It was a month into the fall semester, and visits to the student health center of the mid-size university were beginning to pick up. Ms. A, a 46-year-old nurse practitioner, had been running the health center for the past seven years. She greatly enjoyed working with college students, and the diversity of their complaints made the position interesting and challenging. On any given day, she could find herself treating anything from flu to an STD to a sports injury. The variety of ailments she encountered kept her job from becoming rote. Ms. A was outgoing and friendly, and was well-liked by both students and faculty.

One day in early October, Mr. V—a popular, 19-year-old student athlete—came in complaining of a six-day history of headaches, tinnitus, and dizziness.

“What sport do you play?” asked Ms. A.

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“Football,” Mr. V answered proudly. “I’m a linebacker.”

“Any recent injuries?”

“Well, yeah,” replied the young man. “Six days ago, during a scrimmage, I got head-butted by another player. We were both wearing helmets, but it was a pretty major crack to the head. I got a headache right after and stopped playing for the rest of that practice.”

“And then what happened?” inquired Ms. A.

“Well, four days later, I was playing in a game, and my head was hurting so I told the athletic director and he told me to come see you, so here I am.”

After examining the young man and discussing his symptoms with him, Ms. A diagnosed him with a concussion. She advised him to take OTC pain medication, rest, and stop playing football. Mr. V looked horrified.

“I’m not saying forever,” Ms. A consoled him. “But you need to get some rest and let yourself heal. Come back and see me in a few days and we’ll see how you’re doing.”

The next day, however, the young man took himself to the emergency department (ED) of the local hospital, where physicians performed a CT scan of his head. The ED physician told Mr. V that the results were normal and that he should follow up with his regular physician.

The following day, Mr. V returned to Ms. A and showed her the results of the CT scan. “I’m glad to hear that the results were normal,” said Ms. A, “but I’d like you to continue to rest, and I don’t want you playing football for at least another week.”

Despite this advice, the athletic director cleared the young man to return to the field four days later. About a month after the original injury, Mr. V was playing in a game at another school when he was tackled by a player on the opposing team. He collapsed to the ground and momentarily lost consciousness, then came to and stood up. For a few moments he was combative; he then fell down again and lost consciousness.

The young athlete was rushed to the hospital in a coma and underwent emergency surgery to treat a subdural hematoma and severe swelling of the brain. Unfortunately, Mr. V’s injuries were severe, and even with surgery he was left with permanent catastrophic brain damage. The doctors informed his family that in addition to spastic quadriparesis, Mr. V had a motor speech disorder rendering him unable to talk, neurological injuries, seizures, cognitive deficits including short-term memory loss, and emotional injuries. The young man’s family was informed that he would require 24-hour assistance for the rest of his life.

Ms. A, the athletic director, and Mr. V’s teammates and friends all were devastated by the news. In all the years of working at the student health center, Ms. A had never experienced such a tragedy. She was depressed for weeks, thinking about the promising youth and how his life had been inexorably changed. As the months passed, she began feeling better—at least until she was notified that both she and the university were being sued.

Ms. A spoke with the defense attorney provided by the university. According to him, Mr. V’s family had (on Mr. V’s behalf) originally sued numerous parties, including the player from the opposing team and the emergency department of the hospital, but the other cases had been either settled or dismissed. The only case that was progressing toward trial was the one against the university and Ms. A.

The defense attorney went over the plaintiff’s claims with Ms. A. “They are saying that Mr. V suffered from ‘second-impact syndrome,’ which means that because his brain was contused from the first impact, the second impact caused it to swell rapidly and herniate immediately,” explained the attorney. “They claim that the injury could have been avoided if you had referred him to a physician, had given him a proper neuropsychological evaluation, or, most important, had kept him out of the game for a longer period of time so he could heal. They also claim that you didn’t warn him of the dangers associated with his continuing to play football following a head injury.”

Ms. A felt her stomach sink. She thought back to what she’d told the young patient. She couldn’t remember specifically telling him anything about the dangers of head injuries and football. And perhaps she should have told him to wait longer than a week before playing again.

The defense attorney saw Ms. A’s look of despair. “It’s not all bad news,” he reassured her. “He had a negative CT scan, and that points to the fact that your treatment was reasonable. And we can always argue that the injury was the result of the second impact, not the first. I’m not sure they have enough evidence to support their ‘second impact’ theory.”

The case inched toward trial, leaving a wake of depositions, motions, and paperwork. Shortly before the trial was scheduled to begin, however, the university and Ms. A settled with the plaintiffs for $7.5 million.

Legal background

While it is possible that Ms. A and the university had a chance at avoiding liability, there also existed the chance of a jury giving a much higher settlement to the plaintiffs. Jurors, despite instructions from the judge and promises to be fair, are still only people, and people are affected by a tragic story such as this one. A young athlete, struck down before ever enjoying life as an adult and now unable to speak or care for himself, destined to spend the rest of his life as an invalid … this picture could certainly sway jurors and entice them to be generous when awarding damages. Sometimes the smarter course of action is to negotiate a settlement and not put everyone through the misery of a trial.

Protecting yourself

Ms. A not only should have warned Mr. V about the dangers of playing football after a concussion, she also should have told his athletic director, put a written note in Mr. V’s chart, and sent a written note to the athletic department. Head injuries, especially those that are football-related, can be extremely dangerous. While Mr. V might have been unhappy about sitting out a semester of football, it might have made all the difference to his future.