Three seasons ago, as the NFL faced increasing scrutiny over head injuries and suggested ties to chronic traumatic encephalopathy (CTE), the NBA debuted its new concussion policy. This is a common thing for the NBA: see another league struggle with scandal, and take steps to prevent that from reaching the association. It's basically the performance-enhancing drug playbook. Deny there's a problem, but set policies you can point to in order to show the league is being proactive in defending the sanctity of the game, the welfare of its players or whatever. It's a pretty sharp strategy.
Except when the policy might as well not even exist, because no one heeds it. That's the story of the NBA concussion policy right now: it's just words on paper with no actual role in the game.
Here's what the NBA's concussion policy says should happen:
If a player is suspected of having a concussion, or exhibits the signs or symptoms of concussion, they will be removed from participation and undergo evaluation by the medical staff in a quiet, distraction-free environment conducive to conducting a neurological evaluation.
If a player is diagnosed with concussion, he will not return to participation on that same day.
Paul George wasn't removed from participation. Pacers PR said he answered some questions that are a part of the concussion protocol and complained only of pain in the back of his head. (Wade's foot or knee likely caused that.) George didn't leave the court area, so we know he certainly didn't get evaluated in a "quiet, distraction-free environment conducive to conducting a neurological evaluation." When the Pacers doc looked at him, it was in the presence of 18,165 screaming Pacers fans in crunch time of an incredibly important game in which George figured heavily.
Here's the problem, from George's post-game comments.
Paul George said he blacked out from his collision with Wade, and he tried to play through having blurry vision.— Scott Agness (@ScottAgness) May 21, 2014
Even worse, as it turned out, George did have a concussion. According to the Pacers' press release, they only sent him to a neurological specialist after he told the media he blacked out. No concussion was discovered then, but further testing on Wednesday revealed it.
Following the game, George stated for the first time that he "blacked out" on the play. As a result of this statement, the team conducted the NBA-mandated concussion assessment, which did not reveal any active symptoms of concussion.
Because of the statement and Indiana's ongoing evaluation and management of potential concussions, George underwent further testing and evaluation Wednesday morning. He has been diagnosed by the team's consulting neurologist with a concussion, based on his post-game reporting that he had briefly lost consciousness during the game.
Why bother having a concussion policy if guys are going to black out on the court, play with blurred vision and never even really get checked properly during the game?
This isn't a new issue for the Pacers. Last year, George Hill suffered a head injury in the course of a game ... and no one checked him out ... for several days, until he complained of headaches. Turns out he had a concussion! In that case, the symptoms took a while to manifest, which is common. But there was no mechanism to determine that a player who had been laid out on the floor for three seconds after being hit in the head needed to be checked. Otherwise, perhaps the concussion would have been diagnosed sooner, getting Hill the neurological rest his brain needed.
And we know the Pacers know how to run an in-game concussion test -- they did it for Roy Hibbert two months ago after he got popped by a LeBron James elbow. But Indiana -- and the rest of the league, frankly -- has been inconsistent and sloppy about following the policy.
I understand the difficulty: following the policy to the letter takes Paul George out of the game for at least a couple minutes in the fourth quarter of a tight, crucial game. It likely would have resulted in P.G. missing the rest of the game. George doesn't want to come out. And that decision shouldn't be in his hands. He shouldn't be asked to take himself out after that, not when there are trained physicians right there watching him.
Those team doctors have a duty to the players to act in their best medical interest. That means that when a head bounces off the floor, the concussion test must be done properly, regardless of the time of year, the time left in the game, the score or whatever. You take a blow to the head? You're getting tested backstage. (Especially if that blow leaves you sprawled out on the floor.) It's the only way the league's concussion policy can work. There can be no discretion as to whether a player gets the proper concussion test after a blow to the head. None.
Because if there is discretion? Paul George never takes the test in that situation, his neurological health remains at risk and the policy remains simply a C.Y.A. feel-good measure with little practical usefulness. If the NBA isn't going to strengthen its concussion policy to mandate tests for every blow to the head and penalize teams who ignore the rule, it might as well set the policy on fire. So long as the discretion of players and coaches determines when players get tested, the concussion policy is worthless.