Zach Buchanan

zbuchanan@enquirer.com

Patients hoping to see orthopedic surgeon Dr. Timothy Kremchek late in July might want to follow the thrust of the season for the Cincinnati Reds. If the team is in clear buy or sell mode as the trade deadline approaches, that creaky shoulder may have to wait until August.

Kremchek, the team’s medical director, is very likely to be busy with baseball duties.

“It becomes very stressful. Very stressful,” Kremchek said. “I’ve had times where I’ve basically had to cancel my afternoon patients that I see because stuff is going on.”

Kremchek represents the last line of defense for the Reds when it comes to not getting ripped off in trades. He’s the one who gives the final medical opinion about whether prospective acquisitions are healthy enough to be worth the transaction. It was on his advice the Reds chose not to trade Jay Bruce to the Toronto Blue Jays in February.

That deal, a three-team swap that included the Los Angeles Angels, reportedly fell apart because the Reds had medical concerns with one or more of the minor-leaguers they were set to receive. The aborted trade was just the latest offseason move in Major League Baseball to run into health issues.

Of course, teams have always taken medical information into account when considering any acquisition. But with the proliferation of social media in the last few years, that part of the trade process that has become more public, with reports of an agreement outpacing the due diligence needed to officially reach one.

That concerns Reds general manager Dick Williams. He doesn’t like players popping up in trade reports, only to be unfairly branded with a scarlet “H” for health risk when the deal falls apart over medical opinions. That was exactly the trajectory of the near Bruce trade, with some reporters openly speculating about the condition of Bruce’s knee.

Williams also knows he can’t do anything about it.

“I feel like I’m hearing more of the reporters saying nothing’s done until it’s done,” Williams said. “But they still want to be first reporting this sort of discussion. They’re still getting the names out there, and that’s part of the issue.”

While advancements in mass communications have given Williams some headaches along those lines, they’ve likely also saved the Reds millions of dollars in the form of bad investments avoided. There is more medical information available, and it is far more accurate and accessible. The process may be more public than it ever was, but it’s also less painful for the same reasons.

But, as any doctor will tell you, less pain doesn’t mean painless. The stakes riding on Kremchek’s medical expertise are as high as ever.

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Pending medical review

Most of the time, trades are agreed upon in principle before team doctors and trainers ever get involved. Even if a player is coming off a recent surgery or is still out of commission with injury, a thorough medical accounting is the last step.

“In general, you get the deal done,” Williams said. “You agree on the deal as if the player is healthy.”

Once an agreement is reached, the medical experts are called. Years ago, that used to require physically sending a player’s entire medical history – including copies of X-rays and MRI scans, along with other accompanying material – from one team doctor to another. It was a hassle.

But in 2010, MLB introduced its Electronic Medical Records system, housing medical information on every player on every team in one centralized, online location. When a trade is being discussed, one team doctor can give another an electric key to access the records of a specific player. (Players are also given this key to distribute to whomever they wish once they reach free agency.)

Access to such records usually shuts off after 24 hours, underlining how streamlined MLB has made a process that used to take at least several days.

“We could do it the same day now,” Kremchek said. “The girls who work in my office can pull it up on a computer, and I can do it in the matter of 10 minutes.”

Those records are also dizzyingly complete. All available medical information on every player at every level of every organization is included, and go far beyond the scans taken when players first report to spring training each February. If a player sought treatment for any issue at any point in the season – even if he was issued two ibuprofen for a headache – that information is included.

That’s a stark contrast from years ago, when a team didn’t know much about its own players, much less anyone else’s.

“Twenty years ago when we started doing this, we had our own minor-league players showing up who had surgeries,” Kremchek said. “We never knew who had what, and they’d show up and have bandages on.”

The Reds know that better than anyone the benefit of accurate and consistent medical record-keeping after its brouhaha with the Washington Nationals over their acquisition of pitcher Gary Majewski midway through the 2006 season.

Cincinnati accused Washington of willfully omitting the fact that Majewski had received cortisone shots for shoulder pain prior to the trade, and later filed a grievance with MLB. Majewski never pitched well with the Reds after strong results with the Nationals.

Results of MLB’s inquiry into the situation were never revealed, and both teams now have different GMs. The centralized system helps prevent such issues from happening again.

“We had the Majewski thing that happened years ago, and there were no records, no nothing,” Kremchek said. “It was not a good situation. That became very public, at least locally. It’s tamed down a lot since then.”

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High-stakes decisions

Even armed with more medical information on trade targets than has ever been available, declaring a player healthy enough to acquire is no less daunting for team physicians like Kremchek. Players are also more expensive than ever, and trading for a damaged one can sink a team’s competitive fortunes.

Team doctors feel that pressure acutely. Everyone wants the trade to work out, and no one wants to be the reason why it falls apart at the 11th hour.

“You want to be able to say, ‘Yes, pull that trigger. They’re going to be fine,’” Kremchek said. “But you know the accountability if they can’t perform is going to be up to you.”

Early in his career, Kremchek erred firmly on the side of caution. Anything that had feathers was a duck, and Kremchek shot them all down. Now in his 20th year in his current role, he has a better idea of how to distinguish different water fowl.

With that longevity comes similarly long relationships with other team doctors. When teams are on the verge of a big trade, it’s very common for one team’s medical personnel to reach out to their counterparts for an in-depth inquiry about something in a player’s medical history. Doctors who know each other also know how to serve two masters at once – loyalty to their employer and their team’s interests, and honesty to another trusted medical colleague.

“We’re friends, we know each other,” Kremchek said. “There are certain words they give you, and it’s a key word to say, ‘Look, I’m telling you this, but you know what I’m really telling you.’ We all do it that way.”

Still, there are blind spots. Judging the health of minor-leaguers is a crapshoot – a procedure done by a doctor in a High-A town isn’t treated the same as one performed by renowned orthopedic surgeon Dr. James Andrews. Prospect trades require lots of phone calls and a healthy dose of medical skepticism.

There’s also just bad luck, and teams looking to avoid it might want to make all trades at the beginning of spring training. For many players, that could be the only time they’ll undergo a full medical work-up, including all kinds of diagnostic scans.

A pitcher who tears his ulnar collateral ligament a day after being dealt to a new club may have never reported issues up to that point. The last MRI performed on his elbow may have come when he reported to camp in late February, meaning that there is a five-month information gap for many deadline acquisitions.

Teams can ask for an in-person physical before trading for a player, but that is next to logistically impossible during the season, when many deals have to be consummated at the last second.

“Your hands get tied sometimes,” Kremchek said. “That’s when you have to trust what these (other doctors) are telling you.”

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Send it back to the kitchen

It’s not uncommon for agreed-upon trades to be changed or even dropped because of medical issues. With advances in medical technology and the amount of money being poured into the game, there are more health issues to find and more incentive to identify them.

“You’re hearing more about the ones that don’t happen,” Williams said. “I do think because the technology is better. In the old days, it’s like, ‘Well, he has a sore elbow, but I’m sure it’ll be fine by spring.’ Now they’re taking scans and x-rays and you’re getting a lot more detail. There’s a lot more opportunity for interpretation. The dollars have gotten so much bigger that doctors don’t want to be the scapegoat.”

Some teams are more forgiving when it comes to the medical part of trade discussions, while others are sticklers. For instance, the Baltimore Orioles are notorious for their stringent physical examination process when negotiating free agent deals.

Much of it depends on the needs of the trade in the first place. A team looking for a two-month rental to get over the playoff hump may be more willing to ignore a slightly fraying tendon than a team looking to bring in a future star for the long term.

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If issues do arise, teams often reopen negotiations, either scaling down based on a player’s medicals or substituting new players instead. Sometimes teams decide to dump the trade altogether if they can’t get a healthy version of the player they wanted in the first place. Kremchek said last year’s Johnny Cueto deal took a good two weeks to complete because of a protracted medical review process. He also said the Reds have gotten better players in deals as recently as last year because they’ve been diligent in their review process.

Sometimes you send a meal back to the kitchen for a second attempt at a good meal, and sometimes you choose to eat somewhere else. Kremchek has yet to regret a meal.

“That has not happened to us yet, knock on wood,” he said. “God, I hope it doesn’t.”