PCB chief medical officer quits after damning report over Ihsanullah s treatment

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The PCB's chief medical officer Dr Sohail Saleem has quit after a damning independent report criticised "delays in the diagnosis of [fast bowler] Ihsanullah's injury and inappropriate prescription of treatment".

Ihsanullah, who was injured last April and remains out with what was initially an elbow injury, did not have his right elbow pain treated, addressed and operated on appropriately, and never received the formal rehabilitation process required by his condition. These were the conclusions reached by the committee in a judgment that lays bare the extent of medical failure at the PCB over an extended period of time, particularly with respect to its treatment of injured fast bowlers.

The report, comprised by an independent three-member panel, also laid partial blame on Ihsanullah himself for "non-compliance with the prescribed rehabilitation plan" even as it concluded that the plan itself was inadequate. Crucially, the panel concluded that Ihsanullah's return to cricket remains a prospect of the distant future, recommending "aggressive physiotherapy of the right shoulder and elbow" and possible surgery if he does not recover in the 12 months.

The report, however, reserves its most trenchant criticism for Dr Saleem, and the treatment plan Ihsanullah was eventually put under. It stated that Ihsanullah's surgery was "planned hurriedly", lacking specialist review and preoperative assessment. It also stated that the surgeon Dr Saleem recommended for the procedure "lacked academics and experience in the field", calling the choice "inappropriate".

"Postoperatively, Mr Ihsanullah was not fully compliant to the rehabilitation protocols as alleged by the PCB officials," the report said. "He continues to have medial elbow pain along with shoulder dyskinesia. He has significant elbow stiffness for which surgery is not advised currently as per advice of national and international appropriate experts in the specialty shoulder and elbow.

"However, we strongly believe that in view of the talent possessed by Ihsanullah, he be physically assessed on his arrival to Pakistan whereby an appropriate rehabilitation plan be developed in a multidisciplinary fashion, including consideration of hydrodilation and the same be implemented to provide the best chance to the player to live up to his potential again."

Dr Saleem's resignation was announced as part of the official statement the PCB issued after the conclusion of the report into the injuries of Ihsanullah was made public. It brings an ignominious end to Dr Saleem's second stint as the PCB's chief medical officer; he quit in 2021 after an unsuccessful attempt by the PCB at holding a PSL season in a Covid-19 bubble in 2021, before being brought back to the cricket board under Najam Sethi's chairmanship in early 2023.

There was little by way of information regarding Ihsanullah's injury for nearly a full year after it happened last April. The issue was brought back into the spotlight after Multan Sultans owner Ali Tareen took to Twitter last month to reveal it was Sultans and not the PCB who bore the brunt of his living expenses while he recovered, saying they would also arrange for Ihsanullah to travel to England later this month "to be assessed by a world-renowned surgeon".

He told ESPNcricinfo at the time the PCB's medical department failed to pick up an elbow fracture in the scans they conducted, and subsequently put him on a training regimen that included regular bowling and gym work before a serious injury had been conclusively ruled out.

The comments put the PCB's medical department under the scanner once more, with the PCB chairman Mohsin Naqvi promising an independent inquiry. At the time, Dr Saleem spoke to ESPNcricinfo, admitting a "delay" in Ihsanullah's diagnosis, but maintaining there was "no mishandling".

That version has been decisively rejected by the committee's conclusions. Dr Saleem did say Ihsanullah was not compliant with the rehabilitation process, a rare point of agreement between the outgoing chief medical officer and the committee's report, though a number of players, and coaching and management staff, have privately expressed to ESPNcricinfo that there existed a trust deficit between several players and Dr Saleem.

In the last two years, multiple Pakistan fast bowlers have suffered lengthy injury layoffs. In July 2022, when Shaheen Shah Afridi suffered a knee ligament injury, it was also initially undiagnosed. He attended camps and travelled with the team for a month, before flying to the UK while paying for himself and staying in a two-star hotel as he sought independent treatment. It was only after Shahid Afridi complained publicly that the PCB said they would cover all of Shaheen's expenses.

Naseem Shah was known to be managing a back and shoulder complaint that caused him discomfort in the build-up to his right shoulder injury, which happened two months after Afridi was injured, and caused a six-month lay-off. That led to Naseem missing the World Cup and the Australia tour that followed.

The report was commissioned by Naqvi, who was elected PCB chairman in February. It was also tasked with investigating the injury-related absences of fast bowlers Arshad Iqbal and Zeeshan Zameer, as well as women's batter Shawal Zulfiqar. The committee recommended a two-month rehabilitation programme for Iqbal, examination by a foot and ankle specialist for Zameer, and a CT scan of the right shoulder for Zulfiqar.