By Alan Schwarz
c. 2010 New York Times News Service
Washington state’s law that mandates strict procedures for handling youth athletes’ concussions has served as a template for similar policies.
It has helped shape laws in several other states and will be discussed at a House Education and Labor committee hearing on the subject today.
But examples of the way concussions are handled even in one community in Washington, regarded as perhaps the most enlightened state on the issue, demonstrate the limits of such legislative action — and how persistent football culture, as well as questions of legal liability and resources, can leave young athletes in danger.
Two parents in Sequim criticized how a local hospital handled their sons’ treatment after the boys sustained concussions playing high school football this month, with one player’s discharge papers reading, “May return to sports when able.”
The other player received no medical attention on the field because emergency technicians were required only for varsity games, and he was on the junior varsity.
Another player’s mother who asked the Sequim School District to begin a baseline neuropsychological testing program — which can assist in evaluating when a player has recovered and can return to play — was told that such testing, “due to liability and legal issues, is not recommended either by the insurance provider” or the Washington Interscholastic Activities Association (WIAA).
Other communities across the United States have encountered similar roadblocks to improving player safety.
Boston University researchers offered to staff every Wellesley Youth Football game and practice with an athletic trainer to watch for concussions that might otherwise be missed and arrange for treatment — but were turned down because of time and administrative issues, according to the e-mail declining the offer.
The official who wrote the message did not return an e-mail seeking comment.
A different group trying to educate communities about concussions offered to speak to participants in a Sarasota, Fla., youth football program and said it was told, “We don’t want to alarm the parents or scare the kids.”
Washington’s state law, known as the Lystedt Law and named after Zackery Lystedt, who sustained permanent brain damage during a high school football game, requires education for coaches and parents, the immediate removal of any athlete suspected of having sustained a concussion, and written authorization from a “licensed health care provider trained in the evaluation and management of concussion” before an athlete can return.
The legislation has served as a template for more than a dozen states that have enacted or are considering similar bills.
The NFL has lobbied state legislatures and the United States Congress to consider language from the law.
The Lystedt Law, and other state legislation like it, still allows for mismanagement of injuries, said parents in Sequim — including Jean Rickerson, whose son Drew plays quarterback for Sequim High School.
This year she started a Web site, sportsconcussions.org, to share information and best practices with a community of athletes and their parents.
“The situation here is not isolated — that’s why I run the site,” said Rickerson, adding that Drew sustained a concussion in a game two years ago, received little medical care and did not recover for months.
“I know there are other communities who are struggling as we are. We don’t have proper experts nearby who know how to handle concussions. I know of a player in Los Angeles who was cleared by a trauma center to go back and play in the game right then.
“We’re just a snapshot of what’s happening across the country.”
Two players for Sequim High School have received inadequate medical advice about how long they needed to stay out of football after concussions this month, according to interviews with their parents and supporting documents.
Robin Hall’s son Joey, a senior linebacker, was blindsided by an opponent at full speed, snapping his head violently backward before he was slammed to the ground.
He was taken by ambulance to the area’s primary hospital, Olympic Medical Center, about 20 minutes away in Port Angeles, where the emergency doctor diagnosed a concussion.
Joey was released about 90 minutes after arriving at the hospital. His release papers, under “Activity Restrictions,” read only, “May return to sports when able.”
Modern guidelines state that athletes of all ages and in all sports, after sustaining a concussion, should not return to play until they display no symptoms (like dizziness, headache, nausea or sensitivity to light or sound) both before and after gradually increasing physical exertion.
It is less known that students feeling symptoms should also be advised not to tax their cognitive function by playing video games or even studying too hard.
“It was very old-school,” Robin Hall said. “‘You got your bell rung? When you feel better, go back to play.’
“I was just a little confused. With Jean in our community, and the Lystedt Law in our state, everybody’s being, I thought, educated.”
Dr. Scott Kennedy, chief medical officer of Olympic Medical Center, said that he could not comment on any individual case because of privacy laws and that he had not spoken with the emergency room doctor.
“What we do want to see is careful consideration of what’s needed in follow-up evaluation of these patients,” Kennedy said, “and to promote the situation where the youth will be safe for return to play.”
A Sequim junior varsity linebacker, Christian Velarde, was severely dazed on a helmet-to-helmet hit and removed from a game but received no sideline medical attention because emergency technicians staff only varsity games, said his stepfather, Neal Butterfield.
Butterfield said he had to drive Christian to a nearby fire station to have its ambulance take the player to Olympic Medical Center for evaluation.
Butterfield said that the doctor there told the family that Christian had sustained a concussion, and that he could perhaps return to play in two weeks.
Butterfield said that because he and his wife, Julie Velarde, had backgrounds in health care, they knew that was providing Christian false hope. After consulting a neurologist two hours away in Seattle, the family decided Christian would not play football again this season.
“Just because the junior varsity’s playing, they hit hard too,” Butterfield said. “I think they’re entitled to the same types of emergency medical availability that the varsity team gets.”
Regarding the emergency room doctor’s two-week appraisal, he added:
“So much is left up to the parent. What the E.R. said as far as aftercare goes, that might have resulted in a kid going back there before he should have.”
Kennedy said: “It’s important for us to hear this.”
He added: “We need to look at the way we communicate with patients and their families to be certain that the care continues beyond the E.R. as intended. We need to have good, serious discussions about that.”
The Lystedt Law does not require or even mention the presence of emergency or other medical personnel at practices or games of any sport, largely because such requirements would be too costly for some rural communities, people involved in the law have said.
According to the National Athletic Trainers’ Association, only 34 percent of Washington high schools, and 42 percent nationwide, have access to a certified athletic trainer educated in proper concussion care.
Neither Sequim player had taken a baseline neuropsychological test to help confirm when his cognitive function was back to normal, the players’ parents said.
Rickerson had lobbied the Sequim School District to begin such a program.
She was told that the Port Angeles School District had looked into the idea but was told it was not recommended by its insurance provider or the WIAA.
“To say that it’s not recommended does not necessarily mean that it is discouraged,” John Miller, assistant executive director of the WIAA, said in a telephone interview.
“We leave it up to the school districts.”
Mary Sue Linville, director of risk management for the Washington Schools Risk Management Pool, said that her organization relied upon the interscholastic association’s advice not to recommend the program.
She added that the Lystedt Law did not require it, and that liability concerns will greatly influence decisions on establishing any standard of care.
“If you purchase the program, you better be using it consistently and properly, because if you don’t, that opens up liability,” Linville said.
“If you don’t own it at all, then you do not have that liability, and you are not responsible.”
Questions of concussion-related liability are not new to Sequim.
In 2006 a Sequim High School running back, Adrien Gault, sustained several concussions before one in October of that year that led to bleeding in his brain and, years later, recurring headaches and memory loss.
In January he sued the Sequim School District and an area chiropractor for mishandling his injuries.
