Canada: Concussions & Varsity Sports: What Colleges And Universities Should Know

Sports-related concussions have been in the news a lot recently. Hockey star Sidney Crosby¹ made headlines after he suffered his fourth career concussion in 2017. Closer to home, a high school football team in New Brunswick forfeited a game after nine players sustained head injuries.² Stories like these highlight the fact that concussions are an ever-present risk in sports.

As awareness grows regarding the dangers (both short and long-term) of concussions, athletes should no longer just "shake it off" and go back into the game after a head injury. Colleges and universities should ensure that their student athletes and coaches know the signs of a concussion and ensure that proper procedures are in place to prevent athletes from returning to play before it is safe to do.

WHAT IS A CONCUSSION?

A concussion is a traumatic brain injury which can result from a blow to the head or from the head or upper body being violently shaken so that the brain moves within the skull. Concussions can range from mild to severe. Symptoms of concussion may include:

• Headache
• Nausea and vomiting
• Ringing in the ears
• Dizziness
• Blurred vision
• Light sensitivity
• Slurred speech
• Convulsions
• Loss of consciousness
• Drowsiness
• Confusion
• Fatigue
• Problems with concentration
• Memory problems
• Behavioural and mood changes
• Sleep problems

Some people recover from concussions in days, while others suffer symptoms for weeks, months or longer. The brain needs time to heal after a concussion and rest is key.

SOMETIMES ATHLETES DON'T ADMIT THEY ARE INJURED

Quite often, athletes will not report that they are experiencing concussion-like symptoms because they do not want to miss out on competing. If an athlete remains in the game, he or she is at a higher risk of suffering another concussion because the brain is more vulnerable to damage when it is already injured. Repeated concussions can lead to long-term brain damage or in some cases, even death.

In 2013, a 17-year-old high school student died a few days after sustaining a head injury in a rugby game.³ Rowan Stringer hit her head and neck on the ground after being tackled. A few days prior to that game, Rowan hit her head in another rugby game but she ignored her concussive symptoms. A coroner's inquest found that Rowan died from Second Impact Syndrome⁴ which can be fatal after even a minor blow to the head, chest or back.⁵ In the aftermath of Rowan Stringer's tragic death, Ontario became the first and only province in Canada to enact concussion legislation aimed at preventing concussions in youth sports.⁶

CONCUSSION LAWSUITS

Sport-related concussions have led to several lawsuits. In the United States, the National Football League reached a settlement with thousands of former players and their families for $1 billion.⁷ In their class action lawsuit, the former players alleged that the NFL knew of the harmful effects of concussions but concealed those dangers from coaches, trainers, players, and the public.⁸ There are over 20,000 registered members of the class action and former players or their families will qualify for monetary awards based on varying degrees of brain or neurological problems.⁹ Some former players are suffering from dementia, ALS, Parkinson's Disease, and CTE (chronic traumatic encephalopathy) which is a degenerative brain disease that can occur after repeated head trauma.¹⁰

In this country, a former CFL player suffering from post-concussive problems, Arland Bruce III, has been trying to sue the Canadian Football League for negligence, negligent misrepresentation, and failure to warn about the dangers of concussions. The British Columbia Supreme Court dismissed Bruce's lawsuit on the basis that the dispute arose out of the collective agreement which means the issue is outside of the jurisdiction of the courts.¹¹ The B.C. Court of Appeal agreed with the lower court's ruling and now Bruce is seeking to appeal to the Supreme Court of Canada. There is no word yet on whether the Supreme Court of Canada will hear Bruce's case.

There is a plethora of litigation south of the border involving lawsuits against colleges for the mishandling of students' concussions. In Illinois, Casey Conine filed an action against her alma mater, the University of Illinois, alleging that the university failed to follow the protocol when she suffered a concussion playing soccer.¹² After colliding with another player, Conine collapsed. When she got up, she was grabbing her head and stumbling but she was never checked for a head injury and she continued to play. Two days later, Conine was diagnosed with a concussion. Two weeks later, the team trainer cleared Conine to play but Conine alleged there was no follow-up examination by a physician. In her next soccer game, Conine made at least one header with the ball and she was hit in the back. After the game, she felt nauseous and felt pain in her head and neck. Her symptoms worsened and she was no longer medically permitted to play soccer. She eventually withdrew from university because she was unable to concentrate.

In Canada, Kevin Kwasny recently reached a settlement with Bishop's University after he suffered a brain hemorrhage during a football game. One of Kwasny's lawyers was quoted as saying that if the matter had proceeded to court, it would have been "one of the largest personal injury lawsuits . . . involving a Canadian university."¹³ The lawsuit alleged that Kwasny's coaches forced him to continue playing despite showing signs of a concussion. After he sustained a hit to the head, Kwasny alleged that they failed to assess him for signs of a head injury even though he told his coaches that he felt dizzy and had blurred vision.¹⁴ After returning to play in the same game, Kwasny was hit again and suffered a brain hemorrhage which has left him permanently disabled. This is just a small sampling of the concussion litigation involving North American athletes. The theme emerging from the various lawsuits is that those in charge (coaches, trainers, universities, athletic associations, leagues) failed to take action to protect athletes. In some cases, the failure involved a failure to warn of the long-term risks of repeated concussions. In other cases, the failure stemmed from coaches and trainers not following concussion protocols and keeping athletes in the game after a head injury.

WHAT SHOULD COLLEGES AND UNIVERSITIES DO?

When a student athlete suffers a suspected concussion, coaches and trainers need to remove the injured player from the game immediately. Not only does this protect the athlete from further injury, it can help limit the educational institution's liability in the event that the athlete brings a lawsuit. The question may arise: under what circumstances should a concussion be suspected? The Canadian Guideline on Concussion in Sport¹⁵ suggests the following:

A concussion should be suspected in any athlete who sustains a significant impact to the head, face, neck, or body and reports ANY symptoms or demonstrates ANY visual signs of a concussion. A concussion should also be suspected if an athlete reports ANY concussion symptoms to one of their peers, parents, teachers, or coaches or if anyone witnesses an athlete exhibiting ANY of the visual signs of concussion.

This means that coaches, trainers, medical officials and others employed by an educational institution should take a hands-on approach when evaluating a student athlete. As mentioned above, some athletes may try to hide their injury and thus it is not enough to ask the athlete how he or she feels or to rely on self-reporting. If in doubt, remove the player from the game. It should also be pointed out that in the event a player is seriously injured, the player should be taken to the hospital. An athlete recovering from a concussion should not return to play or to practice until cleared by a medical professional. Any return to action should be gradual. If your institution does not yet have a concussion protocol, now would be a good time to implement one.

It is important to remember that student athletes are also students – this means they will need to rest physically from sports and also mentally from their course work after a concussion. Your institution should facilitate any necessary academic accommodations for your athletes while they recover.

You can help keep your student athletes safe by educating everyone involved in campus sports about concussions. Start at the beginning of the academic year and make sure students know the signs of a concussion as well as the dangers that can occur if they do not rest after suffering one. Make sure your athletics staff is aware of the potential liability your institution can face if staff members neglect their duties to keep athletes out of the game after a head injury. You may wish to hold educational campaigns and seminars with students and staff on these issues.

CONCLUSION

While it may not always be possible to prevent injuries, colleges and universities can help educate all those involved in campus athletics so that head injuries are taken seriously when they do occur. Furthermore, educational institutions should make sure that adequate policies, procedures and protocols are in place and are being strictly followed. Doing so will help to protect your student athletes and it can also help minimize your institution's exposure to liability.

For more information on what your educational institution can do, please contact Stewart McKelvey. We can assist with reviewing existing policies, procedures and protocols, and in drafting new ones. We can help you with planning in-house educational programs on liability issues for your athletics staff. We can also assist with legal representation in the event that your institution is sued following a student's injury.

Footnotes

1 "A look at Sidney Crosby's NHL concussion history", http://www.sportsnet.ca/hockey/nhl/look-sidney-crosbys-nhl-concussion-history/

2 "School board to examine concussion policies after 9 players suffer head injuries",http://www.cbc.ca/news/canada/new-brunswick/football-concussions-attendees-school-cancelled-1.4356835

3 "Teen rugby player dies after suffering head injury in game", http://www.cbc.ca/news/canada/ottawa/teen-rugby-player-dies-after-suffering-head-injury-in-game-1.1361147

4 "Rowan Stringer ignored concussion symptoms days before death", http://www.cbc.ca/news/canada/ottawa/rowan-stringer-ignored-concussion-symptoms-days-before-death-1.3077245

5 "Second Impact Syndrome", http://www.sportsmd.com/concussions-head-injuries/second-impact-syndrome/

6 Rowan's Law Advisory Committee Act, 2016, S.O. 2016, c. 11.

7 "Supreme Court leaves $1B NFL concussion settlement in place", http://www.chicagotribune.com/sports/football/ct-nfl-concussion-settlement-supreme-court-20161212-story.html

8 "Former Players Sue NFL For Hiding Concussion Dangers", https://www.athleticbusiness.com/former-players-sue-nfl-for-hiding-concussion-dangers.html

9 "Official NFL Concussion Settlement Program Website", https://www.nflconcussionsettlement.com/

10 "CTE found in 99% of studied brains from deceased NFL players", http://www.cnn.com/2017/07/25/health/cte-nfl-players-brains-study/index.html

11 Bruce v. Cohon, 2016 BCSC 419 , affirmed 2017 BCCA 186.

12 "Former Illini soccer player sues school over concussion treatment" http://www.chicagotribune.com/sports/college/ct-illinois-soccer-concussion-met-0614-20150612-story.html

13 "Bishop's University reaches settlement with brain-damaged football player", http://www.cbc.ca/news/canada/montreal/bishops-university-football-settlement-kevin-kwasny-1.4339677

14 "Football player sues Bishop's University over severe head injury suffered during game", https://www.theglobeandmail.com/sports/football/football-player-sues-bishops-university-over-severe-headinjury-suffered-during-game/article14218664/

15 Parachute. (2017). Canadian Guideline on Concussion in Sport. Toronto: Parachute, http://www.parachutecanada.org/injury-topics/item/canadian-guideline-on-concussion-in-sport

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