The NFL Players Association exercised its right to remove the independent neurological expert who was involved in the decision to clear Miami Dolphins quarterback Tua Tagovailoa to return to a game last Sunday after being evaluated for a head injury, according to a person familiar with the matter.
The league and union said in a joint statement that they “agree that modifications to the Concussion Protocol are needed to enhance player safety.” They said they “have already begun conversations around the use of the term 'Gross Motor Instability’ and we anticipate changes to the protocol being made in the coming days based on what has been learned thus far in the review process.”
The NFLPA had declined to comment earlier Saturday on its decision regarding the independent doctor, citing its ongoing joint investigation with the NFL into the issue of whether the concussion protocols were followed properly in the case. Union officials had said Friday they were focused on the medical judgments made in the matter, more so than the overall process and whether the protocols were followed as written.
The league and union oversee the protocols in tandem, and either side can choose to end the participation of any of the independent doctors — called unaffiliated neurotrauma consultants or UNCs — involved in the concussion-evaluation process for players.
The NFL and NFLPA said in their joint statement that their investigation “remains ongoing” and they have not reached “any conclusions about medical errors or protocol violations.” They said that they “share a strong appreciation for the unaffiliated neurotrauma consultants who contribute their time and expertise to our game solely to advance player safety.”
Tagovailoa is in the NFL’s concussion protocols after suffering a head injury during Thursday night’s game at Cincinnati. He struck the back of his head on the turf on a first-half sack. Tagovailoa was taken from the field on a stretcher and transported by ambulance to a hospital. He was diagnosed with a concussion, according to the Dolphins. Tagovailoa was released that night from the University of Cincinnati Medical Center and accompanied the team on its flight back to Miami. He underwent further tests Friday.
He played in Thursday’s game four days after being cleared by team physician and the UNC, as required by the protocols, to return to a game Sunday against the Buffalo Bills in Miami Gardens, Fla. The UNC involved in the decision has not been publicly identified.
The joint investigation is ongoing and the doctors involved were interviewed, according to a person familiar with the case. The NFLPA believes that mistakes in judgment were made, according to that person.
“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 Friday. “A failure in medical judgement is a failure of the protocols when it comes to the well being of our players.”
Tagovailoa left Sunday’s game in the first half after being shoved to the ground on a play by Bills linebacker Matt Milano. Tagovailoa got to his feet after the play but stumbled. He walked off the field with members of the medical staff. But Tagovailoa was cleared and returned to begin the second half. He and Dolphins Coach Mike McDaniel said afterward that Tagovailoa had injured his back, not his head.
The protocols outline a step-by-step process for evaluating a player suspected to have suffered a head injury. A player can return to a game if cleared by both the team physician and the UNC following several tests. The protocols say that a player may not to return to a game if he demonstrates “gross motor instability” that is “determined by [the] team physician, in consultation with the UNC, to be neurologically caused.”
Tretter said in his statement Friday: “What everyone saw both Sunday and [Thursday] night were ‘no-go’ symptoms within our concussion protocol. … We need to figure out how and why the decisions were made last Sunday to allow a player with a ‘no-go’ symptom back on the field.”
The NFLPA exercised its right last Sunday to initiate the joint review with the NFL as to whether the concussion protocols were followed properly. The league said Wednesday that the review was ongoing but it had “every indication” that the protocols had been followed properly.
Allen Sills, the NFL’s chief medical officer, said during a televised interview Friday that Tagovailoa underwent a long-form exam called the Sport Concussion Assessment Tool (SCAT) in the locker room last Sunday. After returning to that game, Sills told the league-owned NFL Network, he was evaluated daily for a concussion leading up to Thursday’s game.
“It’s something that we’re reviewing together,” Sills said Friday. “What I can tell you is to reiterate that in real time, these evaluations, when a player is evaluated, they are examined and interviewed by both the team physician and this independent neuro-specialist. And those two confer, and they must both agree together in real time that a player is cleared in order for them to return to the game.”
Sills had left open the possibility Friday of the concussion protocols being modified even if it is determined that no protocol violations occurred in this case, saying that “if we find that there are things that we need to change, we will certainly be up front about doing that.”
George Atallah, the NFLPA’s assistant executive director of external affairs, said in a statement Friday: “The whole point of our advocacy for more than a decade on the issue of concussions 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.
“When the first set of protocols were implemented in 2011, they were designed with that goal in mind and every year since we 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.”