NFLPA initiating investigation into Tua’s concussion protocol

[Mr. WEO]

38 minutes ago, DrDare said:

 

 

Its amazing the thought processes we have here.  We have multiple posters who really thought a professional medical doctor that works for the team they are paid to care for can not make their own decision?

 

below are some snippets from this article: https://www.boston.com/sports/new-england-patriots/2018/03/07/heres-how-the-nfls-concussion-protocol-really-works/

 

"After giving the examination, the UNC and team doctor confer on a “go or no-go’’ decision. The NFL prefers the team approach, especially since the team doctor knows the player well."

 

“There has to be clear consensus,’’ Sills said. “If there’s any hesitancy whether someone is normal or not normal, they’re going to keep him out.’’

 

"But just because a player passes a test doesn’t mean the doctors are done observing him.

“This isn’t a one-and-done thing,’’ Sills said. “I’m going to watch him during the next set of plays, see how he looks, and probably walk up to him after the series and say, ‘Hey, are you OK?’ ’’

 

There is much more in the article also

I'd like to see the source that says the contrary if there is one.

Ss you point out,  this is system run by employed and independent physicians both evaluating the player.  Any disagree and it’s a no go.  
 

You won’t find an article claiming those two systems of doctors are paid to rubber stamp a players return.  But yeah, plenty here believe so for some reason..  

[Scott7975]

I dont think there were any Drs on the take.  Was he actually evaluated for a concussion at all though?  I really don't buy that it was his back either.

[SlimShady'sSpaceForce]

7 minutes ago, Mr. WEO said:

Ss you point out,  this is system run by employed and independent physicians both evaluating the player.  Any disagree and it’s a no go.  
 

You won’t find an article claiming those two systems of doctors are paid to rubber stamp a players return.  But yeah, plenty here believe so for some reason..  

 

I’m wondering how many people know what you do. 
 

or what I thought you did when we conversed on the D&C 

Is it something like the initials of Maryland?

[Mr. WEO]

6 minutes ago, Nextmanup said:

You sound like you are either 17 years old, or have just lead a very isolated life such that you have no understanding of how things work in the world, generally speaking.

 

You can't understand how an impartial doctor would in fact be partial? 

 

The NFL is going to interview/question three people as I understand it.

 

They are going to talk to Tua.  He is NOT going to say he had a concussion.  Hopefully you understand THAT.

 

Then they are going to talk to the team's doctor(s).  He/they are also NOT going to say he had a concussion, hopefully you understand why that would be.  Long story short: they want to keep their sweet, cool, cushy job, and not get fired tomorrow.

 

Lastly, they are going to interview the "impartial neuro surgeon" or whoever it was evaluating Tua at halftime.

 

He is equally going to say NOTHING about a concussion.  Why?  Because that would be career suicide for him.  Think about it a little while.  Also, think about where that doctor lives.  What team do you think he pulls for?  Who is giving him the gig to be the independent doctor involved in the protocol?  BINGO!  The Miami Dolphins...he lives in Miami...he likes the Dolphins...he likes being involved with the team behind the scenes, access to the players, etc....he ain't gonna rock the boat.  Comprende?

 

So this begs the question: what exactly does the NFL hope to accomplish with this "investigation" ????

 

Answer: NOTHING.  It will be something they can say they did, so as to check a few boxes and look like they conducted a responsible review of the matter, and concluded that there was no wrongdoing.

 

Selling Tua's utter punch drunkeness as a bad back was a creative idea from the legal department (I'm a lawyer) and I give them credit for that!  But it's absurd, and doesn't pass the smell test.

 

They have to sell his actions on the field as having nothing to do with his head.  That is the only way it would have been correct to get him back in the game for the second half.  The regs make it clear that if a player exhibits physical manifestations of head trauma (like being punch drunk with noodle legs and falling to the ground) he CANNOT RETURN TO THE GAME....and yet he did.  

 

So suddenly, all those indications of head trauma were really just a manifestation of a bad back.

 

And you wonder why the whole crew down there might stick together and say "no concussion," huh?

 

Good God man.  Wisen up.

 

 

 

And here, unfortunately, is their most eloquent spokesman..

 

The lead paragraph is just so awesome on so many levels.  It's a 30M dive into a (knowingly empty) pool.

 

I'm not 17, but have been in practice for 27 years, but it's always refreshing to hear how my business runs from the perspective of someone like you, who is so wise in the world.  Tell me more about medicine and medical practice and liability exposure (you are "a lawyer", after all!).

 

Anyway....the "neurosurgeon" evaluating the player on a Sunday for an NFL game certainly would not be "risking his career" by saying "you need to go into the concussion protocol" to a play who got his bell rung.  This should be obvious for 2 reasons (even to " a lawyer").  One, that's what he's paid to do and these guys do this very thing all the time, so to (bizarrely) claim that putting a player into the protocol would ruin the doctor's career is idiotic.  It's also rally dumb because that doctor already has a practice--this is a side job.   He/she makes his/her money outside of the NFL. 

 

I'm trying not to laugh, but what type of law do you practice?  If you were representing an independent neuro examiner in general, would your advice to him be:"no matter what it looks like, make sure you put the guy back in the game if the team brass gives you the 'wink wink'"---don't worry about this guy cleaning you out if he stokes the next day or needs burr holes".

 

Is that what you would say---seeing as this is your read on the real world?

 

 

 

 

9 minutes ago, SlimShady'sSpaceForce said:

 

I’m wondering how many people know what you do. 
 

or what I thought you did when we conversed on the D&C 

Is it something like the initials of Maryland?

 

 

lol see above.  this guy is something!!

[RangerDave]

7 minutes ago, Scott7975 said:

I dont think there were any Drs on the take.  Was he actually evaluated for a concussion at all though?  I really don't buy that it was his back either.

I really don't know what to think.  HIs stumbling really appeared to be from a concussion, not a back injury.

 

Either way, I did not notice Tua having any difficulties throwing the ball or running the offense after half time.  You would think that either of those type of injuries would have affected his game.  Pretty amazed that they didn't, at least from my untrained eye.  Maybe whatever it was wasn't so serious after all?  

[Mango]

10 minutes ago, Mr. WEO said:

Ss you point out,  this is system run by employed and independent physicians both evaluating the player.  Any disagree and it’s a no go.  
 

You won’t find an article claiming those two systems of doctors are paid to rubber stamp a players return.  But yeah, plenty here believe so for some reason..  

 

Honest question. How can they say "The NFL prefers the team approach, especially since the team doctor knows the player well." , "If there is any disagreement it is a no-go" AND "once we make a decision the independent doctor keeps an eye on the player". (paraphrasing)

I doubt the league prefers the "team approach" because a guy who might have a concussion is behaving in a clinically insignificant way and the team can step in and say "No doc! You don't understand, this is not normal for Tua. I know you were going to clear him, but you can't this is dangerous ".

 

It is far more likely that the team rep/doctor is there to explain things that are clinically significant to the independent evaluation, but explainable by past behavior. IE. Tua is wobbling, "no sir, that is just a back issue". In fact, having another doctor to explain Tua's back issues no longer allow the evaluation to be independent. 

 

I will go a step further to say that having the team doctor present and consulting is actually there to provide legal protection to the league/team because there is another physician providing clinically plausible explanations outside of the possibility of concussion. 

Miami Dolphins: This guy bashed his head and was wobbling around. Couldn't even stand on his own. 

Doc 1: Not good. Likely concussion. 

Doc 2: Could it be because of his history of back issues. 
Doc 1: Sure. 
Miami Dolphins: Get back out there and win this football game Tua


 

[Mr. WEO]

1 minute ago, RangerDave said:

I really don't know what to think.  HIs stumbling really appeared to be from a concussion, not a back injury.

 

Either way, I did not notice Tua having any difficulties throwing the ball or running the offense after half time.  You would think that either of those type of injuries would have affected his game.  Pretty amazed that they didn't, at least from my untrained eye.  Maybe whatever it was wasn't so serious after all?  

 

countless posts since the game have remarked on how Bills players were flopping all over the place from heat and exhaustion.  If you get blasted after playing a half in that heat as a QB, you may not bounce right back up.   Dane Jackson and Hyde both took big head shots (Hyde's was enough to cause him to go out on IR)--neither entered the protocol. 

[Scott7975]

5 minutes ago, RangerDave said:

I really don't know what to think.  HIs stumbling really appeared to be from a concussion, not a back injury.

 

Either way, I did not notice Tua having any difficulties throwing the ball or running the offense after half time.  You would think that either of those type of injuries would have affected his game.  Pretty amazed that they didn't, at least from my untrained eye.  Maybe whatever it was wasn't so serious after all?  

 

I dont know.  You can have a concussion and go hours to days without any symptoms.  I would think a back injury that is serious enough to make you collapse on the field wouldnt just go away by halftime. Im no dr though.

[Mr. WEO]

Just now, Mango said:

 

Honest question. How can they say "The NFL prefers the team approach, especially since the team doctor knows the player well." , "If there is any disagreement it is a no-go" AND "once we make a decision the independent doctor keeps an eye on the player". (paraphrasing)

I doubt the league prefers the "team approach" because a guy who might have a concussion is behaving in a clinically insignificant way and the team can step in and say "No doc! You don't understand, this is not normal for Tua. I know you were going to clear him, but you can't this is dangerous ".

 

It is far more likely that the team rep/doctor is there to explain things that are clinically significant to the independent evaluation, but explainable by past behavior. IE. Tua is wobbling, "no sir, that is just a back issue". In fact, having another doctor to explain Tua's back issues no longer allow the evaluation to be independent. 

 

I will go a step further to say that having the team doctor present and consulting is actually there to provide legal protection to the league/team because there is another physician providing clinically plausible explanations outside of the possibility of concussion. 

Miami Dolphins: This guy bashed his head and was wobbling around. Couldn't even stand on his own. 

Doc 1: Not good. Likely concussion. 

Doc 2: Could it be because of his history of back issues. 
Doc 1: Sure. 
Miami Dolphins: Get back out there and win this football game Tua


 

 

First, it's team physicians and the independent neurologist evaluating, not "team rep".  

 

Second, if after his neuro exam, the independent doc agrees that ther is no evidence of concussion and that opinion concurs with the team doc, he's cleared.  If the independent doc disagrees, the player enters the protocol.  He's specifically there be able to disagree with the team's MD staff.  His disagreement is enough to put the player into the protocol.  It really doesn't matter if the team doc were to say "oh, this is what Tua always looks like after a back injury".  The other doc doesn't have to believe that. 

 

 

[Low Positive]

8 minutes ago, Mr. WEO said:

 

First, it's team physicians and the independent neurologist evaluating, not "team rep".  

 

Second, if after his neuro exam, the independent doc agrees that ther is no evidence of concussion and that opinion concurs with the team doc, he's cleared.  If the independent doc disagrees, the player enters the protocol.  He's specifically there be able to disagree with the team's MD staff.  His disagreement is enough to put the player into the protocol.  It really doesn't matter if the team doc were to say "oh, this is what Tua always looks like after a back injury".  The other doc doesn't have to believe that. 

 

 

Is the independent doc local?

[Mango]

1 minute ago, Mr. WEO said:

 

First, it's team physicians and the independent neurologist evaluating, not "team rep".  

 

Second, if after his neuro exam, the independent doc agrees that ther is no evidence of concussion and that opinion concurs with the team doc, he's cleared.  If the independent doc disagrees, the player enters the protocol.  He's specifically there be able to disagree with the team's MD staff.  His disagreement is enough to put the player into the protocol.  It really doesn't matter if the team doc were to say "oh, this is what Tua always looks like after a back injury".  The other doc doesn't have to believe that. 

 

 

 

But is that the differential the league requires? Does the report read "no evidence of concussion"? or can the report from the independent neuro's report read "Patient was pushed backwards and become unstable upon standing. Mental cognition is within the normal limits of previous evaluations. Team physician says unstable gait has appeared in the past due to ongoing spinal issues". 

This feels reasonable to me. I have had some health issues the last few years and have seen doctors all over the country. Many of which have written similar reports to the above. Specifically around the history of my spinal health along the lines of "Patient reports shortness of breath, lower back pain, and swollen lymph nodes. All blood work is normal. Patient states he has herniated discs in his lumbar spine and that these issues arose around the time of being covid positive. Likely long term sequalae from previous infection" While others have written reports along the line of "unlikely back pain is due to herniated discs. Swollen lymph nodes, shortness breath and back pain may be due to enlarged spleen as patient is tender to touch in the area. Referred to hematology with the recommendation of abdominal CT with contrast and excisional lymph node biopsy." 

 

I am pro doctor and pro science. But the above are two doctors with the exact same information and two totally different differentials that just happened in the last few weeks. I have had similar reports on multiple occasions, with multiple doctors, in multiple networks. It is certainly feasible that the independent contractors are able to provide a medically feasible differential outside of a concussion to avoid protocol while also protecting themselves legally.

 

 

[Gugny]

16 minutes ago, Mr. WEO said:

 

First, it's team physicians and the independent neurologist evaluating, not "team rep".  

 

Second, if after his neuro exam, the independent doc agrees that ther is no evidence of concussion and that opinion concurs with the team doc, he's cleared.  If the independent doc disagrees, the player enters the protocol.  He's specifically there be able to disagree with the team's MD staff.  His disagreement is enough to put the player into the protocol.  It really doesn't matter if the team doc were to say "oh, this is what Tua always looks like after a back injury".  The other doc doesn't have to believe that. 

 

 

 

I'm curious as to whether you or any others here in the medical field know any neurologists to whom you could show this video; then ask them whether they think it's a good idea to let this young man keep playing a game:

 

 

The first thing he did was shake his head.  Then shook his head again before collapsing (nearly passing out) to the turf.  This particular clip doesn't show him wobbling to the sideline before being escorted to the locker room.

 

But come on ... how can anyone who watches this say, "a neurological exam is necessary in order to determine whether or not he suffered a concussion?"  

 

That's simply silly.

 

[FireChans]

2 minutes ago, Gugny said:

 

I'm curious as to whether you or any others here in the medical field know any neurologists to whom you could show this video; then ask them whether they think it's a good idea to let this young man keep playing a game:

 

 

The first thing he did was shake his head.  Then shook his head again before collapsing (nearly passing out) to the turf.  This particular clip doesn't show him wobbling to the sideline before being escorted to the locker room.

 

But come on ... how can anyone who watches this say, "a neurological exam is necessary in order to determine whether or not he suffered a concussion?"  

 

That's simply silly.

 

They did a neuro exam Gug.

[Gugny]

Just now, FireChans said:

They did a neuro exam Gug.

 

Yeah, I know.  But how does someone go from not being able to stand or walk unassisted to being cleared to play in an NFL game 30 minutes later?  It just doesn't add up.

[Mr. WEO]

9 minutes ago, FrenchConnection said:

Is the independent doc local?

 

 

probably

[RangerDave]

1 hour ago, Mr. WEO said:

Dane Jackson and Hyde both took big head shots (Hyde's was enough to cause him to go out on IR)--neither entered the protocol. 

True, although those injuries occurred in the Titans game when it wasn't dangerously hot.  Also, I believe both players sustained neck injuries, not concussions.  Or at least not suspected concussions.  I don't know the procedure for when a player who gets hit in the head has to enter the "concussion protocol".  Then again, it seems like no one in Miami knows that either.

[FilthyBeast]

Tua showed a lot of grit coming back in the 2nd half and leading the dolphins to a come from behind win in the 4th quarter.

 

Will be interesting to see what he looks like tomorrow against the Bengals in a very tough matchup on short week.

 

 

[Mr. WEO]

1 hour ago, Mango said:

 

But is that the differential the league requires? Does the report read "no evidence of concussion"? or can the report from the independent neuro's report read "Patient was pushed backwards and become unstable upon standing. Mental cognition is within the normal limits of previous evaluations. Team physician says unstable gait has appeared in the past due to ongoing spinal issues". 

This feels reasonable to me. I have had some health issues the last few years and have seen doctors all over the country. Many of which have written similar reports to the above. Specifically around the history of my spinal health along the lines of "Patient reports shortness of breath, lower back pain, and swollen lymph nodes. All blood work is normal. Patient states he has herniated discs in his lumbar spine and that these issues arose around the time of being covid positive. Likely long term sequalae from previous infection" While others have written reports along the line of "unlikely back pain is due to herniated discs. Swollen lymph nodes, shortness breath and back pain may be due to enlarged spleen as patient is tender to touch in the area. Referred to hematology with the recommendation of abdominal CT with contrast and excisional lymph node biopsy." 

 

I am pro doctor and pro science. But the above are two doctors with the exact same information and two totally different differentials that just happened in the last few weeks. I have had similar reports on multiple occasions, with multiple doctors, in multiple networks. It is certainly feasible that the independent contractors are able to provide a medically feasible differential outside of a concussion to avoid protocol while also protecting themselves legally.

 

 

 

 

Yours is not an acute evaluation for an acute injury.  Chronic problems are often hard to disposition to a patient's satisfaction.

 

A neurologist would be able to ascertain in his own way whether the mechanism of injury and exam favor concussion or other chronic injury (back).  He would be able to interpret the team doctor's opinion ("this is how he looks after a back injury") with the appropriate skepticism.  He is under no mandate to agree with it.  That's the point of him being there.

 

 

 

1 hour ago, Gugny said:

 

I'm curious as to whether you or any others here in the medical field know any neurologists to whom you could show this video; then ask them whether they think it's a good idea to let this young man keep playing a game:

 

 

The first thing he did was shake his head.  Then shook his head again before collapsing (nearly passing out) to the turf.  This particular clip doesn't show him wobbling to the sideline before being escorted to the locker room.

 

But come on ... how can anyone who watches this say, "a neurological exam is necessary in order to determine whether or not he suffered a concussion?"  

 

That's simply silly.

 

 

They would say "a neurological exam is mandatory", not just necessary.

[quinnearlysghost88]

1 hour ago, Mr. WEO said:

 

And here, unfortunately, is their most eloquent spokesman..

 

The lead paragraph is just so awesome on so many levels.  It's a 30M dive into a (knowingly empty) pool.

 

I'm not 17, but have been in practice for 27 years, but it's always refreshing to hear how my business runs from the perspective of someone like you, who is so wise in the world.  Tell me more about medicine and medical practice and liability exposure (you are "a lawyer", after all!).

 

Anyway....the "neurosurgeon" evaluating the player on a Sunday for an NFL game certainly would not be "risking his career" by saying "you need to go into the concussion protocol" to a play who got his bell rung.  This should be obvious for 2 reasons (even to " a lawyer").  One, that's what he's paid to do and these guys do this very thing all the time, so to (bizarrely) claim that putting a player into the protocol would ruin the doctor's career is idiotic.  It's also rally dumb because that doctor already has a practice--this is a side job.   He/she makes his/her money outside of the NFL. 

 

I'm trying not to laugh, but what type of law do you practice?  If you were representing an independent neuro examiner in general, would your advice to him be:"no matter what it looks like, make sure you put the guy back in the game if the team brass gives you the 'wink wink'"---don't worry about this guy cleaning you out if he stokes the next day or needs burr holes".

 

Is that what you would say---seeing as this is your read on the real world?

 

 

 

 

 

 

lol see above.  this guy is something!!

I think what he’s saying is the neurosurgeon would be risking his career because he may a. Not have even evaluated him or b. Let him play regardless. Either way, admitting that he had a concussion after the fact during the investigation would be bad. Again I’m not saying he didn’t evaluate or let him play regardless, just trying to get into this guy’s head. 

[Mr. WEO]

5 minutes ago, quinnearlysghost88 said:

I think what he’s saying is the neurosurgeon would be risking his career because he may a. Not have even evaluated him or b. Let him play regardless. Either way, admitting that he had a concussion after the fact during the investigation would be bad. Again I’m not saying he didn’t evaluate or let him play regardless, just trying to get into this guy’s head. 

 

That's the part that makes zero sense.  

 

I haven't seen a report that there was no evaluation at all. 

16 minutes ago, RangerDave said:

True, although those injuries occurred in the Titans game when it wasn't dangerously hot.  Also, I believe both players sustained neck injuries, not concussions.  Or at least not suspected concussions.  I don't know the procedure for when a player who gets hit in the head has to enter the "concussion protocol".  Then again, it seems like no one in Miami knows that either.

 

head shots are what initiate the concussion e v a l...