Does the NCAA Even Care About Concussions?

Okay, pop quiz. Which of the following will incur the full wrath of the National Collegiate Athletic Association?

A) Bartering for tattoos;

B) Accepting money and gifts from people who want to give them to you and your family;

C) Smoking weed at a college party;

D) Sending a concussed football player back onto the field, violating both medical ethics and common sense.

The correct answers, of course, are "A," "B," and "C." But not "D." And that's a problem. It's a problem when former University of Southern California receiver Robert Woods absorbs a vicious helmet-to-helmet hit that left him falling face-first to the ground, yet only misses a single play; a problem when former University of Arizona quarterback Matt Scott is hit twice in the head on the same play, vomits on the field, and is allowed to keep playing; a problem when University of Michigan quarterback Shane Morris is concussed and staggers past the same coaching staff that later places him back into the same contest; a problem when all of the preceding incidents and every other one like them place college athletes at undue and unnecessary risk of additional brain damage, and no one responsible for protecting those same athletes loses their job—or even a day's pay—for screwing up the one thing you can't afford to botch.

Thankfully, the Big Ten is planning to take action. Earlier this week, the conference announced new concussion protocols that will include not only independent athletic trainers stationed in television replay booths to better spot suspected brain injuries, but also penalties for schools that fail to comply, the better to ensure what a Big Ten press release calls "a higher level of accountability."

Does the conference want to do right by its athletes? Seems like. Is the Big Ten also responding to the recent apparent suicide of Ohio State University football player Kosta Karageorge—who, before his death of what was reportedly a self-inflicted gunshot wound, sent his mother a text message reading, "Sorry if I am an embarrassment, but these concussions have my head all fucked up"—as well as ongoing fallout from Michigan's mishandling of Morris, a failure that prompted Rep. Bill Pascrell (D-NJ) to write a critical letter to conference commissioner Jim Delany? Most likely. Could the Big Ten have adopted a uniform concussion policy—with uniform punishments for recklessness, irresponsible medical care—years ago? Without doubt.

Still, better late than never. And given the potentially serious, even fatal health consequences of badly-managed concussions, better to try something than continue to do nothing. Only here's the thing: we're talking about the Big Ten. A conference consisting of 10 11 12 13 oh, fuck it 14 universities. A tiny fractionof the 250 universities and colleges that field NCAA Division I football squads, never mind the 1,000-plus sports-playing schools that make up the association as a whole.

Strange but true: the NCAA doesn't have a mandatory, uniform set of athlete concussion protections. It has no immediate plan to create them, either. Unlike the Big Ten, the association hasn't promised a corresponding enforcement system that would investigate and discipline schools and athletic programs for brain-threatening bad behavior, the same way the NCAA currently investigates and punishes serious public health threats such as enthusiastic calling and text messaging and signing autographs for money. And this, in turn, raises a question.

Specifically, what the hell is the association waiting for?

Fact: the NCAA was created in 1906 after Teddy Roosevelt summoned campus leaders to the White House to address a series of gruesome football injuries and deaths. Protecting athletes from injuries—particularly head and brain injuries—is the association's entire raison d'être.

Also fact: when it comes to concussions, the NCAA has done a half-assed job of fulfilling its founding mission.

Prior to 2010, the association required nothing of its member institutions regarding concussion diagnosis or athletes returning to play. No rules about holding injured players out. No bylaws demanding appropriate medical care. Zilch. That year, the NCAA belatedly began requiring schools to have concussion management plans on file that: (a) inform athletes about the signs and symptoms of concussions; (b) remove athletes who show signs of a concussion from play; (c) prohibit students with concussions from returning to play the same day they were initially injured.

Note: the association didn't actually require schools to follow said plans, just to have them on a hard drive or in a filing cabinet somewhere.

Last year, former NCAA medical director David Klossner admitted that his organization wasn't even monitoring schools for having said plans, and that schools weren't required to submit them to the association for review. Klossner's revelation came during a deposition for a concussion lawsuit brought by former athletes against the NCAA, a suit that revealed stunning, long-running association indifference to brain injuries, despite ample historical evidence of the problem.

Here's just one example, something I've written about before:

… in 2009, the [NCAA Committee on Safeguards and Medical Aspects of Sports] recommended that the [association] adopt rules that would remove athletes showing signs and symptoms of concussion from the field of play and not allow them to return until cleared by a physician. Hardly a comprehensive plan. But a much-needed, long-overdue bare minimum. As a University of Georgia football athletic trainer and committee member put it in an email, "we all know that there are times where athletes are returned to games with concussions. I personally have seen an athlete knocked unconscious and return in the same quarter in recent years."

Klossner backed the recommendation. He promptly met resistance. Ty Halpin, [the NCAA's] Associate Director of Playing Rules Administration, wrote that any such rules could be "problematic" because they could create liability for game officials. Halpin colleague Teresa Smith was even more concerned, asking in an email "are the refs more at risk if we don't provide the educational piece on concussions or if we do provide it? And, what about the NCAA? Would we be protecting/helping the organization by not providing the information?"

In a separate email exchange, Halpin and NCAA associate director of research Nicole Bracken even made fun of Klossner's efforts to, you know, prevent athletes from suffering life-altering neurotrauma:

Halpin: Dave is hot/heavy on the concussion stuff. He's been trying to force our rules committees to put in rules that are not good -- I think I've finally convinced him to calm down.

Bracken: He reminds me of a cartoon character.

Halpin: HA! I think you're right about that!

As part of a proposed settlement of the aforementioned concussion lawsuit, the NCAA tentatively has agreed to make much-needed changes to its concussion and return-to-play policies, including preseason baseline neuropsychological testing for all athletes; a requirement for schools to have appropriately-trained medical personnel at all contact sport games and practices; the creation of a concussion reporting and whistle-blowing system to track injuries and report concerns about individual school concussion management; and prohibiting athletes diagnosed with concussions from same-day returns to practices or games.

All of this is good. Blindingly obvious. Wholly overdue. But good nonetheless. However, there's still a catch: currently, the NCAA doesn't plan to enforce the changes. There's no potential punishment behind them. Flout the policy, and the association's compliance investigators won't be knocking on your athletic department's door. No matter how much a school messes up and puts a player in harm's way, there will be no sanctions, no show-cause letters, no postseason bowl bans. No deterrence. No punitive measures to make pressure-cooked, win-or-get-canned coaches, administrators, athletes, and medical personnel realize hey, wait a second, maybe we should err on the side of caution here, as opposed to the side of play-first, possibly-pay-later. A side where Woods reportedly was administered a Flintstones-quality sideline concussion test that consists of three questions—Who is the current president? What is today's date? What is 100 minus seven, minus seven, minus seven?—while former USC coach Lane Kiffin subsequently praises his concussed player for being a "tough kid."

None of this is good enough. Suggestions aren't sufficient, no matter how well-intentioned or strongly-worded. After all, the NCAA has a history of issuing non-binding concussion guidelines that its member schools promptly disregard. Case in point: once upon a time, the association's Medical Handbook for School and Colleges stated that "the seriousness of [concussions] is often overlooked" and that concussions "should not be regarded lightly." According to Travis Waldron at ThinkProgress, it also laid out recommendations for immediate treatment, including rest, constant supervision, and x-rays of the brain as long as headaches persisted; suggested hospital treatment for players with recurring symptoms until they were symptom-free for 48 hours; and recommends that any player who experienced symptoms for longer than 48 hours "should not be permitted to compete for 21 days or longer, if at all."

The year of the handbook's publication? 1933.

Look, rules backed by muscle aren't going to prevent schools from mishandling concussions, any more than traffic lights and speed traps prevent reckless driving and car accidents. But enforcement certainly could help. It could discourage football coaches from pressuring trainers to return concussed players to action before they're medically ready—something that nearly half of 101 team trainers and doctors surveyed by the Chronicle of Higher Education last year said they've experienced. It could discourage those same coaches from pressuring injured athletes, too, like former Columbia coach Pete Mangurian, who reportedly was accused by his players of "consistently den[ying] the diagnoses of concussions," telling them "to return to practice, that they are faking their concussions, and that they are being soft if they sit out for their concussion injury." It could even encourage schools as a group to take a good, hard look at why college football players report having six suspected concussions and 21 "dings"—episodes of concussion symptoms—for every diagnosed injury, and what might be done to lower that number.

If you don't think the threat of NCAA sanctions is enough to change school behavior, consider this: last Spring, Portland State University self-reported a possible amateurism violation involving a member of the school's women's golf team washing her car on-campus with a hose belonging to the university. The scrub-and-shine turned out to be permissible; nevertheless, the mere possibility of getting on the association's bad side was enough to make Portland State's compliance department go to excessive, ridiculous lengths.

Is the NCAA willing to bring the same muscle—or threat thereof—to brain damage? Hard to say. Earlier this week, Emmert told CBS Sports' Jon Solomon that he would like to see "association-wide polices that go beyond where we are now," and that "I'd very much like to see something like [what] the Big Ten did spread across all of the NCAA." The next day, CBS Sports' Dennis Dodd reported that Emmert supports conferences enforcing new concussion protocols, and not his organization. His wishy-washy attitude isn't wholly surprising: both NCAA history and internal association documents and emails from the recent concussion litigation strongly suggest that the organization wants neither the responsibility nor potential financial liability that would come with policing concussion management, an admittedly difficult task that NCAA chief medical officer Brian Hainline recently told Solomon would be "impossible."

Would it?

The NCAA has spent decades enthusiastically embracing its role as amateurism's Torquemada, refusing to rest so long as some athlete somewhere is renting out a hotel ballroom for his twenty-first birthday party at a slightly discounted rate, or acting as an online model for a clothing line he created in a business class, or just wolfing down an unauthorized ham sandwich because, you know, hunger. Hainline said that he didn't see a way of "having like a police or monitoring every possible thing." Well, yeah. No one can be the Batman of concussion protocols. That's not the point. The point is that the association sure as hell can play the heavy when it wants to—and in this case, doing so would be a major improvement. Imagine how much safer campus athletes would be if the NCAA and its member schools fired their currently useless amateurism enforcement staffers—Poof! Adios! Go find jobs as parking enforcement officers!—and replaced them with top-notch medical investigators, tasked with keeping brains safe. Imagine how much less unjust college sports would be if schools were punished for actually hurting athletes, as opposed to simply hurting their in-school endorsement opportunities.

Last year, I noted that within the NCAA's sprawling, 400-page rulebook, the word concussion appears three times, 76 fewer times than the word meals. Perhaps that should change. Perhaps Michigan should have reacted to the Morris concussion fiasco by sanctioning the people responsible for keeping him safe, instead of reportedly hiring a public relations firm to help manage the school's image. Perhaps the association can take a hint. During a summer Congressional hearing on college sports, Sen. Claire McCaskill grilled Emmert over schools allowing athletic departments to oversee sexual assault cases involving athletes—and brushed off his contention that neither he nor his organization have much power to change anything. "I feel sorry for you," McCaskill said. "I can't even tell whether you're in charge or whether you're a minion (to the universities). If you're merely a monetary pass-through, why should you even exist?" So long as the NCAA refuses to enact concussion rules with teeth, that question remains apt.