MCCPTA FORUM ON MCPS PROPOSED FY 2014 OPERATING BUDGET FEBRUARY 26, 2013 Questions By Parent Tom Hearn Regarding

Funding For Athletic Trainers Good evening Supt. Starr, County Executive Ike Leggett, members of the Montgomery County [Maryland] Public Schools (MCPS) Board of Education, and the members of the Montgomery County Council who were able to attend. My name is Tom Hearn and I am a parent of a student at Walt Whitman High School. I wanted to ask Supt. Starr several questions regarding funding for athletic trainers.i Last night [February 25, 2013], the Board of Education voted to add $6 million in additional funding for employee compensation to the $2.2 billion FY 2014 Operating Budget that the Board recommended to the County Executive and the County Council. In Supt. Starrs October 15, 2012 memorandum to the Board, he discussed options for hiring trainers.1 Supt. Starr estimated that having a trainer as a full time employee at each high school would cost $1.5 million. Having part-time trainers would cost $500,000. Question 1: Can you tell me whether the $6 million increase for employee compensation in the recommended FY 2014 operating budget includes funding for athletic trainers? Question 2: If athletic training funding was not added, how can you reconcile going another year without athletic trainers at MCPSs 25 high schools with the view of Robert Cantu M.D. and other sports concussion experts that, if you cant afford to have trainers, you cant afford to have an athletics program? Attached is a Maryland map showing which Counties have athletic trainers at their high schools.2 As you can see, numerous other school systems, including Howard, Anne Arundel, and Frederick Counties all have athletic trainers at each high school. Not on the map is Fairfax County, Virginia, just across the Potomac River, where each of its 25 high schools is staffed with two full-time certified athletic trainers. While high school sports provide many benefits, they also represent the school-sponsored activity that poses the most serious risk of personal injury to students. Sports are also the school-sponsored activity that is most remote from the school systems sole purpose of academic education. Among the risks of high school sports are injuries, including concussions. The injury to a students brain, along with the cognitive and physical rest 1 Here is a link to Supt. Starrs October 15, 2012 memo.
http://www.scribd.com/doc/122380238/10-15-12-Memo-MCPS-Supt-Starr-to-BOE-Re-Cost-of- Providing-Athletic-Trainers-at-25-High-Schools

2 The Maryland map is also at this link. http://www.scribd.com/doc/120598273/Map-Athletic-

Trainers-at-Maryland-Public-High-Schools

essential for recovery, significantly impair a students ability to participate in academic education. President Obamas Concern About Football Concussions The risks of concussions are greatest in high school football, which accounts for half of all concussions in a high school sports program. President Obama weighed in about brain injuries in football in two interviews leading up to the Super Bowl.3 Obama said that if he had a son, he would have to think long and hard about letting him play football.

If the President lived in Montgomery County, he would have to think longer and harder about letting him play football than he would if he lived in neighboring Howard, Frederick, or Fairfax County Virginia, each of which has athletic trainers at its high schools. Do MCPS Coaches Really Want Athletic Trainers? Perhaps coaches dont really want trainers. During this budget process, Supt. Starr and the Board of Education heard from teachers about the need for more training on Curriculum 2.0, and funding was added for that. They heard from school psychologists about MCPS being last in psychologist staffing in Maryland, and funding was added for that. They heard from school counselors about the need for more counselors, and funding was added for that. No coach showed up to advocate for athletic trainers. Nor did any of MCPSs 25 high school athletic directors. Or any high school principal. Or MPCSs Director of Athletics. Why were they all MIA on athletic trainer funding? Were teachers, psychologists, and counselors being fearless in asking Supt. Starr to fund something that had not been part of his original budget proposal? Were coaches and ADs being feckless in remaining silent? Sports policy is set by the 25 high school athletic directors meeting monthly and the 25 high school principal, the latter group which sits as the Montgomery County Public Secondary School Athletic Association, which meets semi-annually. A review of the minutes of these meetings over the last three years fails to reveal any discussion of the role of athletic trainers in keeping students safe. Nor was there any discussion of the fact that athletic trainers are present in school systems to the East, North, and West of MCPS. I met with MCPSs Director of Athletics William Duke Beattie in February 2012 and asked him why MCPS did not have athletic trainers. Director Beattie explained his view that, while trainers were needed at the college level because students were away from 3 http://www.newrepublic.com/article/112190/obama-interview-2013-sit-down-president
http://www.cbsnews.com/video/watch/?id=50140291n

home, trainers were not needed at the high school level because parents could take their kids to the doctor for medical care for sports related injuries. Maybe MCPS coaches dont really want trainers. In March 2011, Kevin Crutchfield, M.D. testified to the Maryland House Ways and Means Committee in favor of youth sports concussion legislation.4 Dr. Crutchfield is the Director of the Sports Concussion Program at the Sandra and Malcolm Berman Brain and Spine Institute in Baltimore. Dr. Crutchfield is also a team neurologist for the Baltimore Ravens. In his testimony, Dr. Crutchfield recounted how, while serving as the team physician for the Winston Churchill High School football team against another MCPS opponent in October 2010, he witnessed a player on the opposing team take a hard hit. As [the player] staggered to the sidelines minutes later, with seconds left in the game and a chance to win, the coach called time out, allowing the child to remain on the field. When I arrived at the opposing teams sidelines with the EMT, I identified myself as a physician with expertise in brain injury and the EMT asked an assistant coach to bring the child out for concussion evaluation. The assistant coach became angry and verbally threatening to the EMT. On the very next play, the ball was thrown to the injured player, who was wide open in the end zone. He dropped the ball on a very easy throw. The game ended. After the post game huddle, I approached the opposing teams head coach and made him aware of what had happened. He called the boy over and allowed me to examine him. [The boy] had marked neurological abnormalities and signs of brain injury so it was no surprise that he dropped the ball. The boys father, who overheard my conversation with the coach and watched me evaluate his son, was angry when I said his son suffered a concussion. The assistant coach recruited other coaches and became verbally abusive towards me as well as physically threatening.5 Athletic trainers dont only help with managing concussions. They also help with other sports safety issues. Like heat stroke. Heat stroke is an entirely preventable disease. Sadly, three and a half years ago, Edwin Dek Miller, a Northwest High School student, died of heat stroke in a no-pad practice with the team.6
4 http://www.scribd.com/doc/98410052/Testimony-of-Kevin-Crutchfield-MD-to-Maryland-

Legislature-March-2-2011

A tragic account of a conflict between a California coach and an athletic trainer is given here. UnRinging the Bell: Lessons From Eveland v. San Marcos Unified School District Andrew Blecher, M.D., April 19, 2012, posted at Concussion Inc. http://concussioninc.net/?p=5535

6 http://www.gazette.net/article/20090708/News/307089631/0/gazette&template=gazette;

http://www.gazette.net/article/20090715/News/307159642/0/gazette&template=gazette

The press reported that the coach performed CPR on Miller. Coaches are supposed to have emergency plansideally having a kiddie pool available to fill with ice that is also available so that a student suffering heat stroke can be quickly immersed. Was such a plan in place that day? Is such a plan in place today? Had there been a trainer, there definitely would have been a plan. Question 3: So what do MCPS coaches want? Athletic trainers to help ensure the safety of their players? Or to be left alone so they can be the sole decider of whether a concussion is suspected?7 Funding for Gradual Return-to-Play Steps? I want to ask Supt. Starr whether MCPS will include in the FY 2014 operating budget funds to comply with the Maryland State Board of Educations requirement that each school system have in place gradual return to play procedures. The State Board adopted this requirement in an emergency regulation issued last July and reiterated it in regulations adopted last month.8 At schools that have athletic trainers, they perform this function, including the detailed recordkeeping that is required. Here is what gradual return to play steps are and why they are so important. Getting a second concussion before fully recovering from a first one puts a student at risk for longterm post concussion syndrome. It also exposes a student to the risk of second impact syndrome where the brain bleeds uncontrollably which can lead to rapid death. The absence of symptoms may not mean that a student has recovered from a concussion. It may only mean that the student is symptom-free at rest. To screen out a still recovering student, since at least 2001 it has been best practices to reintroduce athletic activity over 5 stages of gradually increasing physical activity. Between each stage, a student waits 24 7 MCPSs August 2010 Staff concussion policy statement provides, In the absence of an assigned

paramedic, the coach makes the determination on whether the student may have suffered a concussion. http://www.scribd.com/doc/97075887/Montgomery-County-Public-Schools-MCPS- Guidelines-and-Procedures-for-Concussions-Head-Injuries-August-2010 While EMTs may be present at games, they are never present at practices, which for football is when most concussions and subconcussive blows to the head occur. Nor does MCPS Policy instruct coaches, when in doubt, sit them out. Compare the MCPS Policy with the way Harford County [Maryland] Public Schools puts it: If student-athlete exhibits any sign of concussion or reports any symptom, they are to be removed from practice or play. When in doubt, keep the player out of play and seek an evaluation from a qualified health care professional trained in concussion assessment and management. The coach is not to try to judge the severity of the injury. Health care professionals have a number of different methods that they can use to assess the severity of concussion. (emphasis added) http://www.hcps.org/departments/docs/curriculum/athletics/Admin_Handbook.pdf at p. 41.

8 http://www.scribd.com/doc/125614995/Md-State-Bd-of-Ed-COMAR-Concussion-Emergency-

Regulation-With-Gradual-Return-to-Play-Requirement

hours. If symptoms resume during any one of these 5 stages, it means the student has not recovered and resuming contact or collision sports would pose a great risk to the student.9 I have attached for you an exchange of emails between MCPSs Director of Athletics Duke Beattie and Montgomery County Public Health Officer, Ulder Tillman, M.D., MPH regarding their meeting on June 29, 2013. Director Beattie told Dr. Tillman that MCPS did not have the staff/resources/budget available to monitor a gradual return to play for student-athletes after a concussion, saying, Montgomery County, like most Maryland school systems, has the doctor indicate the return to play date.10

9 Emerging research raises questions about whether gradual return to play procedures are adequate to keep
athletes safe. Scientists at Purdue University released a report in February 2012 of a study that had followed a high school football team for two seasons. http://www.purdue.edu/newsroom/research/2012/120202NaumanFootball.html Each players helmet was outfitted with an accelerometer to measure impacts and each player given a functional MRI (fMRI) of his brain doing certain tasks both at the beginning of the season and at the end. "The most important implication of the new findings is the suggestion that a concussion is not just the result of a single blow, but it's really the totality of blows that took place over the season," said Eric Nauman, an associate professor of mechanical engineering and an expert in central nervous system and musculoskeletal trauma. "The one hit that brought on the concussion is arguably the straw that broke the camel's back." The Purdue Studys results show that even players who had not been identified as having sustained a concussion showed altered brain function on their fMRIs from the beginning of the season to the end. The Purdue studys findings are consistent with findings reported back in December 2012 in the Journal of Neuroscience that changes in a students brain after a concussion still persist even if the student is symptom-free. http://blogs.edweek.org/edweek/schooled_in_sports/2012/12/concussions_alter_childrens_brains_for_mont hs_after_injury_study_finds.html Functional MRI technology used in the Purdue study is not available in most clinical settings. The implications of the Purdue and other studies for gradual return to play procedures is that, were fMRI available, it would likely show in some cases that a student who had successfully complete the five stages without symptoms returning still had altered brain function. For football, given that studies show that a high school football player averages 650 subconcussive blows to the head during a season, 1,000 for a player in a line position, health professionals need to take this into account when clearing a football player for return to play after a successful completion of gradual return to play. For example, in clearing a student to return to football mid-season, physicians and other health professionals need to be mindful that their patients brain may still not have resumed pre-concussion functioning and that they are clearing the student to resume the remaining 325 subconcussive blows to the head, 500 if the student is on the offensive or defensive line. Athletic trainers currently fill the gap where there is no fMRI. A good trainer makes judgment calls sometimes to recommend that a student be withheld even though the 5 stages have been successfully completed.
10 http://www.scribd.com/doc/127933619/07-16-202-Email-From-MCPS-Ath-Director-to-

MCHHS-Director-of-School-Nurses-Mentioning-Lack-of-Gradual-Return-to-Play-Monitoring

The County Public Health Officer replied: I do understand the gradual return to play to be a goal of best practices, but it may not be able to be implemented due to budgetary constraints.11 I think Dr. Cantu, the concussion expert, would say if you dont have athletic trainers and you cant afford to have gradual return to play procedures in place, then you definitely should not be running a high school sports program. Question 4: So my question is whether the FY 2014 MCPS Operating Budget includes funding to comply with the Maryland State Board of Educations requirement that it have gradual return to play procedures in place? Or are we just going to continue to ignore the requirement? Disclosing the Absence of Athletic Trainers to Parents If MCPS is not going to fund athletic trainers, yet still operate a sports program, it needs to disclose this to parents so that they can make informed choices about whether to allow their children to participate in school sponsored sports. Last month, MCPSs 25 high school football coaches hosted meetings with parents of eight grade boys to invite them to let their son join the team next year. I attended one of these meetings and the coach never mentioned the absence of trainers and the significance of not having trainers for their sons safety. Question 5: Will there be funding in the FY 2014 budget to cover the cost of coaches disclosing to parents the lack of athletic trainers? Thank you for listening to what I have to say. END OF TESTIMONY After I spoke, Supt. Starr gave the following response to my questions: I am not going to discuss issues that are not related to the budget. And I will say that we are currently in negotiations with our three employee groups about monies that I asked the Board to put in last night in addition to the ones I already requested that they already approved are part of a hold that we have in our budget that will be determined in the normal course of negotiations and it would not be appropriate for me to discuss any of those terms. 11 http://www.scribd.com/doc/125418375/06-29-2012-Email-Md-Health-Officer-for-Montgomery-
County-to-MCPS-Athletics-Director-Re-OK-That-Concussion-Gradual-Return-to-Play-Steps-Not- Implemented

MCPS Board Member Pat ONeill pointed out that the 2014 Recommended Budget included $75,000 for funding baseline concussion testing at all high schools. With all due respect, that money, if it is ever included in the budget, could be better spent elsewhere to improve the safety of students who play sports. http://rockville.patch.com/blog_posts/mcps-concussion-baseline-testing-mcps- athletics-has-higher-priorities-for-keeping-student-athletes-safe Endnotes i I have previously advocated for athletic trainers at MCPSs 25 high schools in testimony to the Board
of Education on: April 30, 2012 http://www.scribd.com/doc/122435826/Sports-Concussions- Parent-Testimony-to-MCPS-Supt-Starr-and-Bd-of-Ed-April-30-2012; May 21, 2012 http://www.scribd.com/doc/97421191/Sports-Concussions-Parent-Testimony-to- Montgomery-Cty-Md-Board-of-Ed-May-21-2012-Comparison-of-Sports-Concussion-Surveillance-in- Mont-Cty-and-Fair and January 17, 2013. http://www.scribd.com/doc/122566860/MCPS-2014-Operating-Budget-01-17-2013-Parent- Testimony-to-MCPS-Supt-Starr-and-Bd-of-Ed-Re-Funding-for-Athletic-Trainers I have also blogged about MCPS funding athletic trainers at the Rockville Patch On February 5, 2013 http://rockville.patch.com/blog_posts/superintendent-starr-and-mcps-school- board-please-include-athletic-trainer-funding-in-the-fy-2014-operating-budget and February 13, 2013 http://rockville.patch.com/blog_posts/funding-athletic-trainers-in-fy-2014- activity-fees-on-students-or-choosing-student-safety-over-non-essential-travel-for-mcps- administrators