Un-Ringing the Bell: Lessons From ‘Eveland v. San Marcos Unified School District’

by Andrew M. Blecher, M.D. / guest columnist

$4.375 million is a statement.  But what exactly does it say?  School districts don’t usually hand out multi-million dollar settlements unless there is some level of culpability.

Because the case of catastrophically injured Mission Hills High School football player Scott Eveland never went to trial, the truth will never be determined by a jury.  But let’s suppose for a moment that the allegations are true (which might be a reasonable assumption given the settlement). If so, this makes the National Football League’s “bounty-gate” look like child’s play.

In the NFL, grown men are paid millions of dollars to risk life and limb for the game we all enjoy.  It’s true that they might not all be fully aware of the long-term sequelae which may result from injury, particularly head trauma.  Yes, the football culture needs to change at every level, from athlete to fan to coach.  And yes, coaches like the Saints’ Gregg Williams do portray deplorable behavior that needs to stop.  But regardless of whose responsibility it is, or was, to provide injury awareness and enlightenment, in the end, it is adults making adult decisions about their lives.

But what if something terrifyingly similar is happening in our high school football programs?  What if grown men are getting paid to portray deplorable behavior to our children?  What if minors are being intimidated by adult coaches to risk life and limb for a game that not only doesn’t pay them millions of dollars, but puts them at risk of being permanently debilitated their entire lives?  The Eveland case touches on these questions.

Scotty Eveland was a student with a promising future.  He was also the backup middle linebacker on his high school football team.  When the starter was injured, Scotty was excited about his opportunity to start.

According to allegations, he developed headaches during the week of practice leading up to his chance to start in a game.  It may never be known whether these headaches were concussive symptoms or not, but he might have developed other worrisome concussion symptoms as well.  In fact, right before the game started, it is alleged that Scotty’s headaches were so relentless and  he had such blurry vision that he couldn’t see the football and didn’t feel well enough to play.  Despite his overwhelming desire to finally start in a game, his symptoms were so severe that he asked not to play.

According to accounts, he reported this to his head athletic trainer, who assessed him and agreed that he should be held out of play.  But when the head coach was notified, he allegedly yelled at the athletic trainer, “You are no fucking doctor!  He is my football player and if I want to put him in the game, I will damn well put him in the game!”

And put him in the game he did.  It is to be assumed that Scotty then proceeded to play against his own better judgment.  After all, how does a teenage boy challenge his head football coach who has sent him in to play as his only chance as a starting middle linebacker?  He wouldn’t have any reason to believe that his coach would intentionally put him in harm’s way in order to win the game, right?  Coaches have training in these things and act in the best interests of their players – right?

Scotty’s condition deteriorated; he was heard mumbling the defensive play-calling in the huddle right before he started complaining of leg numbness and collapsed on the field. There was no apparent hit, trauma or any other immediate explanation for his collapse. Yet he quickly became comatose and was carted off the field and rushed to the hospital, where he likely would have died if not for emergency craniotomy surgery.

Today Scotty requires around-the-clock care.  More than four years later, he still can’t walk or even transition himself out of a bed without help. He can’t talk. He can’t feed himself.  He has been robbed of all of his athletic, physical, and intellectual abilities.

The treating neurosurgeon stated under oath that Scotty most likely suffered from Second Impact Syndrome and had likely sustained a previous concussion before the fateful game when he collapsed: “Had he been provided appropriate medical attention based on the alleged pre-game symptoms he would have likely had a complete recovery.  Returning him to play after he complained of headaches and difficulty seeing was a catastrophic error of judgment.”

The larger question is whether the coach’s action was an isolated error of judgment or part of an ongoing antiquated culture.  What if other athletes on the team were coerced to play injured?  What if injections were given and casts were cut off, just to get players back into the game?  What if others were pressured to play with concussions?

Too many high school coaches continue to overlook the seriousness of injuries in general and concussions specifically.  Out-of-touch coaching comments still abound, such as “Getting your bell rung is part of the game” or “Back in my day we played with headaches all the time.  I got knocked out so many times I can’t even remember, and look at me now, I’m fine.”

The game has changed and so too has our level of understanding of head injuries.  Any athlete (particularly one playing a contact sport) who reports headaches or any other concussion related symptoms must be thoroughly evaluated by someone who is adequately trained in concussions.  Neurologic exams and cognitive testing must be performed to adequately assess the athlete.

Even a normal head CT scan does not rule out a concussion.  A note from the local ER doc that says the athlete is clear to play the next day because his CT scan was normal is not appropriate.  Concussive symptoms cannot be ignored.  And if there is any concern that the symptoms are concussion related, the athlete MUST be held out of play until all symptoms have fully resolved and a progressive return to play protocol has been implemented. You must always err on the side of caution when dealing with head injuries.

You can’t belittle your players when they have a headache.  You can’t try and stop them from seeking medical treatment. And you can’t yell at them to go get a second, third, or fourth opinion until they find someone who will clear them. Yet yet these things happen every day in high school football – I’ve witnessed them myself.

Where are we as a sporting society when parents feel the need to attend their kids’ football practices because they don’t trust the coaching staff?  We can improve the helmets and we can change some rules but we really won’t make any progress until we change the culture. “When in doubt, keep them out.”

Cases like Scotty Eveland are not new.  It is only now that they are finally getting legal and media attention, and only now that $4 million statements are being made.   It’s too late for Scotty, but we owe it to him to make sure we prevent the next athlete from sustaining an injury we can’t un-ring.

Dr Andrew Blecher (Twitter: @the_jockdoc) was an expert witness in the Eveland case. Blecher, a Board Certified Sports Medicine physician at the Southern California Orthopedic Institute, provides concussion management for both amateur and professional athletes, including youth sports, high school, and college, and he has also served as a treating physician in the NFL as well as the Los Angeles X-Games.  He is a Certified ImPACT Consultant and has lectured extensively on concussions from hospital grand rounds to national conferences.  By providing continuing education to other physicians, athletic trainers, coaches, parents and athletes, he strives to improve concussion awareness and prevention.  Dr Blecher is also the Director of the SCORE Concussion program which, in partnership with the Wells Fargo Play it Safe Program, provides comprehensive concussion insurance coverage for 10 Los Angeles area high schools.