Unchallengeable autonomous medical authority remains elusive…

Guideline 1B in the NCAA’s 2025 Sports Medicine Handbook reads in part, “(S)chools must establish an administrative structure that provides independent medical care and affirms the unchallengeable autonomous authority of primary athletics health care providers (team physicians and athletic trainers) to determine medical management and return-to-play decisions related to student-athletes.”

Similarly, in the NFL, “The Club physician remains responsible for all final decisions regarding Return-to-Play.” So says the League’s 2024 “Concussion Diagnosis and Management Protocol.”

The purpose for those rules is to prevent the conflict of interest which is likely to occur when a coach wants a player back in the line-up but (s)he is not yet ready to return.

Unfortunately, the rules in print are not necessarily observed on the field in real time during a game or, for that matter, during the days that follow in the training room and locker room when the pressure builds to return a key player to participation.

That reality has played out repeatedly since the beginning of the 2025 football season. Even as coaches who have been accused of interfering in medical decisions have been among those fired recently, the culture that contributes to undermining medical independence remains unchanged.

In the wake of Penn State firing James Franklin on Oct. 12, former Nittany Lion team physician Dr. Scott Lynch, in a story on pennlive.com, said, “Here’s what I think about Coach Franklin’s dismissal: the health and safety of the athletes is better because of his removal.”

Back in May 2024, a jury awarded $5.25M to Lynch following a trial during which the orthopedic surgeon alleged he had been improperly fired by Penn State Health – a separate entity from the school — in 2019. Claims by the doctor against Franklin and the school’s athletic department had been dismissed pre-trial because of a technicality. However, Lynch’s case hinged entirely on his allegation that he was fired by Penn State Health due to his repeated battles with Franklin over the playing status of injured athletes.

Penn State Health is appealing the judgement. Meanwhile, the school itself and its athletic department are willingly paying Franklin the $49M still owed him at the time of his firing.

Lynch remains out of college sports since 2019 but Franklin, with a career record of 128-60 at Vanderbilt and Penn State, agreed on Nov. 17 to become the new head coach at Virginia Tech.

Brian Kelly supposedly walked away with a $53M golden parachute of his own when he was fired by LSU on Oct. 26. Since then, though, the school fired its athletic director four days after he dismissed Kelly and is now balking at paying Kelly. Intimating that Kelly was dismissed “with cause,” LSU has prompted Kelly to file suit.

Both parties should be intimately familiar with the legal process since they are co-defendants in a lawsuit filed by a former Bayou Bengal player in August of 2024.

Greg Brooks, Jr. is alleging the coaching staff threatened his scholarship and forced him to play through training camp and two games despite feeling ill. He first displayed neurological symptoms on Aug. 5, 2023. His persistent and worsening complaints ultimately led to the discovery of a brain tumor but not until six weeks later, on Sept. 13.  By then, emergency surgery was required, which Brooks and his lawyers also allege was botched and has left him permanently disabled. 

No lawsuits should be expected from Giants quarterback Jaxson Dart, even though it took trips to the medical tent in four separate games this season before he was diagnosed with a concussion on Nov. 9. The third such incident is the most famous. On Oct. 9, during a game against the Eagles, the rookie was tackled and had his head treated like a pinball as he fell to the turf with 2:17 remaining in the 3rd quarter. 

While facedown, the rookie grabbed for his helmet and did so again after rolling over on his back. And he could not get up. During a slow-motion replay, Dart appeared to lose consciousness briefly during the fall.  Eventually, he was able to get to his feet and jog off to the medical tent.

That’s where the controversy started. Giants head coach Brian Daboll was right behind Dart, supposedly — according to Daboll — just sticking his head in to see if his quarterback was alright.

If that was not bad enough, while the examination in the tent continued, Daboll was seen on the sideline yelling at Giants head team physician Dr. Scott Rodeo, a prominent New York orthopedic surgeon. Apparently not satisfied with what Rodeo said, Daboll was then observed yelling and gesturing toward the injury tent, making clear he wanted the process accelerated.

Dart was ultimately cleared and allowed to return for the next series, missing only two offensive plays, and the Giants won.

Daboll, anticipating trouble, volunteered at the post-game press conference that he was in the wrong and had apologized to Rodeo. The following morning, he was called on the carpet by Giants co-owner and CEO John Mara.

The incident also triggered an NFL and NFLPA joint investigation into whether or not the league’s concussion protocol regulations were violated. The League fined the Giants and Daboll for Daboll’s conduct – and that of a teammate who also entered a tent. However, the League exonerated Giants medical staff for allowing Dart to return to play, saying their examination followed the League’s protocol.

The SCAT 6 should take a minimum of 10 minutes to complete, yet, Dart returned after a total of seven plays…

However, the sideline exam mandated by the NFL – essentially the SCAT 6 — should take a minimum of 10 minutes to complete, according to the British Journal of Sports Medicine.

Yet, Dart returned after a total of seven plays were run and only 3:19 had elapsed on the game clock. Feeling pressure from Daboll, did the Giants medics really complete the entirety of the mandated testing in that time? Was video of the play thoroughly reviewed as it was supposed to be? And if it was, how was the apparent loss of consciousness missed?

Just 10 days later, after Patriots quarterback Drake Maye was thrown on the back of his head during an eventual 31-13 victory over the Titans, he was slow to get up and shook his head as if to clear the cobwebs, both signs of concussion. Before the Patriots could run another play, concussion spotters in the press box buzzed down to the referee and had Maye sent to the sidelines for an evaluation. He missed two plays total. How was that possible?

While Maye may have escaped the dreaded “C” word that day, Dart was finally unable to do so on Nov. 9 against the Bears. Once again, his head hit the ground, he lost the ball, and crumpled up on his side – rather than trying to recover the ball. Slow to get to his feet, he eventually left the field because of the turnover and neither the concussion spotters nor sideline personnel seemed any the wiser because he was allowed to return for two plays. At that point, the third quarter ended and the coaching staff removed him and summoned medical staff because they became concerned with his appearance.

Credit the coaches for once but their conduct was not enough to save Daboll’s job. Mara dismissed him the next day, not for his conduct in relation to injuries but for another blown lead, as the Giants fell to 2-8.

Don’t worry about Daboll. While his send-off will not be as lucrative as Franklin’s or Kelly’s, he is owed the remainder of his $5M salary for this season and another $5M for next year. Undoubtedly, given his previous success as an offensive coordinator, he will have no trouble finding lucrative work, just like Franklin and Kelly – regardless of any allegations of mistreatment of injured players.

Doubt me?

Go no further than the football program at Auburn University, where head football coach Hugh Freeze was fired on Nov. 2 and given $15.8M going out the door. At least the school’s leaders did not saddle themselves with the bills Penn State and LSU now face. Still, did you happen to notice whom they elevated to replace Freeze, at least temporarily?

Defensive coordinator D.J. Durkin, the same D.J. Durkin fired by the University of Maryland in November of 2018 in the wake of Terrapin offensive lineman Jordan McNair’s death from heat stroke in June of that year. Two athletic trainers also lost their jobs as a result of the incident. Neither of them has ever returned to college athletics. But Durkin spent only one year in exile – as a consultant with the Atlanta Falcons. Since 2020, has held defensive coordinator positions successively at Ole Miss and Texas A&M prior to landing at Auburn, where he was earning $2.5M this year before being promoted.

The patterns established are clear and unbroken. High-price coaches keep getting recycled no matter how they treat their athletes, as long as they win. They generally bring with them strength and conditioning coaches earning high six-figure salaries.

Meanwhile, physicians and athletic trainers are treated as disposable. Furthermore, too many athletic trainers receive five-figure salaries despite making six-figure and seven-figure decisions regarding the health of athletes on a daily basis. The major college and professional levels show how much they value athletic trainers – and physicians – by how they pay them and treat them. As long as low pay and poor treatment persist, “unchallengeable autonomous authority” will remain a myth – and athletes will suffer as a consequence.

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at jdoherty@powershealth.org. Follow him on X (formerly Twitter) @JDohertyATCPT.