Around the time the Baltimore Ravens completed a Thursday night win over the Cincinnati Bengals last November, Dr. Thomas J. Graham received images of injured quarterback Joe Burrow’s wrist from Cincinnati’s medical staff.

Burrow, Cincy’s franchise QB, exited midway through the prime-time game with a damaged scapholunate ligament. He missed the rest of the 2023 season. That night, though, the public had no concrete details about the severity of Burrow’s setback—and sports bettors grew impatient.

So, they found Graham’s phone number online and called it, knowing from news reports that he had also worked on Burrow the previous summer. They wanted a scoop on the quarterback’s status, which could enable them to place bets with special intel.

“Your name gets published that you’re taking care of an individual, and you get a flood of calls,” Graham, a hand surgeon at Jefferson and Lehigh Valley Health Network, said in a video interview. “When you see someone hurt, it’s like a button gets pushed, and the [betting] machine starts.”

Players and coaches across major United States sports leagues have been the most visible targets of harassment from bettors following the 2018 Supreme Court ruling that allowed states to legalize sports betting. But doctors have not been immune.

The HIPAA Privacy Rule makes the disclosure of private patient diagnoses illegal, but before legalized betting, it was rare for strangers to actively hunt for such details. Now, droves of gamblers have an incentive to seek records, and doctors and their offices must defend against them.

“People want an inside track,” said Dr. Timothy Kremchek, the head of medicine for MLB’s Cincinnati Reds and a surgeon at Beacon Orthopaedics. “We have to be smart, and the people who work under us, our nurses, our assistants, people in our operating rooms, they have to be closed-lipped too, because (bettors) are smart, they’ll do anything to get to whoever they can to find out this information.

“If you knew a star player was going to be out, it gives you a tremendous advantage.”

The NFL and MLB have emphasized safeguarding medical information during annual meetings, league representatives said. Professional organizations for doctors are also monitoring the situation.

Before the 2024 NFL season, Cathy Lanier, the league’s chief security officer, said in a virtual press conference with reporters that stadiums are grappling with a spike in “problem gamblers” making criminal threats toward players and coaches.

“One thing about our integrity program that I just don’t want to get missed is managing the increased hostility from some of our fans,” Lanier said. “In recent years, we’ve really observed a rise in the aggressiveness of the threats that we see. I think nationwide, [people] in the business world have experienced similar.”

Players in the NFL and other prominent sports leagues recognize the shift in fan behavior, whether it’s hearing the threats during games or seeing angry comments directed at them on social media.

“When you used to lose, you would hear about it because of a fan’s loyalty to the team,” Detroit Lions quarterback Jared Goff told the Associated Press. “Now you hear about it because they’re losing their money because of you.”

In the NBA, Indiana Pacers guard Tyrese Haliburton told reporters this year that the current betting environment made him feel like a “prop.” Detroit Pistons head coach J.B. Bickerstaff claimed his family received threats in 2023 when he was the head coach of the Cleveland Cavaliers

“There’s no doubt about it that it’s crossed the line,” Bickerstaff said at a news conference in March. “The amount of times where I’m standing up there and we may have a 10-point lead and the spread is 11, and people are yelling at me to leave the guys in so that we can cover the spread, it’s ridiculous.

“I understand the business side of it and the nature of the business of it. But I mean, it is something that I believe has gone too far.”

After the Supreme Court struck down the Professional and Amateur Sports Protection Act six years ago, allowing states to determine their own betting policies, 38 states have allowed wagers in some form.

FanDuel and DraftKings dominate market share, having deftly pivoted their focus from daily fantasy sports apps to sportsbooks. Partnerships with professional leagues, including MLB, the NFL and NBA, have seemingly strengthened their presence. This NFL season alone, the American Gaming Association expects $35 billion to be legally wagered.

The market share leaders expect their user counts to grow, as additional states such as Missouri could soon allow mobile sports betting through public ballot measures.

Consequently, physicians like Graham and Kremchek must brace themselves for more unwanted approaches from gamblers, all while still tight-roping through the typical anxieties of the medical profession.

“It’s a lot of stress, and now there’s a lot more stress,” Kremchek said, with “the potential that if you say the wrong thing to the wrong person or somebody in your office, do you get sued for that because you let information out? The stresses of doing this are totally outweighing the benefits at this point.”