Posts Tagged ‘concussions’

Super Games, Super Pains

Tuesday, February 7th, 2012

I watched the Superbowl with a group of friends on a 60″ High Definition TV, sipping a few beers and compulsively downing munchies. My team lost (but to my mind, second place in a league of 32 teams is not all that bad – kind of a silver medal). I find the organized mayhem of football fascinating, as if J. S. Bach were being performed by a deranged, full contact orchestra. A number of years ago, my then 4 year old daughter Julia called the game “all fall down.” She was right in more ways than she knew.
We have been following two tracks in the saga of the NFL: the workers comp claims filed by former players in California (where benefits are easier to secure) and the lawsuits alleging that the league knowingly hid the effects of repeated concussions, resulting in dementia and other serious medical issues among retired players. While there are numerous lawsuits filed across the country, there is a movement to consolidate several of them into one big federal case, under Senior Judge Anita Brody in Philadelphia.
The stories of diminished mental capacity that have emerged over the last few years are disturbing – easily reaching the threshold where all of us who view the sport must question our complicity. For decades, the football mentality has been to keep the best players on the field, regardless of (future) consequences.
Touchdown Tony Dorsett
One of the parties to the lawsuits is the former Dallas Cowboy running back, Tony Dorsett. He was a smooth, electric runner on the field, but the mask of his helmet and pads only served to make invisible his considerable pain and suffering:

Dorsett’s had surgery on both his knees, and problems with his left arm and right wrist. He says then-Cowboys coach Tom Landry once told him he could play despite a broken bone in his back. Not even the flak jacket Dorsett says he wore beneath his jersey could bring relief, the injury so painful that “tears would just start flowing out of my eyes, profusely and uncontrollably” during practices.
“They would see me and just point to the training room. ‘Go to the training room, get some ice and heat and come on back out here,'” Dorsett says.

That, indeed, was (and to some extent, still is) the coaching mantra: “Suck it up and get back out there!”
Presumption versus Denial
For many years, the NFL denied any relationship between the violence on the field and the subsequent mental traumas of former players. Much like the company doctors who once denied that smoking caused cancer, the league’s doctors insisted that there was no demonstrable relationship between multiple concussions and dementia.
The systematic denial has ended, but the implications for hundreds of retired players are still not clear. I envision that they will eventually reach a settlement, where the league accepts responsibility for virtually any and all mental incapacity in its retirees. Much like the cancer and heart attack presumptions granted to public sector firefighters and police, the league would presume that mental disabilities among retirees are work related, with the burden of proof on a given owner to show that they are not.
While any such settlement will involved the commitment of millions of dollars, the league is so wildly popular, only a small percentage of gross income will be required.
Appetite for Sport
In the meantime, we face half a year without football. Come fall, there will be a Thursday night game every week, along with the full Sunday menu. To be sure, the players don’t like the short week of preparation that Thursday games entail; they will lack the usual full week to recover from the bumps and bruises of the prior Sunday game. Oh, well, the public’s appetite for America’s Game is nearly insatiable. The players will just have to suck it up and get back out there…

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Posted in Compensability, Disability, Law | 2 Comments »

NFL and Dementia: A Changing of the Guard

Wednesday, May 4th, 2011

Last month we blogged the suicide of Dave Duerson, a former NFL star who killed himself at the age of 50. In order to preserve his brain for study, he took the unusual step of shooting himself in the chest. He suspected – and the subsequent autopsy confirmed – that he suffered from chronic traumatic encephalopathy, a degenerative and incurable disease that is linked to memory loss, depression and dementia. A definitive diagnosis is available only through an autopsy.
Among the many ironies surrounding this sad tale is the fact that Duerson sat on the six person NFL committee that reviewed claims for medical benefits submitted by retired players. Duerson was known for his harsh line on these claims, apparently voting to deny benefits in many cases (the votes of individual committee members were not recorded). He even testified before a Senate subcommittee in 2007, supporting the NFL’s position that there was no definitive relationship between repeated concussions and subsequent dementia.
The days of denial appear to be over. Dr. Ira Casson, who represented the “prove it” mentality of the NFL, is no longer actively involved. The medical evidence is accumulating; while some refuse to connect the dots, it’s increasingly clear that repeated brain trauma (concussion) is often directly related to a precipitous decline in brain function in the post-gridiron years.
Old Game, New Order
The NFL is trying to improve the safety of its players. The new rules limiting return to the playing field after a concussion are taking root. Helmet to helmet hits are being penalized with increasing financial severity. But even as the league tries to limit future exposures, the fate of retired players looms large. There will be increasing numbers of claims for disability, including workers comp where applicable, by players who face a substantially diminished burden of proof to connect dementia to playing field (“workplace”) exposures.
It is painful to contemplate the agony of Dave Duerson’s final days. Confronted with the incontrovertible evidence of his own demise, he must have realized how wrong he had been in taking the company line on dementia. He knew what his own autopsy would reveal: a brain damaged by chronic traumatic encephalopathy, caused by repeated trauma. His choosing to shoot himself in the chest was a farewell gesture, not only to his own life, but to the beliefs that had led him to take a hard line with his former colleagues. A loyal member of the “old guard,” he ended his life with the unmistakable and moving embrace of the new order.

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Posted in Best Practices, Disability, health care, Medical Issues, Safety & Health | Comments Off on NFL and Dementia: A Changing of the Guard

Health Wonk Review, CTE, bill review, messing with Texas, and more

Thursday, March 3rd, 2011

Jared Rhoads of The Lucidicus Project hosts this week’s Health Wonk Review, and he dishes up a heaping helping of the blogosphere’s best heath policy posts from the last two weeks. Check it out!
Happy Birthday – to David Williams at Health Business Blog for 6 years of quality healthcare blogging. David is one f the regular Health Wonkers. See his Best of the Blog post for a fine sampling of his work.
More sports-related head trauma tragedy – Earlier this week, my colleague posted about football-related chronic traumatic encephalopathy (CTE). Yesterday, the New York Times featured a story about how hockey brawler Bob Probert also suffered from CTE: “But the legacy of [Bob] Probert, who died last July of heart failure at 45, could soon be rooted as much in his head as his hands.After examining Probert’s brain tissue, researchers at Boston University said this week that they found the same degenerative disease, chronic traumatic encephalopathy, whose presence in more than 20 deceased professional football players has prompted the National Football League to change some rules and policies in an effort to limit dangerous head impacts.”
Bill review – Are you getting what you pay for with medical bill review? At Managed Care Matters, Joe Paduda takes some of the mystery out of the equation in his discussion about what your savings should be from your work comp medical bill review program.
Criminal indictment for Massey mine official – Hughie Elbert Stover, the chief of security for Massey Energy’s Upper Big Branch Mine has been charged with two felonies related to the April 2010 explosion that killed 29 coal miners. He is accused of lying to investigators and destroying records. On his blog, reporter Ken Ward asks if this is just the beginning of indictments.
Don’t mess with Texas – If you ever use the words “workers compensation” and “Texas” in the same sentence, you better think twice. TX law blogger John Gibson has been issued a “cease and desist” order and threatened with further legal action for his TX Workers Comp Law Blog for having the temerity to use the words “workers compensation” and “Texas” in his blog. We can’t get Gibson’s take because his blog appears to be down (www.texasworkerscomplaw.com), but Julius Young posts the scoop on the Texas workers comp language imbroglio at his Oakland Workers Comp Blog. If you don’t see his post – or ours – please blame Texas. Just to be on the safe side, from here on out we may begin referring to Texas as “Exas-Tay.”
Sedgwick acquires SRS – In a major move in the world of third party administrators, Sedgwick completed the purchased of Specialty Risk Services for $278 million. SRS was the claims TPA arm of The Hartford. In his bog on the Hartford Courant, Matthew Sturdevant reports that: “The deal makes Sedgwick CMS the largest independent North American provider of claims administration services. The combined companies will have annualized revenue of about $1 billion as well as almost 8,500 employees.”
Devil’s in the details – Yvonne Guilbert of Complex Care Blog posts two concrete incidents that show how one small detail missed in home care could easily end up costing $50,000 or more.
Safe hiring practices – As the economy ramps up, new hires will increase an employer’s potential for workplace injuries. At MEMIC Safety Blog, Greg LaRochelle says that a new employee is 5x more likely to have a lost-time injury than a more experienced worker, and that 40% of all workers injured on the job have been on the job for less than a year. He posts about hiring practices to help mitigate risk.
Hiring Vets – HR Daily Advisor offers a good roundup of tips and advice for hiring returning veterans. The post includes questions to ask and to avoid during the interview.
Short Takes
AIG results and workers comp
Four steps to evaluate absence policies
Insurance Fraud Hall of Shame 2010
Smiling makes the world go round
7 wellness benefits employees want most

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Posted in News roundups | Comments Off on Health Wonk Review, CTE, bill review, messing with Texas, and more

A Bullet to the Heart

Tuesday, March 1st, 2011

Dave Duerson was a star safety in the NFL. He used his head in the way that aggressive defensive backs often do – as a battering ram to bring an opponent down, maybe even jar the ball loose. He was articulate, generous and in his post-football life, successful. So it saddened many of his friends and colleagues to learn that he had committed suicide last month. But even in this last, desperate act there was a method to the madness: he shot himself in the chest, so that his brain would be left intact. He was convinced that the downward spiral of his life over the past few years was due to football-related brain damage – chronic traumatic encephalopathy. He texted his ex-wife just before he shot himself, requesting that his brain be given to the NFL brain bank. Just in case she did not get the message, he left a written note with the same instructions.
We have blogged the issue of concussions in the NFL and their potential for long-term brain damage. As this prior blog pointed out, a changing of the NFL’s medical guard indicates that the league finally appears willing to confront the issue head on (so to speak). They no longer systematically deny a connection between concussions on the field and severe cognitive problems after football careers come to an end.
Over the past few years, Duerson was in a downward spiral. He lost his business to bankruptcy. He (uncharacteristically) assaulted his wife, who soon felt compelled to end their marriage. While his friends did not see major changes in his behavior, he talked openly of his fears of dementia. He suffered short-term memory loss, blurred vision and pain on the left side of his brain. He looked into the future and despaired at what he saw coming. At the time of his death, Duerson was only 50.
Suicide as Political Act
Duerson’s last gesture was an explicitly political act. He was convinced that his life problems – and the rapidly diminishing quality of that life – were directly connected to his years as a football player. So he not only decided to end his life, he made sure that suicide would leave his brain intact for research. The NFL has been (belatedly) collecting the brains of deceased players willing to donate them, to try and determine the impact of repeated violent collisions on aging. At this point, there is not much doubt of the causal connection – not in every individual who played the game, but surely in a significant percentage who suffered from multiple concussions.
With this connection medically proven, the burden falls on the NFL to improve player safety. That will not be easy. This past season, a number of players – most notably the Steelers linebacker James Harrison– complained about the newly implemented fines for helmut to helmut hits, defined as:

“using any part of a players helmet (including the top/crown and forehead/hairline parts) or facemask to butt, spear, or ram an opponent violently or unnecessarily; although such violent or unnecessary use of the helmet is impermissible against any opponent, game officials will give special attention in administering this rule to protect those players who are in virtually defenseless postures…”

Duerson the player would have agreed with Harrison about the rule. Duerson the retiree would have supported it. Experience is an exacting and often cruel teacher. As Duerson’s sad demise demonstrates, what we choose to ignore in the prime of life may give birth to demons that haunt us as we age.

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Posted in Business, Medical Issues, Safety & Health | Comments Off on A Bullet to the Heart

Concussions: A Softening in the NFL’s School of Hard Knocks

Tuesday, December 1st, 2009

Hines Ward is the epitome of the NFL tough guy. As a wide receiver for the Pittsburgh Steelers, he is known for his flamboyant personality and his ability to give and take ferocious hits. He was the most valuable player in Superbowl XL. In his pursuit of athletic excellence, he is a gambler. No, he is not betting on games. He is betting with his own life.
In the course of his football career, Ward has suffered numerous concussions. But he continues playing. He has even lied about his symptoms, so that the doctors would allow him to keep playing.
In this regard, Ward is part of the mainstream culture of professional athletics. Play today, pay (perhaps) tomorrow.
Until recently, the NFL was complicit in allowing players like Ward to gamble away their futures in the interest of the next game. The league’s leading advisor on concussions, Dr. Ira Casson, routinely dismissed every outside study finding links to dementia and other cognitive decline, including three papers published by the University of North Carolina’s Center for the Study of Retired Athletes.
The NFL is in the midst of a major change of policy regarding concussions. Dr. Casson has resigned. The league is requiring teams to have an independent consulting neurologist examine players with concussions. They have finally acknowledged what has been obvious for years: repeated concussions, especially when occuring over a relatively short period of time, can have a devastating effect on the brains of athletes. Well, duh!
Roethlisberger Sits, Ward Frets
Hines Ward came face to face with the new, more cautious NFL this past weekend, when star quarterback Ben Roethlisberger sat out a crucial game against the Baltimore Ravens. He suffered a concussion the prior week, when his head collided with the knee of an opposing player. Even though he practiced with the team all week, Big Ben suffered from recurring headaches toward the end of the week. At the last minute, the coach kept him from the game and substituted a relatively inexperienced quarterback. The Steelers lost.
After the game, Ward said the Steelers players were split 50-50 on whether Roethlisberger should have played. Ward added that, “these games, you don’t get back.”
“I understand what the league is doing,” he said. “I don’t judge another man.”
He went on to say: “We needed him out there. We wanted him out there. This is the biggest game of the year. We lost and we kind of dug ourselves a hole. Me being a competitor, I just wish we would’ve had all our weapons out there. It’s frustrating.”
Paradigm Shift: Sudden or Gradual?
The NFL will never be for sissies. Nonetheless, the policy shift on concussions is long overdue and most welcome. However, it may not be easy to enforce. Players like Ward may soon learn to remain silent on critical symptoms (dizziness, headache). They may avoid talking to the team doctors so they can stay in the game. These old school tough guys might even call out teammates who choose a more cautious route. As the legendary coach Vince Lombardi supposedly said: “Winning isn’t everything. It’s the only thing.”
Well, not quite. There are many things in life that are a lot more important than winning. Just ask one of the many retired NFL players with Parkinson’s or dementia.
In the conventional workplace we tend to fret about people with minor injuries, who may resist returning to work even though it is safe to do so. In professional sports, it’s usually the opposite: athletes will do almost anything to get back into the game, even jeapordize their future health. Just as we could use a little more of a “get me back in the game” attitude from reticent employees, we need to recognize that concussions require time to heal. Toughness is fine in its place, but let’s not be stupid about it. A game is just a game, a job is just a job. Neither is worth a single life.

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Posted in health care | 3 Comments »