There’s a way to boil down the Tua Tagovailoa flashpoint to its essence, and I think I found it.Just answer this question: If Tagovailoa’s head bounces off the turf, and he stumbles as he did against Buffalo, and the Dolphins are up, say, three touchdowns in the fourth quarter against a nondivision opponent, is he still going back in the game? My guess is no. And, thus, it sure looks like competitive factors contributed to a decision that’s supposed to be made on medical factors alone.
Anyway, we covered a lot of this in my column Friday, but there’s a lot more to dive into. First and foremost, I wanted to update you on the NFLPA’s investigation (and then get you information from the NFL’s side of it). Here’s some insight into the union’s effort …
• First, the union’s reason for opening the investigation, I’m told, was simple: It didn’t believe Tagovailoa should have reentered the Buffalo game. And it wanted to know why he was cleared.
• The second concern was that, while the NFL and Dolphins maintained Tagovailoa was checked all week, the call to put him back into the game against the Bills kept him out of the concussion protocol. Had the protocol been initiated with Tagovailoa, it would have been difficult for Miami to get him cleared for Thursday’s game against the Bengals. Which begs the question: Was there any intention by the Dolphins to keep Tagovailoa available for Thursday’s game?
• The union was also incensed that the NFL twice went on the record saying protocols were followed before the investigation even got off the ground.
• Another central question: How did Tagovailoa’s back injury play into this? Was it there before the game? Was he treated for it? And how was he cleared to return in that time frame when it came to the back injury?
The effort to get answers led the NFLPA to exercise its right, on Saturday, to fire the UNC (unaffiliated neurotrauma consultant) that worked the Dolphins-Bills game. In interviewing him, union officials found he didn’t understand that his job wasn’t just to run down a checklist. It was, really, to work with the team doctor to make a decision for the care of the player being evaluated. So that served as the first salvo here, with the union’s investigation expected to wrap up in the next seven to 10 days or so.
And with that in mind, we touched base with NFL chief medical officer Allen Sills with a few questions. Here are his answers (and if you just want football this morning, scroll down).
Sports Illustrated: Let’s start with the basics—how hard is it to diagnose a concussion in-game?
Allen Sills: As a practicing neurosurgeon, I would tell you that we often struggle to identify whether or not a concussion has occurred because we lack objective tests for a concussion. And what I mean by that is, our diagnosis of concussion is still very much dependent on self-reported symptoms. We obviously do have some objective neurologic findings, where we’ll check, for example, cranial nerves, and we’ll check memory and we’ll check balance. Those items, when they’re abnormal, make the diagnosis easy. There are difficult situations where all of the objective neurologic findings are normal, and we have to rely on symptoms. And those are difficult situations for all clinicians.
SI: Do you think there’s been progress on self-reporting?
AS: The data tells us that we’ve made a lot of progress in that area. If you look at the last several seasons, we’re now approaching 40% of all concussion evaluations that have some component of self-report, meaning that the player themselves acknowledged or endorsed symptoms or either asked for the evaluation. And so that, I think, represents an enormous amount of progress from what we might have seen 10 or 15 years ago. Certainly, we want to continue to make that progress.
SI:Why does the team doctor take the lead, per the protocol, when it comes to determining whether gross motor instability was neurologically caused?
AS:The reason the protocol was written that way several years ago was that gross motor instability, again, is a nonspecific sign that can be recognized on video. And it’s important, then, once it’s seen that the player gets a concussion evaluation and a determination made on was the instability due to a brain injury? Or was it due to another type of injury? Was there an orthopedic injury or other injury that caused the player to stumble or lose balance in a way that looked like it could have been a brain injury but in fact reflects something else? The team doctor’s role in that is the team doctor is the one who knows the player. They know the history, and they know whether that player had a preexisting injury.
SI:Are you confident that team doctors aren’t making decisions for competitive reasons?
AS:I have absolute confidence in our team physicians across the league, from my own interactions with them and my direct observations in all of the games and practices that I attend. They are men and women who are leading physicians in their communities. They go through a very careful selection and vetting process. And we always have to remember that their ultimate authority is to their state medical licensing and regulatory boards, and everything they do in their practice has to conform to the highest standards of practice of medicine within that jurisdiction. I can’t speak to what happened many years ago, Albert, but I can tell you that since I’ve been with the league for five years, I’ve never seen nor heard of any interference in any way from any coach, general manager, owner, any other individual on the club side from any of our teams. I am confident that our physicians operate in a fully independent manner.
The league and union are reworking the concussion protocol, and the biggest change will come with the aforementioned section on gross motor instability—the union and league have agreed that, as part of the revised policy, any player showing gross motor instability after a hit to the head will immediately be done for the day, regardless of whether there might be another reason for it.
And that, to me, is the good that comes from situations such as these—they’re high profile (and don’t think the NFL missed that the story made the A block of on Friday) and often force change.
As for what it means? I figured we’d check in with a couple of high-profile lawyers who represented players in the NFL concussion case that led to a billion-dollar settlement. I asked both a simple question: What should be the impact of what happened to Tagovailoa on Thursday night?
“I think that the whole gross motor thing is deceptive in some ways—it means that there is an assessment,” said Philadelphia-based attorney David Langfitt, who’s also the son of a neurosurgeon. “There’s an assessment of symptoms, and I think that when something like that happens to a guy like Tua, he’s out and he stays out. And you wait. You wait a week. You have him assessed over a long period of time. If it’s seven days, it’s seven days. If it’s 14 days, it’s 14 days.
“But the idea that there would be more subjective analysis of gross motor, that’s taking it from an individualized neurological standpoint, and I don’t think that that’s adequate. I think it’s got to be a ‘When in doubt, sit them out’ approach. That will insulate the neurologist or his designee from any kind of second-guessing by coaches, trainers, executives, owners, that sort of thing. I think that you have to insulate the neurologists.”
“What happened with Tua could’ve killed him,” added Miami-based attorney Brad Sohn. “You hope something that reckless never happens again, but this was more like the 500th time it happened. I’m just trying to do my part to avoid 501. Concussion protocols need to have teeth and consequences. Right now, I see neither. I know we can do better and just hope we will.”
I will say it’s unfortunate that a lot of times it takes events such as Tagovailoa’s unfortunate five-day stretch to force change. But at least it feels like more change is coming, and we probably won’t have to wait more than a few days to see it.
