Under intense public scrutiny and facing sharp criticism, the Miami Dolphins and the NFL on Friday defended the process by which quarterback Tua Tagovailoa was cleared to return to a game Sunday after being evaluated for a possible head injury and then permitted to play Thursday night in Cincinnati.
“Until we have an objective and validated method of diagnosing brain injury, we have to do everything possible, including amending the protocols, to further reduce the potential of human error,” former Cleveland Browns center JC Tretter, the NFLPA president, said in a statement. “A failure in medical judgement is a failure of the protocols when it comes to the well being of our players.”
Tagovailoa said in a statement posted to social media that he was “grateful for the support and care I’ve received” and added: “I’m feeling much better and focused on recovering so I can get back out on the field with my teammates.”
The Dolphins said Tagovailoa was undergoing further testing and evaluation Friday after getting released Thursday night from the University of Cincinnati Medical Center and accompanying the team on its flight back to Miami. According to Coach Mike McDaniel, Tagovailoa was suffering from a headache and underwent an MRI exam Friday after undergoing a CT scan and X-rays in Cincinnati.
“I’m not even really thinking about timetables or anything regarding him as a player right now,” McDaniel said during a news conference. “It’s all about, really, Tua the person.”
McDaniel said he would not have allowed Tagovailoa to play Thursday if he had been given any “medical indication” the quarterback suffered a head injury during Sunday’s game against the Buffalo Bills in Miami Gardens, Fla. Tagovailoa left that game after absorbing a first-half hit, then wobbling after getting to his feet. But he was cleared to return after undergoing a concussion evaluation, and both he and McDaniel said then that he had suffered a back injury rather than a head injury.
“If there would have been anything lingering with his head, I wouldn’t have been able to live with myself if I had prematurely put someone out there and put them in harm’s way,” McDaniel said Friday. “This is a relationship that I have with this human being. I take that serious. I wouldn’t have put him out there if there was any inclination given to me whatsoever that he was endangering himself from that previous game.”
Allen Sills, the NFL’s chief medical officer, stressed during a televised interview Friday that for a player to be cleared to return to a game under the concussion protocols, there must be agreement between the team physician and an independent neurological consultant following a step-by-step evaluation process involving prescribed tests.
Sills told the league-owned NFL Network that it is “important to recognize that these are not decisions made by one person. They’re made jointly by team staff and also this independent neuro-expert.”
According to Sills, Tagovailoa underwent a long-form exam called the Sport Concussion Assessment Tool in the locker room Sunday. After returning to Sunday’s game, Sills said, he was evaluated daily for a concussion leading up to Thursday’s game.
“I know that he was checked after the game,” Sills said. “I know that he was checked the following day. In fact, every player that gets an examination on game day gets a follow-up exam the following day even if that exam was negative. That’s part of our concussion protocol. And then I know that this player was checked every day leading up to the game.”
Sills said the joint review with the NFLPA will include interviews with the athletic trainer, the team physician, the unaffiliated neuro specialist, the injury spotters in the booth, the neuro specialist in the booth and Tagovailoa.
Our interview with NFL CMO Dr. Allen Sills on why Tua Tagovailoa was allowed to fly home, what happened last Sunday and on the subsequent concussion checks during the week, and on whether the concussion protocol could be changed as a result. pic.twitter.com/Q5N9TLBYgt— Judy Battista (@judybattista) September 30, 2022
“We want to get better at these things,” Sills said. “We have gotten better. We’ve seen our care improve drastically. But that doesn’t mean that we’re done. … And whatever our review leads us toward, that’s the direction we’ll move in. If we feel we need to make adjustments collectively with the players union, we’re absolutely committed to that.”
Christopher Nowinski, the founding CEO of the Concussion Legacy Foundation, said Friday he was “horrified and disgusted” by the handling of Tagovailoa’s health.
“I was one of the people saying the NFL is not as bad as it used to be,” Nowinski said. “And I was starting to focus on other sports and other leagues around the world to try to get them to a better place. And now I realize I’ve got to laser back on the NFL.”
The “hole in the protocol here,” Nowinski said, is the provision that allows a player to return to a game if he demonstrates “gross motor instability” but that condition is determined by the doctors not to be neurologically caused.
“The idea that they tried to claim it was something else and that lets him go back in shows you can cheat what is obvious signs,” Nowinski said. “There were no signs of a back injury. There were five signs of concussion. Either the doctor is not qualified, which I doubt, or for some reason they felt like risking his career for a win. … It’s not just the failure of the medical care. It’s a failure of the culture. It’s a failure of the leadership. It’s a failure of the coaching staff. It’s a failure of the ownership. Every fan knew he had a concussion on Sunday.”
The NFLPA initiated the joint review with the league Sunday.
They are only effective if the people applying them and making decisions place patient / player care above checking boxes to clear someone back to work as fast as possible. Our culture has come a long way and we have to remember that when we talk about these issues.— George Atallah (@GeorgeAtallah) September 30, 2022
“The whole point of our advocacy for more than a decade on the issue of concussions,” George Atallah, the union’s assistant executive director of external affairs, said in a statement Friday, “is to shift the culture of our game from one that was previously focused on the fastest path back to the field, to one that emphasized player care above all. … [W]e have improved on those protocols to the point where today’s concussion protocols are far more comprehensive and safer for players than ever before. … But they are only effective if the people applying them and making decisions place patient/player care above checking boxes to clear someone back to work as fast as possible.”
McDaniel said Tagovailoa was laughing and demonstrating his “definitely normal Tua” personality on the plane ride back to Miami as the two spoke and then Tagovailoa pulled out his phone to watch a movie.
“All of his teammates were absolutely elated to see him on the plane,” McDaniel said. “He was elated. It brought him some joy, which was good to see.”