Brain Injury Lawyer - New York

NFL to tell teams to keep players out following any concussion or suspected concussion

The Associated Press reports that NFL commissioner Roger Goodell will tighten the restrictions on returning to play following a concussion or a suspected concussion.

Citing information obtain by Fox Sports, it is reported that Goodell will issue a memo this week to all 32 teams expanding grounds for the removal of a player with a head injury or concussion. Under the new rule, any concussion or suspected concussion will ban the individual from competing for the remainder of the game.  Currently, a player can return to the game after being diagnosed with a concussion if he is asymptomatic at rest and under exertion, and is cleared by the team doctor. The lone exception is if the medical staff determines the player lost consciousness, in which case he is ruled out for the remainder of the game.

The report said that if a player is "woozy, has general dementia or memory loss," Goodell wants him barred from returning to a game.

While it has taken some time, it is encouraging to see that the league is now taking a more aggressive stance on concussions.  At least they are beginning to read the medical literature and understand that a concussion can happen even without loss of consciousness and that it takes time for the full array of concussion symptoms to develop.

When in doubt, keep them out!

Read the full AP story here.

Heads of NFL Concussion Committee Quit

In the latest development concerning implementation of a new concussion policy by the National Football League, the co chairpersons of the league’s brain injury committee have resigned.

 

In newspapers this morning, it is reported that the panel’s co-chairs, Dr. Ira Casson and Dr. David Viano have resigned.  Good riddance to both of these individuals who should have been replaced by the league a long time ago.

 

The opinions of Drs Casson and Viano concerning concussions have for many years been criticized by world renowed experts on concussions and their long term effects.  As a result of their backward thinking and insistence that concussions were a minor problem and posed no danger to the health and safety of players, they not only placed the lives and health of professional athletes in danger, they also placed in danger the health and safety of every child who plays football and engages in other sporting activities where here is a risk of concussion and head injury.

 

The National Football League is looked to by student players, parents, coaches and trainers throughout the country for guidance on how to handle the important decisions of when to allow an athlete to return to play.  By minimizing, trivializing and by issue false and misleading statements, these two individuals, unfortunately set the wrong example.

 

It is time that the league get its house in order and come to grips with the realities and dangers of concussions.  If it means that players must not play, that some will be required to retire and that the league’s disability plan will be required to provide benefits, that’s the reality of the dangers in dealing with head injuries and contact sports.

 

You can read the full story on the resignation of these two “experts”: NFL Head Injury Study Leaders Quit

NFL to require "independent" medical examinations following concussions--will they truly be independent?

FOX Sports has reported an important new policy development in the NFL policies toward concussions.  According to FOX, the NFL  will now require teams to retain the services of independent neurologists and neurosurgeons to assess players following a concussion or head injury.

FOX Sports has learned that the teams were instructed to immediately find "independent" doctors and send names to the league for approval. The league will then team with the NFL Players Association's medical people to determine that each doctor is in fact an expert in this field as well as impartial to the team they are handling.   You can read the full Fox report:  NFL Implements new concussion policy. The New York Times has also followed up with a story of its own on this same subject, NFL To Shift In Its Handling of Concussions.

While this all sounds good, the concept of an “independent” examination is always something I am always cautious of.  In the area of personal injury, insurance companies routinely seek the service of “independent” medical examiners to assess our clients.  Unfortunately, these physicians are anything but independent and are in reality doctors for hire.  They understand who pays the bills and what the insurance company wants them to find and/or not find.  Time and time again, in the context of traumatic brain injury litigation my clients have been subject to phony medical examinations by neuropsychologists and neurologists who were anything but independent, ignored the available medical evidence, gave improper and incomplete examinations, relied upon faulty data and made up medicine to come to a conclusion that insurance company who was paying the bill wanted.  In fact, I call these “independent” medical examiners, Paid doctors for hire.  Other professions have different names for paid services.

The travesty of these exams came to light recently in a three part New York Times expose on “independent” medical examinations in the workers compensation context.  The physicians were retained by third party providers and understood what expectations were regarding their opinions.  These physicians tailored their opinions in favor of those who were paying for their services.

The NFL is no stranger to these biased examinations.  In fact, the examinations conducted by the league's disability plan are anything but independent.  The medical providers hired to perform these examinations to determine a player's entitlement to disability benefits routinely come to conclusions that are biased and faulty.  If the league goes to these same "experts" this time, the results will be predictable and more players will suffer from the life long consequences of a traumatic brain injury.

I am all in favor of taking the decision away from team physicians and team trainers, but I believe that players need the ability to retain their own physicians to provide advice and make important decisions for them.

Is it time that NFL fire the head of its concussion committee?

According to the New York Times and AP, the  National Football League Players Association has called for the removal of Dr. Ira Casson as co-chairman of the league's committee on concussions, saying that he is too biased to lead research efforts and fails to appreciate the dangers inherent with the post concussion syndrome.

Without commenting on the association's position, I can only add that I have had my own difficulties in trying to discuss the important issues of player safety with Dr. Casson.  While president of the Brain Injury Association of New York State an chair of its major sports concussion conference at Madison Square Garden, I invited both Dr. Casson and his co-chair, to participate.  I was amazed that despite the participation of the leading experts in sports concussions from throughout the nation, the NFL "experts" refused to participate.  Later, when the league was holding open meetings on the subject, I asked for permission to attend.  I was curtly informed that as an attorney and president of the Brain Injury Association, I was not welcome.

The player's association has said that they do not feel that Dr. Casson is impartial.  He has dismissed all studies which have found a link between football concussions and early onset dementia. 

It is time that the NFL examines the important public health crisis of concussions in sports in an objective and forthright manner.  It is not only the professional players that need this protection, but also all those involved in youth sports who look to the NFL for advice and guidance on this safety issue.

WHEN IN DOUBT, KEEP THEM OUT!

A refreshing bit of honesty about concussion management

USA Today reports a refreshing bit of honesty regarding the manner in which sports concussions have been treated in the past with the NFL.

The article reports on information obtained by the Huffington Post in which former Packers VP Andrew Brandt questioned whether he had acted appropriately to combat the effect of concussions during his stint with the team.

According to Brandt, "The honest answer is: I don't know. ... I saw the fuzzy looks when some of our players came off the field. I took calls from wives, mothers, fathers and brothers of players who had suffered concussions. I watched players vomit in the triage of the training room after concussions."

The paper also reports that, Brandt, who now serves as a consultant to the Eagles (in addition to writing for the National Football Post), said teams must yield decisions about the playing status of concussed players entirely to doctors and not allow coaches -- or players -- to have a say.

With the current information about concussions now available to teams, coaches and trainers, there can no longer be an acceptable excuse for allowing players who have sustained a concussion or a suspected concussion to return to play in the same game or even in a subsequent game without proper medical clearance.

You can read the full story by clicking here.

WHEN IN DOUBT, KEEP THEM OUT!

Nearly 20 percent of professional football players fail to report their concussion symtoms according to an AP study

A study sponsored by the Associated Press reports that nearly 20 percent of professional football players have hidden the fact that they sustained a concussion or down played their concussion symptoms.

The AP concussion study interviewed a cross section of NFL players, talking to five players on each of the 32 teams, which amounts to approximately  10 percent of all players.  The interview results confirms what we all know, concussions are a bigger problem in football then the NFL or its players association wants to admit to.

Players reported feeling there head vibrate like a bell, but going back to play within minutes and never reporting their symptoms.   Another player said,
"You get back up, and things are spinning," but he didn’t tell anyone.
 
Now the NFL wants players to keep tabs on each other and tell their teams if they believe someone else has a head injury.

The NFL told the AP that they believe all concussion symptoms need to be reported and that team members should be encouraged to report observations of their team mates to the medical staff.

According to the AP,  “What emerged from the AP's interviews was a wide-ranging, unprecedented look at the way active players think about head injuries in a world where "getting dinged" and "seeing stars" — and the potential long-term effects of concussions — are deemed a frightening but perhaps inevitable consequence of their job.”

The NFL says its data shows an average of one reported concussion every other game — about 120 to 130 concussions per regular season.

Of the 160 players interviewed by the AP, half said they've had at least one concussion playing football; 61 said they missed playing time because of the injury.

Players acknowledged staying on the field despite feeling "dazed" or "woozy" or having blurred vision, because, "It's what you're taught."

One thing is clear, the efforts by the NFL and the players association to educate players about the dangers and long term consequences of concussions, to date, have not worked.  Much more is needed and needed now.  Merely handing out brochures to warriors in the locker room about the dangers of concussions is not doing the job.  More serious efforts must be undertaken.  In addition to educational films which should be mandatory of former players who describe their disabling injuries and the need for vigilance, player’s wives and mothers should also be told about the dangers faced by their loved ones.  Maybe it’s time that we bring in the heavy guns to tell players, WHEN IN DOUBT, STAY OUT!

The full AP story can be read by clicking here.

Some important insights into concussions from Harry Carson

Hall of famer, Harry Carson has delivered some important messages on the tragedy of concussions in professional sports today.

Harry has devoted a great deal of time to alert the public and especially those participating in amateur athletics to the dangers associated with concussions. As Harry aptly observed while a guest of  honor at the recent Brain Injury Association of New York State Journey of Hope Gala, "According to the NFL and their physician, Dr. Ira Casson, they've been conducting studies for fifteen years.  How much longer do you have to extend your research to come up with any kind of definitive conclusion?"

Here are some more of his comments:

“It’s that train that’s coming down the track and it’s coming full speed and more and more players are being affected by lingering effect of concussions,”

“As a parent you really should be concerned,” -- “So if there is one thing that should come out of this thing, parents should have the information to determine whether they want their child to play a contact sport, football or not. Unfortunately for many of us who have played the game, there’s nothing really that can be done. The damage is already done."

Hopefully the league and congress will both hear these important messages and take appropriate steps to reduce the risk of permanent damage from concussions to all players, both professional and amateur.

A proposal to reduce brain injuries in football

Today's congressional hearing on the prevalence of brain injuries in the NFL produced few surprises.  The league unfortunately still refuses to concede the connection between chronic brain damage and repetitive concussions.  This denial in the face of overwhelming medical evidence is further evidence that the league may be incapable of policing itself and may cause congressional action including the revoking of the league's antitrust exemption.

Congress needs to go further and also needs to address the protection afforded to the league in erroneous decisions in regard to granting players disability benefits for the chronic and long term consequences of traumatic brain injury.  Injured players deserve access to the Federal court's to present their legitimate claims to a jury.

The following proposal to save the game of football and reduce the incident of concussions and other types of brain damage was presented at today's hearing by Chris Nowinski, president of the Sports Legacy Institute and co director of the Center of Traumatic Encephalopathy of the Boston University School of Medicine.  Chris is also the author of Heads Up, a book which provides a detailed look at the issues of concussions in athletes.

Here is the proposal presented at today's hearing:

10 Point Plan to Save Football:

In the past few years, former football players have begun being diagnosed with Chronic Traumatic Encephalopathy (CTE), a progressive neurodegenerative disease caused by repetitive trauma to the brain
which eventually leads to dementia. Some were famous NFL Hall of Famers like Mike Webster and Lou
Creekmur. Others, like Mike Borich, only played through college. All died sooner than they should have,
and all suffered terribly in their final years.

Since the discovery of CTE in 1928, the disease has been seen almost exclusively in boxers, which is why
it is often referred to as “punch drunk” syndrome. However, it is now diagnosed regularly in ex‐football
players, and in the past year, the Center for the Study of Traumatic Encephalopathy at Boston University
School of Medicine (CSTE) has diagnosed CTE post‐mortem in 11 of 11 former college and professional
football players that died at ages ranging from 37‐82 years. This is significant, as the disease should not
naturally exist in a single human being. The early stages of the disease have even been seen in an eighteen year‐old former football player. In 2009, it is clear that football is in the midst of a brain trauma
crisis.

The game of football has not always been played as it is today. In fact, the most consistent aspect of the
game has been change. In 1905 the game was so dangerous, regularly killing participants, that President
Theodore Roosevelt summoned the coaches of Harvard, Yale, and Princeton to Washington D.C. for a
summit on how to make the game safer and threatened to take action in the absence of significant
reform.

From this meeting the American Intercollegiate Football Rules Committee was created, and that Committee, among other things, legalized the forward pass and made other changes to eliminate dangerous collisions. Over and over, football has had to be changed to be made safer. Now it faces a new challenge.

CTE is a deceptive, quiet killer. The disease begins during a player’s career and then hides, slowly
killing brain cells until the athlete begins showing symptoms years later. Football has evolved into a something it was never intended to be. Football collisions may now be more dangerous for the brain than ever. With the combination of bigger, stronger, and faster players and hard‐shelled helmets that are often used as a weapon to initiate contact, we’ve created a type of repetitive trauma to the brain that has never existed before.

The discovery of CTE inside the brains of so many ex‐football players has shown us that it is again time
for change, and a new Committee. Only this time, it is a Committee to Save Football. Among high school
students, football is the most popular sport in America, played by one in eight American boys. While
football was first played by colleges, today football is a children’s game, with 95% of participants under
the age of 18.

These children are not old enough to make informed choices. Therefore, in light of the new evidence of
CTE in 100% of players studied at Boston University, it seems appropriate that we again reevaluate how
“Solving the Sports Concussion Crisis” we play the game of football before the 2010 season and at all levels of play: youth, high school, college, and professional.

If we can agree that the game is broken and needs to be fixed, we have an incredible number of paths to
a safer game without fundamentally changing football. If we know that practice collisions account for
over 50% of brain trauma, the proposals below could easily eliminate over 75% of brain trauma and
concussions today – it is simply a question of leadership.

Below are 10 paths to a safer game that can and should be used to reduce brain trauma. This would
serve as the basis for evaluating the options available to the Committee to Save Football.

1. Reevaluate how the game is practiced
• Greater than 50% of hits to the head occur outside of games. NFL teams rarely hit in practice due to risk of injury. Youth teams could only be allowed to have full‐contact once a week. Dangerous drills could be banned or used less frequently.

2. Encourage mandatory brain trauma and concussion education  for coaches, athletic trainers, parents, and athletes
• Coaches, athletic trainers, and athletes cannot diagnose concussions if they aren’t trained to look for them or know how to recognize them. Coaches, athletic trainers, and athletes will not voluntarily choose to rest concussions and reduce overall brain trauma if they don’t understand why it is good for the athlete’s short and long‐term health.

3. Reevaluate protective equipment
• Investigate changes to helmets, shoulder pads, and other types of protective equipment to reduce brain trauma.

4. Develop better methods of concussion detection and diagnosis
• The CDC provides clipboards with concussions diagnosis protocols on the back at no cost. Coaches could be required to carry them. We can invest more in research to find simple, objective ways to diagnose concussion that can be utilized in any program.

5. Develop better methods of concussion management
• Return‐to‐play too soon after concussion can result in more extensive brain damage, and can actually result in death. It is now law in Washington state that players are required to see a medical professional with brain trauma expertise before return‐to‐play. Minimum return‐to‐play standards should be enforced at all levels.

6. Consider minimum medical resources
• Football is a dangerous game. Minimum medical resource standards, like having an athletic trainer or doctor on the sideline, should be considered.

7. Reevaluate techniques of tackling and blocking
• We can teach and enforce different methods of tackling and blocking that minimize contact to the head.

8. Reevaluate the rules
• Recently the NFL banned the wedge on kickoffs to reduce trauma. Many other rules could be changed, at all levels of football, to reduce brain trauma.

9. Reevaluate rule enforcement and the role of referees
• The NCAA recently began suspending players for intentional helmet‐to‐helmet hits. Referees could eject players for illegal hits to the head. Referees could be trained to identify concussed players on the field.

10. Reconsider the culture of the game
• Television announcers could stop glorifying illegal hits. Children could stop being pressured to play through concussions.

The evidence now exists to support immediate and radical change to the game of football to dramatically reduce brain trauma. Let us not let this opportunity pass.

Concussions in the NFL--A problem that won't go away

On the heals of new medical evidence that chronic traumatic encephalopathy (CTE) is linked to repetitive concussive injuries in football players, the House Judiciary Committee has scheduled a hearing for tomorrow to examine the way that the NFL handles brain injuries both for present players and those who have unsuccessfully sought disability retirement benefits.

Last week, neurologists and pathologists associated with the Center for the Study of Traumatic Encephalopathy announced their findings that even college athletes who received multiple concussions were found to have this brain damage.  Dr. Ann McKee, an associate professor of neurology and pathology at the Boston University School of Medicine and co-director of the Institute is quoted in the New York Times as saying, "I've looked at more that 1,000 brains and I've never seen this in any individual living a normal life--it's only through head trauma. "

The health care crisis goes for beyond professional football players.  Evidence of this disease in younger athletes raises serious safety concerns and again raises the issue, is the NFL and their poor decisions setting the wrong example for younger athletes and leading to more brain injuries and permanent brain damage?

Here are some additional comments by Dr. McKee: "The fact that we are seeing this disease, it had a devastating effect on their lives, mow in a 42 year old who never played in the N.F.L. indicates that it's a more pervasive problem that we recognize.  What are we doing with our kids?  Are we doing enough to protect against their developing this awful condition?"

Tomorrow's hearing will focus on these issues.  Among those invited to testify are Dr. McKee and neurosurgeons, Robert Cantu and Julian Bailes who have also down extensive research on concussions and the effects of cumulative concussions in athletes.  Another witness, David Weir from the University of Michigan recently published research sponsored by the NFL that suggested that professional football players had rates of cognitive disease several time higher then the general population.

I also heard that Dr. Eleanor Perfetto, the wife of former lineman Ralph Wenzel who was institutionalized for dementia is also scheduled to testify.  I had the privilege of meeting Dr. Perfetto last week at the Sports Legacy Institute awards dinner in Boston, Mass. She has fought a long and hard battle with the NFL over this injury had has been a great friend and advocate for other football families who face the uphill battle with the league's disability plan to obtain benefits that these players are entitled to.

Chairman Conyers and the House Judiciary Committee must press NFL Commissioner Roger Goodell as well as players executive director Maurice Smith on why the league continues to try to minimize this serious condition and why players who suffer from traumatic brain injury can't obtain benefits that they bargained for as part of their collective bargaining agreement.

Brain Injury affects all sports

An interesting article appears in today's New York Times, after Injury, an F1 driver's mind must recover also, reporting on the testing and evaluation that takes place in formula one car racing before drivers a permitted to return to the track following any closed head brain injury.

In addition to cognitive evaluations there is a great recognition of the psychological component to mild head injury.  Here is an interesting description of the evaluation that is performed:

“When we evaluate drivers, we evaluate whether a driver is a sponge or is waterproof,” Ceccarelli said. “Waterproof means it is raining but you don’t absorb it. A sponge means it is raining and you absorb it. If you are a sponge, all the details — everything that’s wrong and everything you believe is wrong and everything that you feel around you is negative — affect your mentality and your enthusiasm and your mood.”

The driver who absorbs will have a harder time recuperating from an accident, he said. But another key to how a driver will be affected is whether he was responsible for the accident.

When in doubt--Keep them out!