UPDATED: Aug. 28, 2017 at 11:08 a.m.

On Nov. 1, 2013, inside a Manley Field House office, then-SU head coach Scott Shafer told defensive lineman Tyler Marona his career was over. For about three months after Marona suffered a concussion at an inter-squad scrimmage, he said he regularly met to evaluate his progress with Shafer and SU team doctor James Tucker, who came to the team facility about once per week. Marona liked both men and thought they cared about his health. He did not know who officially decided to medically disqualify him, but he understood why.

“(Shafer) ended up being like, ‘I don’t want to bring you back and then have you get hurt again, and then I can never look you in the eye ever again and be like, hey, I did what was best for you,’” Marona said this month. “I don’t intend for this to be condescending or any of that, but (Shafer) was covering his ass in that regard, so that he wouldn’t get fired. … I also get it, because if I had a kid, and I was coaching him, I would say the same thing.”

That the decision to disqualify Marona was the team’s to make highlights what experts say is the major issue in how concussions are handled across college football. Because neither the NCAA nor the Atlantic Coast Conference provides oversight or tracks concussions, the onus rests on individual schools to monitor head injuries.

Currently, team doctors are charged with making decisions both routine, like allowing a player to practice or not, and serious, like medical disqualification. Some team doctors, like Tucker, are not neurological specialists. Tucker is certified only in family medicine, yet he has the final say on all medical disqualifications.

Syracuse has disqualified at least five football players in the past four years. There are multiple players still on SU’s roster who have undergone concussion testing protocol in that timeframe, most notably quarterback Eric Dungey, who has reportedly suffered at least two concussions.

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There is an inherent conflict of interest that experts worry about in providing the power to those on a team’s payroll. The conflict could be eliminated, independent doctors and a lawyer said, with the creation of an NCAA-wide — or even ACC-wide — policy that requires independent neurologists to assess head injuries.

Multiple attempts to reach the NCAA, ACC and SU Athletics for comment on this story were unsuccessful.

Further action addressing concussion tracking at the NCAA level likely isn’t imminent, experts said, because doctors are still unsure of the long-term consequences of concussions. This leaves the issue’s severity and legality unclear.

“For now, the more we can provide an environment where an athlete is given the best medical advice independent of the pressures of sport, that’s really the ideal goal,” said Dr. Brian Rieger, the director of the Upstate Concussion Center in Syracuse.

In August 2013, after Marona felt “woozy” from the scrimmage hit, he approached SU’s head athletic trainer Denny Kellington. He “went up the chain of command,” speaking with Timothy Neal, assistant athletics director of sports medicine, as well as Shafer and Tucker. Then, Marona took an ImPACT test, a computer assessment tool to evaluate and manage suspected concussions. Marona said the test results were similar to previous attempts when he was concussed, so all he could do was wait.

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Speaking up as Marona did is not the norm among college football players, doctors and multiple former players said.

One reason is that college players are particularly less open to hearing about safety, said Dr. Theodore Henderson, a concussion expert who has spoken to the NFL Players Association and the players’ safety summit.

“The college system sort of enforces this,” Henderson said. “You have to do your best to show your best if you’re going to get picked up in the (NFL) Draft.”

Athletes also feel a lot of pressure, former SU players said, to reliably perform, which they say can lead to a chain reaction. It could become harder for the player to admit to himself that he’s hurt. This can make players unreliable self-reporters, which is crucial for an injury like a concussion, that cannot be definitively determined with medical equipment. Without the player’s admission, problems may persist unmonitored and players grapple with injury alone.

“Judging a concussion is very hard, unless you’re the person having the concussion,” said Isaiah Johnson, a former Syracuse football defensive end also medically disqualified under Shafer.

Though coaches want to keep their players healthy, it’s not their top priority, Johnson and Marona each said.

“They just want you to be there so that everybody can win,” Marona said. “There’s nothing worse than losing. That’s really the crux of the point, that’s the reason why (not self-reporting) is a problem, because there’s pressure to perform, to win and for the coaches not to get fired.”

At a spring practice in 2015, Johnson said he told a coach that his head wasn’t feeling well seven plays into a 24-play scrimmage. Despite his concussion history, Johnson said, the coach didn’t take him out of the scrimmage and Johnson ultimately participated in 18 of those 24 plays.

In April of that year, Tucker disqualified Johnson after he suffered three concussions in 18 months.

“I just don’t think the coaches at the time cared about preventing other concussions from happening,” Johnson said. “I believe that I was put in a bad spot. I’m not blaming anyone, but I do believe that different things could have happened.”

To prevent predicaments like Johnson’s, many experts endorse the independent neurologist system, which would mirror the NFL’s system. Schools such as SU could contribute to a fund that the NCAA or ACC would use to hire those neurologists, said Paul Haagen, a co-director of the Center for Sports Law and Policy at the Duke University School of Law.

“That’s at least a plausible move,” Haagen said.

Compelling the NCAA to do more, such as significantly changing rules, will likely require more research and a better understanding of concussions. There are no universal guidelines on determining when it is and isn’t safe to continue a career in contact sports after concussion injuries.

Some research has indicated a correlation between football and chronic traumatic encephalopathy known as C.T.E., the degenerative brain disease linked to repeated blows to the head. The issue came into the national spotlight in July, when researchers from the Boston University School of Medicine and the Veterans Affairs Boston Healthcare System found C.T.E. in all but one of 111 brains that belonged to former NFL players.

But experts cautioned against immediately drawing conclusions from that study, noting that the sample was biased. The brains were donated, not randomly selected. There are “strong associations” between concussions and C.T.E., one researcher said, but no scientific link. It’s possible that repeated blows to the head, not concussions, caused the C.T.E. in the players in the study.

There’s also no players’ union in college football as there is in the NFL, where a labor agreement exists between the league and the NFL Players Association. The most recent agreement, reached in 2011, stipulates that players are eligible for benefits if they are found to have neuro-cognitive impairments.

Without a players’ union at the college level, it’s difficult for players to fight collectively against the NCAA. But it hasn’t stopped some from trying: The Chicago-based law firm Edelson PC has filed at least 43 concussion lawsuits on behalf of former players alleging that the NCAA, conferences and individual schools knew or should have known the risks associated with football and did nothing. One of those suits was filed on behalf of former SU player Marcus Clayton. The attorneys at Edelson PC declined to comment on this story.

Former Syracuse quarterback AJ Long was disqualified in 2015 due to concussions. | Courtesy of AJ Long

Lawyers for thousands of ex-NFL players have filed similar lawsuits against the NFL, and in 2015 a judge approved a $1 billion settlement.

But lawsuits against the NCAA are less likely to succeed because, rather than a CBA, the NCAA has only a “loose obligation to consider student-athlete welfare,” said Haagen of Duke’s Center for Sports Law and Policy. Depending on the United States’ future politics, he added, it’s possible the lawsuits could be dismissed completely if the NCAA argues that athletes made an informed choice by playing football.

“The suits may go forward,” he said. “But they may not.”

Concussions suffered by players not involved in lawsuits, such as Marona and Johnson, likely are unknown to the NCAA or the ACC, since neither organization tracks those injuries.

The governing bodies likely don’t know about AJ Long’s injuries, either. Tucker disqualified the former Syracuse quarterback in October 2015 after he suffered multiple concussions. Long then transferred to Wagner and then Division II West Chester to continue his football career. Long declined to comment on this story.

Syracuse has also added players previously medically disqualified at other schools, such as Luke Arciniega in 2013.

Marona had come into the facility “every day” as a part of SU’s concussion protocol, he said, to talk about how he was feeling. He had taken the ImPACT once, then again, then a third time. Each time, he thought he improved and the computer spit back close to the same results. His displayed unreliable judgment, he said, pushed SU to have its final “heart-to-heart” in the head athletic trainer’s office. Looking back, Marona said he knew the risks of playing football and, while Shafer and SU’s staff seemed to care, he knew few in college football beyond the team’s complex did.

“The NCAA is a money machine,” Marona said. “They just want to get the guys on the field. It doesn’t matter to them. ‘We want these guys to get passing grades and we went them to be on the field.’ If something prohibits that, they figure well, injuries are part of the game. … But this injury specifically is a life-altering injury. If you tear your ACL, you’re not going to go dumb.

“Something needs to be done.”

CORRECTION: In a previous version of this post, the medical decision-makers for student athletes were misstated. Coaches are not permitted to make medical decisions on behalf of athletes. The Daily Orange regrets this error.

Published on August 28, 2017 at 12:47 am

Contact Sam: sjfortie@syr.edu | @Sam4TR