Concussion Legislation Proposed in Iowa

[DesMoines]

There's a piece of legislation that's cleared committee in the Iowa legislature that's on our local association's radar. It could -- I think probably would -- make officials legally responsible for observing the symptoms of a concussion and removing a player from a game. Does anyone else out there have this?

I've pasted the summary and a link to the full bill below.

We've sent notes/letters to the bill sponsors and our own representatives outlining what guidance and training are already available (Iowa HS associations, NFHS, NASO, etc.) and in place, but this is something that's tough for them to vote against. Any thoughts or experience dealing with anything like this elsewhere would be appreciated.

(Iowa) House File 385
HOUSE FILE 385 BY KOESTER and LOFGREN
An Act concerning the protection of student athletes from concussions and other brain injuries.

EXPLANATION
This bill directs the board of directors of each public school district and the authorities in charge of each nonpublic school to work in concert with the Iowa high school athletic association and the Iowa girls high school athletic union to distribute guidelines and other pertinent information and forms to inform and educate coaches, student athletes, and parents and guardians of student athletes of the risks, signs, symptoms, and behaviors consistent with a sports-related concussion or brain injury, including the danger of continuing to participate in athletic activities after a concussion or brain injury.

The bill requires school districts and nonpublic schools to annually provide the parent or guardian of a student athlete with a concussion and brain injury information sheet which must be signed and returned before the student athlete may participate in an extracurricular interscholastic athletic activity for grades seven through 12.

The bill provides that if a student athlete’s coach or contest official observes signs, symptoms, or behaviors consistent with a concussion or brain injury in an interscholastic athletic practice or game, the student athlete must be removed from participation.

The bill provides that a student athlete removed from participation shall not recommence participation until the student athlete has been evaluated by a licensed health care provider, defined as a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, or athletic trainer licensed by a board designated under Code section 147.13, trained in the evaluation and management of concussions and other head injuries and received written clearance to return to play.

The bill directs the board of directors of each school district and the authorities in charge of each nonpublic school to adopt rules and procedures necessary to carry out the requirements of the bill.

http://coolice.legis.state.ia.us/lin...Introduced.pdf

[grunewar]

I have no problem sending a kid off who appears injured. Many times this year I have even told a coach, "Hey, watch #32, he just landed pretty hard."

The part that we, as officials will have no control over, that the school will have to deal with is the "written clearance to return to play." There's no way we'll know about individual players unless informed.

[DesMoines]

I don't have a problem sending them off, I have a problem with some sue-happy parent who (two weeks later) thinks I didn't send them off quick enough...

[mbyron]

Originally Posted by DesMoines

The bill provides that if a student athlete’s coach or contest official observes signs, symptoms, or behaviors consistent with a concussion or brain injury in an interscholastic athletic practice or game, the student athlete must be removed from participation.

The bill provides that a student athlete removed from participation shall not recommence participation until the student athlete has been evaluated by a licensed health care provider, defined as a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, or athletic trainer licensed by a board designated under Code section 147.13, trained in the evaluation and management of concussions and other head injuries and received written clearance to return to play.

As I read this, it's exactly the NFHS policy. Officials must remove players who exhibit symptoms consistent with concussion, and the player may not return until cleared in writing by a suitable health care professional. I don't see any additional liability imposed on officials beyond what's already in NFHS rules.

The clearance clause fails to specify who is to receive the written clearance. That's an oversight.

[BillyMac]

Originally Posted by mbyron

Officials must remove players who exhibit symptoms consistent with concussion, and the player may not return until cleared in writing by a suitable health care professional.

In Connecticut, which is, obviously, not Iowa, we have been told that if the possibly concussed player reports back into the game, that we are to assume that he has been cleared by a health care professional. No written clearance necessary. Not even any oral clearance needed.

[26 Year Gap]

Originally Posted by BillyMac

In Connecticut, which is, obviously, not Iowa, we have been told that if the possibly concussed player reports back into the game, that we are to assume that he has been cleared by a health care professional. No written clearance necessary. Not even any oral clearance needed.

That is the way it is in FL. You guys should know that there is free course on the NFHS website on recognizing concussion signs. Online. Takes about 25 minutes.

[grunewar]

Originally Posted by BillyMac

.......if the possibly concussed player reports back into the game, that we are to assume that he has been cleared by a health care professional. No written clearance necessary.

This is also the way it's written in the NFHS Preseason Guide.

It further states, "the responsibility for obtaining that clearance rests with the coach/school, and need not be verified by the officials (less state procedures require verification). If A2 appears at the scorers table to reenter the game, the official shall assume the coach/school followed the appropriate return to play procedures and A2 is eligible to participate."

[26 Year Gap]

Originally Posted by grunewar

This is also the way it's written in the NFHS Preseason Guide.

It further states, "the responsibility for obtaining that clearance rests with the coach/school, and need not be verified by the officials (less state procedures require verification). If A2 appears at the scorers table to reenter the game, the official shall assume the coach/school followed the appropriate return to play procedures and A2 is eligible to participate."

VT needs a designated HCP BEFORE the game for EACH team who must provide written okay for re-entry. What I hope any legislation does NOT do, is lead to hesitation to send someone off because he might be a star and it would mean no re-entry. Could be headed that way. Take the course at NFHS | National Federation of State High School Associations It is free. Even if it looks like you are buying it.

[ref2coach]

Originally Posted by 26 Year Gap

What I hope any legislation does NOT do, is lead to hesitation to send someone off because he might be a star and it would mean no re-entry. Could be headed that way.

Unfortunately it has in TN. TSSAA in it's instructions at the State rules meetings and information passed through the State supervisors has "recommended" that referees not utter the word "concussion" or any variant thereof. I will not be complying if I see a player who exhibits "signs or symptoms" as described in the NFHS online training referenced above.

[Adam]

Originally Posted by ref2coach

Unfortunately it has in TN. TSSAA in it's instructions at the State rules meetings and information passed through the State supervisors has "recommended" that referees not utter the word "concussion" or any variant thereof. I will not be complying if I see a player who exhibits "signs or symptoms" as described in the NFHS online training referenced above.

sounds like the state is ripe for a lawsuit here.

The Iowa law, as explained in the article, seems to be a codification of the NFHS policy. I personally find that to be a silly use of legislative time, but unless there's something in there that's not being reported here, I don't see anything that makes it more likely for an official to get sued.

And it seems to me pretty obvious that my NASO atty could get the case thrown out on the grounds that I'm not a doctor and thus not trained to recognize concussion symptoms.

[BillyMac]

Originally Posted by ref2coach

TSSAA in it's instructions at the State rules meetings and information passed through the State supervisors has "recommended" that referees not utter the word "concussion" or any variant thereof.

We got the same advice here in the Land of Steady Habits from our interpreter.

[bob jenkins]

Originally Posted by mbyron

The clearance clause fails to specify who is to receive the written clearance. That's an oversight.

No, it's not (imo). It's providing flexibility to allow (require) the states to determine who can provide it -- some states might require an MD or MO. SOme might allow trainers. Some might allow any "licensed medical professional."

[refiator]

Georgia brought in the "concussed" language this year. If a player shows any signs of concussion, they must leave the game and cannot return without a written doctor note. Good rule.

[mbyron]

Originally Posted by bob jenkins

No, it's not (imo). It's providing flexibility to allow (require) the states to determine who can provide it -- some states might require an MD or MO. SOme might allow trainers. Some might allow any "licensed medical professional."

I'm talking about the clause in the Iowa law, not the clause in the NFHS policy.

[mbyron]

Originally Posted by Snaqwells

And it seems to me pretty obvious that my NASO atty could get the case thrown out on the grounds that I'm not a doctor and thus not trained to recognize concussion symptoms.

I'm fairly confident that your attorney would NOT bring that up, given the wide availability of training in such recognition, including most obviously the NFHS online training. A plaintiff's attorney would feast on an admission that you were officiating without proper training.

The crucial distinction here, it seems to me, is "recognizing symptoms" vs. "diagnosing." We are now expected to do the former.