Timeline: Cam Newton flap the latest blow to NFL's scrutinized concussion protocol

The story is that Cam Newton was poked in the eye. After suffering a brutal hit from Saints' defensive tackle David Onyemata in the fourth quarter of Sunday's wild-card game in New Orleans, Newton slowly trotted off the field, then collapsed to his knees, gesturing to his face.

It sure looked like a concussion. But Newton was back out on the field on the Panthers' next drive. The Carolina offense was off the field for just under seven minutes in real time, during which Newton was seen ducking into the medical tent. He was quickly cleared to return to the game, and upon his return, he threw a 56-yard touchdown pass to Christian McCaffrey to get the Panthers to within reach of the Saints. Ultimately, the Panthers' comeback attempt fell just short. 

After the game, Newton said he suffered an eye -- not a head -- injury when the impact with Onyemata bent in the protective visor on his helmet and poked his eye. However, a heightened sense of the dangers of football have left many observers questioning this story in the wake of numerous instances of teams skirting the NFL's concussion protocol throughout the 2017 season, most notably with starting quarterbacks.

Newton being back in the news again over being allowed to stay in a tight game after it appeared he'd possibly been concussed brings the story of the NFL's scrutinized concussion protocol full circle. In the 2016 NFL opener, after the league had overhauled its on-field concussion procedures that offseason, Newton took numerous hits to the head against the Broncos, including several on the game's critical final drive, but never left the game. 

This, despite the league's new protocol implementing more stringent rules related to concussions -- namely that independent spotters could halt the game if they believed a player may have suffered a concussion. Also included in the league's mandated protocol: Players who show signs of a concussion must get independent evaluation from doctors independent of the team. Wooziness, glazed eyes, involuntary bodily functions all fell under this umbrella. So did stumbling.

Below is a timeline of the NFL's efforts to improve its rules relating to player safety and the high-profile incidents that have raised questions about how well the protocol works in real-time, with tight games on the line.

July 25, 2016: NFL adds a provision to punish teams

After the Rams left a visibly concussed Case Keenum in a 2015 game without punishment to Jeff Fisher or the Rams, the NFL instituted a rule that would punish teams that did not follow protocol. Teams violating protocol would be assessed a $150,000 fine for the first offense, and $100,000 for any following offenses.

Sept. 8, 2016: Newton battered against the Broncos

The game got a lot of buzz due to the sheer violence of the hits that Cam Newton took throughout it. The two most notable hits came courtesy of DeMarcus Ware and Von Miller and Shaq Barrett and Darian Stewart.

Midway through the third, Ware came screaming around the corner for a sack that propelled Newton directly into Miller. Miller's facemask collided with Newton's and Newton was visibly shaken, in addition to sustaining an ankle injury on the play. This affected Newton's mobility, and made it more difficult for him to avoid contact throughout the game.

However, the most brutal hit of the game was while Newton was being dragged down by Shaq Barrett. Darian Stewart flew in and smashed Newton's helmet while Newton tried to throw the ball away. Stewart was flagged for the play, but an intentional grounding (as unintentional as it may have been) offset the penalty. By the end of the game, Newton was on another planet.

The game not only raised issues about the safety of NFL players, it also showcased a mistreatment of more physical players like Newton that take abuse. Newton was hit to the head numerous times, and he stayed in the game without even getting flags for the hits -- or a spotter demanding the game be halted for Newton to be evaluated. 

Sept. 14, 2016: Roger Goodell says NFL can do better

Newton's injuries created so much buzz that it was impossible for the NFL to hide from them. In response, Goodell wrote a letter called "NFL Commitment to Player Health and Safety." In it, he acknowledged the violent nature of football, and said the NFL "can and will do better." He outlined the "Play Smart. Play Safe." initiative, in which the NFL hired a leading physician to act as the Chief Medical Officer of the league. The letter was controversial, as it felt a bit too "rah-rah" towards the NFL's approach for some people.

For starters, the letter called the NFL a "leader in health and safety in many ways." It announced an independent advisory board that would study the effects of concussions -- not dissimilar to the partnership with the National Institutes of Health that the NFL had had since 2012. The NFL also pledged $100 million -- in addition to the $30 million that was pledged to the NIH -- to research and study the effects of concussions on NFL players. Ties with the NIH were severed in August of 2017, ending a long and tumultuous partnership. More on that below.

July 25, 2017: Study reveals 110 of 111 former players' brains have CTE

The NFL hit another speed bump in the concussion conversation when a report from The New York Times showed that 110 of 111 brains of former NFL players that were studied showed signs of CTE -- including a place-kicker and a punter. Linemen, running backs and defensive backs got it the worst, and Dr. Anne McKee, the doctor behind the study, concluded that "it is no longer debatable whether or not there is a problem in football -- there is a problem."

The NFL issued a response to the report the next day, focusing on the questions around the report. The report was broad, targeting players aged between 23 and 89. It thanked McKee for her work, before concluding:

As noted by the authors, there are still many unanswered questions relating to the cause, incidence and prevalence of long-term effects of head trauma such as CTE. The NFL is committed to supporting scientific research into CTE and advancing progress in the prevention and treatment of head injuries.

In 2016, the NFL pledged $100 million in support for independent medical research and engineering advancements in neuroscience related topics. This is in addition to the $100 million that the NFL and its partners are already spending on medical and neuroscience research.

Aug. 31, 2017: NFL cuts ties with National Institutes of Health

The NFL and the aforementioned NIH struck an agreement in 2012 that would allow the NIH to research the effects of brain trauma on NFL players. From the start, it was a tricky relationship to manage. The NIH was doing something that inherently exposed the brutality of the NFL, while the NFL tried to uphold its image. The NFL pledged $30 million to the NIH for research upon the agreement, and shortly before cutting ties, Congress asked the NFL if it would honor the rest of its commitment.

The commitment was for about $18 million, according to an ESPN report. The NIH released a statement, saying that it wouldn't seek to renew the contract due to the NFL "[backing] out of a major study that had been awarded to a researcher who had been critical of the league." This conflict occurred in 2015, three years after the deal was initially made. In response, a letter from an NFL spokesman said that "We are currently engaged in constructive discussions with the [NHI] regarding potential new research projects and the remaining funds of our $30 million commitment," before reaffirming the NFL's commitment to the $100 million pledge made a year before.

The New York Times also reported that a Congressional study found that the NFL was trying to influence the NIH's findings -- which contributed to the bad blood between the two sides. The NFL denounced this report as well.

Nov. 9, 2017: Wilson ducks in and out of medical tent

In a Thursday night game against the Cardinals, linebacker Karlos Dansby's helmet plowed into Russell's chin on a nasty hit captured by NBC's cameras.

It was the kind of hit that should have initiated a concussion check by an independent doctor. But after Wilson ducked into the medical tent, he jumped right back out in a close game against the Cardinals. Before Austin Davis could even line up (while Mike Tirico went on a diatribe about the NFL's current policies), Wilson ducked under the tent before immediately popping back out and putting his helmet on. Wilson re-entered the game without further ado.  The Seahawks would eventually be fined $100,000 for the transgression and Wilson had to have his jaw re-aligned after the game

Nov. 12, 2017: Brissett re-enters the game with clear concussion

With the Colts up eight on the Steelers in the third quarter of a Week 10 game, Colts QB Jacoby Brissett dove forward in his own territory, taking a hit to the head as he did so. Brissett was slow to get up before trotting off the field. Brissett was "cleared" to re-enter the game on the sideline, but "developed [concussion] symptoms" after the game, according to the Colts.   

The proximity to the Wilson incident drew a lot more attention to this one. Concussion doctor Chris Nowinski called the NFL's concussion protocol a "fraud," as Brissett was cleared by both the Colts and independent doctors.

Dec. 10, 2017: Savage comes back in after hit left him twitching

In one of the scarier looking hits of the season, Texans' quarterback Tom Savage was drilled and left twitching on the ground against the 49ers. The Texans were not punished for the incident, although those reviewing the incident called it "unacceptable" that Savage was allowed back in the game.  

Savage was immediately removed after the hit, but he passed the evaluation, and it was said that the video of Savage twitching wasn't broadcast until much later. Savage came in on the very next series before coming out again. Texans' head coach Bill O'Brien came under fire for the video, with O'Brien saying that he never saw the video of Savage twitching.

Dec. 29, 2017: NFL revises concussion protocol

In reaction to the Savage incident, the league decided to change its protocol once again. This time, it made it so that players that show signs of concussions must immediately go to the locker room for evaluations and not return. It also said that a central offsite authority would watch games and could tell local medical staff to evaluate an incident. The change was thought to be in direct response to the Savage incident. O'Brien didn't see the issue with how the Savage hit was handled.

Seizures and fencing responses are now auto-pulls, in addition to players that stumble while trying to stand or get to the sideline. Injured players have also been granted the ability to take those showing signs of concussion to medical staff to get the proper evaluation. During playoff games, yet another unaffiliated neurotrauma consultant has been added to the sidelines in case the previous two independent consultants are attending to other players. Dr. Hunt Batjer, a prominent brain surgeon based in Dallas, said that although these steps are positive, more needs to be done. 

"When a player has a suspicious either helmet-to-helmet or helmet-to-playing-surface hit and he's down on the field and play is stopped because of that play then that person should be escorted to the locker room for a full exam," Batjer said. "So that should be added to this."

Jan. 7, 2018: Newton takes a hit, stumbles off field, returns 

The new concussion protocol got its first real test on Sunday, against the Saints. In a playoff game, Newton took a shot from David Onyemata after escaping Tyeler Davison. Once again, Nowinski was there to sound off.

The real issue was Newton stumbling as he trotted off the field. However, there is one issue with that stipulation: Injured players are taught to fall on the way off the field so as to stop play and give the backup time to get in the game and get a play in. It may be "gaming the system" a bit, but it isn't uncommon. Newton played well the rest of the game, but that obviously doesn't have any bearing on his medical status. The fact is, people think the NFL failed. Maybe his visor did poke his eye, but the protocol is clear. The NFL has contacted the Panthers on their handling of the incident, and the team insists that it was Newton's eye.

The bottom line is simple: The NFL has postured about concussion protocol for a long time, but when a star or key player gets hurt with the game on the line, its enforcement breaks down. It's been reinforced time and time again. If the NFL was serious about these things, Newton wouldn't have been able to return. The fact is, teams are looking at keeping players in as a business decision. Playing Newton injured would be worth the $100,000 fine every time, and that's because Newton gave the Panthers a chance to win. 

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