he feels fitter now than when he was in India. However, at no time during the tour of India did he complain of pain in his knee. In fact, we all witnessed an awful ankle sprain which he weathered through the tour quite well.

RN: At the age of 22, Marlon has already had two knee surgeries. Is there a genuine fear this knee will conk out and ruin his career?

AM: Actually, he has had three surgeries. He had an earlier operation when he was a teenager and they were all on the same left knee and surrounded the same condition. That's precisely what I stated in the report. Yes, I worry about the long term prognosis of his knee. Incidentally, this has been echoed in all the other reports (from the U.S. doctors).

Marlon does not have a straightforward knee problem. Unfortunately, the course of his knee cannot be predicted. It can only be monitored. There is a legitimate fear, included in all three reports, that the condition can degenerate....

RN: Were it not for the World Cup, would you say the knee would have already been operated on?

AM: I did make the point in my report that cricket does not follow seasons. I suggested that, because of the World Cup and its importance, the follow-up assessment be delayed until afterwards. To answer the question, yes, were it not for the World Cup, I would have suggested the assessment be immediate.

RN: There's a perception out there that the operation in Sharjah last wasn't such a success after all...

AM: That's not correct. That's just speculation. What was done in Sharjah would have been done anywhere in the world. The doctor in Sharjah was as guarded in the prognosis as any of us subsequently.

RN: But, we were told after the Sharjah operation that he'd be back in action after six weeks. Yet, the knee was swelling up during the Red Stripe Bowl several months after...

AM: That 'six-week' statement was another problem. That came from a press release issued by the board. The (Sharjah) doctors there made it clear this had to be assessed periodically and they gave a six-week time frame as a minimum. I don't know why that was thrown out there.

The swelling in the Red Stripe Bowl was not completely a surprise. With this condition, that does happen from time to time. But, subsequent examinations revealed that it was not something that would prevent him from going to India. This was expressed to the board and the selectors and he had no problems thereafter.

RN: What can be done to improve on the medical care and attention that West Indies players get? There's a feeling that unless you're a 'star' player, the board doesn't pay as much attention.

AM: There is a structure that was put in place for monitoring the management of players. That was put in place and headed by Professor Peter Fletcher, at University Hospital in Jamaica. For the first time, a network was set up across the Caribbean for treating and following up on injuries. I think improvements can be made in the implementation phase but there is a structure in place.

RN: What specific improvements?

AM: For one, there needs to be better communication between the doctors scattered around the Caribbean. A lot of times, decisions are made in the territories and we don't know about it. I read where Reon King said he had to make a nuisance of himself to get some treatment. Well, when I talk about the lack of communication, Reon King's name is one that comes to mind. He was sent to me for an examination and I didn't even know he was coming. I was returning home from Chicago and bumped into Reon at the airport. He told me he was in Jamaica to see me and it was the first I was hearing about it...

RN: Speaking of Reon King, what's the story with him failing an EKG test?

AM: I saw that report but I also saw that he played the game the next day. I know exactly what you know...what was reported in the media.

RN: Given the hectic player schedule set up by the ICC, do you think that the West Indies team should have a full time medical staff, including an orthopaedic doctor and a physio travelling with the team at all times?

AM: Listen, we are the only team in the world that does not have a fulltime physiotherapist. Ronald (Rogers) is a trainer, not a physio. I won't comment on whether we need to carry a doctor on tour. What I will say is that the nature of management of injuries has to change. The concept of on-tour management of injuries and on-tour prevention of injuries and the resting of players to allow minor injuries to heal has to be adopted.

Point in case, Michael Bevan of Australia. He has been taken to the World Cup in spite of having an injury and in spite of them saying it'll take weeks to get better. But, the Australians plan to manage the injury during the World Cup.

Also, we have to start considering a plan to rotate players, especially on tour. We started it in India by alternating bowlers who were carrying injuries. It allowed them to complete the tours with some success.

We have to get serious about dealing with injuries. Going back to Australia, they are the other extreme. On tours, the Australians carry a manager, an assistant manager, a computer analyst, a physiotherapist, a trainer, a massage therapist, a media liaison officer, a security liaison officer and sometimes a doctor. India and New Zealand travel with a trainer and a physio. These are two separate posts. On the other hand, we only have a trainer. It has to change.

EDITOR'S NOTE:
After the publication of our interview, Dr Mansingh sent a press statement to CaribbeanCricket.com that provides details around the questions he earlier declined to answer. Here is the full text of Dr Mansingh's statement;

February 6, 2003

For professional reasons I am not at liberty to discuss the details of Mr. Samuels' medical condition, but I am compelled to make a statement to clear various misconceptions which have appeared in the media concerning my medical report on Marlon Samuels.

My report, though cautious and professional, made it clear that Mr. Samuels could attend and participate in the World Cup in South Africa, and included specific recommendations about how to manage his condition during the tournament.

This conclusion was reiterated to the executives of the WICB and the Selectors in a teleconference call, on the day that the Selectors took the initial decision to drop Mr. Samuels from the touring squad. In that teleconference call, the Chairman of the Selectors stated that only players who were "100% fit" should go to South Africa, and he would not change his decision not to send him.

As I had recommended, the matter was referred to Dr. Answorth Allen, a specialist in New York. His conclusions confirmed mine, both as to the nature of Mr. Samuels' condition and also as to his ability to play, again subject to specific recommendations about how to manage his condition during the tournament. The only difference between us concerns whether the condition is now at a stage requiring surgical intervention. My own view has been informed by having seen the progression of the condition first hand, while Dr. Allen (who was seeing him for the first time) recommended further evaluation before deciding.

There is therefore no difference between myself and the other specialists, as to whether Mr. Samuels should go to South Africa.

The uproar that the Selectors' initial decision caused, has precipitated a change of their decision. I do not appreciate this misrepresentation being perpetuated.

- Dr. Akshai Mansingh