Dr. York 'perfectly comfortable' with handling of Smith's concussion

November 20, 2012, 10:50 pm
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Before there can be any quarterback controversy, 49ers quarterback Alex Smith must receive medical clearance to return to play after sustaining a concussion Nov. 11.

Smith was cleared to practice last week through Saturday, according to the 49ers' practice reports. His participation was listed as "limited." Even team owner Dr. John York said he was surprised when he learned that Smith would not be available Monday night to play against the Chicago Bears.

And under the NFL protocol on concussions, Smith would not be cleared to play Sunday against the New Orleans Saints unless his symptoms clear.

Coach Jim Harbaugh said after the 49ers' game Monday that Colin Kaepernick got all of the practice snaps on Saturday and Sunday, which seems to indicate Smith was experiencing symptoms over the weekend.

Teams are not required to provide an injury update on the day before a game, so the 49ers did not submit any notification of Smith's participation -- or lack thereof -- in Sunday's practice.
The 49ers made the call to start Kaepernick on Sunday before knowing if Smith would gain medical clearance to play, Harbaugh said."Yeah, (we) made the decision Sunday that Colin would start the game," Harbaugh said. "And then we found out Monday that Alex would be out. But that decision was made to start Colin on Sunday."Again, not a big mystery here. Just felt that Alex still had some symptoms on Sunday and we were going to make the decision to go with Colin."The 49ers announced Monday at 10:30 a.m. that Smith was declared out after being evaluated by team medical director, Dr. Dan Garza, one of the leading concussion researchers at Stanford.Dr. York is the chair of the NFL Owners Committee on Health and Safety. After the game, I spoke with him about his team's handling of Smith's situation:"The 49ers handled it according to the (NFL) protocol," York said. "That's what we're supposed to do, and that's what the other 31 teams are supposed to do. So I'm perfectly comfortable with how we handled it."At what point did Alex Smith begin experiencing symptoms?
Dr. York: "This is not avoiding your question, but I don't know the answer to that. That's between the doctors and Alex, so I don't get into that."If he were cleared to practice for four days, I'd assume that means he did not have any symptoms. Is that correct?
Dr. York: "Well, I don't know exactly because I wasn't here all week. You tell me the sequence of where Alex was."He took part in limited practice Wednesday -- well, unofficially Wednesday -- officially on the reports, Thursday, Friday and Saturday.
Dr. York: "So what that would mean to me is that he did not have symptoms at those times and that in meeting with the neurologist, which he had to do, that he was OK. He probably went through the neuropsychological testing and I don't know at what time he started to develop symptoms. But what you need to understand is if you have a concussion, you might not have symptoms right away. You may have them later. You may have symptoms now, they go away, and they come back. So trying to figure out whether or not he had symptoms on Wednesday or Thursday or Friday, obviously, he didn't have symptoms to the extent that the doctors knew it and Alex felt uncomfortable. I don't know when Alex felt those symptoms."Are you apprised of it as the chair of the committee?
Dr. York: "No. I'm not apprised of it from any other team, nor should I be from our team. I'm kept in the loop as the owner of the team."Do you believe everything is working league-wide as it pertains to the handling of concussions?
Dr. York: "It is far better than it has ever been. Can it improve? I think the answer is yes. But you have a situation where there is a big game between the Bears and the 49ers, and both quarterbacks had concussions. I personally thought that Alex was probably going to play. So I was surprised when he did not. But when I was told that he had symptoms and he was not going to be able to play, that's the protocol, I accept it. Jay Cutler, I don't know what happened to Jay because I'm not privy to that. But he's out. And my understanding is that Michael Vick was out. So you had three starting quarterbacks, all pretty high profile, and not one of them played. And to my knowledge, if they had passed all of the protocols, all three of them would have played."Is that a signal to you that it's working?
Dr. York: "I think it's a signal that people are following the protocols and if you don't clear, you don't play. So we've seen things where we thought we had things covered, and we do other things, such as putting the AT (athletic trainers) spotter in the video booth. There are going to be things that we're going to have to continue to do better and better. So we're going to be diligent about finding out what the protocols are, and that people are following them. And when things need to be changed or improved, we'll do that. But it won't come from me, it'll come from the physicians."

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