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Patrick Hruby

Haven't Got a Clue

An open letter to Mark Emmert on the NCAA concussion lawsuit

Sports on Earth

Dear Mark Emmert,

Did you know that the National Collegiate Athletic Association is facing a potential class action lawsuit over its failure to protect college athletes from brain trauma? I know: that sounds nuts. Not the lawsuit itself. The notion that you've never heard of it. After all, you are the association's president. It's kinda sorta your job. To protect athletes, that is. And also to be up-to-date on potentially ruinous litigation. Still, I've read over the most recent plaintiff's complaint, filed on behalf of a group of brain-damaged former athletes -- from football, women's soccer and hockey -- and after sifting through hundreds of pages of evidence that includes a number of emails and documents from inside your organization, I can only assume one thing: You don't have a clue about what's going on. Not about the lawsuit, and not about brain trauma. Otherwise, there's no way a person in your position of authority and responsibility would let any of this stand.

Not in good conscience, at least.

Take Rickey Hamilton Jr. He's a former Division III football player, one of the thousands of young men and women whose physical and mental well-being is supposed to be your organization's raison d'être, the reason you earn a $1.6 million salary. Five years ago, Hamilton emailed your organization's health and safety director. He was worried. A little incredulous, too. Football is a violent sport, and for two seasons Hamilton and his teammates had played without an athletic trainer at both practice and most of their games. Which is a lot like opening a public pool without a lifeguard. Anyway, injuries -- such as concussions -- weren't being treated properly. What, he asked, can we do about this?

A week later, your health and safety director wrote back. He told Hamilton that the NCAA doesn't have any rules about athletic trainers; that both responsibility and potential legal liability for athlete health falls to individual schools; and that Hamilton could apply for an association grant that might cover the cost of a trainer for a single season.

Helpfully, he also included a link to a concussion awareness video.

I know: that also sounds nuts. Not the lack of rules, shirking of moral duty to avoid financial responsibility and let-them-eat-CTE trainer grants. Rather, the part where your health and safety director linked to a video. Believe it or not, that goes above and beyond the NCAA's current concussion policy. No joke. Have you read your organization's 400-plus-page rulebook? It's in there. You might have to squint. Adopted in 2010, the NCAA's current guidelines are 206 words long. Total. They require schools to have concussion management plans on file that: (a) inform athletes about the signs and symptoms of concussions; (b) remove athletes who show signs of a concussion from play; (c) prohibit athletes with concussions from returning to play the same day they were initially injured. And that's it. Really. A mandatory, specific concussion diagnosis and treatment protocol, like the detailed ones put forth by the National Athletic Trainers' Association and the American College of Sports Medicine? Nowhere to be found. Heck, the word "concussion" only appears in your organization's rulebook three times; meanwhile, the word "meals" appears 79 times, mostly in reference to amateurism regulations designed to protect college athletes from the clear and present danger of eating food purchased by other people.

Oh, and guess which one of those areas your crackerjack staff spends time enforcing? Hint: it involves condiments. David Klossner -- he's your health and safety director, in case you were wondering -- testified in April that the NCAA's concussion guidelines are less urgent than laissez-faire suggestion, given that your organization neither monitors whether schools have developed plans nor disciplines schools that fail to do so. By contrast, former University of Nebraska quarterback Eric Crouch once was suspended for eating a ham sandwich at the home of a friend of a friend -- a suspension that was lifted after the NCAA allowed him to write a $4 check for the sandwich's cost.

Anyway, Crouch had it better than Adrian Arrington. Ever heard the name? I'll fill you in. Arrington played football at Eastern Illinois University. He was a team captain. He suffered at least four concussions during his college career, which ended in 2009. Today, he suffers from memory loss. Has seizures. Can't work. Can't drive a car to take his daughter to the store. Collects welfare. Wonders why he bothered going to school, given that he can't use his degree. Arrington is one of the plaintiffs in the current concussion lawsuit, and according to an extensive supporting report authored by sports brain trauma expert Robert Cantu, his condition and that of the other brain-damaged former athlete plaintiffs are the direct result of mismanaged treatment stemming for the NCAA's failure to mandate concussion care best practices -- or any practices, for that matter -- that otherwise have been widely known and agreed upon by medical experts for more than a decade.

Of course, NCAA spokeswoman Stacey Osburn disagrees. In a statement responding to the lawsuit, she said that your organization "has been at the forefront of safety issues throughout its existence." Did you read the statement? Did Osburn? I doubt it. I doubt either of you read anything. Did you know that in 1996, the presidents of the American Academy of Neurology, the Brain Injury Association and the American Association of Neurological Surgeons wrote to then-NCAA executive director Cedric Dempsey demanding action on concussions, stating that the injury was "being overlooked," that athletes who suffered those injuries required close medical monitoring and that coaches and trainers were not properly equipped to handle concussions? Or that in 2003, the Journal of the American Medical Association published two college football concussions studies -- funded by your organization -- concluding that players with a history of previous concussions were more likely to have future concussions and that while athletes generally need up to seven days for injury symptoms to resolve, many were being withheld from competition for an average of less than five days -- a disparity that raised concerns of increased risks of "recurrent injury, cumulative impairment or even catastrophic outcome?"

Did you know that your organization's 2004 Sports Medicine Handbook doesn't mention the above studies nor warn college athletes about the acute and cumulative effects of concussions? Did you know that the NCAA's 1933 Medical Handbook for Schools and Colleges says that concussions should be treated with rest and medical attention, that athletes suffering concussive symptoms should "not be permitted to compete for 21 days or longer, if at all" and that individuals who are repeatedly knocked unconscious should be "forbidden to play body-contact sport?"

For that matter, did you know that the same 80-year-old handbook also says that the "seriousness of [concussions] is often overlooked?"

My hunch is no. On all of the above. Otherwise, more would have been done. The problem would not have been ignored and overlooked. And here's something else I'm fairly certain you've ignored or overlooked: your own data. According to the NCAA's injury monitoring system, college athletes suffered 29,225 concussions from 2004-2009 -- 16,277 of those from football alone -- a disconcerting number that is almost certainly low, given the fact that concussions tend to be significantly underreported. I'm pretty positive neither you nor Osburn attended your organization's 2010 concussion summit, either -- and if either of you did, you must have suffered some brain trauma of your own and forgotten the whole darn thing. The numbers were equally memorable. Memorably grim. According to a survey sent to the head athletic trainer at every NCAA school that was later distributed at the summit:

* A third of schools did not perform baseline neurocognitive assessments on their athletes;

* Less than half of all schools did not require concussed athletes to see a physician;

* Only 13 percent of athletes, 24 percent of coaches and 15 percent of campus health care nurses had been required to receive concussion management education in the previous two years;

* Almost 40 percent of schools did not have established return-to-play guidelines;

* Nearly 50 percent of schools said they allowed athletes to return to play in the same game following a concussion diagnosis.

While all of the above results run afoul of accepted concussion care standards, the last statistic is especially noteworthy. Not that you seem like the kind of guy who takes copious notes. Too busy lambasting Penn State University for allowing the "values of sports to overwhelm the values of the academy," I suppose. Still, when you have 60 seconds, look up a condition called second impact syndrome. It's horrifying. Basically, when an athlete suffers a second concussion while still recovering from a previous one, the brain can swell rapidly and catastrophically, causing severe disability or death. While you're at it, look up Preston Plevretes, a former La Salle University football player who suffered second impact syndrome in 2005 after the school allegedly mismanaged his concussions and has been severely impaired ever since. Of all the possible brain trauma health and safety rules your organization is failing to mandate and enforce, not returning to play on the same day as a concussion is unquestionably the most important. Improbably enough, some people within your organization have known that. Not you, of course. Because then you would have done something. But people like the members of the Committee on Safeguards and Medical Aspects of Sports, which is tasked with protecting athletes.

In 2009, said committee recommended that the NCAA adopt rules that would remove athletes showing signs and symptoms of concussion from the field of play and not allow them to return until cleared by a physician. Hardly a comprehensive plan. But a much-needed, long-overdue bare minimum. As a University of Georgia football athletic trainer and committee member put it in an email, "we all know that there are times where athletes are returned to games with concussions. I personally have seen an athlete knocked unconscious and return in the same quarter in recent years." Klossner backed the recommendation. He promptly met resistance. Ty Halpin, your Associate Director of Playing Rules Administration, wrote that any such rules could be "problematic" because they could create liability for game officials. Halpin colleague Teresa Smith was even more concerned, asking in an email are the refs more at risk if we don't provide the educational piece on concussions or if we do provide it? And, what about the NCAA? Would we be protecting/helping the organization by not providing the information?

In a separate email exchange, Halpin and NCAA associate director of research Nicole Bracken even made fun of Klossner's efforts to, you know, prevent athletes from suffering life-altering neurotrauma:

Halpin: Dave is hot/heavy on the concussion stuff. He's been trying to force our rules committees to put in rules that are not good -- I think I've finally convinced him to calm down.

Bracken: He reminds me of a cartoon character.

Halpin: HA! I think you're right about that!

So: this actually happened. And since you're not an analyst with the National Security Agency or anything, my guess is that this is the first time you've seen these emails. Otherwise, you would have fired Halpin, Bracken and Smith posthaste -- and with good cause, given that they put the financial health of the NCAA and its referees ahead of the mental health of college athletes. Likewise, I can't imagine you're aware of a 2010 email exchange between Klossner and association director of enforcement Chris Strobel, in which Klossner asks what the penalty would be if a school fails to follow a new same-day return-to-play prohibition, and Strobel states that the NCAA would not "suspend or otherwise penalize a coach" even if a player was "required to participate after having been diagnosed with a concussion." If you knew about Strobel's reply -- and didn't reprimand/overrule him immediately -- you'd probably feel guilty about a trio of dangerous, badly mismanaged cases of head trauma that took place last football season, incidents I've previously summarized as follows:

… Southern California receiver Robert Woods absorbed a jarring helmet-to-helmet hit from a Utah defender. He got up, staggered toward the wrong sideline and fell to the ground, face-first. He reportedly took and passed a sideline concussion test not by undergoing a careful exam from a trained neurologist, but by correctly answering three questions: Who is the current president? What is today's date? What is 100 minus seven, minus seven, minus seven? Woods missed one play before returning to the game; afterward, a teammate said, "There's no way you're gonna have Robert sit on the bench, no matter what it is," while coach Lane Kiffin praised him for being a "tough kid."
Tough like Arizona quarterback Matt Scott, who last October absorbed two hits to the head during a single play against USC, vomited on the field and remained in the game to throw the winning touchdown pass. Tough like Connecticut quarterback Chandler Whitmer, who last November suffered a concussion against Louisville and then took two more hits to the head -- one of which he described as "a bullet" -- against Cincinnati the next week before being sidelined …

Woods could have been seriously injured. He could have died. Scott and Whitmer, too. Neither their schools nor their coaches violated NCAA rules. Reminder: those rules don't exist. Earlier this month, your organization announced a $399,999 grant to study the long-term effect of head injuries. I suppose that's progress. Still, do you know about this? Do you know that head injuries are serious enough to warrant scientific inquiry? Do you know what happened to the extra dollar? My guess is that you don't. I have to assume that you're utterly clueless and uninformed, because only a callous, out-of-touch bureaucrat would be satisfied with the status quo, with all the other things the association isn't doing. Like promising to cover ongoing medical expenses for athletes who suffer brain injuries. Or monitoring and helping former athletes who may develop long-term neurological disorders like chronic traumatic encephalopathy. Or requiring schools to inform athletes about other long-term cognitive health risks associated with contact sports. Or devising a standard return-to-classroom protocol, given that cognitive injuries affect academic as well as athletic performance. Or just doing something. Three years ago, a study found that football players at Brown, Dartmouth and Virginia Tech averaged about 2,500 total hits to the head over the course of a season during practice, with 300 forceful enough to cause concussions; just this week, the Pac-12 conference announced it would follow the Ivy League's lead and limit full-contact regular season practices to twice a week, because getting hit in the head less is better than getting hit in the head more.

Note: that's a hint. All of it.

Do you know who Brian Hainline is? My hunch is that you don't. Otherwise, you'd be royally pissed. Hainline is your organization's new medical director. Earlier this month, he told The Chronicle of Higher Education that he has "a fire in [his] eyes" about concussions; he also told the publication that there was not a "widely accepted" consensus among medical experts about the need to keep players out of action on the same day of a concussion until late 2012, and that the NCAA cannot mandate change. You can do better. You can do better because now you know better -- you know how the association has failed, and that Hainline is full of it. (He's also a former professional colleague of National Football League junk scientist and concussion denier Elliot Pellman. Look him up sometime, too.) Experts have frowned upon same-day return-to-play for years. Your organization was created to mandate change that would protect college athletes. Later this week, the NCAA's highest governance committee will meet. Take advantage. Push for real rules with real teeth. Put the same institutional energy into brain trauma that you put into sandwich policing. Do the right thing. Do you know who James Roscoe Day is? He was the chancellor of Syracuse University, and at your organization's 1909 convention he proclaimed that "the lives of students must not be sacrificed to a sport."

I assume you agree with him. Otherwise, you wouldn't be heading the NCAA in the first place. Am I assuming too much?


Read the original article at Sports on Earth