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Concussions & Sports–Legal & Ethical Review: Part 2

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[To read part 1 of this report, click here. To download a PDF of the full report, click here]

The second section of The Journal of Law, Medicine & Ethics3 report on “Concussion and Sports” discusses the ways in which the individual states (and the District of Columbia) have dealt with sports concussion law, as exemplified by the state of Georgia’s adoption of legislation. All states now require distribution of educational materials to students and parents/guardians, and all states require qualified medical clearance prior to return to play.

However, there is less agreement on legislation requiring baseline testing, data collection, and required training for coaches. The reason, say the section’s contributors, is money: “In a time of limited budgets, states prefer to keep legislation budget neutral.”

There is also a reluctance to put the legal and medical onus on coaches, many of whom are volunteers without any stated or implied medical expertise.

There are some surprises: “Interestingly, Wyoming is the only state that does not require student-athletes to be removed from play if suspected of a concussion,” say the authors. “Their law only prevents them from playing if they have already been removed for concussion symptoms, and those student-athletes must obtain medical clearance before returning.”

Another issue of disagreement is in the required medical clearance for return to play. All states require some sort of clearance, but there is no consensus regarding who is authorized to give it. “Some states allow any health care provider trained in the management of concussions
without further defining,” write the authors. “Some states permit any health care provider regardless of training. Some states specify that it must be a physician, physician assistant, nurse practitioner, athletic trainer, or psychologist.”

In most states, the law stipulates that concussion education literature be distributed to all student athletes. However, there are often no such rules in place for youth athlete education. The authors believe that, despite the lack of legislation, youth sports organizations should also focus on concussion education: “It is our opinion that inclusion of the recreational leagues in this legislation is very significant…. Therefore, we believe that requiring these organizations to provide concussion educational material to parents, coaches, and legal guardians is a great first step in protecting young athletes.”

Another concern about the existing legislation is the reporting mechanisms set up by these laws. Neurology magazine notes that the laws “may create potential conflicts between athletes and their care providers.”4 The publication also notes concern that the law is insufficient with regards to multiple concussions and their specific effects.

As noted, thus far only state legislation has been made into law. While many attempts have been made introduce sports concussion legislation on a federal level, nothing has been passed (as of this writing).

3 Amanda Cook, B.Sc., et al, “Where Do We Go from Here? ,” The Journal of Law, Medicine & Ethics, 42:3 (2014): 284 -289.
4 Matthew P. Kirschen, MD, PhD., et al, “Legal and ethical implications in the evaluation and management of sports-related concussion ,” Neurology, 83:4 (2014): 352 - 358.

[Photo courtesy of John Martinez Pavliga]

A Legal & Ethical Review of CONCUSSIONS & SPORTS
A Legal & Ethical Review of CONCUSSIONS & SPORTS
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