The full USADA report on Alberto Salazar has been leaked - Here it is

That Dr. Brown appears to have failed to advise Dathan Ritzenhein and possibly other athletes of the fact that their L-carnitine infusions violated the WADA 50 mL limit.

For the reasons set forth above, it appears highly likely that Galen Rupp received an L-carnitine infusion from Dr. Brown in excess of 50 mL in violation of the applicable anti-doping rules and in violation of Dr. Brown’s duty to Galen Rupp not to cause him to violate the rules.

For the reasons set forth above, it appears highly likely that Lindsay Allen received an L-carnitine infusion from Dr. Brown in excess of 50 mL in violation of the applicable anti-doping rules and in violation of Dr. Brown’s duty to Lindsay Allen not to cause her to violate the rules.

For the reasons set forth above, it appears highly likely that Alvina Begay received an L-carnitine infusion from Dr. Brown in excess of 50 mL in violation of the applicable anti-doping rules and in violation of Dr. Brown’s duty to Alvina Begay not to cause her to violate the rules.

For the reasons set forth above, it appears highly likely that Dawn Grunnagle received an L-carnitine infusion from Dr. Brown in excess of 50 mL in violation of the applicable anti-doping rules and in violation of Dr. Brown’s duty to Dawn Grunnagle not to cause her to violate the rules.

For the reasons set forth above, it appears highly likely that Tara Erdman received an L-carnitine infusion from Dr. Brown in excess of 50 mL in violation of the applicable anti-doping rules and in violation of Dr. Brown’s duty to Tara Erdman not to cause her to violate the rules.

USADA wrote on page 188:

The Logged Formula Worksheet indicates that on January 4, 2012, one day before Galen Rupp received his L-carnitine infusion(s), four (4) 100 mL IV infusion bags containing a concentration of 9.67 grams of L-carnitine per 45 milliliters were prepared by the compounding pharmacy. Galen Rupp’s lawyer has apparently misread the “Logged Formula Worksheet” as allegedly referring to a “45 ML injectable.” However, on closer examination what the worksheet actually reflects is the preparation of 4 x 100 mL bags of injectable L-carnitine at a concentration of 9.67 grams per 45 mL. That each of the four (4) infusion bags prepared actually contained 100 milliliters at a concentration of 9.67gm per 45 mL is made clear by the fact that the bottom of the log records that each infusion bag contained approximately 21.4889 grams of L-carnitine.

Thus, the “Logged Formula Worksheet” is a clear indication that Galen Rupp received at least a 100 mL L-carnitine infusion and that he most likely received considerably more than this because 4 x 100 mL infusion bags were prepared the day prior to his infusion which occurred on January 5, 2012....

Page 179-80wrote:

Ritzenhein’s wife at this point still had “reservations” about the proposed L-

carnitine infusion and told him, “you don’t have to do it,”411 but Ritzenhein said heresponded to her, “if you want to be in the Oregon Project, and you want Alberto to coach you, you have to do it.”412 Ritzenhein felt he had no choice other than to get the infusion or leave the Oregon Project, “[t]here’s no way for me to get around it at that point, in my eyes.”413

USADA wrote :

Subsequently, USADA requested and received from Ritzenhein a medical records release to obtain records directly from Dr. Brown’s office. The Dathan Ritzenhein medical records obtained directly from Dr. Brown’s office (through his medical records service) have been Bates labeled USADA 000811 – USADA 000948. When the records obtained from Dr. Brown by USADA were compared to the records previously provided by Ritzenhein it became apparent that the records provided to USADA by Dr. Brown’s office had been intentionally altered. For instance, as reflected in the screen shots below, a note provided by Dr. Brown’s office to USADA related to the L-carnitine infusion had a notation of “(40 ml)” surreptitiously added.

Additionally, an entire page of handwritten notes from the L-carnitine infusion was completely removed from the set of medical records that Dr. Brown’s office sent USADA. The page of handwritten notes that was removed is set forth at p. 192, supra, and contained the key notation pictured immediately below. As explained below, this notation is useful for establishing that Ritzenhein’s infusion exceeded the 50 mL limit and constituted an anti-doping rule violation. It is curious that the page Dr. Brown left out of Ritzenhein’s records sent to USADA was perhaps the most important one to help confirm that the volume of the Ritzenhein infusion exceeded the the WADA 50mL limit.

The improper, non-contemporaneous insertion of a notation of “40 ml” in Dathan Ritzenhein’s medical records, as well as the apparent removal of a key page of the infusion chart notes, by Dr. Brown or someone in his medical office is significant for a number of reasons. These reasons include:

x Dr. Brown’s alteration of medical records supports the inference that additional records from the compounding pharmacy (which should have set forth information regarding the infusion volume of Ritzenhein’s L-carnitine infusion) may likewise have been removed from the medical fileprovided to USADA.

x Dr. Brown’s alteration of medical records supports an inference that he was well aware that the infusion which he gave to Dathan Ritzenhein exceeded the WADA 50 mL limit.

x Dr. Brown’s alteration of medical records supports an inference that he failed in his ethical duty to his patient by giving him an infusion in excess of 50 mL after specifically representing to Ritzenhein that the infusion would not exceed 45 mL.

x Dr. Brown’s alteration of medical records constituted a breach of Dr. Brown’s ethical duties to Dathan Ritzenhein because Ritzenhein (through his medical records release)459 specifically requested that Dr. Brown provide Ritzenhein’s complete medical file to USADA.

Of course, in light of the recently revealed document from the Compounding Corner Pharmacy demonstrating a concentration of 9.67 grams per 45 mL was used in making the Rupp infusion bags a reference to “40 ml” is even more curious....

Furthermore, as explained in this Interim Report, Alberto Salazar and Dr. Brown have to date taken the position that the L-carnitine infusions provided to the Oregon Project athletes were 45 mL or less and therefore below the 50 mL WADA threshold. Yet, the post infusion plasma carnitine levels measured in post infusion blood samples taken from each athlete who received an infusion from Dr. Brown reflects in each instance a supraphysiological L-carnitine level approaching or exceeding 2,000% higher than the athlete’s pre-infusion plasma carnitine level. This would necessarily mean that if the athlete got sufficient L-carnitine through an infusion of 45 mL to raise their post infusion carnitine level to such an extraordinary level that the concentration of L-carnitine infused by Dr. Brown would have had to have by far exceeded the concentration of L-carnitine that is recommended as safe for L-carnitine injections or infusions. It is clear from USADA’s interviews with each athlete who received an L- carnitine infusion that no athlete recalls any warning or disclosure by Dr. Brown of any risks of the infusion whatsoever, let alone any disclosure by Dr. Brown that he intended to administer L-carnitine at a concentration far greater than levels recommended as safe by manufacturers of injectable L-carnitine. However, the “Logged Formula Worksheet” provided to USADA on March 15, 2016, indicates that just such risky infusions of an extraordinarily high concentration of L-carnitine (i.e., about 21.5 grams of L-carnitine in 100 mL as opposed to the 9.67 grams in 1,000 mL used in the Magness infusion) was apparently tried on one or more NOP athletes.464

Page 215...

There are a number of significant differences between the medical records for the L-carnitine infusion received by Dathan Ritzenhein and the records for every NOP athlete who subsequently received an L-carnitine infusion from Dr. Brown. A comparison of these records reflects that in terms of the records kept the infusion received by Ritzenhein looks much more like the infusion received by Steve Magness than it does the infusion received by other athletes…..

For the reasons set forth below, the fact that Ritzenhein’s medical records state that he received 9.67 grams of L-carnitine over 1 hour demonstrates that Ritzenhein likely received an infusion far in excess of 50 mL…..

Thus, just as appears from the “Logged Formula Worksheet” we understand that even if Ritzenhein’s infusion was prepared at a concentration of 9.67 grams per 40 mL (a concentration even higher than that evidently given to Galen Rupp), that well over 50mL must have been used in the infusion in order to continue the infusion over the full one hour period of time that Dr. Brown evidently believed was required to attempt to get sufficient uptake of L-carnitine. As noted above, Ritzenhein’s recollection that his infusion bag was squeezed in an effort to accelerate the flow rate makes clear that well over 50 mL must have been used during the infusion procedure, precisely as the Rupp infusion “Logged Formula Worksheet” indicates happened for Galen Rupp’s infusion.

In any case, it is important to note just how extraordinary and potentially unsafe are the concentrations of L-carnitine which Brown has apparently acknowledged giving the NOP athletes and which are reflected in the “Logged Formula Worksheet.” 9.67 grams of L-carnitine diffused in 40 mL amounts to an L-carnitine concentration in the infusion solution of 241.75 mg/mL. This is more concentrated than the highest concentration of injectable L-carnitine commercially available in the U.S. and elsewhere. Injectable carnitine is available in the U.S. at a concentration of only 1 g per 5 mL (200 mg/ml).476 Moreover, as explained below, the manufacturers of injectable L-carnitine recommend it be diluted to 25 times less than 200 mg/ml before injecting it into a human being.

P220

For the reasons set forth below, the fact that Ritzenhein’s medical records state that he received 9.67 grams of L-carnitine over 1 hour demonstrates that Ritzenhein likely received an infusion far in excess of 50 mL.

P224 Concentration of Ritz’ infusion was unsafe

The concentration of the L-carnitine solution reflected in the altered records for Ritzenhein’s infusion (i.e., 9.67g/40 ml or, in other words, 241.75 mg/mL) is therefore more than thirty times higher than the concentration recommended by the manufacturer.

Page 226 Amount missing for all other athletes.

Perhaps the most telling aspect of what is known about subsequent L-carnitine infusions given to Oregon Project athletes is what is not recorded in their medical records. For each of the subsequent L-carnitine infusions485 the amount of the L- carnitine used in the infusion is not recorded in the medical records provided to USADA by Dr. Brown’s office. Nor was the amount of the L-carnitine used in any of these infusions set forth in any of the other documents provided to USADA by Salazar, the athletes or their legal counsel until the “Logged Formula Worksheet” was provided on March 15, 2016.

USADA has still not received any medical records from Dr. Brown which state the amount of L-carnitine used in the infusions. The omission in the medical records of the amount of L-carnitine used in the infusions should impress as truly shocking. After all, what piece of information could possibly be more valuable to record in order to evaluate the success (or not) of the infusion and to ensure the future reproducibility of the infusion protocol than the amount of the L-carnitine used? The answer, of course, is that no piece of information could be more valuable and useful for evaluating and comparing the infusions and in order to permit data about the infusions to be used in the future. This is why the omission of the amount of L-carnitine used (either by concentration of the infusion solution or via the absolute amount of L-carnitine) in the records of all five (5) subsequent infusions performed by Dr. Brown must either be regarded as either: (1) the most stunning and improbable of all possible recordkeeping failures, or (2) evidence of an intentional effort to conceal the amount of L-carnitine used (and more to the likely point, the volume of infusion solution used) in the infusions…...

Given that this tremendous, practically insatiable curiosity about the effectiveness of L-carnitine loading was present, and Dr. Brown was well aware of it, makes the utter lack of information in the medical records regarding the amount of L-carnitine used in the infusions both striking and utterly incomprehensible, unless the repeated omission of this information has been intentional. In context, neither Salazar’s professed apathy about the amount of L-carnitine used in the infusions, nor the absence of this information in the medical records are plausible. Both lead to an inference that information about the precise amount of L-carnitine used in the infusions may not have been included in the medical records because it could be damaging if disclosed.

Page 231 (Salazar may have lied to UK people about how much Rupp got.)

On March 24, 2014 Alberto Salazar sent an email to Barry Fudge, a physiologist with UK Athletics with whom Salazar regularly worked in developing the training plan for British Oregon Project athlete Mo Farah. Salazar’s email was sent in order to assist Fudge with preparing an L-carnitine infusion for Mo Farah to use prior to Farah’s marathon debut, set to occur in the London Marathon on April 11, 2014. Accordingly, Salazar provided what he referred to in his email as “the protocol that was used on one of our runners.”491 Salazar, however, did not identify this “Mystery Athlete” in his email to Fudge.

The emailed information provided to Fudge by Salazar included the Mystery Athlete’s pre-infusion blood sugar level, when glucose fingersticks occurred during the Mystery Athlete’s infusion, and pre and post infusion insulin and carnitine levels. Essentially, the email to Fudge contains a description of the data found in the medical records for a single NOP athlete. The measurements concerning the infusion of the Mystery Athlete, which are described by Salazar in his email to Fudge, are the same measurements which recorded in the medical records of most of the NOP athletes.492

Salazar does not identify the Mystery Athlete in his email to Fudge. However, it is clear that at the time Salazar sent the email he was aware of the identity of this athlete because Salazar knew that the athlete had been given a treadmill test. Salazar wrote to Fudge: “I will look for the treadmill results later.” Salazar was also aware that this particular athlete had a “baseline total Carnitine level of 129 [which was] a little high, . . . because the athlete had already been taking the drink daily for about three weeks.”493

A comparison of the recorded values for the Mystery Athlete who was the subject of Salazar’s email reflect that the Mystery Athlete was almost certainly Galen Rupp, as the values set forth in Salazar’s email are by far the closest the values reported for Rupp in his medical records. Yet, Salazar wrote Fudge, “Unfortunately, the records we have don’t show the amount of LCarnitine that was used.”

However, the “Logged Formula Worksheet” reflects that Salazar’s emailed statement to Barry Fudge about not having “records” that “show the amount of LCarnitine that was used” was not accurate. The “Logged Formula Worksheet” contains a fax marking indicating that it was faxed on “Oct 08 2013 [at] 8:23 AM[.]” While we do not know at this point to whom the “Logged Formula Worksheet” was faxed, it does appear that the information regarding the amount of L-carnitine used in Galen Rupp’s L-carnitine infusion was likely easily available to Alberto Salazar in October of 2013 and in March of 2014 when he sent the email to Barry Fudge claiming that this information was unavailable. Thus, it may be suspected that Alberto Salazar had a reason for not sharing the amount of L-carnitine used in Galen Rupp’s infusion. Of course, a possible reason for not wanting to share the amount of L-carnitine used would be Salazar’s knowledge that the infusion exceeded the WADA 50 mL threshold.

It's none of their business! wrote:

rojo wrote:

I am all for medical privacy. WE're not talking about releasing them to the public. We're talking about releasing to USADA.

A) You could redact anything sensitive and

B) We're talking about sharing reports with your visits to Dr. Brown.

They wouldn't have to release they terminated a pregnancy two years ago.

I think you are missing the point. The point is not what USADA planned to do. The problem is what they did do. They planned to keep this information private, but as a matter of fact, they didn't. In other words, despite what they said, releasing your information to the USADA turned out to mean releasing it to the public.

This information got out because someone at USADA was careless.

PS All medical information is sensitive. Why should I have to tell USADA anything about my relations with Dr. Brown? The way the WADA Code is written, USADA does not have a right to that information. Seeing it would be useful to them, but given the Code, they are out of luck.

Careless or super careless? wrote:

It's none of their business! wrote:

I think you are missing the point. The point is not what USADA planned to do. The problem is what they did do. They planned to keep this information private, but as a matter of fact, they didn't. In other words, despite what they said, releasing your information to the USADA turned out to mean releasing it to the public.

This information got out because someone at USADA was careless.

PS All medical information is sensitive. Why should I have to tell USADA anything about my relations with Dr. Brown? The way the WADA Code is written, USADA does not have a right to that information. Seeing it would be useful to them, but given the Code, they are out of luck.

Let's see, one day someone posts on let's run "I hope someone leaks the USADA report."

The next day it's leaked, off axis... To flotrack.

Careless or corrupt?