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Photo Credit: Brace Hemmelgarn-USA TODAY Sports

The Canucks—And The Rest Of The NHL—Are Dropping The Ball On Brain Injuries

A few days after their defeat in Game 7 of the Stanley Cup Finals, it emerged that Boston Bruins forward Jake DeBrusk had played through four rounds of the playoffs with a concussion—one he sustained in the first round back in April.

At the time of this writing, there are still many questions that need to be answered when it comes to DeBrusk’s injury—including whether or not he informed the Bruins’ medical staff of his concussion symptoms and just how much the team knew when it cleared him to play. In any case, the DeBrusk conundrum makes one thing perfectly clear—as if it weren’t already—the National Hockey League is dropping the ball when it comes to traumatic brain injuries.

Even if DeBrusk attempted to hide his brain injury from the medical staff—and there’s a high chance he did exactly that, a problematic reality we’ll get to later—the fact that he was able to play high-level hockey for two months while suffering from concussion-related symptoms without anyone else noticing is an indictment of the entire organization.

Of course, the medical staff of the Bruins don’t deserve too much of the blame—they’re not experts on the subject. Like most NHL franchises, Boston does not employ a neurologist—despite the high frequency of brain injuries in the sport.

When it comes to treating traumatic brain injuries, Canucks fans can rest easy knowing that the organization appears to be one of the most reasonable—but then toss and turn when they realize that the team’s preparedness for TBIs is still woefully inadequate.

When Sven Baertschi suffered a concussion early in the season on a high hit from Vegas’ Tomas Hyka, he spent an above-average amount of time out of the lineup—which would seem to suggest that the Canucks are more patient with recoveries that most NHL teams. While that might be true, the fact that Baertschi still returned to the ice before he was fully recovered—and had to subsequently hit the IR once again with concussion-related symptoms for another two months—is a sign that there remain major flaws in the system.

Like the Bruins, the Canucks don’t employ a neurologist. Baertschi was ultimately sent to a league-affiliated doctor in Michigan-based neurologist Dr. Jeff Kutcher. There’s no reason to doubt that Dr. Kutcher is a qualified and capable physician, and he’s helped many Canucks—and other players around the NHL—recover from concussions. But the fact that Baertschi had to fly to Detroit to see someone about a head injury is a sad statement in and of itself.

If the Canucks had a neurologist on staff during the 2018/19 season—or at the very least a part-time local affiliate—perhaps they would have noticed Baertschi’s ongoing symptoms earlier. One would certainly hope that had the Bruins employed a team neurologist, they would have caught on to Jake DeBrusk’s struggles at some point in the two months he played with a concussion.

But neither team has deemed that a worthy investment as of yet—nor has any other NHL franchise that this author can find. For the record, several teams do employ full-time chiropractors, despite that field’s dubious track record—and we’ll let you draw your own conclusions from that.

The Vancouver franchise experienced a real scare—and its first confirmed concussion of the regular season*—when Elias Pettersson was thrown headfirst to the ice by confirmed coward Mike Matheson.

*(Don’t forget that the organization experienced two on-ice concussions before the season even started in Antoine Roussel and Thatcher Demko—in case anyone needed a reminder on the sheer frequency of TBIs in hockey.)

Again, the Canucks’ staff and league officials went through all the right motions—Pettersson failed concussion protocol, was removed from the game, missed an appropriate amount of time, and returned to the lineup with no further symptoms.

That Pettersson didn’t have immediate access to an expert in traumatic brain injuries, however, should frighten any fan of the team. Pettersson is the franchise, more or less, so why is it not worthwhile to invest in an employee that can ensure the ongoing health of his most vital organ—the source of his nigh-legendary hockey sense.

The Canucks have an operating budget in the hundreds of millions—surely the Aquilinis and most other NHL owners can spring for a neurologist’s salary. They can still continue to send players with particularly bad injuries to the foremost experts in the field—but having someone on hand every day to observe and assess the members of the team seems like a no brainer, if you’ll pardon the pun.

There are probably already people rushing to the comment section to counter that players “know what they’re signing up for”—but do they? Has anyone sat each NHL player down for a seminar on the brutal reality of traumatic brain injuries, and all of the lifelong consequences that can ensue when an individual has experienced even a single concussion? Are the players briefed on the latest research on TBIs, and in particular the exponentially cumulative effects of repeated impacts?

The fact is that the only regular point of contact for an NHL player when it comes to traumatic brain injuries are the league-mandated concussion protocol handlers—and by that point, it’s too late for them to make an informed decision.

Speaking of those league-mandated concussion “spotters,” they’re hampered by the limits of an inadequate protocol that simply doesn’t work—and perhaps intentionally so. The onus seems to be on erring toward the side of a player returning to play, when the exact opposite should be true. The fact that Jake DeBrusk beat the concussion protocol—along with others like Josh Anderson who almost certainly played with concussion in the 2019 playoffs alone—is proof that it is ineffective, and that it needs to change.

The decision of whether or not an individual player should return to the ice following a traumatic brain injury is still left far too much in the hands of those individual players—and that should not be the case for a multitude of reasons. NHL players are rarely medical experts, and most of them have been raised in a culture where showing weakness is sinful and playing through injuries of any variety is highly encouraged.

Of course, that’s to say nothing of the truth that players who have suffered a brain injury literally don’t have the ability to make an unimpaired decision in regard to their health. A concussion temporarily—and sometimes permanently—alters one’s brain functions, so there’s no way to determine whether or not a concussed player is truly capable of making decisions. In that case, the responsibility obviously falls to their employer—and if those employers continue to eschew paying for neurologists and other experts, this author would argue that they’re also eschewing their legal, moral, and ethical obligations.

  • I’m trying to understand what you mean by having a neurologist around observing players? Neurologist are highly specialized doctors that have only so much time in a day. To think a person would go through all the years of training to sit around an arena observing hockey players is fantasy land. There are regular people that need neurologists for far more than concussions. Salaries being even, I imagine most Doctors would choose a practice in which they help many more people than 30-40 hockey players w concussions.
    As far as player responsibility goes, there is no definitive scan for a concussion. A doctor, trainer or parent can only go by what the player tells them. If I don’t tell anyone my tooth hurts because I don’t want to go to the dentist…. I probably will eventually have a root canal. Who’s fault is that?

    • A team-employed neurologist wouldn’t have to be there literally all of the time. Any level of observation–even weekly check-ins–would be an improvement on what NHL teams currently do.

      Just having a local affiliate would do wonders.

      And if “salaries being even” wouldn’t attract neurologists, then pay them more. The Canucks’ operating budget is in the hundreds of millions, they can afford it.

      And there are significantly more accurate tests for brain trauma than what they “concussion spotters” currently perform. It just happens to be more expensive and time-consuming–but it is definitely worthwhile.

      • Fact is that out of 860k total docs in US 8k are neurologists. That is less than 10% of all doctors.
        Basic economics means a scarcity of resources cause the price to go up. Gold is more expensive than silver because gold is scarce.
        A neurologists time is a valuable resource. Every hour they spend in a hockey arena means one less hour those 9.5% of docs are not helping the general public.
        If your argument is that each NHL club should pay for the training of a neurologist then employ them… that makes sense.
        An analogy is that every team that has 11.5 million in cap room should have an Erik Karlsson, just pay them. Unfortunately there aren’t 30 Karlssons out there to pay. It’s a good thought in a vacuum, but life doesn’t work that way.

        • I would absolutely support the NHL funding the training of more neurologists. It also doesn’t necessarily have to be one neurologist per team–perhaps Vancouver could share with Calgary and Edmonton. That’s not ideal, but it’s progress.

          • Clarity over agreement is awesome and you and I agree.
            I truly believe your intention in the piece is noble, but factual actually plays a big part.
            That’s a really deep dive into how much teams rely on Docs…. Orthos/Psychology from the the Gillis days and where the resources can be better allocated.
            You started a conversation and that’s what this thing is all about.
            Well done Stephan

      • So why not be honest and dissect the actual problem instead of this fairy tale? The problem is hitting and other incidental or purposeful contact but mainly hitting.

        Without hitting — and the brain dead Don Cherry’s will cry for days and still be wrong — the incidence of brain injuries would be drastically reduced.

        No neurologist or spotter required— just eliminate all hitting and other bodily contact and you return hockey to being a sport of skill not one of hits, punches, elbows, slewfoots, tripping, slashing and whatever else passes for ‘sport’ in hockey today.

        Imagine a sport where you can’t bash someone’s head into a station, or turn a player upside down and pile drive them into the ice or smack them in the head with an elbow or drive them into the boards hard enough to break their back. What do we lose?

        Competitiveness? Or simplistic aggression?

        The solution is simple— eliminate the cause of the problem. No different from banning trolls from this site … it improves it without needing mods … but then it cuts into the bottom line and neither this site nor the NHL wants to lose their audience or their revenue so they both do nothing about it.

        Funny thing is you don’t even need a neurologist to spot a troll on this site. So what’s the excuse for not banning trolls?

    • I think you’re barking up the wrong tree here. Most NHL teams have the resources to pay to have a neurologist on staff, if not full time, then at least on call.

      The bigger issue with suggesting teams employ neurologists is: to whom does that neurologist owe loyalty? There’s a long history in pro sports of team doctors acting in the interests of the organization, and not the individual players, when providing medical services, because it’s the team, not the player, who pays the doctor’s salary. The team may be pressuring the doctor, directly or indirectly, to get the player back on the ice, even if that is not in the long-term interests of the player. If a team employs a neurologist, are they really employing someone who’s going to diagnose more players with concussions and keep those players off the ice until they’re fully recovered, or are they employing someone who is going to be facilitating teams putting their players in harm’s way in pursuit of ticket sales and a Stanley Cup?

      Regarding your “who’s fault is that?” question: It’s the team’s fault, unquestionably. NHL teams have a widely-documented culture of “suck it up and play throught it”. For a truly disgusting example look at what the Oilers did to Sheldon Souray – the many almost lost his hand to a bacterial infection, and they called him a faker and a baby and forced him to play in the minors. NHL teams are heavily pressuring players to hide or play through their injuries.

      • Well said on all counts. The question of neurologist loyalty is a major one that Dan Carcillo has raised in the past. Perhaps that’s where the PA needs to be involved–vetting the neurologists in some way.

  • I agree with a lot of what you are saying, but think you left out the players and the NHLPA. In this salary cap era, the owners and players are in a partnership. Are the players properly educated? Maybe or maybe not, but I think that is more on the players and the PA than on the owners.

    I also think J-Canuck is correct about teams employing neurologists. There aren’t many of them and they will not gain significant expertise in their field sitting around watching hockey. Each team should have medical staff with significant training around concussions, which they may already have.

    • Legally speaking, it should be the responsibility of the employer to educate their employee of the risks of the job. The union can play a role, but the obligation is definitely more on the owners than it is the PA.

      • While that’s true as a broad principle, whether the NHL has a duty of care to educate their players about concussions is the subject of an ongoing lawsuit. Hopefully it goes to trial rather than out-of-court settlement so that we can get a definitive answer.

      • And the Union’s job is to make sure the employer lives up to their obligations. I’m sure the owners have a legal opinion and live up to at least the minimal level of their obligations.

        The PA has been complicit in many of the current concussion issues. When Tom Wilson received a long suspension for a dirty concussion causing head shot on Oskar Sundqvist, the league did not protect their members and Sundqvist by requesting a longer suspension. Instead of acting on his behalf, they screwed over Sundqvist and worked hard to get Wilson a shorter suspension. I get that they owe their members representation, but the players through the PA have constantly undermined the NHL’s efforts to get head shots out of the game.

          • The problem here is that the PA has an obvious conflict of interest – they’re tasked with protecting both Wilson and Sundqvist. The PA should simply not be involved in suspension appeals that involve player-on-player incidents.

      • Nowadays anyone who says they didn’t know what the potential ramifications of a concussion is lying. There is now a vast amount of information publicly available and anyone with an interest in sports is fully aware of the dangers inherent in concussions. I think the duty to educate certainly applied in the past but much more less so today.

          • Do you really think that with the premature deaths of NHL and NFL players, and the horror stories of life after hockey for enforcers anyone can say they didn’t realize there can be serious consequences stemming from concussions? It may sound harsh but with all information out there anybody who plays through post concussion syndrome is a candidate for a Darwin award.

          • Yeah, but how many of them are told to “suck it up.” Or have it heavily implied that a lengthy injury could have them sent back to the minors. There’s a real culture issue at play here that works against awareness.

  • Bettman has made statements recently indicating he and the league are fighting a rear guard action of denial pending further research probably related to long term liability. He is not in position to even acknowledge that a problem exists – never mind hiring neurologists which would be viewed as an admission of guilt.

  • While the premise of neurologists for each team is fine, it’s the reality that I have a problem with.
    I personally know an orthopedic surgeon that was sued by an NFL player while being the team doctor. He left and said it wasn’t worth all the headaches.many Docs, especially younger Docs get notoriety from being X teams doc, but many players go to their own doctors.
    With the uncertainty around brain injuries, I don’t see any doctor signing on as a team Neurologist. One misdiagnosis could put the Doc at risk for law suit. If the team and player agree to seek treatment that is a whole different story. A player like deBrusk slips through the cracks, ends their career…. who do you go after?

  • What i find whats pretty ridiculous is.. are there any highly qualified and experienced neurologists living in Vancouver.. Need to have 1) sufficient number of cases treated, with sports in mind.. 2) With enough publications that show they are at the cutting edge of treatment and not some old dinosaur still left in the dark ages in terms of treatment.. Vancouver doesn’t exactly have some top world class medical center… going to NY, LA or whatever seems pretty reasonable..

    • I can’t speak from experience, but I’d imagine there has to be someone qualified in town. And if there’s not, you simply pay one enough to move here. No amount of money should be an obstacle when lives are on the line.