Doctor: NFL Exams Far Exceed Standards

The NFL’s medical liaison said Monday that each team’s physical examinations were comprehensive, that it was too early to judge whether the death of 23-year-old San Francisco 49er lineman Thomas Herrion was caused in part by obesity, and that one test that might have found a difficult-to-detect heart problem wasn’t necessary.

Dr. Elliott Pellman, an internist who also works with the New York Jets, said the standards of the exams were part of the league’s labor agreement with the NFL Players Assn.

“They’re head to toe -- a complete medical examination,” he said. “Within the NFL community, they far exceed the ‘standards of the community.’ ”

Herrion, a first-year player who weighed about 330 pounds, collapsed in the 49ers’ locker room Saturday night after an exhibition at Denver and was pronounced dead at a hospital about an hour later.

The cause of Herrion’s death is not yet known, but because of his weight, speculation has centered on a possible heart problem.

Pellman said Herrion must not have set off any alarms when he had his physical examination.

“Most likely, it was normal,” the doctor said. “What can you look for to see if they had any kind of electrical circumstance? An EKG could help, but even if it shows nothing, that doesn’t necessarily mean nothing’s there.”

It’s possible that another test, an electrophysiological study, could have found something that an EKG would not have, Pellman added, explaining that it might be called for in unusual circumstances, such as after an abnormal EKG or a history of health problems.

However, Pellman said, such a study is invasive, carries a risk of a stroke or heart attack and is generally considered only as a last resort. “That would be completely out of left field with this guy,” he said. “No physician would have ever recommended a test like this on this player.”

Herrion’s father, J.C. Herrion, died less than two years ago, after his second stroke, at 51.

Dr. Neal S. El Attrache of the Kerlan-Jobe Clinic in Los Angeles, a sports medicine expert and a consultant to the St. Louis Rams, Denver Broncos and Dallas Cowboys, said the elder Herrion’s condition wasn’t necessarily linked to any of his son’s health problems, whatever they were.

“The guy was 23 years old,” El Attrache said. “It depends on what his [family’s physical] history is. You have to really sort out the cause of his father’s stroke. Maybe he was a smoker. Maybe he was hypertensive.

“It’s very difficult to take a young athlete like him and know for sure, unless he had a significant set of symptoms.”

It is possible that postmortem tests will show that Herrion’s heart stopped, but that the muscle had not been deprived of oxygen, which would mean that the probable cause of death was arrhythmia -- a massive electrical malfunction -- El Attrache said.

According to Pellman, the NFL’s physical includes an eye, ear, nose and throat examination. It also includes listening to the heart and lungs, checking the abdomen for possibly enlarged liver and spleen, gauging pulse, looking for hernias, testing the thyroid’s activity and liver and kidney function, plus a neurological exam, an EKG and also blood work in order to come up with a cell count.

It is at the team’s discretion whether to go further, such as to check iron level for anemia, Pellman said, but that echocardiograms aren’t always administered.

Regardless of the extent of the NFL’s physical examinations, they don’t go far enough, according to player agent Leigh Steinberg. More rigorous testing is called for, he said, but isn’t done because it’s too expensive.

“The cost is minimal compared to the human cost and the enormous investments that these teams make in training and in contractual commitments to contemporary NFL players,” he said.

Steinberg said that since Herrion’s death, he’s spoken with experts in the medical community and they voice their support for echocardiograms and CT scans.

“We plan to seek these tests privately if teams aren’t doing it,” he said.

El Attrache, who also works with the Dodgers, Lakers, Angels, Kings and Mighty Ducks, says team sports medicine is at a high point: “These guys are getting better cared for better than ever, by better people than ever.”

Herrion was on the field for the 49ers’ 14-play, 91-yard touchdown drive in the fourth quarter, then inhaled oxygen after going to the sideline.

“He blocked hard, and he talked a little bit,” said Bronco defensive lineman Luther Elliss, who went against Herrion during the final drive. “He seemed fine.”

After the game, according to the Denver Post, Herrion told Bronco Aaron Hunt, a former teammate on the Hamburg Sea Devils in NFL Europe, that the altitude bothered him.

Dr. Peter LePort, an obesity specialist at Orange Coast Memorial Hospital in Fountain Valley, wasn’t sure whether the combination of Herrion’s weight and the altitude of Denver had anything to do with his death.

“You’ve got a lot of problems here,” said LePort, who is an expert in morbid obesity, which is by definition being 100 pounds overweight from the standard.

“He fits the technical term, but does that mean he’s unhealthy? Most physicians would say yes, but if he’s healthy and active, I don’t know of any studies that would show that.”

LePort also said the exact cause of Herrion’s death might never be known.

“He was a young guy, active, physically fit,” he said. “Other than a routine examination, I’m not sure all the other tests would show anything or not. The question is, what’s reasonable with an NFL player?”

Herrion’s 300-pound-plus frame is not unusual in the NFL. When the 49ers reported to training camp in Santa Clara, 18 of the 84 players who showed up weighed 300 pounds or more. That is about normal for each of the 32 NFL teams.

At a news conference Monday, Commissioner Paul Tagliabue said that the league had a committee keeping tabs on cardiovascular health and that the size of players was being monitored.

“We’re staying ahead of the curve in terms of understanding how big they should be, what characteristics they should be able to display, what kinds of performance levels they should be able to achieve and so on,” Tagliabue said.

Pellman urged caution before tying Herrion’s death to his weight.

“The debate has started about obesity and whether it contributed to his death,” he said. “We need to wait for the medical experts before we move on to the next stage of things. I think everyone wants to be there because this is so horrific.

“When you lose a young one, you want to know why. But there are some things that are inexplicable. Sometimes you just don’t know. You just know the end result.”

The 49ers returned to work Monday in Santa Clara, conducting a light afternoon practice in a subdued atmosphere.

“It was a waste for me,” left tackle Jonas Jennings said of the hourlong workout. “Mentally, I wasn’t there. But you’ve got to be a professional. You’ve got to do what’s expected of you.”

There were flower arrangements in the complex’s lobby, and grief counselors were available to the players when they arrived.

The organization has scheduled a private memorial service tonight in nearby Mountain View. The 49ers, who play host to Tennessee on Friday in an exhibition, will wear a black decal with Herrion’s No. 72 on the back of their helmets this season, and Herrion’s locker near the door to the practice fields will remain unchanged.

And in Salt Lake City, the University of Utah, where Herrion played college football, announced it would observe a moment of silence before its opening game against Arizona on Sept. 2. The Utes will add a black 76, Herrion’s old number, to their helmets to honor the captain of their 2003 team.

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Times staff writer Sam Farmer and Associated Press contributed to this report.