Ohio’s new law requiring that young athletes be pulled from practice or play if they appear to have suffered a concussion is likely to get a mini-makeover because of a dispute over who should be allowed to clear injured kids to return to competition.
Chiropractors want in on the action. Medical doctors want to keep them on the sidelines, saying that chiropractors lack the training and expertise to diagnose and treat brain injuries in young athletes.
Current Ohio law, which took effect 14 months ago, requires coaches and officials to pull kids from practice or play if it appears they suffered a concussion or brain injury. Medical doctors, or health care professionals working under the guidance of licensed physicians, must clear a kid before he or she is allowed to go back to competition or practice.
But tucked into an extensive education reform bill signed into law by Gov. John Kasich this month is a provision to re-examine the question of who is permitted to clear injured kids. The bill sets up a seven-person study committee – three medical doctors, three chiropractors and the state health director – to look at what training and education a health care professional should have to be able to assess and clear a concussed athlete.
Tim Maglione, senior director of government relations for the Ohio State Medical Association, said this ground was covered two years ago when Ohio adopted its current law.
“I suspect we’re back to square one with respect to this debate,” he said. “The issue of a traumatic brain injury or concussion is such a significant health issue that we believe a physician has to be involved in the assessment.”
The OSMA is asking lawmakers to un-do what they just did.
Nicholas Strata, public policy and government affairs director for the Ohio State Chiropractic Association, said legislators saw a need for more discussion over who has the necessary education and training to clear kids to return to play. Chiropractors tried unsuccessfully to be included in the youth concussion law in recent years. In the fall of 2012, the OSCA hired lobbyists with close ties to the Kasich administration and then this spring won the provision that may open the door for chiropractors to be authorized to clear kids who may have suffered brain injuries.
“As much as the OSCA agrees with the OSMA this legislation is not a turf issue, we disagree that all medical doctors and doctors of osteopath have the most up-to-date training and education needed to practice concussion management,” Strata said. “Under previous law any medical doctor, from a gynecologist to a dermatologist, could assess and clear a concussed athlete. Youth concussions are a serious injury and require the most qualified health care provider to assess them, regardless of type of initials or abbreviations follow a health care provider’s name.”
Strata noted that chiropractors under take 149 hours of study in neurology as part of their training and managing concussions is within their scope of practice.
The Ohio High School Athletic Association opposes changing the law.
Reaction from parents
Parents of student athletes interviewed this week weren’t keen on the idea of having chiropractors clear kids to return to play.
Eric Boykin, of Springboro, was a football standout at Dayton’s Meadowdale High School in the early 1990s and played college ball. He isn’t ready to let a chiropractor clear his son, Eric Boykin Jr., if he were to suffer a head injury while playing basketball for Alter High School.
“I don’t think that’s a good idea. I think that either the participating family physician or a neurologist who are trained with dealing with concussions would probably be a better option,” Boykin said. “Chiropractors are really not trained to deal with concussions and I just don’t think that’s a great idea because at the end of the day the student athlete’s health is the number one priority when it comes to sports.”
Boykin said he suffered concussions as an athlete, back when it was standard practice to send a kid right back into a game.
“I’ve seen it as a player and as a player you want to get back on the field immediately because you don’t want to let your team down. But as a parent, you’re cautious for your child and you want the best health care option available to them.”
Tanya Clark, of Harrison Twp., and her son Justin have used chiropractors to treat injuries but Tanya said she doesn’t think a chiropractor should decide whether to clear a concussed athlete.
“I think in terms of chiropractors being strictly for the back. I’m a little skeptical when it comes to the head. That’s where the brain is and we want to make sure everything is alright. That’s my preference. That’s where my comfort level is,” she said, noting that Justin suffered a concussion while playing basketball for Chaminade Julienne High School last year.
Roughly 350,000 kids play middle school and high school sports, according to the Ohio High School Athletic Association. It is unclear how many others play in younger grades and in recreation leagues.
The number of children visiting emergency rooms with sports and recreation related traumatic brain injuries grew to 5,167 in 2010, up from 2,970 in 2002, according to the most recent data available from the Ohio Hospital Association. Boys accounted for 77 percent of the patients.
No entity is collecting comprehensive data in Ohio to determine how many young athletes suffer brain injuries, how many are treated in doctor’s offices as well as emergency rooms or urgent care centers, how long they’re held out of play on average or other statistics.
The current law requires:
* Parents signing off that they received information on head injuries and concussions before their child is allowed to participate;
* Coaches and referees pulling players who show signs of suffering a head injury or concussion;
* Coaches banning those players from competition and practice until they are cleared by a doctor or health care official designed by the school.
It also requires training for coaches and referees in how to recognize the signs of a concussion or head injury and mandates that the Ohio Department of Health produce information materials for distribution to parents.
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