Tua Take 2: Dr. John Leddy’s Thoughts

Last week I wrote about the NFLPA’s investigation into how the Miami Dolphins handled quarterback Tua Tagovailoa’s injury. Dr. John Leddy weighed in and explained what he saw and how he was shocked that Tua was able to return to the game. The injury appeared to look like a concussion to most people besides the independent physicians and the Dolphins’ medical staff that decided that Tagovailoa passed the NFL’s concussion protocol.

Unfortunately, I have to write a follow up about this because of what happened during Thursday night’s game between the Dolphins and the Bengals. In the first half, Tagovailoa was hit and his head slammed into the turf once again, this time resulting in a much scarier scene. Tagovailoa did not stand up and his hands “fenced,” which was a very scary sight to see. Immediately, everyone knew something serious had happened. Tagovailoa was eventually taken off the field on a stretcher and taken to a local hospital immediately. Unlike last week, the Dolphins immediately ruled that Tagovailoa suffered a head and neck injury and was out for the game.[1]

Luckily, it was reported shortly after that Tagovailoa had movement in all of his extremities.[2] Tagovailoa was released from the hospital shortly after, and he flew home with the team.[3]

The first thing that came to a lot of people’s minds was the hit five days ago against the Bills, where Tagovailoa stumbled and looked like he had sustained a head injury. Although it was deemed that Tagovailoa passed concussion protocol, many people were still skeptical. Many people, including myself, were saying to themselves that he should not have even been out there on Thursday in the first place.

https://library.sportingnews.com/styles/crop_style_16_9_mobile_2x/s3/2022-09/Tua%20Tagovailoa.jpg?itok=_M7puvr9

The NFLPA’s Investigation

While yes, the investigation is a step in the right direction, it is still a flawed process. Michael Smith of Amazon’s Thursday Night Football broadcast team reported after the game that the investigation had not even begun yet and that they were still figuring out who they were going to talk to, what they were going to ask, and how they were going to go about the whole process.[4]  Certainly, an investigation is necessary and warranted by the NFLPA; however, if they were concerned that Tagovailoa may have had a concussion and was going to play a game with one, it would be better if they investigated and either confirmed or denied their suspicions before he played in another game.

After the game the NFLPA released a statement saying: “Player health and safety is at the core of the union’s mission. Our concern tonight is for Tua and we hope for a full and speedy recovery.”[5] The NFLPA has said that they will “pursue every legal option” to keep their players safe.[6] While the investigation can lead to positive changes in the future, it did nothing for Tagovailoa due to the timing. While the NFLPA’s mission is for player health and safety, they moved slowly on the investigation and did nothing to prevent Tagovailoa from playing and putting himself in a position where he could be suspectible to irreversible brain trauma.

While the NFL has independent neurological consultants examine the players and has concussion protocols in place, maybe the NFLPA needs to have the ability to step in when they see something as egregious as this so they can fulfill their mission of player health and safety, because these things happen in real time and there is not always time to let an investigation play out if you want to protect the player.

Dr. John Leddy’s Thoughts

I talked to Dr. John Leddy again about what he saw on Thursday. Dr. Leddy is a leading concussion expert from UBMD Orthopedics and Sports Medicine. When I talked to Dr. Leddy about the risks of continuing to play if Tagovailoa had sustained a concussion, his main worries were significant worsening of the concussion with weeks to months of lingering symptoms, or the worst-case scenario, “Second Impact Syndrome.” Dr. Leddy explained that when Tagovailoa’s hands “fenced,” it was a primitive brainstem reflex that is seen with significant trauma to the brain and upper spinal cord. Luckily for Tagovailoa, Dr. Leddy states that he did not suffer “Second Impact Syndrome,” which is “irreversible brain swelling that typically results in death when a person sustains another head injury before having recovered from a prior injury.” The emergency room’s evaluation of Tagovailoa’s injury did not show any signs of this, which is great news for Tagovailoa.

After the game, Dolphins’ coach Mike McDaniel said “that he didn’t have anything more serious than a concussion.”[7] I think it is important to not let McDaniel’s comments diminish the seriousness of a concussion, especially if he had one already going into the game. Dr. Leddy says even though Tua “only” sustained a concussion, “the course of events could certainly be impactful for Tua if he has a protracted recovery because of the proximity of his concussions,” especially if he had a concussion going into the game and had not recovered from it.

Tagovailoa was able to fly home with the team. Dr. Leddy said that as long as Tua did not have a brain bleed or a cervical spine fracture, then it is safe to fly with a concussion.

I asked Dr. Leddy if Tagovailoa would have shown the same symptoms had he not taken the first blow in the Bills game. He said that there is “No way to know for sure. The hit alone could have produced a concussion whether or not he had one during the Bills game. If he had not recovered from the concussion he sustained during the Bills game, however, then he is at very high risk for the second injury to have been worse and he is at greater risk for a prolonged recovery.”

Obviously, Dr. Leddy was not able to examine Tagovailoa, so he is only speaking based on what he saw and what has been reported. Dr. Leddy does not know what his condition is now, so he cannot say whether or not he will have a prolonged recovery, but Dr. Leddy’s opinion is that it is more likely than not that he will have prolonged recovery.

Finally Some Progress

To illustrate how serious this situation is and how badly it was botched, Congress has gotten involved. Bill Pascrell Jr., a representative from New Jersey and the head of the Brain Injury Task Force, sent a letter to Rodger Goodell and Dolphins’ owner Steven Ross asking a series of questions, and at the center of it, demanding action.[8] It seems like this got the attention of the NFL and the NFLPA, as there were some serious actions taken over the weekend.

https://deadline.com/wp-content/uploads/2022/10/nfl-nflpa-concussion.jpg

It is clear that the NFL and the NFLPA have more work to do here.  The NFLPA initiated their investigation on Friday following the game and interviewed both the unaffiliated neurotrauma consultant and the Dolphins team doctor who evaluated Tagovailoa during the Bills game.[9] On Saturday, the unaffiliated neurotrauma consultant who examined Tagovailoa was fired for making “several mistakes” during the evaluation of Tagovailoa.[10] While this may not be definitive that Tagovailoa was concussed during the Bills game, it certainly shows that there were violations of the protocol and that Tagovailoa should not have been cleared to return to the game.

Additionally, the NFL and the NFLPA released a statement saying that changes to the existing concussion protocols are needed.[11] The statement says: “The NFL and the NFLPA agree that modifications to the Concussion Protocol are needed to enhance player safety. The NFLPA’s Mackey-White Health & Safety Committee and the NFL’s Head Neck and Spine Committee have already begun conversations around the use of the term ‘Gross Motor Instability’ and we anticipate changes to the protocol being made in the coming days based on what has been learned thus far in the review process.”[12]

New protocols are expected to be approved and be in place for Week 5.[13] These updates to the protocol are expected to close a “loophole” and say that players are not allowed to return if they show any “Gross Motor Instability,” regardless of what they say the cause of it is, which would have made Tagovailoa ineligible to return against the Bills, even if he did indeed injure his back.[14]

It is sad that it took a situation so egregious and obvious for the NFL and the NFLPA to take head injuries more seriously, but at least they are taking steps in the right direction now.


Feature Photo: https://www.gannett-cdn.com/presto/2022/09/30/PCIN/7c651e93-20c6-4bb3-b09c-212890a89cd0-092922_BENGALS_0026.jpg

[1] https://twitter.com/MiamiDolphins/status/1575662129205870592?s=20&t=cj33hKmspa4j7lluWafJNw

[2] https://twitter.com/MiamiDolphins/status/1575663929287905282?s=20&t=YZeAHLd0hRBnzTnqJYo-Lg

[3] https://www.nfl.com/news/dolphins-qb-tua-tagovailoa-exits-thursday-s-game-after-suffering-apparent-head-i

[4] https://www.amazon.com/gp/video/detail/B0B52ZGBB4/ref=atv_me_pvs_c_TOLoB6_3_1

[5] https://www.si.com/nfl/2022/09/30/nflpa-issues-statement-dolphins-tua-tagovailoa-injury

[6] https://www.cbssports.com/nfl/news/tua-tagovailoa-injury-nflpa-executive-director-says-it-plans-to-pursue-every-legal-option/

[7] https://www.cbssports.com/nfl/news/dolphins-mike-mcdaniel-details-tua-tagovailoa-head-injury-qb-issues-heartfelt-statement/

[8] https://profootballtalk.nbcsports.com/2022/10/01/congress-turns-its-attention-to-the-tua-tagovailoa-situation/

[9] https://www.espn.com/nfl/story/_/id/34702740/unaffiliated-neurotrauma-consultant-evaluated-miami-dolphins-qb-tua-tagovailoa-fired-several-mistakes-source-says

[10] Id.

[11] https://profootballtalk.nbcsports.com/2022/10/01/nfl-nflpa-agree-that-changes-to-the-concussion-protocol-are-needed/

[12] https://www.nfl.com/news/nfl-nflpa-agree-to-parameters-of-updated-concussion-protocols

[13] Id

[14] Id.

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University at Buffalo School of Law Class of 2023

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