CSAC to review medical exemption policies after Chael Sonnen suspension ruling
The California State Athletic Commission’s decision Thursday to cut Chael Sonnen’s one-year suspension in half for banned-substance use will have an immediate effect on the polarizing UFC middleweight’s career, but the case itself will probably have long-lasting ramifications on how the regulatory agency handles medical exemptions moving forward.
Sonnen had been put on suspension in September after his pre-fight urinalysis revealed a heightened testosterone-to-epitestosterone ratio during his fifth-round defeat to middleweight champion Anderson Silva at UFC 117 on Aug. 7 in Oakland.
Because of its performance-enhancing potential, testosterone is a banned substance under CSAC regulations unless pre-approved as a therapeutic medical exemption by the regulatory body beforehand.
At the fighter’s two-and-a-half hour appeals hearing on Thursday, Sonnen and his legal team explained that the fighter had been undergoing twice-weekly, intra-muscular testosterone injections after he was diagnosed with the condition hypogonadism in early 2008.
Sonnen’s attorneys, Steve Thompson and world-recognized doping specialist Howard Jacobs, presented ample evidence that their client had been on testosterone replacement therapy (TRT) since 2008, including eight blood tests spanning two years from the fighter’s osteopathic physician Dr. Mark Czarnecki. (The tests all showed Sonnen had low- to mid-level testosterone levels during the treatment, according to his legal team.)
The Oregon-licensed physician also testified about his diagnosis and treatment of Sonnen.
“At his state and at his level of fatigue, he was already displaying signs of severe mental fogging,” said the physician. “He would have an accelerated mental function at times, an accelerated coronary artery, accelerated muscle deterioration and accelerated fat accumulation and he’d have anemia due the lack of bone marrow stimulation.”
Dr. Czarnecki stated he wouldn’t approve the fighter to compete without the therapy to boast Sonnen’s low testosterone levels into a “normal” range.
“Chael’s body would not tolerate the extreme stress associated with such a sport,” said Dr. Czarnecki. “With the amount of trauma to the body, his healing would be deteriorated. His anemia in his blood level would increase. He would not have adequate oxygenation. It would just not be safe (for him.)”
“There was no doubt that he was probably on this treatment,” CSAC Executive Officer George Dodd told The Times following the hearing. “I believe by what he provided and from the declarations by his doctor, that he may have been on this treatment. The eight tests over two years – that’s hard to just come up with. But what I think the commission was focusing on was the disclosure issue.”
Much of the hearing focused on the sequence of events that unfolded the day before Sonnen and Silva entered the cage. Senior Assistant Attorney General Alfredo Terrazas, who presented the case to the commission on behalf of the state, argued that Sonnen had multiple chances to disclose to CSAC officials that he was on the drug treatment, but didn’t.
Dodd testified that Sonnen failed to list testosterone where asked to identify any medications or drugs he was taking on his pre-fight questionnaire. Dodd said Sonnen later approached him privately prior to his urine test and said he’d taken a shot of testosterone the day before, but hadn’t indicated he was undergoing TRT. This was then documented on a second worksheet.
The executive officer said he lacked the authority to call off the contest -- based on the perception that Sonnen was taking a non-approved substance -- without verification through a drug test. Dodd said he didn’t ask the athlete why he was taking the hormone because he didn’t want to inadvertently concern the fighter on the eve of his bout.
"If I’m putting something in his head that’s going to hurt him in the ring, distract him or anything else, I'm putting the health and safety of the fighter at risk," Dodd told The Times.
Dr. Gary Furness, the cageside physician assigned by the CSAC to conduct the pre-fight medical screenings before UFC 117, said he asked Sonnen two times during the fighter’s physical about any prescription medications or supplements he might be taking, and that Sonnen didn’t volunteer that he was undergoing TRT.
Furness said he was notified on the day of competition that Sonnen had declared to a commission official the day before that he’d taken testosterone, but by then he felt it was too late to take any action.
During Sonnen’s testimony, he said didn’t include testosterone on his first form because other fighters sitting alongside him could read it.
“I don’t have problem with disclosing testosterone,” Sonnen told the commission on Thursday. “What I do have an embarrassment in is that I don’t want somebody to ask me why. I don’t want them to say ‘why are you on testosterone’ and I have to re-live my youth and not going through puberty and being teased.”
Sonnen also testified that he’d already disclosed his condition and that his physician and management had provided requested documentation via e-mail to the previous CSAC interim executive officer Dave Thornton prior to his October 2009 bout against Yushin Okami at UFC 104 in Los Angeles. Sonnen said his management was notified of the fighter’s exemption approval via telephone.
Dodd said there was no record of the correspondence in Sonnen’s file.
In addition, Sonnen said he’d previously disclosed his testosterone therapy to Dr. Jeff Davidson, who was present alongside Dr. Furness and, at one point, physically handled his paperwork. Sonnen said he believed Dr. Davidson -- who he said had been present during the fighter’s past bouts in Nevada and England and had allegedly passed the fighter’s medical information onto California in 2009 to obtain his exemption -- to be a CSAC doctor.
Sonnen said Dr. Davidson had also e-mailed him directly prior to his August contest to tell him he’d been “approved” to fight with the exemption still in place.
Marc Ratner, the UFC’s Vice-President of Regulatory Affairs, who was in attendance at the hearing, confirmed to the Times later that Dr. Davidson is an independent contractor hired by the promotion to assist in the medical licensing process for some events. Dr. Davidson is not a CSAC official.
Not all of Sonnen’s testimony meshed with the recollections of others.
Sonnen stated that a U.S. Anti-Doping Agency representative was also present at the UFC 117 pre-fight screening. However, Dodd denied this to be the case.
“It was just the athletic commission that was there to do the testing,” Dodd told The Times afterward.
During his testimony, Sonnen also stated that he’d been granted a verbal exemption from Nevada State Athletic Commission Executive Director Keith Kizer prior to a World Extreme Cagefighting bout against Bryan Baker in March 2008 and was told “not to bring it up again.”
Kizer denied granting an exemption or even speaking to Sonnen about the therapy to multiple media outlets both before and after Thursday’s hearing.
Prior to the commission’s 3-1 vote to shorten Sonnen’s suspension to six months, Commissioner Dr. Van Buren Lemons, a California-licensed neurosurgeon with years of experience in the sport, stressed the magnitude of the agency’s ruling.
“Hormone replacement is complicated, it’s controversial, and with this particular form, testosterone, it will speak to the safety of this sport,” said Dr. Van Lemons. “We’ve got to have an agenda item soon about this therapeutic use exemption for all of our banned substances. This may come up again, and I hope it doesn’t, but we have to be proactive.”
Dr. Van Lemons’ statements foreshadowed an obvious concern for the regulatory agency, which must tread carefully with medical exemption requests for drugs that have performance-enhancing potential.
Dodd said his offices would be conducting a full review of its exemption policies and protocol, which includes providing an environment where an athlete feels comfortable disclosing private medical information. Dodd said the review would focus on all medical exemptions, including those for therapeutic marijuana use.
“The question really for the commission is ‘what do we do with this type of treatment?’ That’s the next step,” said Dodd. “We know the guy’s on it. How do we deal with it? How do we go about building a policy, because if the fighter’s tried everything and that’s the last resort, how do we move forward and say, ‘OK, this is what you need to do to fight.
“There has to be a (clear) policy,” Dodd continued. “I don’t think it’s just the California Athletic Commission. I think all commissions are going to have this problem.”
-- Loretta Hunt