Investigation finds no violation in handling of Tua Tagovailoa; NFL and NFLPA agree to new concussion protocols

On Saturday, the NFL announced that an investigation requested by the NFLPA into how the concussion protocols were applied and followed regarding Miami Dolphins quarterback Tua Tagovailoa had concluded. According to the investigation, there were no violations of the NFL’s concussion protocols and that the guidelines were followed as written. However, the report and investigation found that the protocols in place at the time of Tagovailoa’s injury against the Buffalo Bills were “insufficient,” and the NFL and the NFLPA agreed to a new series of concussion protocols, to be implemented immediately.

Findings of the NFLPA-requested investigation

Shortly after Tagovailoa’s injury against the Bills back in Week 3, the NFLPA requested, as is their right under the current Collective Bargaining Agreement, an investigation into how Tagovailoa’s injury was handled. During the first half of that game, Tagovailoa was pressured on a throw and fell to the turf, striking his back and head on the playing surface. The quarterback then got to his feet and after taking a few steps, staggered and fell.

The team initially reported that Tagovailoa was being evaluated for a head injury, but returned to the game for the second half. After the game, Tagovailoa reported that he sustained back and ankle injuries, and not a head injury.

The NFLPA requested an investigation into the situation under the CBA, and as that investigation was pending, Tagovailoa was cleared to play just four days later on Thursday against the Cincinnati Bengals. In that contest the quarterback was spun to the turf on a sack, once more hitting his head on the playing surface. He was visibly shaken after the hit, and was removed from the game and taken to a nearby hospital for evaluation of a head injury.

The investigation, which included interviews with medical personnel, team staff and Tagovailoa, found that there were no violations of the concussion protocols that were present at the time of Tagovailoa’s injury.

However, that was not their only finding: “Following the complete review, the parties concluded that while the step-by-step process outlined in the Concussion Protocol was followed, the outcome in this case was not what was intended when the Protocol was drafted.” (Emphasis in original).

The investigation found that “[t]he Club medical team and the [Unaffiliated Neurotrauma Consultant (UNC)] properly viewed the video of the play in question as required by the protocol and engaged in a locker room examination of Mr. Tagovailoa before the player was cleared to return to play.” In addition, the Dolphins team physician “cleared Mr. Tagovailoa, following consultation with the UNC. The steps set forth in the Concussion Checklist were, therefore, conducted.”

The investigation also found that the quarterback “ … did not report or exhibit any signs or symptoms of concussion during his locker room exam, during the remainder of the game, or throughout the following week.”

However, the investigation found that while the protocols were followed, the outcome was not what was intended, or envisioned, when the protocols were drafted:

NFL and NFLPA agree to new concussion protocols

In the conclusion and findings section of the report, it states that “ … the NFL and the NFLPA agree that the outcome in this case is not what was intended when the Protocols were drafted.” (Emphasis in original)

Then the investigation outlines the modifications of the protocols:

… based on the advice of the parties’ respective medical experts, the Protocol will be modified to enhance the safety of the players. Specifically, the term “ataxia” has been added to the mandatory “no-go” symptoms. “Ataxia” is defined as abnormality of balance/stability, motor coordinator or dysfunctional speech caused by a neurological issue. In other words, if a player is diagnosed with “ataxia” by any club or neutral physician involved in the application of the Concussion Protocol, he will be prohibited from returning to the game, and will receiver the follow-up care required by the Protocol.

The report concludes with the following statement: “ … the parties remain committed to continuing to evaluate our Protocol to ensure it reflects the intended conservative approach to evaluating player-patients for potential head injuries.”

Following the release of the report Dr. Allen Sills, the NFL’s Chief Medical Officer, addressed the investigation and the revised protocols on a session with the media. During that session, Dr. Sills stated that the doctors involved acted with “absolute integrity,” and that the video alone does not provide the best diagnosis:”

Dr. Sills added that under the revised protocols, Tagovailoa would have been ruled out of the Bills game back in Week 3:

Dr. Sills also outlined that a player diagnosed with ataxia under the new protocols would be required to be cleared by an independent neurologist, and that it would be “extremely unlikely” a player in that situation would be cleared within four days, the timeline in Tagovailoa’s case for playing the following Thursday:

However, Dr. Sills did concede that while Tagovailoa was “evaluated” every day after the Buffalo game before paying against Cincinnati, he was not placed in the mandatory five-step process to be cleared prior to the Bengals game. Had that happened, Tagovailoa would likely have been ruled out:

The decision by the NFLPA to remove the UNC involved with Tagovailoa was addressed during the Saturday media session, and both Dr. Sills and NFL executive Jeff Miller responded to that line of questioning:

Near the end of the session, Dr. Sills addressed how the new protocols may lead to players who have not suffered a concussion being ruled out, but his response reflects the “conservative” approach the league wants to take with head injuries: