Let's End the Charade. Leach's Firing is not about Concussions.

At the risk of stating the obvious, Coach Leach was not fired because of his negligent handling of a player’s concussion.

In my opinion, Leach was terminated for two reasons: 1) Texas Tech's Administration had grown tired of him, and 2) the Administration and the Athletic Department's financial supporters did not wish to fulfill their contractual obligations to Leach.

To achieve this end, the Tech Administration opportunistically leveraged a dim-witted media personality and his disgruntled son to create a pretense for Leach's dismissal.  The Administration, according to its statement,  suspended and later terminated Leach  because of his alleged "treatment of a player after the player was diagnosed with a concussion" (whereby) "the player was put at risk for additional injury."

The story about Leach's alleged mistreatment of the concussion, however, has been unravelling from the start. 

The Tech Administration and certain media interests (one ESPN), recognizing that the pretense has not withstood even cursory scrutiny, have rushed to obfuscate the arguments by tarnishing Leach’s reputation, making unsubstantiated generalizations about Leach’s handling of injured players and alluding to tantilizing ‘other’ reasons for his dismissal  - none by the way which are mentioned in his termination letter.   

Let us now shed further light on this comedy of errors by examining the facts of concussions in general and Leach's handling of the concussed player in question.

Fact 1:  Mild Concussions are actually hard to diagnose.

Concussion or mild traumatic brain injury (MTBI) is common among most contact and collision sports participants. For many physicians, even those who specialize in MTBI, this area is confusing due to the paucity of scientific evidence to support much of the clinical decision making that is faced in the office.

Source:  http://emedicine.medscape.com/article/92095-overview

Fact 2:  There appear to be no universally accepted guidelines for diagnosing, managing or treating concussions.

At least 16 different guidelines for the evaluation of concussion have been proposed. The plethora of guidelines reflects the lack of consensus, which results from the absence of evidence-based data.

In 1986, Cantu formulated a set of guidelines that became widely used; it was subsequently adopted by the American College of Sports Medicine (ACSM). In 1991, the Colorado Medical Society Guidelines were formulated in response to several deaths secondary to head injuries in Colorado high school football players. These guidelines are more restrictive than previous versions; they were subsequently adopted by the National Collegiate Athletic Association (NCAA). Most recently, the American Academy of Neurology (AAN) proposed another set of guidelines. Currently, no consensus exists within the sports-medicine community as to which set of guidelines is the most appropriate.

Source: American Association of Family Physicians, http://www.aafp.org/afp/990901ap/887.html

Fact 3: Mild concussion symptoms appear to be well known.

Headache is the most common MTBI symptom. Other symptoms include dizziness, vomiting, nausea, lack of motor coordination, difficulty balancing, or other problems with movement or sensation. Visual symptoms include light sensitivity (emphasis added), seeing bright lights, blurred vision, and double vision. 

Sources:  Archive of Internal Medicine, Journal of Athletic Training, Journal of Emergency Nursing.

Fact 4:  There appear to be no specific treatments for mild concussion (this is my favorite section).

Usually concussion symptoms go away without treatment and no specific treatment exists. 

Source:  The Harvard Medical School Family Health Guide and Current Treatment Options in Neurology.

Treatment for concussion includes the elimination of all physical activity and the elimination of all cognitive stimulation (relatively new) (Annual National Summit on Concussion and Other Sports Medicine Injuries, May 15, 2009). This includes the removal of student-athletes from school with instructions of no reading, no computers, no video games, and no texting/communication on electronic devices. (emphasis added) The goal of removing the cognitive stimulation is to allow the brain to heal. Just as in any other type of injury, rest is crucial to the healing process especially within the first 48 hours.

Because some individuals may experience photophobia (sensitivity to light) with a concussion, placing the athlete in an area void of sunlight or artificial lights may make the athlete more comfortable (emphasis added).

However, a key part of ensuring the safety of an athlete diagnosed with a concussion is to never leave the athlete unsupervised or alone (emphasis added). Athletes recovering from concussions need constant monitoring to ensure that no other symptoms appear that may indicate a more serious brain injury (subdural hematoma).

Source:  http://sportsinjuries.suite101.com/article.cfm/recovering_from_a_concussion.  Terry Ziegler, Professor of Kinesiology

 

Leach and the Concussed Player

Using the preceding discussion about concussion management in general, let’s see where that places Leach vis-a-vis his handling of the particular concussed player:

1.     The science of minor concussions is imprecise

2.     The guidelines for treating minor concussions are not universally accepted

3.     There are no specific treatments for minor concussions

4.     In the event that a patient suffers light sensitivity, one professional publication suggests "placing the 

        athlete in an area void of sunlight or artificial lights" 

5.     The publication also suggests to never leave the patient unsupervised

Regarding points 1-3, Leach deferred decisions regarding diagnosis and treatment of the player's concussion to doctors and trainers, who in the execution of their duties adhere to medical guidelines which are not universally agreed upon.

Regarding point 4, Leach requested that the player, who was diagnosed as suffering from light sensitivity, to be placed in a dark area - in accordance with the advice of at least one sports medicine publication.

Regarding point 5, Leach advised that the player be monitored at all times - in accordance with the advice of at least one sports medicine publication.

Final Thoughts

I am failing to see, based on the above discussion, how Leach’s actions a) put the player at substantial subsequent risk to injury; and b) deviated from the normal medical standard of care (especially as there is not a universally accepted standard of care regarding MTBI)  which Dr. Michael Phy referred to in his affidavit. 

Let it be asked here. Once the artifice for Coach Leach’s dismissal has been exposed, where does the Tech Administration go from here?  Let’s hope heads roll.

ESPN and other national sports journalists please take note.

Other references:  2009-2010 NCAA Sports Medicine Handbook Guideline 2i, Concussion or Mild Traumatic Brain Injury (mTBi) in an Athlete (revised July 2009).

 

 
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