Indiana Pacers forward Paul George was diagnosed with a concussion Wednesday and will now have to go through NBA protocol before he is allowed to return to the court, according to the Pacers. The news comes a day after George took a knee to the head against Miami in Game 2 of the Eastern Conference Finals and raises questions of whether he was tested properly by the Pacers' medical staff.
The injury occurred during the fourth quarter, when George dove for a loose ball and took an inadvertent knee to the head from Dwayne Wade. The contact caused George's head to hit the floor and he remained down momentarily:
What did Indiana do?
According to NBA concussion policy, if a player is suspected of having a concussion or exhibits signs or symptoms of a 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."
Given the hard contact to the back of his head and his face hitting the floor, George would seemingly be a prime candidate to have suffered a concussion. The team, however, did not conduct an evaluation per NBA policy, as George did not leave the bench area. As Tom Ziller wrote, whatever Indiana did was far from a "quiet distraction-free environment":
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.
In a statement, the Pacers said George "exhibited no symptoms of a concussion" and denied symptoms, including dizziness, nausea and vision issues. George saying he was alright and not immediately exhibiting any symptoms was apparently good enough for the Pacers, as he went right back into the game.
But following the game, George told the media he blacked out from the hit and continued playing despite having blurry vision. He did not relay those facts to the Pacers' medical staff, instead telling them he didn't have any symptoms.
With the admission that he blacked out and had other symptoms, the Pacers conducted a concussion assessment on George Tuesday night after the game. The assessment, according to the team, did not reveal any active symptoms of a concussion. Concussion symptoms, however, don't always occur immediately. George underwent further testing on Wednesday, which did reveal the concussion.
Should the Pacers have done more?
According to NBA policy, a player doesn't have to exhibit the signs to be removed from participation and undergo a full evaluation. Merely suspecting a concussion -- which you might do after a hard knee to the head -- would have been enough to justify taking George back into the locker room for a full evaluation in the proper environment.
Despite appearing to not conduct the proper test following the injury, Dr. Jeffrey Kutcher, the director of the NBA Concussion Program, said the Pacers medical staff did follow NBA concussion protocol:
"The Indiana Pacers medical team followed the NBA concussion protocol and there was no indication of concussion during the game," Kutcher said. "This case illustrates that concussion evaluation is an ongoing process and manifestations of the injury may not always present immediately."
Whether the Pacers handled the situation correctly, per policy, depends on whether one should suspect a concussion after a knee to the head. George didn't have any immediate evident symptoms and the fact he withheld blacking out and blurred vision didn't help matters. Regardless, if a knee to the back of the head doesn't justify a trip to the locker room for a full evaluation, what does?
What is Indiana's history with concussions?
This isn't the first time a Pacer has gone undiagnosed. Last season, George Hill suffered a head injury and wasn't evaluated for a concussion for several days. He was eventually diagnosed with a concussion after complaining of headaches and was forced to go through NBA protocol to return. Hill's symptoms didn't hit immediately, but he was still not put through an evaluation after taking an obvious hit to the head. He missed one game, then returned.
The Pacers have acted accordingly before, putting Roy Hibbert through a concussion evaluation before allowing him back on the court after he was elbowed in the head in a March regular-season game against the Heat.
Who should be blamed?
George didn't help matters by withholding information from the medical staff. Had he told them he blacked out and had blurry vision, he would have certainly not been allowed back into the game. The fact he lied isn't much a surprise, though, as there are numerous stories of players in various sports withholding symptoms to remain in the game.
That is the reason there are policies in place for the medical staff, and not the player, to be the one to pull the player from the game. Players aren't going to willingly remove themselves from important games. George knew a full evaluation would take several minutes and keep him off the court during crucial fourth-quarter action. He would have probably said anything and everything he could to be allowed back in.
A medical staff can't simply let a player talk his way back into the game, especially one who was just laying flat on the floor from getting kicked in the head. Proper evaluation for a brain injury has to take precedence over the game, even in the fourth quarter of the playoffs.