Sunday, May 8, 2016

Another contentious decision

The National Anti-Doping Disciplinary Panel has issued another contentious decision. It has imposed a two-year sanction on an athlete who tested positive for steroid stanozolol in an out-of-competition dope test conducted by the International Association of Athletics Federations (IAAF) in April last year.
A steroid offence can get a lesser sanction than a standard sanction of four years but such instances are rare and such decisions are invariably based on irrefutable evidence and convincing arguments.
In the present case the decision, dated 9 March, 2016  to impose a milder sanction rested on the fact that the athlete had written down the name of the supplement that he had consumed and that, according to the hearing panel, showed he had no intention to cheat. It was presumed that the supplement was contaminated by stanozolol and it caused the positive test.
The standard sanction for a steroid offence under the 2015 Code is a four-year suspension unless the athlete can establish that the commission of the anti-doping rule violation was “not intentional” in which case it will be two years. For a ‘specified substance’ also the sanction would be two years unless the anti-doping authority can prove that the anti-doing rule violation was “intentional”. Steroids do not come under the category of ‘specified substance’.
This was a case in which the authority to pursue part of the ‘results management’ process was delegated to the National Anti-Doping Agency (NADA) by the Athletics Federation of India (AFI). Just as in the case of two of the woman 400m runners in 2011, Mandeep Kaur and Jauna Murmu, this was a test conducted by the IAAF at Patiala. The athlete happened to be a national-level shot putter.

AFI delegates authority

Again, just as in the Mandeep-Murmu instance, the AFI passed on the hearing process to be completed by NADA. In the case of Mandeep and Murmu, along with four other quarter-milers, the eventual verdict of two-year suspension was handed down by the Court of Arbitration for Sport (CAS) to which the IAAF appealed when the Indian panels imposed one-year sanctions for the steroid infractions.
The top Indian woman quarter-milers took the plea that they had consumed a supplement (ginseng) supplied by the foreign coach of the team and that could have been contaminated. The Sports Authority of India (SAI)_and not the NADA_got the supplement tested at the National Dope Testing Laboratory (NDTL) and the tests returned positive results for steroids methandienone and stanozolol. The women were finally penalized since they, according to the CAS arbitrator, could not establish “No significant fault or negligence”.
In the present case, that of the Chandigarh shot putter, the plea once again was he had consumed dietary supplement and that might have caused the ‘positive’ result for stanozolol since it could have been contaminated. The athlete stated that he had written down the name of the supplement in the doping control form and that, the panel was to crucially observe, was a clear indication that the athlete did not have any intention to cheat. The athlete argued, through his counsel, that he had always been taking supplements and had never in the past returned a ‘positive’ dope test.
Under the 2015 rules, this could have been a “contamination” plea and theoretically could have ended up with as little as a ‘reprimand’, the least of the punishments possible under article 10.5.1.2 (‘contaminated products’).
But it did not though the athlete’s lawyer did try to argue the case under “no significant fault or negligence” rule. But seemed to have been guided eventually by what the panel itself suggested.
The details of all the written submissions made by the athlete’s lawyer and NADA are not available. But the order by the panel headed by Mr. Ramnath does give a good idea about how the arguments went and how the panel arrived at its eventual conclusions and decision.
The order stated: “The pane has also deeply gone through the relevant citation of both parties, again the question of intention of the athlete is very material whether he intent (sic) to cheat. Here, in the present case the athlete from the very beginning i.e. at the filing of doping control form has mentioned of taking nutritional supplements, ‘Tri Troubles’ as athlete is not well educated it means that he had taken in fact ‘Tri Tribulus’ supplement and not the ‘Tri Troubles’. This substance is a nutritional substance which has a unique growth formula and is not banned rather it was recommended and purchased by Indian Weightlifting Federation by inviting quotations (photocopy of letter dated 11.12.2012 of Sahdev Yadv Secretary General, Indian Weightlifting Federation was filed from the side of the athlete wherein in the list of supplements at serial No. 23 Tri Complex Tribulus was mentioned). On the other hand, the Counsel for NADA did not show any document/evidence that this supplement is banned.”

Banned or approved supplements?

Several key points emerge from the above statement. The athlete had consumed Tri Tribulus, a herbal supplement derived from Tribulus terrestris. The panel has noted that the substance is a “nutritional substance” which was not “banned”. It was, on the contrary, recommended by the Indian Weightlifting Federation.
No one apparently told the panel that there is no “banned nutritional substance”. WADA only bans drugs and doping methods, not supplements. WADA also does not ban brand names, only generic drugs. For example, stanozolol is among the banned steroids, not Winstrol, one of the more popular drugs available in the market that contains stanozolol.
NADA should have told the panel that it cannot “show any document/evidence” that the supplement (Tri Tribulus) was banned since it was not in the business of either approving or banning supplements. Or for that matter WADA was not in the business of approving or banning supplements.
Quite often we hear the mention of “WADA-approved” supplements during dope hearings. There are no such supplements in the world. WADA warns athletes about the use of dietary supplements because of their propensity to get contaminated by banned drugs. All the anti-doping agencies including National Anti-Doping Organisations (NADOs) are also supposed to warn athletes about such dangers.
While guiding athletes towards the use of supplements some of the anti-doping agencies make it clear that it is ultimately the sole responsibility of the athlete to make sure the substance is safe.
Athletes are responsible for what goes into their systems. “I didn’t know “ can never be a clinching argument in a doping case.
Coming back to the order of the panel that took note of the mention of Tribulus in the doping control form, it goes on to say “…therefore the possibility of contaminated nutritional supplement Tri Tribulus which the athlete was consuming, cannot be ruled out, however the great burden lies upon the athlete to show that he had consumed contaminated supplement Tri Tribulus. The …Counsel for NADA has submitted that they have not filed any cash memo or not mentioned the name of the shop from where he has purchased and, therefore, he cannot be given any benefit of provisions of “No significant fault or negligence”. But the panel is of the view that it is very difficult for the athlete to keep cash memo etc as he was not knowing at the time of purchasing the nutritional supplement Tri Tribulus that it will contain contaminated supplement.”
What the panel apparently wanted to say in the last sentence above was the athlete couldn’t have known at the time of purchasing the supplement (Tri Tribulus) that it would contain a banned substance/steroid.

No testing of supplement

The main point here seemed to have been missed by the panel as well as NADA. There is only a claim that the supplement must have been “contaminated”. No one tested it! No one seemed to have sought a test! NADA did not ask for a test. The panel did not seek a test to find out whether the supplement was contaminated by stanozolol. The panel would have been within its rights to demand such a test. It did not.
The panel wrote: “However it is the duty of the athlete to explain how the prohibited substance entered in his body, for that to some extent he is able to show that contaminated substance stanozolol entered into his body through Tri Tribulus (emphasis mine) supplement which he consumed regularly. If he would not have mentioned Tri Tribulus supplement in the doping control form, the position would have become different and he would have been guilty of taking the said substance with intention to cheat. Therefore panel has come to the conclusion that the athlete did not consume the substance with intention to cheat and therefore the athlete case comes under clause 40.2 (b) of the IAAF anti-doping rules 2015 where period of ineligibility has been two years only.”
The panel obviously is uncertain about how the prohibited substance entered the athlete’s body. Otherwise it would not have stated “to some extent he is able to show”.

Precedents

There was one case in India of a female judoka who was reported for methylhexaneamine in 2012. She was exonerated on the argument that the substance must have come from beauty aid products. The decision was upheld by the Indian appeal panel, but was eventually overturned by the Court of Arbitration for Sport (CAS) and she given a two-year suspension.
Interestingly, NADA tried to bring in laboratory investigation report rather late during the appeal stage of judoka’s case but was not allowed. The lab report stated that MHA was not present in the beauty aid products that the athlete had applied. The company gave a signed statement that its products did not contain MHA. 
It was widely believed at that time that geranium plant and roots contained MHA. Later in another case, that of a woman swimmer, once again the theory that soaps, shampoos etc may contain geranium which in turn could mean MHA, was proposed and accepted. The swimmer was given a reduced sanction by an appeal panel without testing any product and without NADA advancing what was known to it through laboratory tests in the judoka's case.
In the present case the lawyer representing the athlete mentioned a couple of cases in the athlete’s defence. One of them involved a British rugby player who tested positive for 1-3,dimethylbutylamine, a stimulant, in an in-competition test. The player claimed that his positive test had come out of his use of a supplement.
Many of his arguments were accepted by the UKAD which did not claim that the player had used a doping substance “intentionally”.
The UKAD only pressed for a six-month suspension for the level of negligence shown by the player. It accepted that the prohibited substance had come from the supplement only. But before doing so, it tested the product from a tub of left-over stuff given by the player and the laboratory reported that the substance he tested positive for (dimethylbutylamine) was indeed present in the supplement.
The player received a six-month suspension. He was able to satisfy the panel that he had taken certain basic precautions before purchasing the supplement and consuming it.
There could be dozens of cases like these across the world including in India where either the anti-doping agency would have tested the supplement and found out what it contained or else a panel would have ordered such a test and satisfied itself what its ingredients were or else an athlete would have on his/her own got the tests done to defend oneself.
The mere presence of the banned substance in a supplement alone may not, however, help an athlete escape sanction or get reduced punishment since degree of fault or negligence would also be assessed if a 'no significant fault or negligence'argument is taken. That is what happened in the case of the six woman quarter-milers when their cases went up to CAS in 2012.
Had the substance been tested in this case and found to be contaminated the athlete could have fallen back on the ''Contaminated Products' rule introduced in the 2015 Code which might have enabled him get a simple ‘reprimand’ and no suspension.
His lawyer was keen to proceed on the “No significant fault or negligence” argument. But the panel stated, rather surprisingly: “The argument of the learned counsel for the athlete that his case may be taken under the rules of “No Significant Fault or Negligence” does not appeal to our mind, as the panel has already reached to (sic) the conclusion that the athlete was not having intention to cheat.”
A particular line of defence did not "appeal" to a hearing panel!
Pertinently neither NADA nor WADA (or IAAF) has appealed this decision which may well set a precedent about supplements use.
***************
Other recent debatable decisions:
Click here for Prescription v TUE
Click here for Same class of substance, two vastly different sanctions







Wednesday, May 4, 2016

Prescription v TUE

Can an athlete take testosterone without having obtained a therapeutic use exemption (TUE) from the authorities and eventually get a reduced sanction when he is tested and found ‘positive’?
Yes, he can. At least in India that is possible as has been established through an order given by the National Anti-Doping Disciplinary Panel (NADDP) in the case of an athlete last February.
The athlete, a javelin thrower from Punjab, had tested positive for testosterone in the all-India Police Championships in November, 2014. His T/E ratio showed 13.0, well above the prescribed limit of 4.0. Isotope ratio measurement spectrometry (IRMS) analysis confirmed the use of exogenous (outside the body) steroid.
The athlete happened to be a second-time offender. He was handed down a three-year suspension for his second offence, the first one having come in 2009. That was for stanozolol, and he copped a two-year ban then.
The 2014 offence was also handled under the 2009 rules even though the final hearing in the case was held on 7 December, 2015.

Went by doctor's advice

The athlete’s defence mainly hinged on the premise that he had taken medicines as prescribed by his doctor. In his written submission he stated, according to the order, that he “was suffering (sic) from infertility and taking treatment…” The athlete also submitted medical records of his wife to support his arguments. He submitted that he had been taking medicines for his condition “much prior” to the competition in which he tested positive.
The athlete pleaded that he was “not well literate” (sic) as per the order and did not have knowledge of English medicines. His doctor apparently prescribed him Andriol Testocaps (testosterone in capsule form).
The National Anti Doping Agency (NADA) argued before a panel headed by Mr. Ramnath that the athlete did not obtain a TUE for the use of testosterone. It said the athlete had not disclosed in his doping control form that he was undergoing testosterone therapy.
It further argued that the athlete had taken nearly five months to submit his defence and the submissions made by the athlete were afterthoughts and “documents produced on record have been obtained by fraudulent means and should not be taken into consideration.”
NADA also argued that it was the duty of the athlete to ensure that no prohibited substance entered his body and it was also his duty to advise his doctor that he was an athlete and was bound by certain rules.

'Documents authentic'

The panel ruled: “NADA could not establish that medical documents of athlete and his wife are fraudulent/manipulated after athlete was found guilty of violating anti-doping rules 2010. As the perusal of medical documents of athlete are of dated (sic) 07-07-2014 and 10-08-2014 and 27-09-2014 and the consulting doctor is Dr…, MD, Consulting Physician. No evidence was submitted from the side of NADA to show these papers are frivolous. Secondly the medical documents filed by the athlete, of her (sic) wife were original and they are dated 30-06-2014…”
The order, dated 5 Feb, 2016, further stated: “The submission of NADA with regard to non-submission of facts of taking medicines at the time of sample collection while filing the doping control form or not obtaining TUE can be said (sic) maximum lapses on the part of athlete. As the athlete already submitted (sic) in written reply that he was not well educated and did not have knowledge of English medicines and hail from village farmer’s family (sic).”
(A TUE panel, normally comprising doctors, takes up applications for exemptions from athletes for use of banned substances on medical grounds. A TUE granted or rejected by an anti-doping agency can be reviewed by WADA.)

Case of a weightlifter in 2010

In a similar case involving a weightlifter who was also advised testosterone therapy for “infertility”, a disciplinary panel had ruled in August, 2010 that the contention of the athlete was valid and imposed no ineligibility.
On an appeal from WADA, however, an appeal panel headed by Justice C. K. Mahajan (retd), set aside the disciplinary panel ruling in July 2011 and imposed a two-year sanction on the lifter.
Almost simultaneously another case of an athlete, a woman sprinter from Tamil Nadu, had also ended up in similar fashion. That was a case of stanozolol usage, prescribed by a doctor. The disciplinary panel ruled in favour of the athlete; the Mahajan panel ruled otherwise. The sprinter’s stanozolol case was brought into the arguments by NADA during the javelin thrower’s recent case, but it made no impact. The lifter’s case was apparently not mentioned.
The Mahajan panel wrote in the order that imposed a two-year suspension on the weightlifter: “In order to eliminate or reduce the period of ineligibility the respondent has to establish that he bears no fault or negligence for the violation of the Anti Doping Rules and if he is successful then the period of ineligibility shall be eliminated. We are unable to uphold this finding.
“The question that needs to be answered that whether the respondent bore no fault or negligence. The respondent admits during hearing that he took substances that caused adverse analytical finding in the test. Therefore we can safely conclude that the respondent would have discussed treatment therapy with his doctor and its
effects in relation to the Anti Doping Rule violation.
“A sanction cannot be completely eliminated on the basis of no fault or negligence even when the administration of the prohibited substance has been done by the athlete’s physician/doctor without disclosure to the athlete. In order to benefit from an elimination of the period of ineligibility for no fault or negligence, the athlete
must establish that he did not know or suspect and could not reasonably have
known or suspected, even with the exercise of the utmost caution, that he had
used or been administered the prohibited substance.

Athlete's responsibilities

“In the present case the respondent did not establish that he took any
precaution or made any inquiry to assess whether the medical treatment he was following was free from prohibited substances. He did not either demonstrate having informed his doctor that he was an athlete, bound by a duty of care to avoid the ingestion of any prohibited substance. It is true that the medical
treatment was prescribed by the respondent’s doctor. However, the respondent
cannot hide behind his doctor’s ignorance of the Anti Doping rules in order to
escape from sanctions due to Anti Doping Rule violation.
“The medical treatment prescribed by the doctor does not dispense the athlete to control if the medicine he is prescribed contain prohibited substance. The respondent has not established that he exercised utmost caution and therefore that he bore no fault or negligence. The respondent has also not shown any truly exceptional circumstance to warrant reduction of the otherwise applicable period of ineligibility. It is the duty of the athlete to ascertain that the drug he was prescribed for a long period of time does not contain any prohibited substance. If the athlete fails to exercise this caution he should not get the benefit of no fault or negligence/no significant fault or negligence.”
A TUE for testosterone use is very rare in anti-doping parlance. Here in the case of the javelin thrower there was no TUE but medical prescriptions and laboratory investigation reports. Once again, as had been the case in several instances in the past, the “village” background of the athlete and his inability to read and understand the medicines prescribed in English went in favour of the athlete.

Sanction reduced twice

As for arriving at a sanction of three years for a second offence the panel stated: “…the only consideration left before the panel is to see how much ineligibility be reduced under Article 10.7.1 wherein a table has been prescribed for second violation (sic), therefore, for the second violation the panel is of the view to sanction (sic) one half of the period of ineligibility which comes to 3 years for No Significant Fault & Negligence in the table indicated below”.
The table is a reference point for administering sanctions under the 2009 WADA Code. Various combinations of offences have been given in the table. In this case it happened to be one of “No significant fault or negligence” (as deemed by the panel) in combination with a previous offence that could be described as ‘standard’ since a maximum sanction of two years was given in the earlier case.
Now, NSF (no significant fault or negligence) clubbed with ‘St’ (standard) on the table gives a sanction of 6 to 8 years.
The panel apparently came to the conclusion that this six or eight could be further reduced to half if “no significant fault or negligence” had been established.
That amounted to a reduction being granted twice over after having concluded that this was a case “no significant fault or negligence” and based on that conclusion this could be fitted into the 6-8 year bracket.
It is pertinent to point out here that had the panel come to the conclusion that the second offence was also “standard”, then a combination of two “standard” would have meant a sanction of eight years to life.
The panel had to understand from the table meant for sanctions for multiple violations that once the nature of the offence was determined by it as ‘reduced sanction’ (RS), ‘standard’ (St) or ‘no significant fault or negligence’ (NSF) etc and placed against the table to determine what could be the punishment for a second offence, there could be no further reduction except the range prescribed in the table.
In December last year, in a similar case like that of the javelin thrower, an appeal panel upheld the decision of a disciplinary panel which arrived at the same conclusions about reduction of the punishment under the “no significant fault or negligence” rule. In that case, also that of an athlete, it was reduced to four years though the applicable sanction was six to eight years.
Once the appeal panel had set a precedent, it was expected that other panels would follow suit though it was not a binding precedent.
(Updated 5 May 2016)