Pa. House concussion bill draws a mixed reaction
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To some people keenly involved with trying to limit concussions in young athletes, the politicians are simply piling on.
After all, separate U.S. House of Representatives committees one week ago held sessions feet apart from one another, contemplating two different pieces of proposed federal legislation: HR 1347, the Concussion Treatment and Care Tools Act, and HR 6172, the Protecting Students from Concussions Act.
So when the Pennsylvania House late Tuesday night approved a Safety in Youth Sports Act for middle- through high-schoolers across the commonwealth, a few cheers and a few jeers followed.
"This act has some good stuff in it. It really does talk about a problem that's really prevalent," said Dr. Mike Cordas, chairman of the sports-medicine advisory group for the Pennsylvania Interscholastic Athletic Association. "I'm just not so sure this is the thing to do."
Tim O'Malley, executive director of the Western Pennsylvania Interscholastic Athletic League, noted how this act -- it next must pass muster with the state Senate and the governor to become law -- covers much the same recent ground as has his WPIAL, the PIAA and the National Federation of High School Associations.
"To this point, in regard to concussions, there has been a tremendous amount of effort put into education and awareness," Mr. O'Malley said the day after the House vote, 169-29. "We have provided leadership to not only schools and coaches but parents as well. What the state legislators are choosing to do, we'll have to wait and see what kind of positive impact that has. But what's going on right now are positive steps."
"We're certainly appreciative of Rep. [Tim] Briggs," who sponsored the act, said PIAA assistant executive director Mark Byers. "We neither support nor oppose that piece of legislation."
The Pennsylvania bill is modeled after the Zackery Lystedt Law enacted in Washington, where Zachary suffered a brain injury four years ago when he was 13, leaving him in a wheelchair. It includes the same component already stressed by the PIAA and the WPIAL: an information sheet that must be signed by a parent or guardian.
Those state and local governing bodies also emphasize that a medical doctor, doctor of osteopathy or a certified athletic trainer must identify signs or symptoms of concussions in a scholastic athlete and remove him or her from play. The new act, however, uses a less-restrictive description: It reads that a player can only be removed from and returned to play by "a licensed or certified health care practitioner whose scope of practice includes the management and evaluation of concussions."
"I sincerely hope they get the terminology and logistics correct on this bill before they pass it," said Dr. Cordas, a former Penn State football team physician. "What does that mean? What is 'a health-care practitioner?' Is it a chiropractor? I have nothing against chiropractors, but are they qualified to deal with concussions? You have to have more than a surface knowledge of concussions; you've got to go into depth, otherwise you're going to hurt somebody.
"Not everybody medical-wise is on the same page yet. How can we be sure the paramedics [often found on youth-sports sidelines] are in the same book, let alone the same page?"
The act also calls for: the state Departments of Health and Education to develop guidelines and educational material to post on their websites; a "school entity" to consider holding informational meetings about concussion risks prior to each athletic season; a school district to ensure all of its coaches are certified in a concussion management training course once every three years; and a district to suspend coaches who violate the proposed law for removing an athlete from play or returning him or her without a determination from a health-care practitioner. The act stipulates a one-season suspension upon the first violation, two years for the second and a permanent ban on the third strike.
"If there's punitive action to be taken, who's going to take it?" Dr. Cordas said. And, as sometimes is the case in rural areas or districts with limited finances, nobody but the coach may be present to assess a concussed athlete. "They don't want to accept that responsibility ... You're dealing with someone else's kids; you're dealing with a psychological being. You better know how to deal with those things, because a coach very often is a god to that kid," who may downplay his symptoms in order to return to play for that coach.
Dr. Julian Bailes, a co-founder of the Brain Injury Research Institute and the school of medicine's neurosurgery chairman at West Virginia University, sees the proposed law as another step nationally.
"The awareness and education and taking concussions seriously -- those are three things that are as important as stipulations in the law," Dr. Bailes said. "I kind of like the way the Pennsylvania act puts some teeth into holding the coach accountable. I think it's good to have some sort of consequence."
In addition to Washington, similar laws already are on the books in Massachusetts, Connecticut and Oklahoma. Dawn Comstock, the principal investigator at the Center for Injury Research and Policy and an Ohio State associate professor, said it's too early to collect data to determine if the laws are succeeding.
"Quite frankly, because these laws are coming on board so quickly.... and so recently, it's difficult to do," Ms. Comstock said. "The true answer is, nobody has that data yet. [It's best] to look at trends over time."
She added that "all the laws are different versions of the same thing. I don't want to go on record saying one is better than the other. Bottom line, the biggest value of all these laws is, quite frankly, bringing these issues to light and the educational components. Now we have coaches and athletic directors and athletic trainers and parents thinking about this issue."
In Washington, implementation of the law has gone well, said John Miller, assistant executive director of the Washington Interscholastic Activities Association.
"It's gone over really well, much better than we thought, to be honest," Mr. Miller said. "We thought the first year would be chaotic, and it wasn't. It really was a relatively painless process, and that's what we're hearing from our schools as well."
The Lystedt Law there encompasses youth athletics as well, meaning more than 500,000 athletes have signed concussion-risk information sheets -- "if they don't sign, they don't play," Mr. Miller said -- and more than 50,000 coaches have been certified in concussion training via free online courses already available nationally. He credited the Brain Injury Association of Washington and the medical community there with providing much-needed assistance.
The Washington law does not specify any penalty for noncompliance.
"However," Mr. Miller added, "we all know where the penalty lies." A mismanaged situation could leave an athlete dead or in a wheelchair, and ultimately get decided in a court of law.
First Published September 30, 2010 12:00 am