New Statutory Requirements for Handling of Student-Athlete Concussions

With studies showing that concussion injuries put athletes at immediate risk for traumatic brain injuries and increased long-term cumulative risks for early onset dementia, clinical depression, Parkinson’s disease, and Alzheimer’s disease, school districts are looking to protect their student-athletes from physical harm and themselves from exposure to legal liability for that harm.  Recent California legislation has attempted to address the issue.

In the fall of 2011, the California legislature enacted Education Code section 49475 mandating that school district meet certain requirements in addressing student athletes with suspected head injuries.  This law took effect January 1, 2012 and is based upon a codification of California Interscholastic Federation (“CIF”) Bylaw 213.  Although the legislation provides guidelines for these issues, some of the provisions are unclear and untested.

Education Code section 49475(a)(1) lays out the basic requirement of the law:

An athlete who is suspected of sustaining a concussion or head injury in an athletic activity shall be immediately removed from the activity for the remainder of the day, and shall not be permitted to return to the activity until he or she is evaluated by a licensed health care provider, trained in the management of concussions, acting within the scope of his or her practice.  The athlete shall not be permitted to return to the activity until he or she receives written clearance to return to the activity from that licensed health care provider.

Section 49475 does not apply to an athlete engaging in an athletic activity during the regular school day or as part of a statutorily required physical education course.  [Ed. Code § 49475(b)]

A “licensed health care provider” is not defined by Section 49475.  However, CIF Bylaw 313 states: “The ‘scope of practice’ for licensed health care providers and medical professionals is defined by California statutes.  This scope of practice will limit the evaluation to a medical doctor (MD) or doctor of osteopathy (DO).”  Although Bylaw 313’s definition of “licensed health care provider” was not included in Section 49475, it was cited in Assembly Bill 25, the bill underlying Section 49475.

Districts should be aware that a physician’s written medical clearance of a concussed student- athlete to return to play does not remove the districts’ protective responsibility to make sure the athlete is ready to actually participate in his/her sport.  Injured athletes should be closely monitored and evaluated by nursing staff and trainers to make sure they remain symptom free after exertion from practice and other physical activities before permitting them to participate in the contact activities of their sports.  Even after a release to return to play from a doctor, physical exertion could result in a recurrence of symptoms making it unsafe for the athlete to continue physical activities.  A carte blanche release to full activities could potentially put a student athlete in harm’s way and could also increase the district’s own exposure to liability should the athlete incur an additional head injury after being released from a doctor.  Therefore, the District should remain vigilant for any symptoms of concussion even after a medical release.


A student athlete who has been found to have significant head injury must be evaluated and released by an MD or DO trained in the management of concussions prior to returning to participation in their sports.  A district should not allow any other kind of medical providers (i.e. chiropractors, nurse practitioners, or physician assistants) to provide medical clearance for students with head injuries in order to fully comply with California law.  Districts should also make sure the doctor’s medical release complies with the requirements of Section 48475 before allowing athletes to return to play.

Finally, Districts should establish procedures and a protocol on how to evaluate, monitor, and treat head injuries when they occur in athletic competitions and how to evaluate and monitor the student athletes’ after they are medically cleared to verify that there are no recurrent symptoms.


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