By Robert L. Clayton and Bradford T. Hammock
On December 1, it was reported that La Salle University had agreed to settle for $7.5 million a lawsuit brought by the family of a football player who suffered significant injuries resulting from an on-field collision. 1 The player’s family contended that the player’s injuries resulted from “second-impact syndrome,” where he sustained a second head injury before an initial concussion has fully healed.
This settlement has jarred the landscape of athletics at the collegiate level and in secondary school systems across the country. What the settlement means and how colleges, universities, and school systems should react will be thoroughly studied over the upcoming weeks and months. The NCAA has just updated its concussion guidelines, entering into an area it has tried to avoid for years. It is incumbent upon athletic programs at all levels to engage in concussion management fully and aggressively to ensure the safety and health of their athletes.
The La Salle Lawsuit
The complaint against La Salle University should be required reading for all colleges, universities, and secondary school systems. It details the story of Preston Plevretes, a former football player at La Salle who was severely injured in a La Salle football game, and the alleged negligence of La Salle, its athletic trainers, and other health care providers. According to the complaint:
• Mr. Plevretes played football starting at the age of seven. He received athletic grants to play football for La Salle and played in his first college football game in 2005.
• Before he started the 2005 season, he completed a Pre-participation History & Physical Examination form, indicating he had experienced head injuries or concussions in the past.
• On October 4, 2005, Mr. Plevretes allegedly sustained a concussion during a football game. In the course of another game a few days later, he complained to the LaSalle trainer that he was experiencing headaches whenever he made contact with another player and that he had been having headaches since the October 4 game.
• Mr. Plevretes later went to the Student Health Center and was examined by a nurse, who performed a Standardized Assessment of Concussion or “SAC.” This is a common test used to assess an injured athlete’s mental status. Mr. Plevretes was told he had a grade 1 concussion and should not return to practice for one week.
• Mr. Plevretes would undergo some additional tests, including a CT scan, and ultimately was cleared to play on October 16, 2005, as expressed in a note from the La Salle trainer.
• On November 5, 2005, in another La Salle football game, Mr. Plevretes had a helmet-to-helmet collision and suffered significant head injuries. Since that collision, Mr. Plevretes has undergone several operations and treatments, required around-the-clock care and has difficulty walking and talking.
At various points in the complaint, the plaintiff alleged that La Salle should have taken steps to further protect Mr. Plevretes, did not follow strictly certain concussion protocols, and was – at bottom – too quick to allow him to the return to the field.
Because of the settlement, we may never know precisely what happened in this tragic case. We do know, however, that it is a key part of a larger story on concussions that is causing colleges, universities, and secondary school systems to reexamine concussion management.
The NCAA Takes Stronger Action
For years, the NCAA’s guidance in the area of concussion management has been a few pages in the NCAA Sports Medicine Handbook. 2 Guideline 2i of the NCAA Sports Medicine Handbook provides information on the rates of concussions amongst athletes in a variety of sports. It also lists the signs and symptoms of concussions to help universities in identifying athletes that may have suffered concussions.
The Handbook guides, to a limited extent, colleges and universities in determining when a head-injured athlete should return to active participation. Various factors are listed for consideration, such as clinical symptoms, previous history of concussion and severity of previous concussions, the sport, position, age, support system for the athlete and the overall “readiness” of the individual. The Handbook, however, does not describe what would constitute “readiness,” as a practical matter. The Handbook also emphasizes the difficulties associated with making the “return to the field” decision, noting how each person must be evaluated on a case-by-case basis. In discussing a progressive return to practice and participation for head-injured players, the Handbook cautions, “[h]ow quickly one moves through this progression remains controversial.”
Finally, the Handbook mentions “second impact syndrome, in which a second impact with potentially catastrophic consequences occurs before the full recovery after a first insult.” It notes, however, that there is “some controversy” as to the existence of second impact syndrome.
Perhaps the La Salle settlement jarred the NCAA sufficiently to greater action. On December 16, the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports met and agreed to playing rules changes in all NCAA sports related to concussions. These include:
• An athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as unconsciousness, amnesia, headache, dizziness, confusion, or balance problems), either at rest or exertion, shall be immediately removed from practice or competition and shall not return to play until cleared by a physician or her/his designee.
• Athletes who are rendered unconscious or have amnesia or persistent confusion shall not be permitted to continue for the remainder of the day. These athletes shall not return to any participation until cleared by a physician.
Also approved were new statements in the NCAA Sports Medicine Handbook:
• Any athlete exhibiting an injury that involves significant symptoms, long duration of symptoms or difficulties with memory function should not be allowed to return to play during the same day of competition.
• It has been further demonstrated that retrograde amnesia, post-traumatic amnesia, and the duration of confusion and mental status changes are more sensitive indicators of injury severity, thus an athlete with these symptoms should not be allowed to return to play during the same day. These athletes should not return to any participation until cleared by a physician.
• It is essential that no athlete be allowed to return to participation when any symptoms-persist, either at rest or exertion.
The NCAA’s action is important and all colleges, universities, and secondary school systems should take note.
What to do Now!
The message for colleges, universities, and secondary school systems across the country is to establish and implement protocols for handling concussions. And to do so now! This is particularly true for colleges, universities, and secondary school systems that currently may be focusing on the severity of the issues of concussion management. While each situation will be different, recommended steps include:
• Conduct an independent review of existing protocols, if any, for handling concussions. Compare these protocols against the latest scientific and medical guidance on concussion management.
• Interview key personnel in concussion management and athletes to identify how well the protocols are working and areas where improvement is needed.
• Identify and contact all local and regional resources for handling concussions. If using these outside resources, ensure they are using established protocols. Any use of outside resources should be documented on a case-by-case basis.
• Train (and retrain) key staff and the athletes on the protocols and concussion management.
Concussion management is not a “blip on the radar screen.” The settlement in the La Salle case and the new NCAA guidance demonstrate clearly the need for athletic programs to develop, implement, and embrace concussion protocols.
Robert L. Clayton is the Chair of the Sports Compliance Practice at Jackson Lewis LLP, while Bradford T. Hammock is the Partner Coordinator of the Workplace Safety Practice Group at the firm.
1. See Alan Schwarz, La Salle Settles Lawsuit With Injured Player for $7.5 Million, N.Y. TIMES, Dec. 1, 2009 http://www.nytimes.com/2009/12/01/sports/ncaafootball/01lasalle.html?_r=1&ref=todayspaper.
2. NATIONAL COLLEGIATE ATHLETIC ASSOCIATION, 2009-2010 SPORTS MEDICINE HANDBOOK (2009).
