Planet Rugby

Does rugby need independent doctors?

20th May 2014 11:03


george smith concussion concussed australia wallbies 2013 british irish lions

Medics: Team, independent, or both?

In the wake of the Florian Fritz head injury scandal, we ask whether independent doctors should be brought into domestic rugby.

The Fritz incident represents the latest in a string of concerning cases in the professional game where apparently concussed players have undergone the IRB's Pitchside Suspected Concussion Assessment (PSCA) and returned to play in clear contravention of the head injury protocols.

While the visceral nature of the Toulouse centre's injury and physical state added to the public outcry, it was the footage of head coach Guy Novès appearing to incite the player and medical staff to return him to the game that sparked the greatest shock and so generated the most heated debate.

It is common for us to hear of professional and amateur coaches pressuring their doctors under similar circumstances, but last Friday's Top 14 playoff marked the first time such duress had been captured on camera so vividly.

Since the drama unfolded, the discussion has centred on the introduction of Independent Match Day Doctors - discretely employed with no vested interest in the outcome of the game - to rule on or oversee concussion evaluation pitchside, with French player's association Provale demanding they be brought in to the Top 14 and Pro D2.

The IRB have introduced these physicians at Test level, but say they have no jurisdiction over domestic, union-run competitions.

Rugby's governing body, who announced on Monday an enhancement of the PSCA protocol, also states their stats show it is team physicians, who "know their patients", that remove players more often than their independent counterparts.

An assortment of head injury experts are not so sure, adding their voices to the many condemning the flouting of the concussion protocols in the case of Fritz, and highlighting the "impossible position" faced by team medics.

Last week, leading Melbourne-based neuroscientist Dr Alan Pearce said he felt team medics were placed in a "pressure cooker" environment when assessing players.

Now, Birmingham University researchers Dr Michael Grey, a reader in Motor Neuroscience, and Mr Tony Belli, a neurosurgeon, argue introducing independent doctors across professional rugby would cut down on the number of dangerous decisions and benefit player welfare.

"I would like to highlight that there is a good argument that team physicians are probably in a better position to make the return to play decision based on their history with players," said Grey.

"That said, they are placed in an impossible position by team management.

"In my opinion there needs to be oversight by an independent physician, but the independent physician should not replace the team physician.

"The recent case again demonstrates that some in professional rugby are not following the international guidelines to which they have signed up. Clearly, the governing bodies are not doing a good enough job to police themselves."

Belli added: "I cannot see how Fritz was possibly allowed to return to the match after a clear concussion. There should have been no assessment to make there: the concussion was obvious to everybody and he should have been removed from the game completely.

"Unfortunately the highlights the misuse of the current assessment tools: these should only be used if there is suspicion of concussion; instead, they are being used, even when the concussion is obvious, to determine whether somebody is fit to play on.

"This is not what the guidance says at all.

"Removing players for 'assessment' is not the issue here - and it's no surprise that team doctors assess their own players more often than independent doctors.

"The question is removing players from the game. I think that this should be done by an independent doctor with powers to overrule the team doctor, if the team doctor makes the wrong decision."

By Jamie Lyall

Forthcoming Fixtures
All times are local
Aviva Premiership
Friday , September 19
Gloucester vs ExeterGloucester vs Exeter Preview
Saturday , September 20
Sale vs London WelshSale vs London Welsh Preview
London Irish vs SaracensLondon Irish vs Saracens Preview
Harlequins vs WaspsHarlequins vs Wasps Preview
Bath vs LeicesterBath vs Leicester Preview
Sunday , September 21
Newcastle vs NorthamptonNewcastle vs Northampton Preview
More Aviva Premiership fixtures
Guinness PRO12
Friday , September 19
Munster vs ZebreMunster vs Zebre Preview
Cardiff Blues vs UlsterCardiff Blues vs Ulster Preview
Connacht vs LeinsterConnacht vs Leinster Preview
Saturday , September 20
Newport Gwent D'gons vs GlasgowNewport Gwent D
Scarlets vs Benetton TrevisoScarlets vs Benetton Treviso Preview
Sunday , September 21
Ospreys vs EdinburghOspreys vs Edinburgh Preview
More Guinness PRO12 fixtures
Top 14
Friday , September 19
Brive vs ToulonBrive vs Toulon Preview
Saturday , September 20
Racing Metro Paris vs Toulouse14:45
La Rochelle vs Bordeaux-Begles18:30
Grenoble vs Bayonne18:30
Castres vs Oyonnax18:30
Clermont Auvergne vs LyonClermont Auvergne vs Lyon Preview
Montpellier vs Stade Francais20:45
More Top 14 fixtures
Currie Cup
Friday , September 19
Lions vs PumasLions vs Pumas Preview
Saturday , September 20
Western Province vs Griquas15:00
Blue Bulls vs SharksBlue Bulls vs Sharks Preview
Eastern Province Kings vs Cheetahs19:10
More Currie Cup fixtures
Saturday , September 20
Hawkes Bay vs Bay Of Plenty14:35
Auckland vs North HarbourAuckland vs North Harbour Preview
More ITM Cup fixtures
Recent Results
All times are local
Friday , September 19
Counties Manukau 20 - 28 CanterburyCounties Manukau vs Canterbury Report
Thursday , September 18
Northland 20 - 31 TaranakiNorthland vs Taranaki Report
Wednesday, September 17
Southland 14 - 38 TasmanSouthland vs Tasman Report
More ITM Cup results
Aviva Premiership
Sunday , September 14
Wasps 20 - 16 NorthamptonWasps vs Northampton Report
Newcastle 18 - 20 London IrishNewcastle vs London Irish Report
More Aviva Premiership results
Guinness PRO12
Cardiff Blues 12 - 33 GlasgowCardiff Blues vs Glasgow Report
More Guinness PRO12 results
Top 14
Bordeaux-Begles 27 - 21 MontpellierBordeaux-Begles vs Montpellier Report
More Top 14 results
Waikato 26 - 21 Counties ManukauWaikato vs Counties Manukau Report
Hawkes Bay 41 - 0 Otago
More ITM Cup results
Aviva Premiership
Saturday , September 13
Gloucester 34 - 27 Sale SharksGloucester vs Sale Sharks Report
Bath 53 - 26 London WelshBath vs London Welsh Report
Exeter 20 - 24 LeicesterExeter vs Leicester Report
More Aviva Premiership results
Rugby Championship
New Zealand 14 - 10 South AfricaNew Zealand vs South Africa Report
Australia 32 - 25 ArgentinaAustralia vs Argentina Report
More Rugby Championship results
Guinness PRO12
Leinster 42 - 12 ScarletsLeinster vs Scarlets Report
More Guinness PRO12 results
Top 14
Toulouse 9 - 13 Clermont AuvergneToulouse vs Clermont Auvergne Report
Bayonne 23 - 6 Brive
Oyonnax 40 - 27 Grenoble
Toulon 24 - 28 Stade FrancaisToulon vs Stade Francais Report
Racing Metro Paris 28 - 11 LyonRacing Metro Paris vs Lyon Report
More Top 14 results
Currie Cup
Griquas 31 - 27 PumasGriquas vs Pumas Report
Lions 35 - 33 Western ProvinceLions vs Western Province Report
Cheetahs 30 - 30 SharksCheetahs vs Sharks Report
More Currie Cup results
Bay Of Plenty 12 - 27 AucklandBay Of Plenty vs Auckland Report
Southland 36 - 34 Northland
More ITM Cup results
Aviva Premiership Table
3Leicester Tigers29