BLOOMINGTON, Ind. -- The first doctor Indiana University rower Katlin Beck saw was the medical director for Hoosiers athletics, who told her she had a muscular problem in her back and prescribed physical therapy, less-strenuous workouts and hydrocodone.
Beck went for the therapy and modified workouts but threw the medication in the trash, concerned about the dangers of addiction and the potential of being unable to determine later whether she was truly healed. But the pain persisted for several weeks, and Beck could not keep up during practices and workouts. She saw a second IU doctor after consultation with the school's athletic training staff. He diagnosed her with two spinal fractures, three bulging discs and bone deterioration, and instructed her to spend her summer in a back brace to heal.
Beck followed those orders, started to feel better, and returned to campus that fall hoping to restart her rowing career as a sophomore. An athletic trainer suggested that she consult with a third IU doctor before returning to regular team practices. This one disregarded the prior two diagnoses, telling Beck her pain likely was caused by problems with her hamstring muscles. Beck eased into modified practices, but her pain lingered. Her coaches seemed to doubt her injuries, she said, and as was standard, she and other injured rowers were isolated from teammates and even denied team gear for not meeting practice goals.
Athletes at Indiana and most universities are instructed to see athletic department and school-approved medical staff instead of personal physicians, even for such benign maladies as cold or flu symptoms. But Beck's frustration had reached a tipping point after nearly 15 months of pain, so she made an appointment with Indianapolis spine specialist Dr. Greg Poulter.
At that first meeting, Beck said Poulter gave her a warning: "You shouldn't be rowing." Beck noted that Poulter "was just really confused that doctors at this level missed such significant signs and obvious things that they should have caught."
"She no longer has a solid connection from her lower back to her pelvis," Poulter told Outside the Lines. "Her upper body is no longer firmly connected to her lower body. There's just scar tissue holding that together."
The second IU doctor's diagnosis was closest to being correct, but Beck said that none of the IU doctors -- including medical director Andy Hipskind -- recommended that she stop rowing.
How Indiana University has treated athletes' injuries drew national attention in December, when university officials looked beyond recent on-field improvement and parted ways with football coach Kevin Wilson, who faced accusations that he had belittled and berated his injured players. Wilson had been warned against such behavior previously by IU athletic director Fred Glass. But Outside the Lines has found that the culture surrounding injuries that led to Wilson's resignation has existed elsewhere in the athletic department and medical staff. Multiple athletes interviewed by Outside the Lines describe a pattern of failures, delays and neglect by Indiana's coaches, doctors and athletic trainers.
Beck said that at one point she mentioned her pain to IU medical staffers almost daily, and it took about 20 requests to get an MRI done on her back. A back injury also sidelined former football defensive lineman Nick Carovillano, who said his athletic trainers also were reluctant to order imaging tests. Former quarterback Zander Diamont said he received proper care for some of his injuries but "got laughed at" when he complained of pain in his ankle and requested an MRI; when he did ultimately get one, it showed bone fragments for which he had surgery. Former wide receiver Dominique Booth told Outside the Lines he received improper treatment after he suffered a concussion and that it wasn't just Wilson's aggressive demeanor that created a problematic culture related to injuries.
"Coach Wilson is a hard coach," Booth said. "That's what he is, that's what he does. ... But I think the culture of fear was more made from the people in the [medical] system that couldn't handle it."
Diamont said medical staffers were walking on eggshells and there was only one athletic trainer who would stand up to Wilson, whom Diamont describes as a poor communicator. "They were just always acting out of fear. Like there was always a pressure on them to treat us a certain way or not," Diamont said. "It did inhibit them from doing their job to the best of their ability."
Felicia Dunn, a graduate assistant athletic trainer with the football team in 2012, said Wilson often yelled at the athletic trainers, and recalled one incident when athletic trainers were dealing with an emergency on the field and Wilson shouted at them as if it were their fault the athlete got injured. "The graduate assistants got yelled at," Dunn said. "We tried to protect the students as much as possible. ... I didn't want them to be discouraged."
Wilson, whom Ohio State hired in January as offensive coordinator, declined an interview with Outside the Lines but told a media gathering after an OSU practice: "I know the department at Indiana has looked into everything. I know this school has looked into everything. I know we're very, very comfortable with what we're doing, where we're at, and we're excited to move forward." Former IU head football athletic trainer Craig Tweedy declined comment.
Indiana launched separate investigations into Carovillano's and Beck's complaints in the spring of 2015 and spring of 2016, respectively. When Wilson's departure was announced in December, Indiana officials said another football-related investigation was done in the fall of 2016 but wouldn't say what prompted it. Indiana's investigation into the Carovillano matter -- which included interviews with 12 other injured players -- determined that he did not receive improper medical care, and coaches had not exerted pressure on the medical staff. But it did note "behaviors by the coaching staff that may create an unhealthy environment for players."
Beck said a senior athletics administrator told her that officials had determined the rowing team was understaffed and there was poor communication among the medical staff, but he would not give her a copy of the investigation report.
Next month, Indiana is slated to restructure its sports medicine program to improve the accountability of team doctors. One major change will make Hipskind, the chief medical officer, an employee of the university within the athletic department. Indiana officials, doctors and former and current athletic trainers declined interview requests for this story. But a university spokesman provided answers to some questions via email and stated that bringing Hipskind "in house" should give the athletic department "more direct control over the performance of the [chief medical officer's] duties and makes that position more accountable."
The email also stated, "All students participating in intercollegiate athletics -- regardless of their status as a scholarship student, walk-on, male, female, revenue sport, non-revenue sport, and the like -- are provided quality medical care by Indiana University based on the professional judgment of the physicians, athletic trainers, and other medical providers regardless of the cost of that care."
Indiana athletics spent about $1.6 million in 2014-15 on medical expenses and insurance, according to a 2015 financial report -- higher than the average at public Division I schools. Spending increased by about a third over the previous five years.
Just as Indiana was planning changes to its athletic medical care, the NCAA was finalizing legislation for its member schools. The legislation gives athletic trainers and team doctors ultimate authority over medical care and addresses improper influence from coaches; the NCAA and the National Athletic Trainers' Association say such influence is endemic in college sports.
"There's so much pressure now to win and to win now. There's so much money involved in athletics, and that creates pressure," said Ron Courson, the senior associate athletic director for sports medicine at the University of Georgia and co-chairman of a NATA-led task force that, along with the NCAA, drafted guidelines for how colleges should structure their sports medicine programs and put athlete care first. "I think everyone's job is to sometimes take a step back and not let the pressure influence you to make a decision that you know is wrong. And it goes back on the individual person."
The NCAA's chief medical officer, Dr. Brian Hainline, said surveys have shown that athletic trainers feel pressure from coaches to make certain decisions.
"A coach is part of the entire support staff when it comes to medical decision-making. But a coach should have no role whatsoever in influencing any type of medical decision-making," Hainline said.
The new legislation also requires schools to appoint an administrator to make sure that protocol is being followed and that medical care complies with NCAA policies. (Anticipating that demand, Indiana officials told Outside the Lines they assigned the current senior assistant athletic director for sports medicine administration to that role in January.)
NCAA officials are trying to determine how to make such standards enforceable, including penalties for improper treatment. ?
One week after Wilson was ousted as IU's football coach, Beck filed a complaint with the Indiana Department of Insurance, a state agency unconnected to the university, against the three IU team doctors who treated her while she was a rower: Hipskind and team physicians Michael LaGrange and Ashlee Warren. Her complaint was the precursor to a medical malpractice lawsuit. The doctors either declined or did not respond to a request for an interview.
The 22-year-old former rower, who graduated from Indiana about a year ago, said the decision to file the complaint was not easy.
"I love Indiana University, and what happened has put such a damper on my emotions and feelings for the school that I'm supposed to love," she said. "I just want them to have accountability and say, 'We screwed up. We are not doing a good job of caring for our athletes -- how we should. We're not diagnosing them quick enough and we're not treating them well enough and we're going to do better.'"
In March, she withdrew the complaint, saying she wasn't up to the financial and emotional demands of pursuing a lawsuit, and that her main goal -- to hold IU accountable -- was accomplished by sharing her story with Outside the Lines.
In the fall of 2013, Beck was a freshman just a few months into her first semester on the rowing team when she started experiencing pain in her back. Most of Beck's daily communication about her condition were with a graduate assistant athletic trainer. The rowing team shared a full-time staff athletic trainer with the volleyball team, but when that person was on the road -- as was often the case -- the graduate assistant athletic trainer was responsible for 60 to 120 rowers, depending on the season. (This changed in October 2016, when the university hired an athletic trainer who was a former collegiate rower to work solely with the rowing team.) Beck said the grad assistants wanted to help but their hands were tied because they felt pressure from the coaches and doctors and were simply overwhelmed.
Outside the Lines interviewed two other former rowers, who spoke on the condition of anonymity, and they described similar frustrations. One said she thought that "doctors were in cahoots with the coaches" and she was often told to "row through the pain," even after she had surgery for an injury.
Beck said head coach Steve Peterson, now in his 14th year, and his assistants perceived injured rowers as "wimps" and isolated them from the rest of the team, even going so far as to deny them practice gear as long as they were injured. Beck said that prompted some rowers to formally complain to an athletic department administrator.
The Indiana spokesman declined an interview request for Peterson but wrote in an email to Outside the Lines that Peterson had set a goal rowers had to meet before they could receive their gear as a means of encouraging them to train over the summer. After the injured rowers questioned the practice, the spokesman said, they received their full complement of standard team gear, with racing gear issued to rowers who competed in events and met certain training standards.
Some of the injured football players said they, too, suffered forms of isolation, and a few complained about having to work out in a tent adjacent to the practice field. It was a "shaming tent," Carovillano said, although other injured players have disputed that characterization. Carovillano said Wilson on more than one occasion said that "he's paying $70,000 a year for us to sit on our ass, things like that. Tell us we're soft, we're not contributing, we're not helping him in any way."
Booth, the former wide receiver, said he became part of the "injured squad" after he suffered a concussion in August 2015. "We were not part of the team, really," he said. "Like even eating meals. We had to wait in the training room 'til everybody had ate, and I'm talking about, like, it's 1 o'clock and we hadn't eaten all day." When Booth was cleared to resume low-level physical activity, he said an athletic trainer spotted him standing on the sideline: "He's like, 'Well, I'm not going to get my butt cussed for you. Get over to the tent.'" He said he was forced into an intense workout, after which he started vomiting and experiencing piercing headaches.
"That was the worst decision that's ever been made in my life, probably that day. It's something that's never left my life. Never," he said. "I'm still on anxiety medicines. ... That's sad because I'm 21 years old."
The NCAA's Hainline said any type of "shaming" of injured athletes is something he hopes the new legislation will end.
"When you're dealing with a human being who has been injured and then that human being is ostracized or made to feel bad about the injury or some other thing, my opinion, my belief is exceptionally strong on that. That is unacceptable," Hainline said.
Beck said complaining about poor treatment only made Peterson more upset, and she recalled a meeting he arranged with several injured rowers.
"[He] said he didn't have room for injured people on his team and so we needed to get in there and work out with the rest of the girls or hit the road," she said. "And there were about three girls who got up and went in the room and started working out against their doctors' orders."
Beck said the athletic trainers were aware of the coach's orders.
"Why are the doctors allowing him to have conversations like this?" she said. "There's no proper chain of command. There's no one to hold anyone accountable at any of these levels, and so we're just in this vulnerable position as athletes."
Communication among the medical staff and athletes was poor, Beck added. After LaGrange, the team physician, agreed to an MRI for her, Beck said that in May 2014 she received a call from graduate assistant athletic trainer Mark Forbing.
"He said, 'Yeah, everything came back fine. You're good to go. Keep practicing,'" she said. Beck said she pushed to have a follow-up meeting with LaGrange, who told her about the spinal fractures, bulging discs and bone deterioration.
"I was so confused. Why did Mark just call me a few weeks ago and say that everything was fine?" she said.
Forbing declined to comment about his experience at Indiana other than to say that he did not remember a phone call with Beck about her MRI.
Poulter, the Indianapolis spine surgeon at OrthoIndy whom Beck consulted with and still sees, said he could not speak to how IU doctors treated Beck specifically, but he sees many college and high school athletes whose injuries have been managed poorly.
"Everyone is getting pushed incredibly hard, as if they were professional athletes," he said. "Most of these people will never see a dollar from their athletics, but they're being pushed incredibly hard and pushed to the point where they can be injured with long-term consequences."
Beck's injury -- a spinal stress fracture -- is a common ailment that any athletic trainer should be able to diagnose, or at least refer for an MRI, Poulter said. If the condition is diagnosed early, the bones can heal and there will be no long-term issues, he said. If not, the bones don't have time to heal, creating a weak spot in the spine that can result in chronic back pain and the need for spinal fusion surgery, which Beck has so far managed to avoid.
Carovillano, the former defensive end, had hoped to avoid surgery as well. During a practice in October 2014, he was going one-on-one against an offensive lineman and felt a sharp pain on the left side of his lower back. Over the next few weeks, that pain would worsen, and he would start to feel numbness down his legs. But he said athletic trainers wouldn't take him seriously: "They just kept telling me I was being soft. There was nothing wrong with me. So I kept telling myself that. And I just kept practicing every day with no restrictions."
He described an ordeal similar to Beck's -- waiting for an MRI, feeling isolated and shamed, getting help from an outside doctor, and experiencing lingering problems. In the spring, Carovillano decided not only to quit football but also to withdraw from the university. He said when an MRI finally showed that he had two herniated discs, one of the athletic trainers seemed to acknowledge the diagnosis errors when he asked him, "On a scale from 1 to 10, from 1 to you're going to sue, how bad does your back hurt right now?" Carovillano said Tweedy, the head athletic trainer, told him, "You're not as much of a p---y as I thought you were."
"They knew the whole time that something was wrong and they just hoped it went away because they didn't want to deal with it," Carovillano said. "They didn't want to deal with Wilson. That just shows you they knew something was wrong the whole time; they just neglected it."
On Feb. 20, Carovillano had surgery on what by then had become three herniated discs. His neurosurgeon, Dr. Michael Kachmann of Mayfield Brain & Spine in Cincinnati, said it's not uncommon to try physical therapy and to prescribe pain medication to initially treat an injury like Carovillano's, and even to wait up to six weeks before getting an MRI. But being sent into practice with that type of pain could make the problem worse and cause further damage.
Beck said she is fearful of what is ahead with her injury.
"If I can have the endurance and the pain tolerance to get through childbearing and all that, I still have to pick up my child every day and care for them," Beck said, holding back tears. She married last summer. "When I think about that, I get pretty emotional, just because I want to be able to play with my children and pick them up on a normal basis, just like any mother."
Producer William Weinbaum of ESPN's Enterprise and Investigative Unit contributed to this report.