Pat Leonard: NFL, players’ union, Dolphins medical staff all failed Miami’s Tua Tagovailoa

Tua Tagovailoa shouldn’t have been on the field Thursday night. Loopholes in the collective bargaining agreement between the NFL and players’ union allowed the Miami Dolphins’ medical staff to clear him and create the frightening situation that unfolded in front of the entire nation.

“The problem isn’t necessarily that the protocol wasn’t being followed,” said Miami-based attorney Brad Sohn, a candidate with some player support to become the NFLPA’s next executive director. “It’s that they have these toothless rules and no one’s being held accountable. The league and P.A. codified a protocol that has loopholes big enough to drive a truck through.”

The central question — and the reason the union launched an investigation for a potential protocol violation immediately — is why Tagovailoa was cleared mid-game from the concussion protocol the previous Sunday during a win over the Buffalo Bills.

The quarterback’s head hit the turf after taking a hit from a Bills defender. Tagovailoa immediately raised his hands towards his head, with the fingers on his left hand looking a bit strange.

Then he stood up and tried to shake it off, he stumbled, lost his balance, and had his knees buckle underneath him. Teammates had to hold him up on his feet until trainers came out.

Tagovailoa was taken to the locker room and announced as questionable to return with a “head” injury. But he later returned to the game, and the team clarified he had injuries to his “back” and “ankle.”

“Ninety-nine percent of doctors who don’t work for the team see Tua shake off the cobwebs, wobble, have to be held up, and that player never goes back in,” neuroscientist Chris Nowinski, Ph.D., the founding CEO of the Concussion Legacy Foundation, told the Daily News Saturday.

So how was it possible to bring him back into the game, especially with an unaffiliated neurotrauma consultant (UNC) involved?

Well, the NFL’s concussion game checklist says in the fine print that a players’ “gross motor instability” is “determined by [the] team physician, in consultation with the UNC, to be neurologically caused.”

In other words, Sohn said, “a team doctor can make the finding that an injury wasn’t neurologically caused, that it’s a player’s knee and not his head, and the independent neurologist no longer needs to be consulted. And the PA agreed to that.”

Indeed, the full CBA language says that “the decision to return a player to participation remains within the professional judgment of the head team physician or team physician designated for concussion evaluation and treatment, performed in accordance with these protocols.” And all return participation decisions only need to be “confirmed” by the independent neurologist.

The investigation hopefully will reveal the facts about how this decision was made. NFL chief medical officer Dr. Allen Sills promised all findings would be released to the public.

But when NFL executive VP of communications Jeff Miller said Wednesday that “every indication from our perspective is that [the protocol] was” followed, unaffiliated professionals weren’t buying it.

“It was a series of bad choices that gave Tua a serious brain injury,” Nowinski said. “I could accept if last Sunday was a mistake in the game. But to pretend it wasn’t a mistake the rest of the week shows a callousness with player health that I feel like I haven’t seen in a while.”

“Sometimes the cover-up is worse than the crime,” Nowinski added. “But I feel like the crime is very bad and the cover-up is becoming worse.”

The fact is that Tagovailoa demonstrated at least three “potential concussion signs,” as defined in the CBA, after that Bills hit:

1. Slow to get up following a hit to the head (‘hit to the head’ may include secondary contact with the playing surface)

2. Motor coordinator/balance problems (stumbles, trips/falls, slow/labored movement)

3. Clutching of head after contact

If Tagovailoa’s left hand indicates upon review that he was also in a brief “fencing” posture, that would make it four potential concussion signs. “Balance or coordination difficulties” are also listed as a “potential concussion symptom.”

The difference between signs and symptoms are signs are things you can observe with your eyes, and symptoms are what a player reports to the doctors or tests reveal.

The Dolphins QB was administered the required tests before being cleared to return to the Bills game, according to Sills, and subsequently tested throughout the week. But Nowinski said the league’s preference to lean on these back-room tests is part of the problem, too.

“This is a tactic the NFL has used for years,” he said. “The NFL is trying to make concussion evaluation about the locker room protocol or blue tent protocol. And what trumps those things is on-field signs. But the NFL doesn’t want that because they want the wiggle room of ‘he sobered up and passed the known-to-be-not-fully-accurate concussion test.’”

Returning Tagovailoa to play after unquestionably demonstrating those signs and that symptom was egregious. Thankfully, Baltimore Ravens head coach John Harbaugh stood up and blasted the Dolphins on Friday to make clear that people in the clear do not believe this is OK.

“Like probably most people, I couldn’t believe what I saw [Thursday] night. I couldn’t believe what I saw last Sunday,” Harbaugh said. “It was just something that was astonishing to see. I’ve been coaching for almost 40 years in college and the NFL, and I’ve never seen anything like it before.”

Harbaugh said the Ravens exercise extreme caution. A couple weeks ago, wide receiver Devin Duvernay didn’t have any symptoms at all but Baltimore held him out for the following game and most of the week’s practice.

“I appreciate our docs,” he said. “I think they probably would call themselves conservative, but that’s what they should be. The other part of it, [Thursday] night, was not something you want to see.”

Giants tackle Evan Neal, Tagovailoa’s Alabama teammate in 2019, told The News he turned the Dolphins-Bengals game off after seeing Tagovailoa go into the “fencing” posture with his hands up in front of his face and his fingers twisted.

“I couldn’t watch it anymore,” Neal said. “It was tough to see him carted off like that. It was scary. At first I thought he broke his fingers or something. But I watched the play more and saw that he hit his head. That’s scary. Thankfully he’s responsive, he’s conscious, he can move his limbs.”

Giants coach Brian Daboll, Tagovailoa’s 2017 offensive coordinator at Alabama, started to tear up on Friday when asked about the Dolphins QB.

“He means a lot to me,” Daboll said. “It was tough … I don’t really think about them as players. They’re not too far off from my kids [in age].”

JC Tretter, the NFLPA’s recently-retired player president, said players are “outraged” and “scared for the safety of one of our brothers” after seeing a player cleared from the protocol despite clear demonstration of “no-go” symptoms.

Like Sohn, Tretter advocated for amending protocols, not just reviewing this case.

“Until we have an objective and validated method of diagnosing brain injury, we have to do everything possible, including amending protocols, to further reduce the potential of human error,” Tretter wrote. “A failure in medical judgment is a failure of the protocols when it comes to the well being of our players.”

Unfortunately, the union is part of the problem because there aren’t enough checks and balances to protect the players in the CBA the union signed off on.

Nowinski said in the union’s defense, though, the sad reality for players is that they’re also afraid of concussion diagnoses because it attaches a stigma. And plenty of players have had their careers ended because they were deemed untouchable by teams due to concussion histories.

“It can be worse to be out when you’re healthy than to play when you’re concussed,” Nowinski said of the mindset unfortunately adopted by plenty of players fighting for jobs.

Sohn boiled down the need for reform this way: “There are so many short-term interests that run the risk of being prioritized over health. Tua to his credit is probably a tough kid who wants to get out there and play football. But you need to police guys from making bad short-term decisions. The same is true with the team doctor. The same is true with the league.”

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