U.S. Anti-Doping Agency to the Texas Medical Board Concerning Dr
Total Page：16
File Type：pdf, Size：1020Kb
PRIVILEGED AND CONFIDENTIAL DO NOT DISCLOSE SUBJECT TO: JOINT INVESTIGATIVE PRIVILEGE, ATTORNEY‐CLIENT PRIVILEGE AND WORK PRODUCT DOCTRINE INTERIM REPORT OF THE U.S. ANTI‐DOPING AGENCY TO THE TEXAS MEDICAL BOARD CONCERNING THE U.S. ANTI‐DOPING AGENCY’S INVESTIGATION REGARDING DR. JEFFREY STUART BROWN, ALBERTO SALAZAR AND THE NIKE OREGON PROJECT March 17, 2016 TABLE OF CONTENTS I. Confidentiality and Purpose of this Interim Report ................................................ 2 II. Background Concerning USADA .......................................................................... 3 III. USADA’s Determination Regarding Possible Commission of a Crime, Regulatory Offense or Breach of Other Rules of Conduct and Voluntary Information Sharing with TMB and Other Law Enforcement, Regulatory and Disciplinary Authorities and USADA’s Assertion of Joint Investigative and Common Interest Privilege Over This Response ............................................................................................. 5 IV. Summary of USADA’s Findings to Date Concerning Dr. Jeffrey Stuart Brown ..... 8 A. Potential Breaches of the Applicable Standard of Care .................................. 9 B. Potential Anti-Doping Rule Violations ............................................................ 12 V. Background concerning Dr. Jeffrey Stuart Brown ............................................... 13 VI. Background Concerning Alberto Salazar ............................................................ 13 A. Elite running career ....................................................................................... 13 B. Admitted testosterone use at the end of Salazar’s running career ................ 14 C. Coaching Relationship with Mary Decker Slaney .......................................... 14 VII. Background Concerning Nike Oregon Project .................................................... 14 A. Athletics West ............................................................................................... 14 B. Nike Oregon Project ...................................................................................... 15 VIII. Relationships Between Salazar and Athletes Coached by Salazar .................... 17 A. General ......................................................................................................... 17 B. Economic Pressure and Coercion ................................................................. 18 C. Supplement Use at the Oregon Project ......................................................... 20 D. Allegations of Salazar’s Disregard for Prescription Rules ............................. 21 1. Celebrex .................................................................................................. 21 i 2. Reliance on Asthma Inhalers within Oregon Project ................................ 23 E. Secretive Environment at Oregon Project ..................................................... 24 IX. Background Concerning USADA’s Investigation ................................................ 25 A. December 10, 2012 Email from Steve Magness to USADA “Play Clean” Email Address ......................................................................................................... 25 B. Scope and Course of USADA’s Investigation ................................................ 26 1. April 10, 2013 – Wall Street Journal Article Concerning Thyroid Medication Use .......................................................................................................... 27 2. March 22, 2015 – London Times Article Concerning L-Carnitine Use ..... 28 3. June 3, 2015 -- BBC/Pro Publica Investigation and stories...................... 29 4. Salazar issues “Open Letter” on June 24, 2015 in response to media stories ...................................................................................................... 30 C. Impediments to USADA’s Investigation ......................................................... 31 1. Resistance to Efforts to obtain documents from Salazar and Rupp ......... 31 2. Resistance to Efforts to interview Salazar and Rupp under oath ............. 32 3. Salazar’s Solicitation of Athletes to Be Represented by Salazar’s Lawyer ..................................................................................................... 32 D. USADA’s Investigation Continues ................................................................. 34 X. Relationship Between Dr. Brown and Alberto Salazar ........................................ 34 XI. Conflicts of Interest Arising From the Brown-Salazar Relationship and Dr. Brown’s Treatment of Salazar-Coached Athletes ............................................... 35 XII. Evidence That Salazar Colluded with Dr. Brown to Access Patient Medical Information and Participate in Dr. Brown’s Treatment of Patients ...................... 40 A. Alberto Salazar was highly focused on boosting the testosterone levels of his athletes and consequently sought to involve Dr. Brown in a variety of schemes to use Dr. Brown’s prescription writing authority to seek to boost athlete testosterone levels. ............................................................................ 40 ii 1. Dr. Brown participated in Alberto Salazar’s risky plan to have Salazar’s athletes rely on prescription strength levels of Vitamin D supplementation in order to attempt to boost testosterone levels ....................................... 42 2. Alberto Salazar relied upon Dr. Brown to provide thyroid hormones such as levoyxl, thyroxine and cytomel to athletes based on Salazar’s and Brown’s theory that these drugs would boost athlete testosterone levels. 51 a. Salazar’s participation in Dr. Brown’s thyroid treatment of numerous NOP athletes ...................................................................................... 51 b. Salazar and Dr. Brown apparently believe that thyroid medication can be used to boost athlete testosterone levels and thereby enhance athletic performance ........................................................................... 60 c. Dathan Ritzenhein’s rushed thyroid diagnosis .................................... 62 d. Dr. Brown frequently permitted Alberto Salazar to be the intermediary between Brown and NOP athletes for conversations regarding patient medical care ....................................................................................... 73 e. Dr. Brown allowed Salazar to use NOP athlete’s thyroid medication levels to try to influence their athletic performance ............................. 74 f. Uncharted waters and incomplete disclosure – what happened when two novel medical programs to enhance athletic performance (the unconventional use of thyroid medication and the use of L-carnitine infusions) collided ............................................................................... 79 g. Ariana Lambie appears to have been unnecessarily put on thyroid medication by Dr. Brown .................................................................... 83 h. Chris Solinsky also appears to have been unnecessarily put on thyroid medication by Dr. Brown .................................................................... 85 i. Conclusions regarding Salazar’s involvement in Dr. Brown’s treatment of NOP athletes for purported thyroid conditions ................................ 86 B. Salazar pushed Dr. Brown to organize and run a testosterone testing program that involved giving testosterone to subjects in their twenties who had no medical need and no prescription for the drug. ............................................. 87 C. Additional concerns regarding the use of testosterone by Alberto Salazar and regarding testosterone provided to Salazar by Dr. Brown ............................. 93 iii 1. Concerns regarding Salazar’s potential access to compounded testosterone ............................................................................................. 93 2. Salazar’s personal use of testosterone .................................................... 95 a. Salazar’s admitted use of testosterone ............................................... 96 b. Salazar’s admissions regarding dual prescriptions for testosterone from physicians in different states and other concerns related to his possession of testosterone ................................................................. 98 c. USADA’s requests to Salazar in 2015 for records regarding testosterone use ............................................................................... 101 d. Salazar’s insufficient January 30, 2016 response to USADA’s requests for records regarding testosterone use ............................................. 102 e. USADA’s February 15, 2016, follow up request for Salazar’s records regarding testosterone use ............................................................... 107 D. Salazar pushed Dr. Brown and Dr. Robert Cook to prescribe calcitonin to athletes based on Salazar’s untested premise that the prescription medication would help his athletes avoid stress fractures from overtraining. ................ 108 E. Salazar pushed Dr. Brown to perform multiple untested L-carnitine infusion protocols on athletes for no medical or health benefit to the athletes .......... 113 1. Background Concerning Potential Use of L-Carnitine to Enhance Athletic Performance .......................................................................................... 113 2. Background Concerning 24 Week Minimum Period of Time to Load L- Carnitine in Muscle Via Oral L-Carnitine Supplementation ...................