On Carlos Correa and the Differing Opinions of Doctors

[Lucas Seehafer PT]

The Minnesota Twins on Wednesday introduced their new face of the franchise. Shortstop Carlos Correa, who had previously signed near-record deals with the San Francisco Giants and New York Mets before each fell through due to “concerns” over his right ankle, agreed to a six-year, $200 million deal, the richest in franchise history. If Correa is able to stay healthy and perform at a high level, the deal could reach as high as 10 years, $270 million, only $15 million less than they originally offered him.

But now the question on everyone’s mind is this: Can Correa stay healthy?

Both the Giants and Mets reportedly did not like what they saw on MRI and physical examination regarding his surgically-repaired ankle that he fractured when he was 19 years old and in the minor leagues. What exactly was seen hasn’t been reported, but generally speaking, there are only a couple of pathologies—such as arthritis—that could result in the teams’ physicians taking the stance they did. I do not have inside information on Correa’s condition and this is only educated speculation on my part. (For what it’s worth, the Twins’ doctors were also aware of the status of Correa’s ankle and felt confident enough in its structure to hand out a multi-hundred million dollar deal.)

The stench of the Giants’ and Mets’ findings resulted in Correa losing $150 million from what was originally promised to him, a fact that must sting deep within his core. Correa’s agent, Scott Boras, implied that the interpretation of the MRI his client underwent was the primary instigator behind his struggles to land with a team.

“[T]his scenario is about a large separation in the orthopedic community about functional fitness and clinical exam versus looking at an MRI,” Boras said during Correa’s introductory press conference. “It is a dramatic chasm between how some doctors feel and how other doctors feel about the longevity of a player’s performance.”

Boras is right on the money. Many doctors—particularly orthopedic doctors—subscribe to what is known as the biomedical model. To boil it down simply, the biomedical model believes that health is defined by the absence of pathology. To apply it to Correa, his ankle cannot be healthy because something was found on MRI; in other words, the ankle is something to be concerned about moving forward. 

In many ways, the biomedical model of health is logical, which is why it was so heavily adopted by doctors, particularly in the United States, upon its introduction. However, logic and the body don’t always mesh well. 

Let’s take MRIs for example. MRIs—which stand for magnetic resonance imaging—are wonderful for diagnosing soft tissue injuries, both those that are acute or chronic in nature. If an athlete tears their ACL or strains their hamstring, the extent and exact location of the damage is often determined by MRI.

However, some in the field of orthopedics use what is found on MRI as a way to predict what will happen in the future. The thinking goes something like this: “Well, that individual has a tear in their meniscus. It may not bother them now, but it will in the future, so we better take care of it now.”

Again, this is a perspective based in logic. Damaged tissue or bone is “not normal” (i.e. pathological), the thought goes, and therefore must be remedied (i.e. turn the pathology back to health). However, over the decades, MRI’s ability to accurately predict future injury has been found to be dubious, at best. The meniscus tear or arthritis in the back don’t always come back to haunt the individual; sometimes they simply lay dormant, never causing disruption.

This isn’t logical and is a big reason why many in orthopedics—including myself, full disclosure—believe more in relying on past performance and abilities. “Functional fitness,” as Boras referred to it, is more concerned about “what have you done and what can you do” than “what could happen?”

Carlos Correa has never once gone on the injured list nor has he ever missed time due to ankle pain over the last decade. He has accumulated 32.3 fWAR, won a Platinum Glove, and is on pace to finish his career as a Hall of Famer. Sure, he may have some arthritis and/or some metal in his ankle, but it’s never impacted his ability to perform. Why all of a sudden should we think it will now or anytime in the future?

“One thing I learned throughout the whole process is that doctors have a difference of opinions,” Correa said during his press conference. “I had a lot of doctors tell me I was fine and I had some who said I wasn’t so fine.”

That is really all that Correa’s rollercoaster offseason boils down to. We like to think that medicine is a completely objective field. Players undergo tests, the results are read, and a decision is made. However, much of orthopedics—and especially physical exams—contain a fair amount of subjectivity.

Doctors often have differing opinions; that’s why second opinions exist (and aren’t called second “facts”). The Giants and Mets clearly had a larger issue with Correa’s ankle than the Twins, but that doesn’t inherently mean that the Twins are wrong (or, to be fair, does it mean they are inherently right).

An additional factor in play during Correa’s free agency discussions, it should be noted, was the sheer volume of his potential contracts and the ability for a team to insure such a deal. Suffice it to say, either the Giants or the Mets could have gotten their deals with Correa insured with relatively little issue. (The Twins did, after all.) However, what both teams seemingly did was use Correa’s MRI findings to justify backing out of their agreement and offer something more paltry in return.

The Mets took it even a step further. Their final offer to Correa was a six-year deal for $157.5 million, exactly half of their original, with multiple non-guaranteed years contingent on him passing a yearly physical. Additionally, according to USA Today's Bob Nightengale, they employed the opinion from the exact same orthopedic doctor as the Giants. (Said Boras, "I don’t understand the Mets. I gave them all of the information. We had them talk to four doctors. They knew the issue the Giants had. And yet, they still call the same doctor the Giants used for his opinion. There was no new information. So why negotiate a contract if you were going to rely on the same doctor?") As Aaron Gleeman, John Bonnes, and Dan Hayes discussed astutely in a recent Gleeman and the Geek Patreon podcast, why would Correa agree to such a deal, especially after experiencing firsthand the Mets’ physical exam process?

At the end of the day, the Mets, and to perhaps a lesser extent the Giants, tried to utilize Correa’s body against him in the name of saving money. What is particularly egregious is that the Mets knew full well that they may see something upon exam that they did not like. They agreed to sign him for 12 years and $315 million anyway, only to swiftly pull out the rug from underneath him.

It’s perfectly acceptable for doctors to approach a condition with different viewpoints and opinions. However, the case of Carlos Correa exposed the potential impact differences of opinions—and perhaps outdated medical models—can have on an individual, especially when “just doing business” is involved.

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[Karbo]

The dr. isn't always right. There outlooks are nothing more than an educated guess going by what the majority of people have had. IMHO using the patients history should be factored in more than it is.

[Dman]

I like the analysis but doctors have been right in the past especially Mets doctors as they nixed the trade for Paddack from the Padres and Paddack did end up needing TJ.  Also a while back Houston got a ton of crap about trying to lowball Brady Aiken about likely needing TJ and he blew out his arm right away as well.  As stated in the article doctors can be right and wrong we won't know for sure about Correa until the end of the contract.

[Brock Beauchamp]

18 minutes ago, Dman said:

I like the analysis but doctors have been right in the past especially Mets doctors as they nixed the trade for Paddack from the Padres and Paddack did end up needing TJ.  Also a while back Houston got a ton of crap about trying to lowball Brady Aiken about likely needing TJ and he blew out his arm right away as well.  As stated in the article doctors can be right and wrong we won't know for sure about Correa until the end of the contract.

What I find weirdest about this situation is that the Mets, after Correa's deal with the Giants fell through, turned around and called the same doctor the Giants used. What outcome did they expect, really?

[Dman]

2 minutes ago, Brock Beauchamp said:

What I find weirdest about this situation is that the Mets, after Correa's deal with the Giants fell through, turned around and called the same doctor the Giants used. What outcome did they expect, really?

Yeah that doesn't sound on the up and up does it.  I have to agree with Boras which I am loathe to do but if that was what they were going to do then doesn't it follow that they were always gonna try and lowball Correa in some way?  Why only half the contract value as well?  They couldn't have done a deal like the Twins and pay for performance?  Doesn't add up to me.  Feels a little dirty but that is just my perception of it.

[Brock Beauchamp]

1 minute ago, Dman said:

Yeah that doesn't sound on the up and up does it.  I have to agree with Boras which I am loathe to do but if that was what they were going to do then doesn't it follow that they were always gonna try and lowball Correa in some way?  Why only half the contract value as well?  They couldn't have done a deal like the Twins and pay for performance?  Doesn't add up to me.  Feels a little dirty but that is just my perception of it.

Oh, I think the entire Mets situation feels skeezy as hell. The more we find out, the skeezier it seems. After the dust has settled, Correa landing with the Twins seemed inevitable, as they were the only front office seemingly on the up-and-up. The trust they established with Correa over the past year likely paid big dividends.

[Thebigalguy]

As mentioned, the Mets used the same doc as the Giants. What is that all about? Doesn’t a billionaire know what a second opinion is?

[Steven Buhr]

Great article, Lucas! You've provided some helpful insight into the situation.

I also grant that the Mets and Giants (but especially the Mets) come out of this looking bad.

That said, I'm just a little more cautious about piling on. Those front offices are now face a significant disadvantage, as compared with Correa.

While Correa obviously waived his HIPAA privacy rights to some extent, that doesn't mean the Mets and Giants are now free to discuss his medical information with media/fans (or anyone else). Such a waiver is not a blanket waiver allowing anyone and everyone with knowledge of his medical information to disclose/discuss it publicly.

Correa, conversely, is free to share whatever information he cares to (and can enable his agent to do so, as well). But even after he and Boras speak publicly about it, that doesn't throw the door open for others to do so.

The result is that, even if the Mets wanted to step up and say, "Wait a minute... it wasn't JUST the Giants' doctor we relied on. We had these opinions from four other doctors, and this is what we found out AFTER we agreed on the contract numbers that made us feel we couldn't stick to that deal," they aren't allowed to do so!

The result is that they are left largely unable to defend themselves by explaining their thought processes. 

It doesn't mean the Mets (and, especially, their owner, who unwisely spoke publicly about the signing before anyone had signed anything) weren't stupid. It just means they aren't as free to detail WHY they were stupid to the degree they might like to.

[Richie the Rally Goat]

So the Twins offered 10/285, that was declined. The Twins already had all the same information at this point, knew the risk, took it. Correa declined.

second agreed deal falls apart, Twins jump back in with 6/200 plus vesting options that can bring it up to 10/270.

the Twins used the Mets/Giants situation to leverage a smaller contract, no?

The Mets are particularly dubious, but the Twins were advantageous in their second crack at it. Was Correa to Boras comment “make me a Twin” a bit more genuine than it felt?

[Tiantwindup]

8 hours ago, Brock Beauchamp said:

What I find weirdest about this situation is that the Mets, after Correa's deal with the Giants fell through, turned around and called the same doctor the Giants used. What outcome did they expect, really?

It seems logical to me to call the same doctor. If he is the one who raised the red flag wouldn’t you want to talk to him directly and understand exactly what his position is and why he thinks what he thinks?  Now if that is the ONLY doctor they spoke with it would be a different story. 

[Brock Beauchamp]

4 minutes ago, Tiantwindup said:

It seems logical to me to call the same doctor. If he is the one who raised the red flag wouldn’t you want to talk to him directly and understand exactly what his position is and why he thinks what he thinks?  Now if that is the ONLY doctor they spoke with it would be a different story. 

My understanding is that he's the only doctor the Mets used.

[Bigfork Twins Guy]

I wonder if the Mets process and decision-making had to do with the GM’s difference of opinion regarding Correa on Cohen’s rather hasty agreement on a fully guaranteed contract.

[Nine of twelve]

9 hours ago, Brock Beauchamp said:

The trust they established with Correa over the past year likely paid big dividends.

I think this is the primary reason the Twins were on Correa's short list. And notice that the Red Sox, who have the resources to offer a contract the size of Correa's deal with the Twins and who badly need a good shortstop, were obviously not on his list. I strongly suspect that Correa wanted nothing to do with playing for Alex Cora. Kudos to the FO and Baldelli; doing things the right way makes it more likely that you will be rewarded in the end.

[Nine of twelve]

I'm not clear about this: exactly who engaged the services of the MD or MD's who provided the opinion used by the Giants and the Mets? Was it the teams themselves or was it the insurance company or companies who would be providing coverage for the contracts?

[Brock Beauchamp]

18 minutes ago, Nine of twelve said:

I'm not clear about this: exactly who engaged the services of the MD or MD's who provided the opinion used by the Giants and the Mets? Was it the teams themselves or was it the insurance company or companies who would be providing coverage for the contracts?

Teams. The insurance policies are a completely different thing, in my understanding. 

[Heezy1323]

11 hours ago, Brock Beauchamp said:

What I find weirdest about this situation is that the Mets, after Correa's deal with the Giants fell through, turned around and called the same doctor the Giants used. What outcome did they expect, really?

Why is it that you find this weird? He is the preeminent foot/ankle physician for professional athletes in the world. The "Dr. James Andrews" of foot and ankle. Essentially every high level athlete seeks his opinion after an injury.

I don't think it's weird at all. I would want to know what his concerns were. I may or may not choose to abide by his recommendations, but I sure as hell would want to know what he had to say. He didn't get to his level by accident. 

[Heezy1323]

2 hours ago, Brock Beauchamp said:

My understanding is that he's the only doctor the Mets used.

You don't believe the Mets spoke (at minimum) with any of their own physicians? I think this is tremendously unlikely.

[Heezy1323]

8 hours ago, Steven Buhr said:

Great article, Lucas! You've provided some helpful insight into the situation.

I also grant that the Mets and Giants (but especially the Mets) come out of this looking bad.

That said, I'm just a little more cautious about piling on. Those front offices are now face a significant disadvantage, as compared with Correa.

While Correa obviously waived his HIPAA privacy rights to some extent, that doesn't mean the Mets and Giants are now free to discuss his medical information with media/fans (or anyone else). Such a waiver is not a blanket waiver allowing anyone and everyone with knowledge of his medical information to disclose/discuss it publicly.

Correa, conversely, is free to share whatever information he cares to (and can enable his agent to do so, as well). But even after he and Boras speak publicly about it, that doesn't throw the door open for others to do so.

The result is that, even if the Mets wanted to step up and say, "Wait a minute... it wasn't JUST the Giants' doctor we relied on. We had these opinions from four other doctors, and this is what we found out AFTER we agreed on the contract numbers that made us feel we couldn't stick to that deal," they aren't allowed to do so!

The result is that they are left largely unable to defend themselves by explaining their thought processes. 

It doesn't mean the Mets (and, especially, their owner, who unwisely spoke publicly about the signing before anyone had signed anything) weren't stupid. It just means they aren't as free to detail WHY they were stupid to the degree they might like to.

I think this is a great read of the situation. I agree entirely.

[Brock Beauchamp]

9 minutes ago, Heezy1323 said:

Why is it that you find this weird? He is the preeminent foot/ankle physician for professional athletes in the world. The "Dr. James Andrews" of foot and ankle. Essentially every high level athlete seeks his opinion after an injury.

I don't think it's weird at all. I would want to know what his concerns were. I may or may not choose to abide by his recommendations, but I sure as hell would want to know what he had to say. He didn't get to his level by accident. 

But you already know what he said. Why ask him again?

[old nurse]

Anderson with the Mets, Zaidi with the Giants are analytics guys. The long contracts were to get him in the door, the medical reports were to get a saner contract. Middle infielders break down early. Ozzie Smith was elite until 38, Jeter 36, Lou Witaker about that same time period.. Most start declining about 32. In my opinion they were playing to the greed of Boras

[Heezy1323]

1 minute ago, Brock Beauchamp said:

But you already know what he said. Why ask him again?

How do they know exactly what he said? All they know is that the Giants deal seemed to hinge on his feedback about the MRI. Not exactly what the feedback was. 

Allow me to phrase another way. Why NOT ask him? What is to lose by collecting all available information? You can always choose to disregard it. For $300 million, I am of the opinion that a 15 minute phone call is reasonable. 

[IndianaTwin]

This isn’t a comment on the doctors, but against those TD readers who have suggested that Correa “fell into the Twins lap,” piling on to the whole “FO doesn’t know what they are doing” mantra.

To my mind, the Twins FO acted fabulously in this situation. It’s okay to make an original offer that maxes out what you think you can and/or want to offer, and if the player goes elsewhere, so be it. Knowing your own limits is an attribute.

But from what I read, the Twins were the primary organization that maintained contact throughout the Giants/Mets ordeal. I’m guessing the message was more or less, “Hey, Scott, if things fall through, we’d like to talk. Can’t go higher than we were, but we still like Carlos a lot.” Then, when Boras came back, they tweaked the deal to acknowledge concern, but also put together a deal that’s arguably better than the Mets offer, when the time value of money is taken into account.

[Heezy1323]

I largely agree with you @Lucas Seehafer PT.

Allow me to play devil's advocate to some degree. 

What do you think is the SPECIFIC question being asked of the consulting doctors (Dr. Anderson et al.)?

I think it is most likely something along the lines of "Do you see anything on this imaging study (xray/MRI) that would indicate that there is the chance of Carlos developing an ankle problem that limits his function in the next 10-12 years?"

I don't believe that is a question you can answer using the 'functional model' you are describing. The MD isn't being asked about how he is currently performing or how he has performed in the past. Everyone involved knows the CC of today is an incredible player. If the MD says, "Well, I see some arthritis on this MRI, but he is currently functioning fine," the response is going to be- "OK great. What does that mean for his future?" 
As such, the MD is essentially forced to make a prediction. Are predictions always correct? Absolutely not. But I don't think that the argument that "He is functioning just fine today" satisfies the question being asked.

Also, the MRI here is not 'predicting future injury' to use a term you used. It is, more precisely, 'documenting the current state of the ankle'. This may seem like semantics, but I don't believe it is. The injury isn't being predicted- it is already there (presuming my assumption of some ankle arthritis is accurate). What is being predicted is how this ankle will hold up over time given the amount of arthritis currently present. 

Now, is there some room for subjectivity as to how an ankle with some arthritis will hold up over time? One hundred percent yes. This is likely (IMHO) where the MDs differed in their opinions. Or, perhaps the MDs said similar things, but team officials chose to utilize that information differently. I don't think we can say for sure. 

In any event, I thought your article was a very good synopsis. I agree entirely with the last 2/3 of it. Well done. 

[Brock Beauchamp]

58 minutes ago, Heezy1323 said:

How do they know exactly what he said? All they know is that the Giants deal seemed to hinge on his feedback about the MRI. Not exactly what the feedback was. 

Allow me to phrase another way. Why NOT ask him? What is to lose by collecting all available information? You can always choose to disregard it. For $300 million, I am of the opinion that a 15 minute phone call is reasonable. 

Again, my understanding is that they didn't ask anyone else except him, at least that's what Boras and Correa strongly implied.

Sure, talk to the guy, but what is the point of pursuing Correa if he's the only guy you're going to talk to? He already stated his opinion on Correa's ankle.

[Tiantwindup]

7 hours ago, Brock Beauchamp said:

But you already know what he said. Why ask him again?

Simply to flesh out more information. Did the info from the Giants answer every single question you have about his opinion or do you want to clarify something or go a little deeper?  You are about to commit $315M. Look, I’m not saying the Mets aren’t using this as an excuse to rescind a hastily proposed contract or whatnot, I’m just of the opinion that if you want to sign a guy for 12 years and you know of an eminent physician who thinks it’s not a good idea then I think it would be proper due diligence to speak with him directly versus just relying on a report or whatever it is they had. I think NOT talking to him would be weird. 

[Squirrel]

12 hours ago, Heezy1323 said:

Also, the MRI here is not 'predicting future injury' to use a term you used. It is, more precisely, 'documenting the current state of the ankle'. This may seem like semantics, but I don't believe it is. The injury isn't being predicted- it is already there (presuming my assumption of some ankle arthritis is accurate). What is being predicted is how this ankle will hold up over time given the amount of arthritis currently present.

I think this is the crux of it for all three teams. And I believe that the Twins were the only team that was willing to be creative enough to structure a contract that basically said ‘We’re both covered either way.’ The high AAV early on, the very low AAV with the team opt outs in the latter years beyond 6. The Giants balked and Boras/Correa walked away thinking the Mets were offering guaranteed years and money. But then I think the Mets tried to play a game and leverage information against Correa. And then the Twins came in, with the same information, asking, ‘How can we make this work for both of us?’ The Twins negotiated, imo, in good faith. I’m not sure a deal could have been made with the Giants or not because it seemed the Giants weren’t given opportunity, but I don’t really know. And I believe the Mets tried to put the screws to him. All knowing the exact same thing.

[RJA]

10 hours ago, Heezy1323 said:

Why is it that you find this weird? He is the preeminent foot/ankle physician for professional athletes in the world. The "Dr. James Andrews" of foot and ankle. Essentially every high level athlete seeks his opinion after an injury.

I don't think it's weird at all. I would want to know what his concerns were. I may or may not choose to abide by his recommendations, but I sure as hell would want to know what he had to say. He didn't get to his level by accident. 

I don't think it is weird they considered his opinion, but to agree to the contract they did pending a physical already knowing this guy had caused the SF deal to be nixed, and then not get another opinion makes no sense.  These facts certainly raise the issue of whether they agreed to the contract knowing they were going to negotiate his price down, in which case I question their good faith.  If they sought another opinion, and it was the same, and then took the stance they did, it would be more understandable.  As for doctor's opinions, whether he is "the" guy or not, his opinion is just that an opinion, and experts are often wrong.  IMHO, the failure of the Mets to get another opinion demonstrates they were playing games.

[IndianaTwin]

2 hours ago, Squirrel said:

I think this is the crux of it for all three teams. And I believe that the Twins were the only team that was willing to be creative enough to structure a contract that basically said ‘We’re both covered either way.’ The high AAV early on, the very low AAV with the team opt outs in the latter years beyond 6. The Giants balked and Boras/Correa walked away thinking the Mets were offering guaranteed years and money. But then I think the Mets tried to play a game and leverage information against Correa. And then the Twins came in, with the same information, asking, ‘How can we make this work for both of us?’ The Twins negotiated, imo, in good faith. I’m not sure a deal could be made with the Giants or not because it seemed the Giants weren’t given opportunity, but I don’t really know. And I believe the Mets tried to put the screws to him. All knowing the exact same thing.

We only see the final results, so we don't know the process, but with all the things the team does with options and incentives (think Buxton), it seems to me that the FO office is regularly approaching conversations with the line that I bolded. And I think that's a good thing.

In my limited experiences with negotiations, that's almost always the way to approach it. Not only does it increase the likelihood of success on that particular negotiation, it increases the likelihood of getting the next opportunity as well. And frankly, I think it's more enjoyable to go through life trying to help another person than it is trying to screw them over.

That's why the "who won and who lost this trade" articles bug me -- in a good trade, both teams win by meeting their needs.

Separately, am I right in thinking that the option years also help the Twins in terms of their luxury tax calculation? Not that they appear (on the surface, but who knows about the future, right?) overly concerned about that, but doesn't this now count as $270M/10 = $27M against the tax as opposed to $200M/6 = $33.33M? 

[Squirrel]

1 hour ago, IndianaTwin said:

We only see the final results, so we don't know the process, but with all the things the team does with options and incentives (think Buxton), it seems to me that the FO office is regularly approaching conversations with the line that I bolded. And I think that's a good thing.

It was also something they said in the press conference … maybe not those exact words, but there was certainly an ‘Okay, let’s figure this out’ attitude. And you are right, it’s a good way to approach negotiations. It’s why I said the Twins negotiated in good faith. I can’t really speak to the Giants, or really to the Mets, either, but the Mets asking him to ‘pass’ a physical every year to guarantee money is not a good faith negotiation and is basically a yearly opt out clause. And the Twins didn’t give Correa what they initially offered, either, but I think they approached it fairly, which shows the amount of respect they bring to the table (despite my earlier whines that they only offered 10/285).

Perhaps a different thread, but I’m not sure it’s a luxury tax issue. I think the later years, low AAV and opt outs was simply an insurance plan to a few things. IF Correa’s speculative ankle arthritis is a problem in those later years, it gives the Twins options to move him to another position, become a lesser role player or to cut him if it’s indeed that bad. And if it’s not that bad, Correa has already made his money up front. The lower salary later also leaves them room to take on another big contract or extend younger players. I mean, I’d guess it is more a payroll issue because I don’t ever see the Twins reaching a luxury tax threshold. They have the payroll room now and can do the higher AAV, but again, maybe an insurance plan … who knows what payroll will be then, but the Twins haven’t hampered themselves.

[wabene]

Do we really know for certain that the Mets didn't seek additional medical opinions? 

I guess Cohen could have been scrambling after a rash decision