Written by Brandon George
Experts: With head injuries, an athletic trainer's decision must be respected
Second of four parts
Bucky Taylor built a reputation as one of the area's top high school athletic trainers over the last four decades, but there were bumps - even threats - along the way.
Sometimes coaches or parents didn't agree with his recommendation for an injured Mesquite High School athlete.
"I've had a coach threaten to beat me up and whip me right there," said Taylor, who recently retired after 36 years as Mesquite's head athletic trainer. "I've also had a parent come in my office and threaten to beat me up if I didn't allow their son to play."
The relationship between a high school coach and athletic trainer is among the most important aspects of ensuring the athletes' welfare. High school coaches and athletic trainers must err on the side of caution when dealing with head injuries and must trust and respect each other's decisions, concussion experts say.
"There are two things I always tell parents when they ask how fast will he be back," Cedar Hill football coach Joey McGuire said. "I tell them, 'I don't mess with the head and I don't mess with the heart.'
"We have some really good trainers, and I let my trainers handle everything. The game has become so fast and the kids have become so much stronger, you have to be careful. When you're talking about an ankle sprain or something like that, you might be more aggressive. When you start talking about concussions and a kid's head, it's not worth it."
At the college and professional levels, when an athletic trainer says a player is not re-entering a game, the decision is almost always final. At the high school and youth levels, there is much more gray area.
Often, a high school football coach hires the athletic trainer, who reports directly to that coach. Sometimes, when a football coach changes jobs, he brings "his" athletic trainer with him.
If an athletic trainer's job is on the line when he decides whether to put a player back into the game, an internal dilemma can develop.
"That would definitely concern me if an athletic trainer is considered to be under a coach," said Tamara C. Valovich McLeod, a leading national concussion expert who is an associate professor for the Athletic Training Program at A.T. Still University in Mesa, Ariz. "Ideally, the athletic trainer should be under the athletic director or some other entity at the school.
"Your medical staff should not be influenced by who is hired as the coach. The athletic trainer doesn't tell the coaches which plays to run, so the coaches shouldn't tell the athletic trainer what to do."
Kevin Guskiewicz, director of the Sports-Related Traumatic Brain Injury Research Center at the University of North Carolina, echoes her concerns.
"The medical provider, be it the athletic trainer or the team physician, should not have the direct reporting line to a coach," he said. "The NCAA has done a wonderful job with their new 'best practice guidelines' in making that very clear. It clearly states in their concussion policy now for institutions that athletic trainers and physicians do not report to a coach. It creates a terrible conflict of interest, and I'm sorry to hear that that is the case at the high school level [in Texas] because it certainly shouldn't be that way."
Rockwall head athletic trainer Cary Tyson reports directly to football head coach Scott Smith. Tyson was athletic trainer at Monahans in West Texas when Smith hired him.
Tyson, who is entering his sixth year at Rockwall and has been an athletic trainer at four stops since 1996, said he's fortunate that he doesn't have to deal with a coach who questions him when it comes to injuries. Tyson said that Smith has never questioned his decision regarding an athlete's welfare.
"It's a whole lot different reporting to Coach Smith than some other coaches I've been with," Tyson said.
He recalled one incident at a prior school when an athlete had a hand injury and the coach wanted him back in the game.
"I stood my ground, and the player didn't go back in," Tyson said, "but it didn't do a lot for my relationship with [the coach]."
Tyson said he understands an athletic trainer's predicament when he or she reports directly to a head coach.
"Some of them have told me horror stories," he said. "They hate to tell a coach someone is hurt regardless if it's a hand injury or a head injury. There are trainers who get questioned on everything they say to a coach. There are people who have to go through that fight. Fortunately for me, I don't have to deal with that."
Former Converse Judson coach D.W. Rutledge, executive director of the Texas High School Coaches Association, said he believes a "vast majority" of coaches leave the decision to athletic trainers on when to return an athlete to a game, but he acknowledged that with more than 20,000 coaches in Texas, that's not always the case.
"I sincerely believe that the vast majority of our coaches are very conscious of it and they're going to take the decision out of their hands and put it in the hands of a medical professional," Rutledge said.
But what about when it's in the heat of the battle? Tie game, fourth quarter, your quarterback takes a blow to the head and has to come out of the game for a play. Do you run him back out there with the clock winding down?
"Probably all coaches have said, 'We need to get him back out there. When can he be ready?' " Rutledge said. "But it comes down to the athletic trainer. If he or she says he's not going back out there, then it's over. ... I don't think there is any negligence taking place in trying to make that decision."
Mark Cousins, policy director for the University Interscholastic League, said he doesn't see a big issue statewide with high school coaches and athletic trainers butting heads when it comes to an athlete's welfare.
"Everybody has the child's best interest at heart," Cousins said.
Phil Francis, head athletic trainer in the Dallas ISD since 1984, said there is no conflict of interest within his district when it comes to his staff and coaches.
"There are those stories that exist in Texas that the coaches make the call," Francis said. "I've been in those conversations with several area athletic trainers. I hear stories all the time. I'm so glad I don't work in a system like that. It's not right. It's child abuse."
Taylor also said that he's heard horror stories from some of his fellow trainers in the field.
"I've had colleagues who have felt if they didn't act a certain way or respond a certain way to a coach that they could lose their job," Taylor said. "As our profession evolves, I think it will take care of itself. But there will still be some coaches out there who want to have control. Football coaches aren't used to being told, 'No, you can't do that.' There are school districts in the Dallas area that value winning and competing over protecting the kids."
What's perhaps more alarming, however, is when an athletic trainer isn't available.
According to the Dallas-based National Athletic Trainers' Association, only 42 percent of high schools nationally have access to a trainer. Cousins said about half of the state's UIL schools that play football don't have a licensed athletic trainer on staff.
Most Class 5A and 4A schools have at least one certified athletic trainer on staff, but at 3A and below, it's often a different story. A certified athletic trainer is on the sidelines for nearly all UIL football games, but often practices go on without a medical professional on hand.
McGuire said he has two full-time athletic trainers on staff at Cedar Hill in Julie Torre and Marc Megill. He said he didn't hire either, and both report to Cedar Hill ISD athletic director Gina Farmer.
"I think even if I were over those two, I would still have the same philosophy to trust them to do their job," McGuire said. "You just don't want to put your kid in a situation where it's going to be a long-term injury or something they're going to have to live with the rest of their life. It's just not worth it to me."
Taylor said he feels the same way.
"I don't want to go visit a kid in the hospital who has had a life-changing injury on my watch," Taylor said. "I don't want to go to a kid's funeral."