To provide team doctors with more objective assessments, the N.F.L. in
2012 began the unaffiliated neurotrauma consultants program that put an
expert on each sideline — and, later, a third upstairs in the booth
— who was credentialed at a local trauma center and not on the team
payroll. More than 80 percent of the about 200 consultants are neurologists
or neurosurgeons, according to Sills, though they are not required to
be. The consultants are jointly paid by the league and the players association,
and both parties must approve them after they are vetted for basic criteria,
such as treating patients with acute head injuries at least once a month.
It can be hard to find experts willing to take on this role, which requires
working on days off for relatively nominal compensation. Jack Wilberger,
an emeritus professor of neurosurgery at Drexel University, served as
a consultant at Steelers games for about three seasons but stopped because
of the long hours on the sideline, often in bad weather. The working conditions
are “chaotic,” he said, because of the commotion in the stadium
and players who may be anxious about being taken out, leading to “terse”
evaluations.
The consultants assist and offer input as the team doctor evaluates players,
and they submit their own reports after the game detailing each concussion
screening. Sills said that team doctors and the consultants have differed
in their assessments fewer than once per season in his five years as chief
medical officer. He was not aware of any cases during his tenure in which
a team doctor overruled a consultant so a player could return to the game.
The players union confirmed this.
Samadani said she could not recall a time when she disagreed with the Vikings’
medical staff when she was a consultant on the home sideline. But, she
said, opposing team doctors were sometimes less receptive to her opinion.
Wilberger also recalled being in sync with the Steelers’ neurosurgeon.
But he said that one flaw in the program was that the game-day neurotrauma
consultants received no information on how the player was doing after
the initial evaluation, unless the doctor was also the team’s designated
consultant for return-to-play decisions during the week, a separate role.
“Obviously, we try to make things better each time we do it, but
then we find out things like this happened and somehow slipped through
the cracks,” Wilberger said, referring to the handling of Tagovailoa.
It’s not unusual for an N.F.L. player to appear disoriented or unstable
after a hard hit. In the first quarter against the Broncos on Thursday
night, Colts running back Nyheim Hines’s helmet collided with a
defender’s on a tackle. He slowly climbed to his feet but was wobbly
and needed help to remain upright. He was immediately removed from the
game and was later ruled out with a concussion.
In a game Sunday night between Tampa Bay and Kansas City, Buccaneers tight
end Cameron Brate’s head collided with the torso of his teammate,
Chris Godwin, while Brate ran a route in the second quarter. Brate lay
on the field momentarily before slowly rising and jogging off.
He returned a few plays later and finished the drive, but was taken out
of the game at halftime with a concussion. Coach Todd Bowles said afterward
that Brate had complained of shoulder discomfort and that “nobody
called down” to hold Brate out. But after complaining of concussion-like
symptoms in the locker room, Brate was placed in the concussion protocol.
Still, the situation led some to question if the N.F.L. had learned from
the handling of Tagovailoa’s injury.
“Broken system,” Tony Dungy, the former Colts and Buccaneers
coach and current NBC commentator, wrote on
Twitter. “I was on the sideline very close to Brate — obvious he had
his bell rung. There’s a league-appointed spotter in the press box
who should stop play & alert the referee. Brate shouldn’t have
been allowed to return until after an evaluation. Why didn’t that
happen???”
Ken Belson covers the N.F.L. He joined the Sports section in 2009 after
stints in Metro and Business. From 2001 to 2004, he wrote about Japan
in the Tokyo bureau.
@el_belson