NFL teams required to hear from independent neurologists in brain injury cases

From The New York Times:

In a shift in the National Football League’s approach to handling concussions, the league will soon require teams to receive advice from independent neurologists while treating players with brain injuries, several people with knowledge of the plan confirmed Sunday.

For generations, decisions on when players who sustain concussions should return to play have been made by doctors and trainers employed by the team, raising questions of possible conflicts of interest when coaches and owners want players to return more quickly than proper care would suggest.

As scientific studies and anecdotal evidence have found a heightened risk for brain damage, dementia and cognitive decline in retired players, the league has faced barbed criticism from outside experts and, more recently, from Congress over its policies on handling players with concussions.

The league and Commissioner Roger Goodell have insisted that the N.F.L.’s policies are safe and that no third-party involvement is necessary, pointing to research by its committee on concussions as proof. But after an embarrassing hearing on the issue before the House Judiciary Committee last month in which the league was compared to the tobacco industry, the N.F.L. seems to have begun to embrace the value of outside opinion.

“I don’t want to call it forced, but it’s been strongly urged because of the awareness of the issue these days,” Chester Pitts, a lineman and union representative for the Houston Texans, said in a telephone interview. “When you have Congress talking about the antitrust exemption and them calling them the tobacco industry, that’s pretty big. But it’s a good thing it’s transpiring.”

The league spokesman Greg Aiello offered no details of the new guideline, first reported Sunday on Fox’s N.F.L. pregame broadcast, like when it will go into effect, how the independent doctors will be identified and compensated, or even whether their input must be followed.

But Mr. Goodell, interviewed Nov. 22 on the NBC program “Football Night in America,” referring to the use of independent doctors for concussion cases, said: “As we learn more and more, we want to give players the best medical advice. This is a chance for us to expand that and bring more people into the circle to make sure we’re making the best decisions for our players in the long term.”

George Atallah, the players union’s assistant executive director for external affairs, said in an e-mail message that his organization had been speaking with N.F.L. officials for two weeks about implementing some sort of independent scrutiny for players who receive concussions — perhaps including an outside doctor present at every game. He said that the union’s medical director, Dr. Thom Mayer, “has personally approved and reviewed doctors for roughly one-third of the teams,” suggesting that the union would cooperate on the program.

Mr. Atallah said he did not know when the policy might take effect.

Mr. Atallah added that the union had pushed for the program “with the hope that this example spreads to every level of football.” More than 1.2 million teenagers play high school football every fall, with many getting seriously injured by playing through concussions or not having proper medical care for them.

At the House Judiciary Committee hearing on football brain injuries last month, several members of Congress portrayed Mr. Goodell and the league as impeding proper player care and obfuscating the long-term effects of concussions. The league and a co-chairman of its committee on brain injuries, Dr. Ira Casson, have consistently played down studies and anecdotal evidence linking retired N.F.L. players to brain damage commonly associated with boxers and dementia rates several times that of the national population.

Regarding the care of current players who sustain concussions, in 2007, the league enacted measures that required all players to undergo baseline neuropsychological testing and then be retested before being cleared to play; forbade players who were knocked unconscious to return to play the same day; and set up a hot line through which players could report being pressured to play against a doctor’s advice.

The hot line was in response to the story of Ted Johnson, a former New England Patriots linebacker who said he was coerced by Patriots Coach Belichick into playing too soon after a concussion, and sustained a more serious injury that led to a debilitating case of postconcussion syndrome. (Belichick denied the accusation.) Requiring an independent doctor at games or for follow-up consultation would protect against similar incidents that players say are less overt but nonetheless prevalent in a league without guaranteed contracts.

An independent doctor cannot address what many experts consider the primary area needing reform: the tendency of players who sustain concussions to hide them from medical personnel and endanger themselves. Even Sean Morey, a special-teams player for the Arizona Cardinals who is a co-chairman of the union’s committee on brain injuries, admitted this season that he played a game despite a concussion.

Consulting doctors beyond the team does not necessarily solve all of the league’s conflict-of-interest issues. And it is unclear how guidelines would define who is an independent expert.

The most prominent current — and instructive — N.F.L. concussion is probably that of the Philadelphia Eagles running back Brian Westbrook (pictured). He sustained one major injury Oct. 26, was held out of the next two games by team doctors, and then sustained another concussion Nov. 15.

Given that repetitive concussions are known to cause far more damage than single injuries, the Eagles sent Westbrook to well-regarded concussion specialists at the University of Pittsburgh Medical Center last week for a third-party examination. Complicating matters could be that the Pittsburgh group includes the Steelers’ team neurosurgeon as well as the league’s director of neurological testing.