Lobbying for change
Even before starting Concussion Connection, I had become a pro-active and concerned Oklahoman on the subject of concussions in youth sports. The more I learned about the effects of my multiple concussions, many of which were sustained growing up in Oklahoma, the more concerned I became that the state's youth sports concussion safety law (SB 1700) - enacted in 2010 and modeled on the pioneering law passed by the State of Washington in May 2009, and named for Zachary Lystedt, a high school football player who suffered a catastsrophic brain injury sustained when suffered a second concussion after returning to play before his brain had fully healed from a previous concussion - needed to be strengthened.
In early 2013, I started to conduct in-depth research on concussion legislation to find out what other states were doing, what their laws said, and whether they were effective. The more I dug, the more convinced I became that Oklahoma's law, despite its recent passage, was already outdated and, because it did not penalize those who violated its provisions, lacked the "teeth" needed to be truly effective.
As a result of a conversation on Twitter, I connected with Dan Newman, head athletic trainer at Union High School in Tulsa, Oklahoma, and, at the time, President of the Oklahoma Athletic Trainer's Association. Dan, in turn, put me in touch with Jeff McKibbin at the University of Central Oklahoma, who Dan said was the person I needed to speak with if I wanted to update the concussion legislation. And so began my life as a legislative lobbyist.
From April 2013 to November 2013, Jeff and I met nearly every Thursday. I also spoke extensively with Sherry Stock, who, as Executive Director of the Brain Injury Alliance of Oregon, helped pass an updated version of that state's concussion law - originally called Max’s Law but now called Jenna’s Law, in honor of Jenna Sneva, a skier whose life, like mine, was changed forever as a result of multiple concussions. Sherry provided me with a lot of helpful information on how to get legislation passed. We discussed legislation, how we could bring the Oklahoma law up to date, and how we could do more to protect student-athletes in Oklahoma.
With the help, support, and tremendous input from athletic trainers around the state, especially Dan Newman, Michael Catterson (Tulsa, OK and current President of the Oklahoma Athletic Trainer’s Association), Ron Walker (Tulsa, OK), CJ Fedor (Oklahoma City, OK) and Leander Walker (Yukon, OK), we came to a consensus that Oklahoma SB 1700 needed to be updated in the following ways:
- Mandatory concussion training of coaches and officials. In a 2010 poll, 81% of sports parents favored making training of coaches about concussion risks mandatory, but less than half (48%) of states with a Lystedt concussion safety law currently require formal concussion training of coaches, either online or in a classroom, with another 20% of the states offering some form of optional education or having no recommendations in their laws (this is the group Oklahoma is in), and the remaining 32% requiring coaches to receive some form of education, consisting of an information sheet or other unspecified means of conveying the information. (Tomei KL, et al. 2012). We needed to make such training required of all coaches and game officials;
- A more precise definition of "suspected concussion." The language of Section 1B of SB 1700 speaks vaguely about the removal from play of an "athlete suspected of suffering a concussion." We wanted the law to require the immediate removal and no same day return to play of any athlete who "exhibits signs, symptoms and behaviors consistent with a concussion." The proposed change was prompted by an incident during a high school football game in Oklahoma City in which an athlete who was clearly concussed was allowed to returned to play. The proposed change was intended to compliment the new provision requiring mandatory training of coaches and officials to recognize that any athlete who exhibited signs, symptoms, or behaviors consistent with a concussion needed to be suspected of having suffered a concussion and removed from play.
- Identifying the adults responsible for making removal from play/return to play decisions student-athlete who is potentially concussed and holding them accountable. As written, SB 1700 simply says an athlete suspected of having sustained a concussion must be removed from play but it does not identify who is responsible for making that decision. We felt that it was critical that the law clearly state that coaches, sideline medical personnel (e.g. athletic trainer) and game officials are responsible for making removal from play decisions. SB 1790 thus provides that, if any of the three removed the athlete from play or practice, that same person cannot return the athlete to play.
- Implementing a Return to Learn protocol for school districts and student-athletes. To my knowledge, Maryland is the only state whose concussion law specifically requires that “appropriate academic accommodations must be implemented” for a concussed athlete when returning to the classroom. Given the growing consensus that youth athletes who suffer a concussion need to complete a so-called "return to learn" protocol and be off all academic accommodations before begining the graduated return-to-play exercise protocol leading to a return to play, that their brains are more susceptible to concussion because they are continuing the develop, and that full cognitive activity after concussion delays recovery, we felt that the law needed to recognize that return to learn was just as important than return to play, and that, if anything, concussion recovery for student-athletes should focus first on the student, not the athlete, since it is what a student learns in the classroom that, for the vast majority of student-athletes, is going to determine their success as adults, not what they learn on the playing field.
- Broadening the law's coverage to include non-school youth sports programs. As SB 1700 only covers high school sports, only high school coaches are required to complete a one-day Care and Prevention certificate program - which covers all aspects of health and safety, including CPR and heat illness, not just concussion safety - in order to coach interscholastic sports, the cost of which they must pay out of their own pockets and is not reimbursed by the school district or school. My research identified seven states (Ohio, Nebraska, Nevada, Colorado, Minnesota, Louisiana and Tennessee) that also required coaches of independent, private youth sports programs to receive concussion education. We wanted the law to require training of coaches of youth and middle school teams.
- Penalties for violating the law. Like all Lystedt laws except for Pennsylvania's, SB 1700 does not provide for any penalties for those found to have violated its provisions, either by allowing an athlete exhibiting signs or reporting symptoms of concussion to continue playing or by returning to play an athlete without the necessary written clearance. We proposed to add language lifted from Pennsylvania's Lystedt law, which provides for progressive discipline, up to a lifetime ban, for coaches found to have violated the law by allowing athletes suspected of having suffered a concussion to continue playing. One of the major reasons for including the language in SB 1790 was the incident - caught on videotape - involving the high school football player in Oklahoma City referenced above in which, because SB 1700 lacks a penalty provision, no one was held accountable for their blatant violation of its provisions in allowing an obviously concussed athlete to return to the game. We put the provision in the bill expecting a lot of opposition, but, as it turned out, no legislator was willing to go on the record objecting to the provision, although the Tulsa World later reported an anonymous source who was quoted in the paper as expressing a "fear of losing too many coaches to the penalties,” which we thought made zero sense: if coaches followed the law, they wouldn't be penalized.