Case Keenum sits on the turf during a game against the Ravens. (Patrick Smith/Getty Images)
Columnist

There’s something, call it common sense, that recoils at congratulating the NFL because Pittsburgh Steelers quarterback Ben Roethlisberger pulled himself from a game with concussion symptoms. Sorry, but surely someone — ideally, a doctor — should have done that for him, when his eyes started rolling in his head like slot-machine reels. Otherwise we’re asking a patient to self-diagnose, and the right way to feel about that is uneasy.

This shifts the burden to a place it shouldn’t be. But shifting liabilities is something NFL management is quite expert at when it comes to player health and safety. Recently, league lawyer Jeff Pash told woozy players not to “hide their symptoms,” putting the onus on them to take care of themselves. Now, it’s one thing for Roethlisberger, who has a five-year contract worth over $60 million guaranteed, to bench himself. It’s another for St. Louis Rams backup Case Keenum, who is making $585,000 on a one-year deal and fighting for a career.

The heart of the NFL’s concussion problem is not that players hide symptoms; it’s a compensation structure that forces them to play hurt, or get cut. This is why the NFL Players Association lobbied so hard for safeguards such as independent neurological evaluators on the sidelines and in booths, and the far more salient fact in the Roethlisberger and Keenum situations is that the league isn’t enforcing those safeguards.

There is a serious disconnect in the NFL’s emphasis. Players who commit helmet-to-helmet hits, even unintentionally, have been held responsible with heavy fines and even suspensions, and the victim of the hit is told to “self-report” his symptoms. But when the Rams medical and coaching staffs completely ignored basic precautions and let Keenum remain in a game despite the fact that he literally grabbed his head and lurched sideways, the league declined to penalize anyone and instead called it a “learning experience.”

Ben Roethlisberger leaves the field late in the second half in Seattle. (Stephen Brashear/Getty Images)

So while it’s great that Roethlisberger took some responsibility for his long-term health, it wasn’t the ideal scenario. It’s a mistake to focus on Roethlisberger’s conduct; this is a distraction that helps the NFL slide out from under its own responsibilities and evade what should be growing consternation over its negligent mishandling of concussions. Roethlisberger stayed on the field for nine more plays after he was high-lowed, and he was seeing things by the time he walked to the sidelines and told trainers he was done for the day.

“The brain is not an injury you want to play through,” he said later. “. . . When you’re done, you want to be a father and a husband. . . . If I have these brain injuries, it’s not worth it.”

The NFL terms its policy on concussions a “protocol,” which makes a head injury sound like something you might suffer at a State Department meet-and-greet. Protocol has an orderly, reassuring sound that erases the sense of mayhem around Keenum’s concussion: the splintering blow, the player staggering around and dropping to all fours, staring at the grass, as if hoping to find his name in it, and the decision to leave him in the game. But it was all right. Because there was a “protocol.”

In actuality, the protocol was a joke. The Rams totally failed to follow it. Protocol called for a trained spotter in the booth to watch for moments such as Keenum’s helmet clutch, and immediately radio the field to alert the team’s medical staff as well as an independent neurologist stationed on the sideline.

This part happened. According to a source with the NFLPA, the spotter did that for Keenum. The radio call came down almost instantaneously, directing the medical personnel to evaluate Keenum. At that point, protocol called for Keenum to be pulled off the field and examined by the independent concussion expert. Neither of those two things happened. Instead, a Rams trainer jogged onto the field and briefly questioned a still-dizzy Keenum, who, according to Coach Jeff Fisher, “felt he was okay.” Keenum never left the field. After all, as Fisher said, “it was a critical point in the game.”

According to a source with the NFLPA, “There is no question there was a breakdown in the Keenum situation, and we lay that at the feet of the Rams medical staff.”

The NFL is refusing to do a thing about it. After a brief “investigation,” it decided not to assign fault. The only action the league took was a conference call to review “proper implementation of the protocol.” This makes Keenum’s concussion sound like a software download instead of what it was: an egregious offense. This is the NFL’s idea of a moral brake.

There is a subtle underpinning here that needs to be dragged into daylight: NFL management invariably ducks its failures on health and safety by framing injuries as something for which players signed up, and for which they are ultimately responsible. If a quarterback gets CTE down the line, it’s his fault for not self-reporting and the fault of the other players who hit him.

When C.J. Mosely roughed the passer it cost him a $17,363 fine, and when Kam Chancellor was penalized for spearing, it cost him $23,000. The NFL thereby fines the most egregious hitters — while forgiving coaches, trainers and team doctors who turn a blind eye and leave players in the game to exacerbate the original injury.

“We’re all professionals — the medical staffs, the coaches, the players — and we all have mandates and protocols we have to adhere to,” said Cincinnati Bengals tackle Eric Winston, the NFLPA president. “Players have been asked to take the head out of the game, to take certain measures to take out big hits, and when we don’t comply we’re met with fines. The problem I see is that when other people don’t comply, they’re met with ‘Don’t do that again.’ That doesn’t sit well with players.”

Winston nails it. The NFL tolerates, and even tacitly encourages, a lack of professionalism when it comes to medical misconduct — from abuse of prescription-drug laws, to rushing players back to the field with orthopedic injuries that are bound to result in joint replacements, to looking away from a staggering player clutching his head because it’s a critical point in the game.

What good are “protocols” if there aren’t any consequences for anyone when they’re not followed? Until a team doctor and coach are suspended for leaving a wobbly player in a game, then all the spotters and independent neurologists in the world are just window-dressing. And it will remain clear what NFL management’s interest really is: liability, not player longevity.

For more by Sally Jenkins, visit washingtonpost.com/jenkins.