Testimony on House Bill 2038
Senate Committee on Health and Human Services
By: Theodore Spinks, MD
May 17, 2011
Chairwoman Nelson and members of the committee, I am T.J. Spinks, MD, a pediatric neurosurgeon. I practice in Austin. I’m also co-director of the Dell Children’s/Seton Hospitals Concussion Program. I am speaking “in support” of House Bill 2038 on behalf of the Texas Medical Assocation, the Texas Pediatric Society, the Texas Academy of Family Physicians, and the Texas Orthopaedic Association. Together our organizations represent more than 48,000 physicians and medical students. I also serve on the TMA Ad Hoc Comitttee on Student Athlete Concussions, which has reviewed this legislation and other concussion-related proposals.
We would like to thank Rep. Four Price and Sen. Bob Deuell, MD, for addressing a serious health concern facing Texas’ young athletes and their families in HB 2038. Even with the current media focus on student concussions, many go unreported, and often they are unrecognized. Not all concussions produce immedicate dramatic symptoms such as a loss of consciousness. Someone untrained in their recognition may easily miss them, including the athletes themselves. Unfortunately, a concussion sensitizes the brain to repeat injury. An athlete who is symptomatic from a concussion can be reinjured by seemingly minor insults. These reinjuries can worsen severely or prolong symptoms, and can even put the student at risk for rapid brain swelling and sudden death. Researchers now are finding there are long-lasting effects of concussion as well as cumulative effects of multiple concussions. In addition, newer studies have shown that younger patients may recover from concussions more slowly than adults because their brains are still developing. This makes it all the more necessary for careful concussion management for students, especially as they return back to school and sports.
The most authoritative consensus statement on concussion management was developed by a panel of international experts. The panel revisits and revises the concensus statement every few years. Currently, it recommends a multidisciplinary treatment team that develops individualized return-to-play and return-to-school guidelines for each patient. HB 2038 clearly was written with this plan in mind. For that reason, it is laudable for promoting state-of-the-art concussion management over older, “rule of thumb”-type guidelines. However, the science on concussions still is evolving. It has changed markedly over the past few years. One of the greatest challenges at the state level is to create a system that is flexible enough to incorporate new scientific guidelines. Thus, placing hard and fast treatment recommendations into statute concerns physicians.
The Texas University Interscholastic League’s (UIL’s) Medical Advisory Committee has developed a new policy for the 2012 school year that is appropropiate and contains solid strategies for managing concussion risk and treatment among student athletes. Additionally, we know the UIL committee includes strong sports medicine expertise. The committee also has demonstrated a commitment to implementing solid, evidence-based recommendations. The UIL committee is well-positioned to react to new scientific evidence, and to expediently change its recommendations as needed to ensure young athletes receive appropriate care. We pledge to continue working on the issue of student athlete concussions with UIL and its Medical Advisory Committee during the interim, and to devlop meaningful solutions.
Because student head injuries are serious and occur frequently, we appreciate Representative Price’s thoughtful attempt to develop a comprehensive approach to managing concussion as laid out in HB 2038. We strongly support making concussion training available. Athletes, parents, coaches, school staff, and health care professionals all must receive training and education about concusssion recognition, and assessment on the field; referral to a physician or delegate; and proper management of the concussion. This comprehensive approach will ensure an educational standard across all school districts with equal protection for each young athlete. Education is the cornerstone of this approach.
Many physicians who work with school districts and athletic programs do so in a voluntary capacity. We asked for additional liability protection for these physicians and acknowledgment through a consent form by affected families. This languagewas added to the House committee substitute.
We know sports adds to the quality of life in our communities. We certainly applaud student athletes and want to encourage more students to get involed in these activitites. It is our hope that this new safe-play measure will not be burdensome for school districts to meet or maintain. In fact, we hope to work in the interim with school representatives, UIL, and other parties to further address student athlete safety. We again applaud Senator Deuell and Representative Price for bringing forward this legislation. We look forward to working with all parties involved to help ensure our student athletes can continue to participate safely in health competition.
82nd Texas Legislature Testimonies