CBSSports.com Senior College Football Columnist Dennis Dodd spent the offseason investigating the issue of concussions in college football -- the background on the issue, the competing interests at play in the current debate, and the way forward for the sport. The details of Dodd's reporting will be revealed in a multi-part series throughout the week, with previous installments of the series indexed HERE.
CHICAGO -- Adrian Arrington is going to make a compelling witness.
Twenty-seven, articulate, loving father of three, the former Eastern Illinois defensive back and team captain battles seizures and the effects of multiple concussions. He's on welfare because his condition keeps him from driving or holding a job. Who knows when that next seizure is coming? When it does, Arrington doesn't remember afterward and typically sleeps for two days, exhausted.
Whether the defendants in Arrington's lawsuit, the NCAA, are guilty or not of what he says is neglect on the concussion issue, legal experts have to know what kind of figure he is going to strike on the witness stand -- if his case ever gets in front of a jury. [It was reported Monday that the NCAA is considering a settlement in the Arrington case.]
His girlfriend, Noel, has remained by Arrington's side, mother to two of his children. (The other child Arrington is raising is Noel's from a previous relationship.) Her partner can't even go down to the local Gold's Gym to work out. The seizures were so violent they caused a torn rotator cuff Arrington can't afford to treat.
Not on $430 a month in welfare.
"This is not the type of man you want to be," Arrington said, "especially being a young black male. I don't want this woman to take care of my kids. What am I going to give her when I propose, a paper clip for a wedding ring?"
Arrington and three other former athletes are suing the NCAA, saying it was negligent in establishing a clear concussion policy. The suit and addendums continually cite the NCAA's legacy. The association itself was created more than a century ago in a response to player safety -- notably violence in football.
"The lives of students must not be sacrificed to a sport."
Those words from Syracuse chancellor James Roscoe Day in 1909 are included in the lawsuit.
But no matter where you come down on the issue of concussions, football or the legal system, we all know sympathetic figures can woo juries. This plaintiff is a doting father in the prime of his life struck down, unable to provide for his family.
"We think Adrian's a very compelling witness," said Joe Siprut, Arrington's Northwestern-educated attorney, speaking from his 16th-floor office in downtown Chicago. "Not just because of everything he's been through, but because he comes across so readily and sincerely."
Arrington and three fellow plaintiffs are seeking class-action status for their two-year old suit which could allow hundreds, perhaps thousands of afflicted former college players to join in. For now, Arrington and his story are probably years away from a jury trial. Given its history, the NCAA will use every legal tool at its disposal to fight a suit it already claims is lacking.
All of it trying to rein in a game that everyone agrees has become bigger, faster and stronger. The Zurich consensus statement on concussion in sport in 2008 defined a concussion as: “ … a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.”
What it can't define is the quality of life for Arrington 20 years from now, when he is 47.
"That's something I pray about," he said.
Here we are, then, at a crossroads in what has become, behind-the-scenes at least, the No. 1 issue in college sports: Head trauma, brain injuries, concussions and how to treat them. At the moment, the issue is how to keep them from overwhelming the game. One-hundred forty-four years after Rutgers and Princeton butted unprotected heads, the game has experienced a circle of life. It was dangerous then, it is dangerous now. Then, the sport was just emerging. Now it must be reborn.
Concussion issue at forefront
The game is under attack not only from the result of those concussions but from the legal community which -- even if Arrington vs. NCAA fails -- is ready to pounce.
"Once a plaintiff sees that model," said attorney Bill Conaty, a former Virginia Tech player and nine-year NFL veteran, "they will literally cut and paste."
The concern goes way beyond rules critics whining about football becoming 'two-hand touch,' it's whether the game as we know it will survive.
"It would be a real misfortune to lose the game of football."
Teddy Roosevelt wrote those words 120 years ago. As president, Roosevelt stepped in to reform the game and protect its players.
The issues of player safety that almost killed football at the beginning of the last century, have arisen again in this, the second decade of the 21st century.
"This is a Teddy Roosevelt-type of moment maybe for a number of reasons," according to one prominent administrator from a BCS conference.
The former NFL players' ongoing concussion lawsuit against the league includes 4,200 plaintiffs and is miles down the legal road. The current players have their own union looking out for them. Who is representing college players? Multiple sources have told CBSSports.com that the subject is now at the top of NCAA president Mark Emmert's agenda. Bigger than Johnny Manziel and autographs, bigger than the Miami scandal, bigger than Division 4 or griping about a stipend.
Take control of the concussion issue, the stakeholders say. Make our players safe.
On that and other issues, according to one source, the NCAA "has completely lost support from people."
"I think the game has to change," Siprut said, "or it will die."
It's not an easy fix. Over the next few days, CBSSports.com will chronicle the issues regarding head trauma not only as it relates to college football but the medical and legal communities as well as the players themselves. Three months of reporting have concluded the concussion issue has become -- at the very least -- liability volleyball.
Everyone wants player safety but key figures can't even agree on basic issues of how to treat and prevent head trauma. Forces are sometimes in direct conflict about how to proceed. And no one wants to get stuck with a bill, be it attorneys' fees, insurance premiums, monster judgments or … deaths.
It's almost as if the game gotten too big, strong and fast. Concussion diagnosis is -- according to NCAA chief medical officer Brian Hainline -- "where we were with strokes 10 or 20 years ago."
"We're in the primitive stage of [diagnosis] management," he added.
"I'd say primitive is a fair enough word," Hainline said.
That bill is coming due because of, well, history. The afflicted, downtrodden, don't give up on the first try. Even if Arrington fails, the fact that his lawsuit has reached this point will no doubt prompt others to come forward.
"There is a major lack of clarity on the issues," said Steve Pachman, one of the nation's most accomplished defense attorneys in head trauma and catastrophic injury litigation. "There is great opportunity for plaintiffs' lawyers to sue universities, to sue ADs or coaches whenever a bad outcome can, in some way, be tied to a concussion. Law firms are specifically targeting concussion cases all across the country."
John Grisham has built a career writing about the subject -- mass torts. Are concussions the next Big Tobacco?
Should NCAA be held responsible?
A concept called “duty of care” looms over it all. Students learn the term in their first week of law school. We all have a moral obligation to stop and help a person hit by a car. But who is responsible for what follows -- treatment, care, overall liability?
The NCAA is responsible, according to Arrington's suit.
"Juries are so sympathetic in catastrophic sports injury cases because they get so entrenched in the facts. People relate to sports,” said Pachman, speaking in May to an audience of college coaches and administrators during the Fiesta Bowl concussion summit in Phoenix.
“If the case goes to trial, you can expect the plaintiff to be present, often in a wheelchair in the courtroom. Family, members, parents, friends are going to testify as the tears literally run down their faces. Some of these plaintiffs are seriously disfigured.”
Duty of care seems to be the central conflict in how the NCAA and schools are dealing with the issue right now. The Pac-12 and Ivy League have established limits on how often teams can conduct full contact practices during the season (twice a week). But the SEC has been adamant about putting the responsibility of concussion care on the NCAA.
“At the NCAA level, the question is: Who ultimately has the liability?” Hainline said. “The member institutions are responsible … It's the NCAA's obligation [to have] the most comprehensive and up-to-date guidelines. It would be essentially impossible for us to go manage the 1,200 schools.”
It took the NCAA 35 years from the first documented case of death from sickle cell trait to even recommend schools test for the condition. And that was only as a condition of settling a lawsuit. A series of embarrassing emails in an Arrington filing seems to indicate the NCAA got serious about concussions -- from a liability standpoint -- about the time he filed his suit in 2011.
“What this means,” former CBSSports.com NFL columnist Mike Freeman wrote recently, “is that many college players likely enter the NFL with an already large number of concussions.”
In its sports medicine handbook, the NCAA requires a) an emergency action plan on file; b) no same-day return to play for players with concussion symptoms and c) players must a sign document stating they are responsible for reporting their symptoms. But those damaging emails in the Arrington filing show that failure to follow a concussion management plan is only a secondary NCAA violation -- akin to a coach accidentally phoning a recruit during a dead period.
In a deposition, the NCAA's director of safety and health said he was not aware of a school that had been penalized for violating that policy.
Could the NCAA do more? It may not want to.
“From a safety perspective you would have to think the answer is, ‘Of course,' Pachman said. “Maybe not from the NCAA's perspective, because of potential liability that could result from taking stronger positions.”
Catch, meet 22.
We've known about head trauma in general since at least the 1920s when concussed fighters were referred to as 'punchdrunk.' As early as 1997, Dr. Vernon Williams -- chief medical officer of the Sports Concussion Institute called concussions “an unrecognized epidemic.”
It's widely held that it's easier to get a second concussion after suffering the first, but some fairly significant figures disagree. There isn't total agreement on Second Impact Syndrome.
Dr. Robert Cantu, is a leading Second Impact Syndrome proponent. He's also available as an expert witness for the right price. The clinical professor at Boston University is the co-director of the Center for the Study of Traumatic Encephalopathy and medical director of the National Center for Catastrophic Sports Injury Research, and has at the same time worked as a senior adviser to the NFL.
As a paid expert in the Arrington suit, he also produced a 213-page document advocating class-action status. According to the Washington Times, he charged $800 an hour for the report and was paid a total of $38,800.
Is that furthering the concussion cause, or profiteering?
For now, progress is defined as a growing number of protocols and position statements on the subject. Last year's Zurich consensus statement was the first iteration of concussion papers since 2001. The American Medical Society for Sports Medicine's concussion statement is considered key. The American Academy of Neurology's guidelines were released this year. The National Athletic Trainers Association issued a statement this month on helmet contact.
Will new rules make a culture change?
One of the hottest topics of the offseason was the new rule that calls for an automatic ejection if a player is flagged for targeting the head. What isn't debatable is new kickoff rules, making for fewer kick returns, that have resulted in a 50 percent reduction in concussions. Proponents hope that such rules changes -- as they did during the Roosevelt era -- change the culture of football violence.
Pop Warner youth leagues limit full contact hitting. In the NFL, players hit full-on only once a week during the season. The Ivy League was first in college limiting full contact practices. But as Ivy executive director Robin Harris cautioned, “Traditionally, the NCAA competitive safeguards committee wants data to recommend safety. We don't have that data for them [yet]. I can't tell them our two practices a week is the right number.”
As mentioned, the SEC believes the NCAA should take lead on the concussion issue.
“I happen to agree with Mike Slive,” Harris said of the SEC commissioner. “It should be the NCAA leading.”
If the NCAA, its schools, coaches and administrators are in the legal crosshairs, it should be mentioned that Hainline's hiring has been widely praised. The neurologist was hired away from the Unites States Tennis Association in January with 25 years of experience. Today, he says the concussion issue takes up about half of his time jetting across the country to speak to schools, their administrators and other experts.
“Ten years ago you couldn't get anyone to write about concussions,” Hainline said. “They were way in the background.”
Prevention and treatment seem to vary from school to school. North Carolina, Dartmouth, Brown, Oklahoma and Illinois are among schools on the cutting edge using helmet sensor technology developed by Virginia Tech. Boise State brought in a local rugby team recently to teach players the proper way to tackle.
Think of those schools banding together to put out a position statement touting their proactive approach to player safety. It wouldn't exactly hurt recruiting.
According to the Arrington class-action filing, fewer than 50 percent of schools require a player to see a physician after a concussion. One half of schools surveyed said they would return a concussed player to play the same day.
Joint research by Virginia Tech and Wake Forest has produced positive results. Tech's Dr. Stefan Duma began rating the safety of helmets a few years ago. However …
“There is no clear-cut evidence that one helmet is better than another helmet in terms of concussions,” the Sports Concussion Institute's Williams said.
“That's how a football, hockey, bicycle helmet works,” Hainline said. “They do absolutely nothing to decrease the incidence of concussions.”
It says so right there on helmets in various forms.
And if college football players are at risk, what are we to make of women's soccer with the second-highest rate of concussions? Are certain folks simply genetically predisposed to head injuries? And if the players don't cooperate, concussion treatment ends on the sideline.
“There were a couple of times where I knew I'd been dinged,” former Colorado quarterback Joel Klatt said, “I'd do my best to avoid contact with the trainer on the sidelines.”
Was he the only one?
Conclusion: It's absolutely against the rules to play without a helmet, but rules regarding concussion management are a bit murky once one is strapped on.
If he ever does get on the stand, Arrington knows there will be tough questions from NCAA lawyers.
How do you know conclusively these seizures were caused by football?
Is there any history in your family?
What other head injuries outside of football have you had?
How much alcohol do you consume? Drugs?
Arrington nodded, acknowledging he knows what is ahead. He can't wait to tell his story in open court. A game, the NCAA and the medical field, might hang on the answer to this most basic query: Knowing what you know now, Adrian, would you do it over? Would you risk your health, throw your body around, play that great gladiator game the only way you knew how --- full speed?
Sitting up straight on a couch in his lawyer's office, Arrington said resolutely, “I'd play football again.”
Concussions and college football
Part I: Ex-player's case takes aim at NCAA
Q&A: NCAA's chief doctor answers questions
Part II: Ex-QB Klatt puts onus on NCAA
Part III: Stiles' death may unravel mystery
Part IV: Will college football change? Yes
Quotable: Notable thoughts on concussions