By JOSH WEIR
Repository sports writer
Ohio’s new concussion law debuts on the high school football field this week.
Last winter, Ohio became the 42nd state to pass legislation aimed at ensuring proper diagnosis and treatment of concussions among young athletes.
Ohio’s version is modeled on Washington state’s Lystedt Law, the first such “return-to-play” law passed in 2009 after 13-year-old Zackery Lystedt suffered permanent brain damage during a middle school football game. Lystedt continued to play after sustaining a concussion. Additional hits to the head caused severe swelling in his brain.
Ohio’s concussion law requires certain steps be taken after a high school player suffers a concussion and before they can play again, much like concussion guidelines developed in 2010 by the Ohio High School Athletic Association.
The new law goes further than those guidelines.
• A player suspected of having a concussion may not return to action that day under any circumstances.
• Referees are required to undergo training to recognize the signs and symptoms of concussion.
• Coaches must complete approved concussion training every three years, which comes in addition to related material covered for their coaching license issued by the Ohio Department of Education.
• Clearance for a player to return to play must come from a physician or other “licensed health care provider” authorized by the school district and acting under the supervision of a doctor.
With the kickoff of the 2013 season just days away, here is an overview of what the new law means for referees, coaches, and the medical approval needed for a player to return to action following a concussion.
REFS MAKE THE CALL
Under Ohio’s new concussion law, referees are charged with removing a player who exhibits signs and symptoms of concussion. Ohio’s law is the rare concussion law to name referees in this task.
Once a player is removed on suspicion of concussion, the athlete cannot return to play that same day even if medical personnel believe the player has not suffered a concussion.
“If we get down to the nitty gritty of the game and some stud player gets hurt and you direct them out, you’re going to take some abuse,” said Carl Davidson, who is beginning his 29th season as a football referee.
Lawmakers felt including referees in removing a player would add an extra layer of protection, as they are right there with some of the best vantage points to see a hard hit or symptoms of a concussion.
Lawmakers and the medical community stress that no one expects referees or coaches to truly diagnose a concussion. They are just there to spot symptoms and protect players until medical assistance arrives.
But some coaches and referees feel pulling a player out of a game is tantamount to a diagnosis, and well outside their expertise.
The concussion training officials receive comes from one of two online videos from either the National Federation of High School Associations or the Centers for Disease Control. They are free and take less than an hour to watch.
Although Davidson doesn’t want the responsibility of removing players, he accepts the responsibility as part of his job now and understands the gravity of brain injuries.
“Some guys are going to take the easy road and put blinders on and say they didn’t see anything,” he said. “But if that’s my kid out there and he has to come out of the game, I would want someone to get him out. It’s a serious thing.”
Coaches point out that referees already endure intense scrutiny from fans and teams, and this new requirement will only add to that second-guessing.
“We’re putting a lot of pressure on the officials now to make judgment calls,” said Mike Fell, head coach at Lima Senior High School and current president of the Ohio High School Football Coaches Association. “It’s going to create some problems, I know that.
“It’s not that you’re afraid you’re going to have corrupt officials or anything like that. Officials are just regular guys, not trained medial experts. They make the call, and two minutes later the kid is fine, but it’s the first quarter and the kid is done for the game.”
Beau Rugg is an assistant commissioner in charge of officials and football for OHSAA and a former referee himself. Going into the 2013 season he stresses to officials to look for obvious concussion symptoms and get the player off the field.
At the same time, Rugg cautions against jumping to conclusions if the evidence is not clear. If they do not feel strongly, Rugg points out that officials can send a player to the bench for further evaluation by the team’s coach and medical staff without evoking suspicion of concussion and ending that player’s day.
“We’re not asking officials to put on their diagnosis hat and go through a big checklist of things,” Rugg said. “If an obvious symptom is there, do what you’re trained to do, get the kid out of the game and they’re not coming back that day. If not, get them seen by someone that can diagnose.”
Deborah Moore, an associate OHSAA commissioner in charge of sports medicine, believes officials should err on the side of caution. “We’re really going to be hitting this hard in our rules meetings,” she said.
Referees who don’t adhere to the new concussion rules can be fined and/or suspended by the OHSAA.
Some officials feel an increased legal liability hanging over their heads. However, the law offers immunity from liability unless the action or omission constitutes “willful or wanton misconduct.”
Coaches also have to adjust to pressures raised by Ohio’s new law. Some are clear and concrete, such as pulling a player out of practice or a game when a concussion is suspected. Others are more subtle, involving the culture of the game.
Football is a collision sport. Players get hit and must learn to play through a certain level of pain. Coaches now must make it respectable for a player to quickly say he is hurt when dealing with concussions.
Lowell Klinefelter begins his 41st year as head football coach at Central Catholic High School this season.
“If you’re going to be a football player, you’ve got to play through a few aches and pains,” Klinefelter said. “But you better not play around when you’re talking about the head. … We now know it takes time for the brain to heal.”
At Lima Senior, Fell is one of those football coaches who feels the new law is “a little bit overboard.” Fell said, “I understand they’re concerned about safety. But it’s a tough sport, and you get hit.”
Dr. Joseph A. Congeni is the director of sports medicine at Akron Children’s Hospital and the team physician for Hoban High School’s football team. He is also a former athlete who has appeared on TV spots for the hospital espousing the virtues of sports. And he has coached his six kids at various levels. His oldest son played football into college and his youngest son currently plays freshman football for Hoban.
He understands how coaches such as Fell may feel about the new law and its requirements in the rough and tumble world of football. But the topic of concussions among high school and youth athletes “really has me concerned because of the cumulative effect. We know 85 to 90 percent of kids have a full clinical recovery from this. But what about the other 10-15 percent that have long-term problems? The issues are really big.”
Taking a strong stand for preventing brain injury could also change the relationships between some coaches and team athletic trainers, when there is tension about whether to pull a player out. Jim Thornton, president of the National Athletic Trainers Association, stresses that “an athletic trainer on a high school athletic team should be seen as a vital employee, not a necessary evil. Coaches have to kind of stand back.”
MEDICAL CLEARANCE RULES
An important part of Ohio’s new law is requiring athletes to receive written clearance from a health care provider before returning to play. Who can provide that clearance has expanded in the law.
Previous OHSAA guidelines stated that only an “appropriate health care professional,” defined as a doctor of medicine (M.D), a doctor of osteopathy (D.O.) or an athletic trainer, could provide written clearance for an athlete to return to action following a concussion.
Ohio’s concussion law says that clearance can now come from a physician (M.D. or D.O.) or a licensed health care provider who is not a physician but is authorized by a school district or youth sports organization. The provider must act in consultation, pursuant to the referral, in collaboration or under the supervision of a physician.
Hollie Kozak, the immediate past president of the Ohio Athletic Trainers Association, helped draft Ohio’s concussion law. She said under the new law, “Basically, the physician is the quarterback of the care. You have other health care providers that are part of that team that are going to assist with return to play. The physicians have the final say.”
The thought is that collaboration will result in the best assessment of a player’s condition. For example, if an athlete is having visual problems in connection with concussion, an optometrist might provide the best care.
Hosea H. Harvey, a professor of law at Temple University, says about half of the return-to-play laws around the country specify only a doctor with training in traumatic brain injury can clear a player. Ohio’s law doesn’t.
“Just because you went to medical school doesn’t mean you can identify all the symptoms of a concussion,” Harvey said. “So I think it’s sort of a heightened standard. Being a physician certainly helps. But there is more that can be done.”
Kozak said, “Each clinician needs to look at themselves and ask, ‘Am I comfortable? Have I had the training that should allow me to do this?’ ”
NEW LAW, NEW SEASON
Experts say it will be years before the impact of Ohio’s law is known. But most believe the law is a necessary first effort to protect the brains of young athletes.
Concussion laws in Indiana and Illinois only cover high school sports. Ohio’s law covers all youth sports.
Dr. Henry Feuer, a neurosurgeon and co-director of the Indiana Sports Concussion Network, believes raising awareness at earlier ages is important in educating kids on brain safety.
“Coming into high school, they’re already going to be aware of it,” Feuer said. “To me, that’s a big deal. The younger the kids are, they’re like sponges.”
Preventing severe brain injury is “the next great sports medicine issue we’re trying to deal with,” said Congeni at Akron Children’s Hospital. “I feel legislation has a role, and that’s why I got myself involved in it. I feel this is a good step in Ohio.”
Reach Josh at 330-580-8426 or firstname.lastname@example.org
On Twitter: @jweirREP