Sunday, December 18, 2011

Colt McCoy's Concussion Fumbled by Team Physicians

The Cleveland Browns have been in the news this week, and not because of newfound success on the gridiron. While sports is not among my highest priorities, I have developed increasing interest over the years since professional sports is religion to so many here in Cleveland and in Ohio. Cleveland sports teams all enjoy great success, provided that success is not defined by victories. It’s not if you win or lose but how…

I watched the Cleveland Browns compete against the Pittsburgh Steelers two Thursdays ago. I cringed as I witnessed our young quarterback, Colt McCoy, take a blow to the head that could have landed the perpetrator a 10 year prison sentence had this act occurred on the street. I wasn’t worried that McCoy would have to miss the rest of the game. I feared that he might have to miss the rest of his life. Violence sells tickets.

If an activity requires a participant to don a helmet and a coat of armor, then clearly it is an unwise activity for a human to engage in.

McCoy was taken off the field and reentered the arena 2 plays later, after an exhaustive evaluation that was completed in about 100 seconds. Since everything in sports and medicine is now measured, we know that McCoy was sidelined for a total of 3 minutes and 50 seconds before his soggy head reentered the arena. Perhaps, emergency room physicians should consult the Browns’ medical staff to learn how they can expedite their medical evaluations in their emergency rooms. With a little training, a heart attack patient, for example, can be treated in 3 minutes or less.

McCoy’s father went public chastising the Browns for the decision and the process that led to his son Colt returning to the field. While the NFL is now investigating, the Browns maintain that proper procedures were followed.

As more facts dribble out, we learn that McCoy did not receive the standard medical evaluation that is required after a suspected concussion known as the SCAT2 (Standard Concussion Assessment Tool , version 2). Apparently, Browns’ medical personnel were attending to others and did not witness the helmet-to-helmet collision. Are these folks aware of the futuristic technology commonly known as instant replay?

If the only medical training you ever had was how to swallow aspirin or apply Band-Aids, it is likely you would know that a 4 minute time out is not a sufficient assessment period after a cannon ball blow to the skull. Initially, the Browns were vague on the extent of neurologic testing that was performed on the concussed quarterback. We now know that there was no evaluation.

As a physician who has been sued, I am sensitive to applying blame retroactively. I can understand based on the available facts why McCoy was sent back in. But this event shows that either the process is flawed or that proper procedures were not followed. This episode warrants investigation for the right reasons, not simply to apply the broad brush of blame to make some folks feel good.

Nevertheless, this is a particularly galling vignette for physicians like since we are trained and dedicated to practice high levels of patient advocacy. We advise our patients on what we believe to be in their best interests. Sometimes, we take heat for this. We may, for example, advise an individual that they should surrender their driver’s license. We may counsel a patient not to travel even though a family trip was planned months ago. We may warn a patient that his job is threatening his health.

Our advice should not be contaminated by external considerations. We would not, for example, clear a patient to return to work prematurely because this would serve the employer’s interest.

In professional sports, team physicians advocate for the team. Obviously, there is an enormous conflict between serving the team and serving the player. If McCoy’s primary care physician were consulted after the head thrashing incident, do you think he might have offered a second opinion? Let’s hope so.


Gary M. Levin said...

Pretty basic standards we are taught in medical school is to not consider employee needs and recommend our pure medical decisions. However he was not examined by an MD. Don't they have a team physician? Who made the call? The AMA should be on top of this. Perhaps even the medical board if it was an MD

Drew said...

Everyone from the Browns is saying the doctors never saw the hit, and no one told them to check Cold for a concussion. I would have thought that glassy eyed confused look might have been a clue.

Maybe the medical staff didn't see it, but I think this has to come down on the head coach. He had to see that hit, and no one should have gone back into the game that quickly afterward. He should have double checked that Colt was properly tested.

And as soon as he went back in, he threw a terrible game losing interception.

Nicholas Fogelson, MD said...

Mr McCoy was not treated appropriately for his concussion, and was exposed to additional injury by continuing to play after it.

So what's new or unusual about that?

Are we surprised that a sport that is inherently violent is still played after one is injured from that violence? Is it any different than boxing, where a person who has literally been knocked unconscious from intentional blows to the head continues to fight only seconds after getting up from the mat? Does anyone have a problem with that? It seems not, but why?

As a nation, we find it easily to concentrate on the mitigation of a risk in certain activities like football, yet completely accepting of such risk in other activities, like boxing. I hate to say it.... but as a culture we are totally OK with mostly black young men beating each others head in, and say that's a choice they make by boxing, but think its a crime that our mostly white quarterbacks might have their brains injured in play :(

Potential for racism aside, we have so many opposing ideals here. Football is advertised with repeated fast cuts of bone crushing hits, as if those hits are exactly what people are there to see. The players are increasingly strong and heavy, able to deliver violence with increasing efficiency. The armor technology improves, but this only encourages even harder hits. I've never heard of a rash of terrible concussions in rugby.... where they do similar things and wear no armor at all...

Michael Kirsch, M.D. said...

Appreciate comments. Drew, nice to have you back. I also think the Browns fumbled on this and didn't come clean right away, which is always best approach. Plain Dealer reporting today that Colt will like,y be out for the rest of the season. I don't see a racial element, Nick, with regard to boxing and football. They're both violent activities which sells lots of tickets. They are vestiges of the ancient gladiatorial contests. There is barbarism in both sports. Personally, I find boxing to be more objectionable as the sole goal is to assault so done. There's not even the facade of a game.

Nicholas Fogelson, MD said...

Mike - I think the racial element is in the differing level of outrage. People seem less concerned about boxers getting repeated head injuries. I think though that its also that boxing is obviously all about intentionally causing the head injuries, where there is a perception that football can be played without said injuries (which is probably incorrect)

Michael Kirsch, M.D. said...

Nick, let's face it; both sports are outrageous. If the violence In boxing receives less attention, it may be because it is dwarfed by football's omnipresence and popularity. Tennis is a civilized sport. Ping-pong anyone?

Nicholas Fogelson, MD said...

As a former member of the University of Oregon "Ping Pong" team, I must protest.... Table Tennis Mike, Table Tennis. :)

Michael Kirsch, M.D. said...

As a former member of the Columbia High School ping-pong club, I say, en garde!

Add this