- The Washington Times - Monday, May 20, 2013


This much, at least, we can agree on. At 8:52 p.m. on May 13, Bryce Harper rammed face-first into the chain-link fence covering the right-field scoreboard at Dodger Stadium. The 20-year-old bounced back in slow motion, then crumpled to the warning track’s dirt and writhed in pain.

Harper left the game and needed 11 stitches to close a gash on his chin, while X-rays of his banged-up knee and shoulder were negative.

At no point was Harper diagnosed with a concussion.

That ignited a minicontroversy from armchair neurologists, insisting Harper, in fact, sustained a concussion and the Nationals wouldn’t acknowledge it. They pointed to three items, in particular:

1. Harper’s disorientation after making the wall’s acquaintance

2. Mild nausea similar to carsickness Harper mentioned to reporters the next day (it abated after he ate dinner)

3. Ill-informed comments by Davey Johnson insisting, incorrectly, that one can’t get a concussion from being hit on the chin or being knocked out (no one claimed Harper lost consciousness)

The vitriol generated by the nondiagnosis would leave one believing the Nationals engaged in a Nixonian cover-up with all the concussion know-how of Dr. Ira Casson, the NFL’s infamous “Dr. No,” to shove baseball’s brightest young star this side of Mike Trout back on the field.

“Everybody thinks they’re doctors and everybody thinks they know this and know that,” Harper told our Amanda Comak the other day. “The Nationals did everything they should. My trainers did everything. I saw two doctors in L.A. three days in a row. My trainers did everything. I feel better and my head, I feel fine.”

The well-intentioned caution and concern from living rooms and laptops across the country is laudable (and offering diagnoses based on scraps of information and television clips is tempting). Dr. Jeffrey Kutcher, who directs the University of Michigan’s Neurosport Program and the NBA’s concussion program, regularly receives video clips of athletes outraged senders believed were “obviously concussed.”

“The feeling that you can make this diagnosis via video, that’s completely misplaced,” Kutcher said. “Unless you are there evaluating that athlete and giving a comprehensive neurological evaluation, there’s no way to know for sure.”

Nonetheless, the not-so-subtle implication racing through the Internet of a concussion conspiracy by the Nationals makes as much sense as, well, running into walls. What could they gain by pretending Harper didn’t have a concussion or engaging in a game of semantics to avoid using the word?

The organization’s medical conservatism became legendary last year, after Stephen Strasburg was limited to 159 1/3 innings in his first full year after Tommy John surgery. They took the long view and never wavered, even under withering national criticism and October’s bright lights.

Back in 2011, in an abundance of caution, the Nationals ended Harper’s minor-league season in August over a mild hamstring strain. To believe the course would be reserved, a concussion denied and Harper’s long-term well-being put in jeopardy for a few extra May at-bats requires a certain suspension of disbelief.

With Harper, the Nationals satisfied Major League Baseball’s concussion policy that a panel of independent experts revamped in 2011. That includes baseline testing for each player and umpire; an optional seven-day disabled list for concussed players; and a series of return-to-play steps that must be completed after a concussion diagnosis.

According to Nationals head trainer Lee Kuntz, Harper passed multiple Standardized Concussion Assessment Tool 2 tests immediately after he was removed from the game and in the day after the collision. The four-page exam tests a variety of factors from balance (stand on nondominant foot for 20 seconds with eyes closed and hands on hips) to basic orientation (what’s the time, the month, the day?) to concentration (repeat 7-1-8-4-6-2 backwards).

SCAT2 is a tool best used, Kutcher said, as a method for non-neurologists to organize their thoughts during a neurological examination. But it’s hardly a rubber stamp back onto the field.

Kuntz examined Harper. So did Dodgers team physician Neal ElAttrache and at least one other independent doctor not associated with the Nationals.

Concussions, in fairness, can be notoriously difficult to recognize, as the Centers for Disease Control and Prevention notes, with transient symptoms and potentially vastly different impacts from one person to the next, one day to the next.

“It’s not an uncommon situation where we have somebody who experienced a force and does not produce any symptoms, signs or findings that any tool or scale or protocol will pick up until an hour later, two hours later, the next day,” Kutcher said. “It’s just the nature of the injury. Concussion is a clinical diagnosis made when the patient is experiencing effects of the injury.”

At some point, one has to defer to the involved medical professionals, several of them in this case, with direct knowledge of the situation. The ones who actually examined Harper and know more about his condition than an off-the-cuff comment to reporters or painful television replay.

Harper didn’t start the next two contests (he pinch-hit May 15) as he gradually resumed physical activity. The biggest problem hasn’t been his head. It’s the left knee he whacked on the fence. There’s no reason for outrage or dismissal of Harper’s headache.

“We need to realize a brain can be injured and not produce symptoms,” Kutcher said, “and so it’s an evolution, it’s an injury in progress, especially at the elite-athlete level. … We don’t turn our back on the person and say, ‘Come see me next week in clinic.’ We watch them very carefully.”

The Nationals will, too.



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