One week later, physicians silent on Morris concussion

By Max Cohen, Daily Sports Editor
and Ian Dillingham, Daily News Editor
Published October 2, 2014

One week after sophomore quarterback Shane Morris suffered a concussive hit in the Wolverines’ matchup against Minnesota, the University Athletic Department has begun to open up about the incident with media outlets — including Athletic Director Dave Brandon in an interview with The Michigan Daily Thursday.

In addition to Brandon, University President Mark Schlissel and Michigan coach Brady Hoke have both addressed the media. However, as of Thursday, there has been no communication from any of the eight team physicians currently contracted with the football team.

In a 12:30 p.m. Monday press conference, Hoke told the media the medical department would deliver a statement on Morris’ condition. However, no further communication was received until Brandon’s 12:52 a.m. statement Tuesday.

And there have been no follow-ups by medical personnel since.

Attempts by The Michigan Daily since early Wednesday to contact the team’s eight physicians yielded no responses. Two of the eight declined comment — one citing his desire to not comment on the work performed by colleagues — while the other six did not respond to interview requests.

In addition to their roles with the Athletic Department, seven of the team physicians hold a professorship in the University of Michigan Health System. Each holds a medical degree, unlike the athletic trainers and athletic medicine staff.

Jeffrey Kutcher, the football team’s neurologist, has been widely credited as a leader in concussion research and safety. His prominence in sports medicine landed him a place as one of the Team USA physicians for the 2014 Winter Olympics in Sochi, Russia.

Hired by the Athletic Department in 2011, Kutcher is a longtime Michigan athletics supporter with ties to several teams. Prior to his trip to Sochi, the department praised his contributions to sports medicine nationally.

“His affiliation with Michigan and especially his work as team physician has parlayed his knowledge into becoming one of the most sought-after sports neurological experts in the United States,” the department wrote in a NCAA.com post in February.

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After the fourth-quarter hit on Morris Saturday, Kutcher “saw Shane stumble and determined he needed to head down the sideline to evaluate Shane,” according to Brandon’s statement.

However, before a neurological examination was conducted, medical trainers — who, Brandon wrote, were unaware of the head injury — finished an examination of Morris’ ankle and allowed him to go back on the field for one play after fifth-year senior quarterback Devin Gardner’s helmet came off, mandating an exit.

“The neurologist and other team physicians were not aware that Shane was being asked to return to the field,” Brandon wrote. “(The) probable concussion diagnosis was not at all clear on the field on Saturday or in the examination that was conducted post-game.”

The official diagnosis, delivered via Brandon’s statement: a probable, mild concussion.

However, there is little consensus regarding the definition of a “mild” concussion within the medical field. Most resources dictate that symptoms must not persist past 15 to 30 minutes.

Accepting this timeframe, it remains unclear how such a diagnosis was reached after Hoke’s press conference, especially when the postgame examination did not reveal the injury.

Based on Twitter updates from the Daily’s football beat, Morris returned to the game at 6:21 p.m., three minutes after sustaining his probable concussion. All indications from Hoke and Brandon are that a concussion examination was never started on the sidelines.

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Robert Cantu, clinical professor of neurosurgery at Boston University and senior adviser to the NFL’s Head, Neck and Spine Committee, said a proper concussion evaluation — had it been conducted — would have taken at least 10 to 12 minutes. Certain symptoms, such as loss of consciousness, stumbling and impaired eye movements can lead to a positive concussion diagnosis in fewer than 10 to 12 minutes, but a concussion cannot be confidently ruled out in a shorter amount of time.

“At the moment of concussion, you don’t really know if it’s going to be mild, moderate or severe, because you don’t know how long the symptoms are going to last,” Cantu said.

Proper neurological examination following a concussion includes — but is not limited to — a 26-symptom checklist, a neurological assessment of cognitive aspects and memory, assessment of eye-tracking and movement and a range of physical balance tests.

Each one of these steps is critical to the overall diagnosis, especially in potential minor injury, Cantu said.

“There are certain things that you really know within seconds, but for those that have a lesser degree of concussion you need to go through a complete neurological exam.”

Players who have sustained concussions face two major risks if they return to a game prematurely: second impact syndrome and increased severity of symptoms.

The more serious consequence, second impact syndrome, results from a secondary blow to the head or body before the brain has recovered from the first. Cantu said these situations, while rare, can set off a devastating chain reaction in the body.

“There can be a very rapid loss of auto-regulation of blood flow to the brain so that the brain becomes engorged with blood causing massive increased inter-cranial pressure, which in turn causes brain herniation, which in turn causes death with about 50 percent of those cases,” Cantu said.

The second danger, an increase in symptom severity, is the most common. In these cases, a player returning to play with a concussion can aggravate the concussion — transforming a potentially minor injury into one that involves weeks, or even months, of symptoms.

Contrary to second impact syndrome, however, increases in symptom severity can occur even if a player does not sustain an impact after returning to play. The physical exertion of just returning to the field again is enough to cause serious damage.

While a medical diagnosis and treatment are often conducted on the sidelines during both college and professional games, Cantu said more and more physicians are electing to move players to the locker room for exams — away from the chaos and noise of crowds, coaches and other players.

Cantu also said present-day coaches are much better at respecting the role of physicians on the sideline, but that historically there have been concerns with regard to coaches permitting — or even encouraging — players to ignore injuries. He added that an ideal setup would be one that gives physicians carte blanche over removing players from the field.

In 2013, Hoke told The New York Times he views his role as separate from medical staff.

“I’ll defer to Jeff (Kutcher) on concussions, and he won’t tell me how to coach the defensive line,” Hoke said. “We’ll be good.”

But the responsibilities of the medical staff — especially while players are participating in the game — appear uncertain in this case. After he took the hit, Morris took one more snap before being removed, calling into question the team physicians’ jurisdiction under Hoke’s management system.

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In an interview Wednesday with The Detroit Free Press, Brandon placed the fault for Morris’ reinsertion on the medical staff.

“Our medical staff, which incorporates all of our trainers, our physicians — it’s a rather large complement of people down there — their job is to notify the coaches if a situation occurs where either somebody needs to come off the field or somebody cannot go back on the field.” Brandon said.

To improve this communication, the Athletic Department sent out a statement Thursday evening outlining its plans to improve communication regarding player safety.

The new measures will include having a certified athletic trainer in the press box to receive a better perspective on injuries that may occur on the field. This improvement will allow the athletic trainer to view multiple replays to best watch for potential injuries.

To increase the effectiveness of the system, the program plans to add a two-way radio communication process between the medical staff and trainers to ensure there are no further breakdowns in communication.

Another update to the protocol includes taking players’ helmets away once they are ruled out of the game with an injury.

The new protocol will be implemented Saturday night when Michigan plays at Rutgers.