NFL, NFLPA release findings into review of Tua’s concussion check and alter protocol

In a joint statement released on Saturday, the NFL and NFL Players Association said that the team physician and unaffiliated neurotrauma consultant involved in Dolphins quarterback Tua Tagovailoa’s concussion check on Sept. 25 followed the league’s step-by-step protocols but “the outcome in this case was not what was intended when the Protocol was drafted.”

The two sides also announced an alteration of the concussion protocol, adding a new term, “ataxia,” to the list of no-go symptoms that bar a player suspected of a concussion from reentering the game. This change takes effect starting with the remainder of the Week 5 games.

If a player is diagnosed with ataxia — abnormality of balance/stability, motor coordination or dysfunctional speech caused by a neurological issue — he is prohibited from returning to the game. Ataxia replaces the gross motor instability no-go symptom; a player could return to a game if the team physician and consultant concluded that the instability was not the result of a neurological issue.

In a virtual news conference after the release of the statement, Dr. Allen Sills, the NFL’s Chief Medical Officer, said that the new ataxia no-go symptom would have kept Tagovailoa out of the remainder of the game against the Buffalo Bills on Sept. 25, and Tagovailoa would have been diagnosed with a concussion. Sills said that the gross motor instability term allowed the physician and consultant to use their judgment — for example, factoring in the player’s injury history — to determine whether the instability was caused by a neurological issue. Under the new ataxia term, any instability is deemed to be because of a brain injury.

Sills referenced blood and saliva tests that could better diagnose concussions but said that, for now, the league would err on the side of caution.

“We may mislabel some situations ... but I think we and the players association have agreed that we’re willing to be conservative in that situation,” Sills said.

The review found that Tagovailoa sustained and reported back and ankle injuries earlier during the Bills game. Tagovailoa told the medical staff that he aggravated his back injury after he was shoved by linebacker Matt Milano and hit his head on the ground, according to the review, the play in which he was suspected of sustaining a concussion. Tagovailoa grabbed at his helmet and stumbled after getting up, adding more suspicion that he may have sustained a head injury.

Tagovailoa was examined for a head injury and cleared to return in the second half of the game, a 21-19 Dolphins win.

Tagovailoa didn’t report or exhibit any signs or symptoms of a concussion during his examination in the locker room, during the remainder of the game or throughout the following week, the review found. When asked whether, under the new protocols, Tagovailoa would have been able to play four days later against the Cincinnati Bengals, Sills said there are no finite timetables for return after a concussion diagnosis but it would have been “extremely unlikely.” He said the median time off for a player after a concussion is nine days, and Tagovailoa would have had to clear the league’s five-step process to return to the field.

The team physician and consultant did not examine Tagovailoa’s back during his concussion examination, according to the review, instead relying on the earlier examination by other members of the medical staff. Back pain can be a symptom of a concussion.

The league and NFLPA’s announcement brings to an end a nearly two-week review into Tagovailoa’s concussion check, one that came under increased scrutiny after Tagovailoa sustained a concussion and was carted off the field on a stretcher in Cincinnati on Oct. 29, four days after hitting his head against the Bills. The NFLPA initiated the investigation shortly after the Bills game.

Hours before the league and players union’s statement, NFL commissioner Roger Goodell, speaking at a fan forum in London, said the league was prepared “to make a change or two” to its concussion protocol. Goodell also said that there were “no indications” that the league’s protocols weren’t followed in the case of Tagovailoa.

On multiple occasions, Dolphins coach Mike McDaniel defended the decision to play Tagovailoa, saying he was cleared by multiple medical professionals, including the unaffiliated neurotrauma consultant.

The consultant involved in Tagovailoa’s concussion check during the Bills game was fired by the NFLPA, a source told the Miami Herald, after the union found the person made multiple mistakes in the evaluation. According to NFL Network, the union exercised its right to fire the consultant and cited several reasons, including “failure to understand his role and hostility during the investigation.”

Sills and Jeff Miller, the NFL’s executive vice president of communications, said the league disagreed with the union’s decision to fire the consultant.

“The notion that [a consultant] could be fired at a time when the protocol was followed, it strikes us as something the league wouldn’t do,” Sills said.

Tagovailoa has been ruled out for the Dolphins’ Week 5 road game against the New York Jets on Sunday. McDaniel gave no timetable on a return for Tagovailoa, who did not travel with the team but was in the practice facility this week. Teddy Bridgewater will start for Tagovailoa.