Tuesday 25 September 2018

French farce shows need for neutral doctors

Rugby already has Television Match Official so why not have a Television Medical Official?

France's Antoine Dupont lies on the turf at the Stade De France after an injury which led to him being helped off the pitch by medics Photo: CHRISTOPHE SIMON/AFP/Getty Images
France's Antoine Dupont lies on the turf at the Stade De France after an injury which led to him being helped off the pitch by medics Photo: CHRISTOPHE SIMON/AFP/Getty Images
David Kelly

David Kelly

The problem with concussion is that the more we know the less we know.

When even the medical profession admit that there is a limit to their ability to fully grapple with concussion - we know this because so many doctors have wildly deviating opinions on the issue - how can players, referees and spectators deal with it?

When an MRI scan or CT scan cannot sometimes be sufficient to properly diagnose a concussion, sport cannot conceivably hope to ensure that potential cases are dealt with adequately.

With medical science unable to correctly and accurately identify concussion, it stands to reason that unqualified humans are even more incapable of doing so.

Dupont is led off the field Photo: CHRISTOPHE SIMON/AFP/Getty Images
Dupont is led off the field Photo: CHRISTOPHE SIMON/AFP/Getty Images

Which is why referee Nigel Owens has been pilloried for many quarters for suggesting a head injury occurred to French scrum-half Antoine Dupont last Saturday.

The referee's difficulty is that he knew that he was helpless to influence matters due to rugby's current protocols.

In such a cauldron, with nearly 80,000 spectators baying and players seeking advantage for their side, the obvious risks in attempting to establish in such circumstances whether or not there may or may not be a concussion is clearly fraught with fallibility.

And, when a team eyes the chance to potentially manipulate the situation for their own advantage, as it is alleged France did at the weekend, then it is clear that the whole process is unworkable.

Potential

The difficulty in Saturday's instance is that, according to the fourth official, Thomas Charabas, speaking to 'L'équipe', Owens immediately indicated the necessity for a Head Injury Assessment after being alerted to the potential by his assistant, Paul Williams, who had seen the player fall injured.

Charabas explains how he then initiates the HIA protocol but almost instantaneously, Dupont indicates his knee has been damaged and the French staff concur.

The independent match doctor, Mr Gilles Garet, insists to Charabas that the HIA protocol must continue and the fourth official comes on to the field to communicate this information to Owens, by this stage surrounded by irate Irish players.

"Owens did not take the decision," said Charabas. "It's the match doctor who is the ultimate decision-maker in such circumstance. Never at any moment has the French staff, including Jean-Baptiste Ellisalde (an assistant French coach) who was in the technical area, asked for any HIA."

While all this is happening in such a short space of time, extensive replays throughout the world have alerted viewers to the possibility that there may be something more suspicious going on.

That France indicate they may re-introduce their starting scrum-half - an expert place-kicker who would have been allowed to take the side's 78th-minute penalty which may well have won the game - heightens those suspicions.

However, presuming that the fourth official is correct in asserting that nobody from the French side was involved in initiating the HIA, what can the French side be accused of, other than making the best of a messy situation?

At the very most, they have simply acceded to instructions from match officials and, not for the first time in the history of professional sport, sought to maximise the potential advantage of the ruling.

Many sides and players - including Irish ones - have sought to keep one step ahead of rugby's increasingly convoluted attempts to deal with the issue.

What remains unclear is quite why the French didn't go the whole hog and allow Machenaud to take the penalty that was missed by his colleague.

Previously, he would have been disbarred from doing so but, as if proving the point that the lawmakers remain a step behind the lawbenders, the ongoing change in the protocols would have been allowed him to do so.

At the least, having a specialist scrum-half for the finale offered a clear advantage to the French regardless of the final result.

Ironically, France's manipulation of the HIA protocols against Wales last season had prompted the change which confirms something we do know about concussion.

It is impossible for rugby to keep pace with the perils of its unknown consequences.

Everyone in the sport - players, coaches, administrators - are utterly fearful of an NFL-like deluge of medical tragedies and multi-million lawsuits down the line.

Which is why, for example, a referee will never dispute the assessment of a doctor regardless of the pictures being painted in front of him. If it is hard enough to recognise concussion - symptoms may not emerge for hours or days - it is even harder to identify when there isn't one.

The Six Nations have already established a review but it is difficult to know exactly what they can precisely uncover.

Our money is on, as has already happened this season, the unwitting blame being shovelled in the direction of the match officials. It's always easier to blame the ref.

We would hope that they scratch a little deeper.

As we have mentioned, both the role of fourth official and the newly-unveiled position of independent match doctor were filled by French people. This should not happen. If the sport can pay to ferry neutral referees, TMOs and citing officers around the continent, it should be in a position to do the same for neutral doctors.

And if the ref can be wired to a Television Match Official and his selection of replays, then why not also a Television Medical Official?

If investigators discover flaws in the already imperfect HIA process, the sport will have damned itself yet again in this area.

Unveiling nothing could smack of a whitewash and an admittance that they still don't know how best to tackle the concussion problem. Then again, we know that already.

Irish Independent

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