Please Explain

6 Nov

It is a common thought that crosses my mind when I see questionable actions around a concussion situation.  Unfortunately I don’t have the power to get the answers, so I basically post them on here for others to see.

This is not the case in Australian Rules Football; if you are team and you receive a “please explain” regarding an injury (mainly concussions) you are probably treading on thin ice.

There is a mechanism in AFL that formally puts teams and doctors on notice when things just don’t add up.  Take for example the handling of a concussion by the North Melbourne Roos;

Interim Kangaroos chief executive Cameron Vale emailed AFL operations manager Adrian Anderson on Monday after the Roos were told to respond to a ”please explain” issued by the league last week.

The Kangaroos have been under investigation over the manner in which they handled Hansen after he received a heavy knock against Essendon in round 20, and also for the way they have responded to AFL investigators Brett Clothier and Abraham Haddad in recent weeks.

The AFL has been unimpressed with the club’s handling of the issue, although the Kangaroos have bristled at suggestions football manager Donald McDonald had influenced the testimony of key figures involved.

The letter is not the first step, rather the end step in a process that allows the medical board of the AFL to investigate how the practices of player protection is put in place.  Is it oversight?  You bet and I feel that the AFL does something much-needed in all professional sports.  Really, it is only applicable to the pros because of the resources, however it could translate to large colleges as well.

In Zurich I spoke to Dr. McCrory about what they do in regards to this, here are the basics;

  • Observers in the stands watch and notate during game (video is documented)
  • Primary investigators are then summoned to the teams for an investigation
  • If the primary is not sufficient then the league sends out the formal “Please Explain”
  • The information from the primary with the please explain goes to the board for review

Dr. McCrory says often times the situation is resolved by the primary investigators and there is not much done in the way of discipline, unless warranted.  However when it reaches the please explain phase – using all resources like video, interviews and observation – there can be hefty fines and discipline placed on the team, mainly the team.  The doctors and medicos also face sanction if it is found they acted inappropriately.

Dr. McCrory explained this process is in place to hold teams and coaches accountable and protect the doctors in most cases.  Often times, he told me, it is the team itself that overrides or makes improper decisions against medical advice.

They take this very seriously Down Under.  They had observers at games far before the NFL and have a mechanism to hold teams proverbial “feet to the fire”.

My question, is why cannot the professional sports in North America have the same processes.  The resources are there, heck the NFL has the first step in place, it is high time they start calling into question some actions that take place in the handling of concussions.

Yes, I agree with both Dr. Ellenbogen and Dr. York (owner of 49ers) the NFL does not get enough press for the good things they do and the “right” calls they make.  Not only would this type of system weed out the ugly, but it would also emphasize and promote the good that the league is doing.

Here is my proposal for the NFL, NBA, NHL and FBS NCAA FB;

  • deploy 2 observers at every game (truly independent) that are highly trained at concussion recognition
    • these individuals wouldn’t know who each other are
  • continue “eye-in-the-sky” in NFL and put in NCAA, NHL and NBA
    • would not know who observers are
  • after game if there was a situation where both observers saw an incident that was handled questionably the communications from the eye-in-the-sky would be checked
  • if all three were in sync then the league would investigate with interviews of: coaches, players, athletic trainers and doctors
  • if only observers were to trigger the event then the league would review video and decide if action is needed
  • if the primary was not suffice enough then institute the “please explain” similar to the AFL

Now not only will this take some serious ego checking to be done by a lot of very good and professional people, it will also take the institution of a non-conflicted medical board in each of these sports.  There could even be a combination of medical boards in NFL/NCAA and NHL/NBA.

As for MLB and MLS, I believe that a simple review of the video would be able to accomplish the same end result.

Rugby also needs to adopt this same process, for at least its international competitions.

It sounds rather outlandish, but the fact there is a professional sport that already institutes this makes it feasible and practical.  The most impractical portion, in my opinion, is having the leagues basically be willing to relinquish control over the findings of these “medical boards”.

Lets hear your comments…

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One Response to “Please Explain”

  1. Tom November 9, 2012 at 09:22 #

    I think Dr. Cantu had a potentially simpler idea – at the professional level have the medical staffs (AT’s MD’s, etc) employed by the league, not the teams. Their job performance of the staff would then be evaluated by the league and, therefore, not following league protocols on appropriate injury management (not limited to concussions) would determine their continued employment and salary.

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