State law on youth concussions goes into effect

Local student-athletes, trainers and state lawmakers say extending the recovery period from seven to 10 days offers young athletes more protection from the lingering effects of concussions

Jake Newby
Former Detroit Lions quarterback Eric Hipple undergoes an MRI on his brain on April 19, 2013, in Detroit. A new state law that goes into effect Thursday in New Mexico bars young student-athletes with concussions from participating in sports for 10 days. Over the last several years, the NFL has changed its concussion policies, and many athletic programs have implemented similar policies.
  • A new state law that goes into effect Thursday extends the recovery period for youth athletes diagnosed with concussions.
  • The number of concussions among San Juan County student-athletes is on par with the state average of 2.5 per 10,000 athlete exposures, one trainer says.
  • The new law requires the state Department of Health to establish concussion guidelines for non-academic youth leagues.
  • Despite stricter concussions laws, medical professionals say young athletes often downplay their injuries, which can lead to more problems down the road.

FARMINGTON — Young athletes who suffer concussions will have more time to recover from their injuries under a new state law that goes into effect on Thursday.

The law requires youth athletes who are diagnosed with concussions to sit out practices and games for 10 days, up from the previous requirement of seven days. Local student-athletes and trainers, as well as state lawmakers, say the measure will offer young players more protection, especially during the formative years of brain development.

The bill, sponsored by Senate Majority Leader Michael Sanchez, sailed through the Senate 35-4 during the legislative session earlier this year and was approved 63-0 by the House. The Senate Education Committee cleared it 7-0 before Gov. Susana Martinez signed it into law.

Sanchez, D-Belen, said the new law will ensure the safety of young athletes.

"I think our school districts are going to be more careful, in terms of allowing student-athletes to participate if they’ve had a concussion," Sanchez said. "Parents should be very confident that their kids are going to be seen by those who can diagnose the symptoms and make sure their child is protected through the protocols and procedures that are in place."

Sen. Bill Sharer, R-Farmington, was one of the few lawmakers to vote against the bill, saying it was unnecessary.

"I vaguely remember it, but part of what bothers me is, 'Damn, how many more laws do we need?'" Sharer said. "If you got a problem, don’t play. Let the coach or a doctor figure it out. Why do we have to have a state legislature have to do it?"

Dr. Eric Ketcham, a medical director at San Juan Regional Medical Center, talks about concussions on May 26 at the hospital in Farmington. Ketcham is president of the American College of Emergency Physicians' New Mexico chapter, which supported a new state law that extends the recovery period for young athletes who suffer concussions.

Calling attention to the problem

Over the last several years, treating concussions has been at the forefront of a national discussion about safety in sports.

Since 2010, the NFL has changed multiple rules in an effort to prevent brain injuries, and, in 2013, it agreed to a $765 million settlement after thousands of former players accused league officials of hiding information about the dangers of concussions and hurrying injured players back to the field.

Lawmakers throughout the country have also taken up the issue. The National Conference of State Legislatures reported that between 2009 and 2015, all 50 states and the District of Columbia passed laws to address traumatic brain injuries. The majority of those states enacted legislation targeting youth-related concussions.

While the national spotlight on concussions has brought awareness to the issue, brain injuries among young people are still not handled consistently, said Dr. Eric Ketcham, a medical director at the San Juan Regional Medical Center.

Among people ages 15 to 24, sports are second only to car crashes as the leading cause of traumatic brain injuries, according to the Journal of Athletic Training.

"While my colleagues and I think that many coaches, parents and athletic trainers have been very good about following the current state of research and knowledge about concussions, we know that practice is not uniform," Ketcham said.

Getting trainers into the schools

The number of concussions among San Juan County athletes over the last year was in line with the state average, which is 2.5 per 10,000 athlete exposures, according to Piedra Vista High School athletic trainer Aaron Stem. One hour of practice or game-playing time constitutes an athlete exposure, and students who play multiple sports register multiple athlete exposures.

Stem, along with Farmington High School's Melynda Brenton, are the longest-tenured athletic trainers in the area, each working for their respective schools for 11 years. Aztec has had access to full-time athletic trainers for the better part of 11 years, according to Stem. Dr. Deborah Waters with Indian Health Services serves athletes at Shiprock and Kirtland Central high schools, as well as Navajo Preparatory School in Farmington, on a part-time basis.

While Bloomfield High now employs an athletic trainer, it did not two years ago, when soccer player Bryanna Parrish suffered a severe concussion.

In a game against Socorro High on Aug. 23, 2014, the then-sophomore was struck in the head by a ball on a point-blank kick from an opposing player who was 7 feet away.

Parrish said she immediately fell down in a heap. But, she said, when her coach asked how she felt, she replied that she was fine. Minutes later, she was back in the game. And that's when Parrish said she realized she was far from fine.

"It was crazy, I didn’t remember anything the rest of the game or the rest of the trip," Parrish said. "I went to the (emergency room) in Socorro, and they said I had a severe concussion. When I followed up with my personal doctor, he told me, 'This is really severe, and if you happen to suffer another concussion, you’ll have to stop playing sports.'"

Bloomfield's Bryanna Parrish clears the ball against Kirtland Central on Oct. 9 at Bobcat Stadium in Bloomfield.

Parrish said she did not participate in any athletic activities for a month after the concussion. She was cleared to return in September— which she did — but said she now regrets the decision to play for the rest of the year.

"It took a good year to get over this concussion," Parrish said. "I suffered from depression, anxiety, and I started slacking in school."

Aside from the concussion, the ball hit Parrish with such velocity that it spun her around and she landed on the ground awkwardly, which tore her shoulder's labrum and required surgery.

Her mother, Paula Parrish, estimated her daughter's medical expenses after the concussion exceeded $50,000. In addition to the physical damage, the mother said her daughter struggled emotionally with side effects from the concussion.

"People would say, 'You look fine, there’s nothing wrong with you,' because they could not see it," she said. "She would come home just in tears. She felt like she needed to live up to those expectations even though she was struggling."

Parrish, now 17, played soccer her junior season without suffering another concussion. And she said she has no plans to forego her senior season, though she still gets headaches at times. Parrish said the presence of an athletic trainer at Bloomfield, who was hired last year, is comforting.

"She makes sure that we’re OK. She’ll make sure the student-athletes can run a mile just fine before going back into a game," she said of the school's trainer, Shandiin Copeland. "If they have headaches after being hit, then she’ll keep them out."

Stem, the PV athletic director, said having a trainer on staff is one of the most important things a school can do to protect its young athletes.

"I may be biased, but I think one of the biggest things we can do is get more trainers," he said.

Educating coaches

A critical part of preventing and properly treating concussions stems from educating coaches.

The new law — much like the previous concussion state law passed in 2010 — requires coaches of student-athletes in seventh to 12th grades to undergo annual training on the identification and treatment of concussions. The New Mexico Activities Association, which oversees high school athletics in the state, establishes that training.

Non-academic youth leagues are not under the jurisdiction of the NMAA, so the new law also requires the New Mexico Department of Health to set similar guidelines for those leagues. Those guidelines have not yet been released.

Proponents of the new law say one of its goals is to help coaches better detect and handle concussions.

Recent Piedra Vista High School graduate Marshall Schreffler said he didn’t think his coaching staff fully understood the magnitude of the concussion he suffered in 2013 during football practice.

"I was pretty disoriented when I got hit. It took me a while to get back up," said Schreffler, a former offensive guard and defensive tackle. "Coaches were yelling at me to get back in the drill. I ended up finishing the whole practice."

After practice, the 18-year-old said he underwent a concussion test and "failed pretty bad." He said he missed the school's next five games before he was cleared to return.

Jared Howell, the head coach of Piedra Vista's football program, did not respond to requests for comment.

Dr. Eric Ketcham, a medical director at San Juan Regional Medical Center, talks about concussions on May 26 at the hospital in Farmington. Ketcham is president of the American College of Emergency Physicians' New Mexico chapter, which supported a new state law that extends the recovery period for young athletes who suffer concussions.

The concussions Scheffler and Parrish suffered were severe enough that their recovery times exceeded the 10-day minimum required by the new state law. The bill mandates that athletes sit out at least 240 hours after suffering a concussion, meaning a player injured at 8 p.m. one day, for example, could not return to the field until 10 days later at 8 p.m.

Sanchez said some health care professionals he consulted while drafting the bill believe the minimum recovery period should be 14 days.

"With the studies that are coming out, I would have been satisfied with the 14 days," he said. "These are young people, and they’re not fully developed yet, and it seems to me we should be more cautious with them. Sometimes, young people don’t take their injuries as seriously as they should."

Ketcham, the medical director at Farmington's hospital, is also president of the American College of Emergency Physicians' New Mexico chapter, which consulted lawmakers on the bill and supported its passage.

Ketcham said he is satisfied with the 10-day recovery period.

"We actually felt that 10 was an appropriate compromise, particularly for a first injury, because what you’re looking for is a bill that establishes a minimum standard," he said. "If there’s evidence of a more severe concussion, there are current guidelines that already propose a two-week restriction."

Law's effect on youth sports

While New Mexico's law will most noticeably affect high school sports, it also applies to middle school teams and non-academic youth leagues.

That means it will impact the Four Corners Young American Football League, which includes children ages 7 to 13.

The league previously allowed children diagnosed with a concussion to begin light drills after seven days without any symptoms, said Four Corners YAFL President Nathan McCown. After a week, the players could ramp up their activity every two days before being allowed to play in games after 13 days, if they were cleared by a medical professional.

To comply with the new law, McCown said the league will extend its protocol by another three days. Effective this coming season, Four Corners YAFL competitors diagnosed with a concussion will have to make it through 10 symptom-free days before they are allowed back to practice and light drills. They won't be eligible to play in games until 16 days later, with medical clearance.

McCown said the league’s practices are designed to avoid concussions, and the coaches "don’t coach unless they go through the certification process."

"We limit contact almost completely during practice,” he said. "So we think that helps with limiting concussions. Contact is reserved for game days."

YAFL coaches must be certified through the USA Football Heads Up Program on concussion awareness. McCown said he's confident USA Football's concussion certification process will "meet or exceed" the standards the state health department sets.

Out of the 1,500 kids that compete in Four Corners YAFL — which also runs cheerleading and track and field programs — only two football players suffered concussions in 2015, McCown said. Both were cleared to return to the league, but only one chose to continue playing.

Keeping players safe

Even with stricter concussion laws, some student-athletes have such a strong desire to return to their sport that they may be inclined to downplay their injury.

And that's a concern for medical professionals.

Ketcham said it’s not always easy to convince young athletes to sit out until they are healthy. But, he said, that's critical to avoid potentially life-altering consequences.

"One of the challenges I’ve dealt with in the emergency department in the past has been players trying to downplay an injury, saying, 'No, no, I’m fine, I don’t know why they pulled me out,'" Ketcham said. "I get that they want to play, it’s what they enjoy doing. And for some of them, they see it as their ticket to a college education. But we care about it, and we want them to avoid getting another concussion during that period and therefore particularly becoming susceptible to what we call sudden impact syndrome."

Dr. Eric Ketcham, a medical director at San Juan Regional Medical Center, talks about concussions on May 26 at the hospital in Farmington. Ketcham is president of the American College of Emergency Physicians' New Mexico chapter, which supported a new state law that extends the recovery period for young athletes who suffer concussions.

Ketcham said athletes who resume playing before they fully recover from a concussion are more likely to suffer a second concussion, which could lead to long-term cognitive injuries or deficits, as well as behavioral issues.

Stem said more access to information about concussions has helped student-athletes better understand the ramifications of playing while concussed. Because of that, he said, they are now generally more inclined to heed the advice of medical professionals.

He added that athletic trainers play an important role in keeping students from playing while injured.

"I can’t even count how many times I’ve pulled a player aside who said he or she was OK, just because I see them not acting right and because I know them," Stem said. "I’m not naive enough to think that every injury that’s happened has been reported since I’ve been here, but it’s pretty difficult for these kids to fool me. I think that’s a benefit us school trainers have."

Looking back on their experiences, Parrish and Schreffler both said they support the new law's extended recovery period.

"I actually wrote a paper for a (dual-credit) college class on concussions and learned a little more in depth about them," Schreffler said. "I think the 10 days is a good minimum just to keep players safe and make double sure they don’t get concussed again."

Parrish added that while she’s pleased with the new law, she hopes youth concussions will be handled on a case-by-case basis.

"It’s good giving students more time," she said. "I mean, it’s your brain, and you need to take care of it. I do think that’s a good thing, and it just depends on the concussion and how hard you’ve been hit. Even the littlest concussions can cause big problems."

Jake Newby covers sports for The Daily Times. He can be reached at 505-564-4577.