Bill draws concern for potentially allowing parents to put child back into sports after a concussion

A bipartisan House bill is raising concerns from health care providers for potentially giving parents and guardians the authority - on their own - to allow their child to return to play following a concussion.

The overarching goal of House Bill 116 is to require the State Board of Education and local boards to put more focus on addressing and documenting serious sports injuries for middle and high school students.

The main focus is on concussions, sudden cardiac arrest and heat-related illnesses.

However, a controversial section includes parents and guardians among those who can give a student written permission to return to practice or games after being evaluated following a concussion.

Other individuals listed are: a physician and neuropsychologist licensed and trained in concussion management; an athletic trainer; physician assistant; and nurse practitioner. Those medical professions are included in the Gfeller-Waller Concussion Awareness Act.

The bill has three House committees to clear: health, education K-12, and judiciary IV.

That section of the bill gained the attention of local and statewide health care officials and agencies, as well as ESPN and USA Today.

A co-sponsor is Rep. Donny Lambeth, R-Forsyth, and one of the legislature's leading health care experts. Lambeth served as president of N.C. Baptist Hospital for three years and as chairman of the Winston-Salem/Forsyth County school board for 18 years.

Lambeth said the intent of the bill is not to allow parents to take sole responsibility for authorizing the return to play for their child.

"But parents are ultimately the ones who make the decision, as they are responsible for the child," Lambeth said.

After getting feedback from the medical community since the bill was introduced Feb. 15, Lambeth said he and the other bill sponsors "are looking to clear up any confusion."

"The intent is for the medical experts to work closely with parents, and not necessarily to push student athletes back into a game or practice until they are cleared and the parents are in agreement," Lambeth said. "Some have suggested students may have been pushed, or even the student wants to get back into a game before they are cleared."

Rep. Greg Murphy, R-Pitt, told USA Today on Tuesday that the segment would be removed from HB116.

"It's not necessary because I don't believe parents are medical professionals and they are not qualified to make such decisions,' said Murphy, who is a urologist.

Wake Forest Baptist Medical Center said in a statement that "we want to wait on further clarification from the bill's authors" before making comment.

Wake Forest University has been on the forefront when it comes to evaluating sports-related concussions in recent years, including participating in a football helmet evaluation initiative with Reagan High School.

Dr. Shane Hudnall, with Cone Health Sports Medicine at Medcenter High Point, recommends no legislative changes to the Gfeller-Waller act. Hudnall is team physician for High Point Andrews High School.

The N.C. Medical Society, N.C. High School Athletic Association and N.C. Academy of Family Physicians could not be reached for immediate comment on whether they have asked the bill sponsors to consider revising the parental permission part of the concussion protocol.

The NCHSAA already requires athletes who have experienced a concussion to go through a medical protocol before returning to competition.

Hudnall believes parents and guardians are not qualified for determining on their own when their child can return to play following a serious concussion.

Hudnall said one recent youth sports concussion study by the Journal of Canadian Chiropractic Association showed parents can identify a concussion just more than 80 percent of the time.

"It is critical the person evaluating an athlete is both independent and medically trained in concussions," Hudnall said.

"Parents obviously want what's best for their children, but there are several times a year - despite providing parents with extensive education on concussions, their consequences and risks of returning to play too early - a parent may return their child to sports sooner than is appropriate.

"There are also significant pressures from coaches and the athlete himself or herself placed on parents if this role is adopted to return an athlete to play before their brain has fully recovered," Hudnall said.

Greg Griggs, executive vice president of the N.C. Academy of Family Physicians, said that "with all that we are now learning about concussions and heat related injuries, we believe that a return to play decision should be left up to health-care professionals, not a parent."

"We have expressed that concern to the sponsors of the bill and are hopeful that the language allowing a parent to sign off on their own child's ability to return to play will be changed."

Lambeth said the bill's goals are threefold. It would require:

The state board and local boards to raise awareness and recognition of sudden cardiac arrest and heat-related illnesses;

That includes all head coaches and the athletic director completing and maintaining CPR certification;

The state board to establish a public database on serious sports injuries; and

Enhancing existing concussion safety protocols and emergency action plans.

The NCHSAA already offers heat and humidity guidelines and cardiac arrest training courses. The bill would create a heat-illness protocol for returning to competition.

"We are asking the state board to look at the areas where we have had some serious events and develop the guidelines and track the number of situations across the state where student athletes might be at a higher risk," Lambeth said.

A new guideline would require all students, coaches, school nurses, athletic directors, first responders and volunteers involved in school sports to sign that they reviewed an annual concussion and head injury information sheet before they could participate. Parents would be required to review and sign as well for their child to play.

Schools would be required to keep records of all head injuries experienced from a sports activity and making a monthly report of any injuries to the Department of Public Instruction.

Students would be required to complete a pre-participation form that would include disclosing any history of cardiac illnesses. Schools would be encouraged to hold informational meetings before each sports season on the three health subjects.

Local boards would be required to develop a venue-specific emergency plan to respond to a catastrophic sports injury, including having necessary communications and medical equipment on hand.

"We worked with the different associations and lobbyists and persons from the public to build support," Lambeth said. "I do believe it is a common-sense safety issue we are working to highlight the need."

Hudnall said HB116 "contains a lot of good regarding heat stroke, heat exhaustion, sudden cardiac arrest and education of parents, which is sorely needed in these areas and concussions."