It’s encouraging that reporting on the injury suffered by the Damien quarterback last week has turned to the broader policy level of what is being done to deal with the problem of head injuries in high school sports.
A story earlier this week by Dan Nakaso in the Star-Advertiser flagged the policy issue.
Nakaso noted:
While Damien is in the private school Interscholastic League of Honolulu, state Department of Education officials have implemented a concussion management program for all 43 public high schools and are preparing for an Oct. 6 coaches clinic on concussions.
Unfortunately, the story doesn’t come back to the question of whether or not the private schools making up the ILH have implemented policies regarding concussions similar to those being put into effect by the DOE.
And following up on the quality of the DOE’s actual implementation would be interesting. It might be reassuring, although it would appear some questions remain.
A quick check turned up two bills considered during the 2011 legislative session calling for action regarding concussions.
House Bill 1215 (along with Senate companion bill SB 1373) would have required the Department of Education “to implement a concussion evaluation tool for each high school student athlete participating in the sport of football statewide.” Neither bill got a hearing, despite having numerous sponsors in each chamber.
HB 622, introduced by West Hawaii Rep. Cindy Evans, would have required a broader training for coaches, parents, and student athletes about the dangers of concussions.
Requires the department of education to adopt rules to educate coaches, youth athletes, and their parents or guardians of the nature and risk of concussions and head injuries. Requires that coaches receive annual training to recognize symptoms of concussions and that youth athletes suspected of sustaining a concussion be kept from practice or competition until conditions are met.
The bill was given a triple referral to the House committees on Health, Education, and Finance, and was heard by the health committee on February 4.
The bill was opposed by the Department of Education as unnecessary. Superintendent Kathryn Matayoshi testified:
The Department has instituted a concussion management program which addresses or will address all
items in this bill within a year. Concurrently,the Department is working with the University of Hawaii in conducting a concussion study with funding from the Department of Health’s Neurotrauma Division. The scope of the study is more comprehensive than what HB622 is requiring. It provides for baseline assessments, including symptom assessments, cognitive status assessments, and balance assessments. It provides for education of parents, athletes, coaches, athletic trainers and administrators regarding the nature and risk of concussions and head injuries. Most importantly it provides for standard of care for each concussed student athlete. The Department will annually review its concussion management program and study to ensure the effectiveness of the program and the safety of its student athletes.
The Hawaii Athletic Trainers’ Association also opposed the measure on similar grounds, saying the DOE’s program would exceed the standards established by the bill.
The bill was deferred by the committee.
However, testimony by the same Athletic Trainers’ Association and other organizations in support of SB 155, a separate measure that would have required state regulation of trainers, raised several additional issues. The bill was also supported by the Hawaii Chapter of the American Physical Therapy Association, the Occupational Therapy Association of Hawaii, Hawaii High School Athletic Association ad hoc Sports Medicine Advisory Committee, and the University of Hawaii’s Athletic Program (see testimony before the House Committees on Commerce and Consumer Protection, and Judiciary and Labor).
According to the testimony, Hawaii is one of only three states that does not license and regulate athletic trainers.
The DOE’s concussion management policy relies substantially on athletic trainers, so concerns about unqualified or ill-trained athletic trainers could impact actual implementation of the policy.
According to the Hawaii Athletic Trainers’ Association:
Some schools have hired unqualified personnel to serve as athletic trainers. For example, an individual lied about being certified when he was not, and another individual began working in Hawaii when he was under federal investigation in another state….
Several years ago one of our members called the DCCA and RICO to report a complaint that a person who was serving as an athletic trainer was unqualified. The person was not certified and had not finished college. DCCA referred her to RICO who told her there was nothing they could do since Athletic Trainers are not regulated.
In addition, according to the association:
The Hawaii High School Athletic Association has 98 member schools and about 36% (36/98) do not currently employ certified athletic trainers. There are schools in every league that do not employ certified athletic trainers. In the ILH, 13 of 26 schools, 50 % do not have athletic trainers and only 5 ILH schools employ full time athletic trainers. In the OIA 8 out of 31 schools do not hire athletic trainers.
The Board of Certification, a private organization that offers a certification program for athletic trainers, testified that it relies on state regulators to take action when it takes disciplinary action against a trainer, including suspension or revocation of certification. However, since Hawaii does not regulate the profession, BOC has no way to follow-up on its disciplinary actions.
Hawaii, California and Alaska are all at risk for becoming the states where disciplined or incompetent “ATs” can go to practice without reporting to anyone their previous professional and/or criminal record. Hawaii can prevent this from occurring by regulating ATs.
Despite strong support from health and athletic organizations, the bill ultimately failed to go to a final vote after negotiations broke down in conference committee.
However, with the Damien case again raising the visibility of concussions, it’s an issue that will likely emerge again as a legislative issue.