One of the foremost authorities on concussion in sport, Dr Willie Stewart, is considering his position on World Rugby's Independent Concussion Advisory Group following another report into a player being left on the field despite a suspected concussion.
The written report by a review group, convened by EPCR and published last week, concerned an "untoward incident" where Conor Murray was injured in Munster's Champions Cup game in Glasgow, in January. Murray was flattened in the incident; treated by medics; allowed to continue; flattened again in a separate incident; then withdrawn for a Head Injury Assessment (HIA); and then allowed to return to the field.
"The Head Injury Assessment, and particularly this review process, is in tatters," Stewart told the Sunday Independent. "Serial reviews that have continued to find no fault in the process, and no fault in the application of the process, just don't hold water."
The reviews Stewart was referring to include those convened by the (English) RFU into incidents in Premiership games this season involving George North, playing for Saints against Wasps, and TJ Ioane playing for Sale against Harlequins. In both cases no action was recommended against the clubs concerned.
World Rugby convened a meeting last week to discuss the efficacy of the review system, which is under the control of competition organisers. Stewart did not attend.
"We'd be disappointed if Willie decided to stand aside," World Rugby chief medical officer Dr Martin Raftery said. "But if Willie decides to do that then I can't change his mind. He's a strong personality; I respect his decisions and I respect his opinions."
Asked if he was uneasy about the way the review system was operating, Raftery said: "We had planned a meeting to review it and got a subject expert from the United States to facilitate it - so we're not going to do that if we're happy with the way it's going."
The initial decision on the Murray incident was handed down a week after the game and cleared Munster. The written report however, which comes seven weeks after the event, has no testimony from players who witnessed the collision. Moreover, it includes testimony from Munster that a key element of the HIA - the Maddocks questions - was carried out on the field. This is contrary to SCAT3 - the accepted concussion guideline - which says: "The Memory Function (Maddocks Questions) should not be used to clear a player who has a suspected concussion."
"There is no place in rugby at any level for the Maddocks questions on the field," Willie Stewart says. "World Rugby has been very clear on that from the outset. If you ask Maddocks questions on the field you're already beginning the process of establishing if the player is orientated, and if his brain is functioning OK. If you're asking then it's because you think the player has been involved in a head collision that may have injured the brain. That's a Head Injury Assessment, and the player needs to be off the field."
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