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An in depth look at the New Mexico Concussion debacle

When Shawn Nieto felt the hit, he clutched the football tight, making sure not to lose his grip, even as his 16-year-old body fell limply to the ground.

When Erica Nieto saw the hit, she sprinted from her seat in the stands, down near the sidelines and screamed for her son’s attention.

When the trainers at Cleveland High in Rio Rancho, N.M., saw the hit, they ran onto the field to make sure their junior running back was okay.

This much, everyone agrees on. What happened in the seconds, minutes and days that followed the state semifinal playoff game ultimately led both sides to a courtroom. School officials say Shawn was knocked unconscious for 20 to 30 seconds. He suffered a concussion, they said, which meant under state law, he was forced to sit out seven days to recover — which meant he’d miss the following week’s state championship game.

But Shawn says he never lost consciousness and his family insists he didn’t suffer a concussion. So they hired a lawyer and filed a motion in court last month, pleading with a judge to let Shawn play in the title game.

The case highlighted much of the confusion surrounding concussions, particularly as it concerns children and teen-aged football players. In recent years, youth leagues across the country have changed the way they teach football. States have passed laws to ensure high schools monitor player safety better. And the NFL has tweaked its rules and aired public-service announcements to educate a football-crazed nation about head injuries.

Yet, there still remains uncertainty and inconsistency about head injuries in young athletes. Participation numbers continue to drop in many areas, and according to a Harris Poll last year, one in three parents lives in fear that their child will get a concussion and one in four prohibits their kids from playing contact sports because of concussion concerns. The same poll found 87 percent of adults can’t correctly define a concussion, and 37 percent say they’re confused about what a concussion is.

Parents have to sort through conflicting information. Doctors such as Bennet Omalu, the subject of the movie “Concussion” who’s credited with identifying chronic traumatic encephalopathy (CTE) in football players, and Robert Cantu, who co-authored the book “Concussions and Our Kids,” have said children shouldn’t play tackle football until the age 14. Many other concussion experts say the science doesn’t yet support such a drastic conclusion.

And while football families try to sort out the facts, science and the proper precautions, the Nieto family is among those who say concussion hysteria has made the sport’s decision-makers overcautious at times.

“That’s the bogey-man blanket they’re throwing in sports now,” said Peter Nieto, Shawn’s father.

By barring Shawn from competing, the family said the school district violated his constitutional right to due process, his state constitutional right to participate in extracurricular activities and interfered with his educational opportunities.

School district officials in Rio Rancho, meantime, say they were just following the law and protecting the young player’s health and well-being.

When a state judge heard the case last month and was presented with the evidence in an Albuquerque courtroom, he felt he had no choice: Shawn Nieto, who may or may not have suffered a concussion one week earlier, was granted a temporary injunction and allowed to play in the state title game.

Versions of events

Shawn began playing youth football at age 7. His father competed in the sport and his siblings were athletes too. His older sister even wrestled for the school team.

“As a mom, of course you’re concerned about how dangerous this is,” his mother, Erica, said this month in the first interview the family has done, “but I’ve always been an active parent when it comes to this stuff, attending practices, games, events to ensure if there is an injury, I’m there and able to seek medical attention as needed.”

Peter has coached wrestling and junior high football and said he’s gone through specific training related to concussions. “I’m not a professional by any means,” he said, “but I do know what people are concerned with.”

Standing just 5 feet 5, 140 pounds, Shawn took over his team’s starting running back position midway through the season and went on to run for 931 yards and 18 touchdowns. His Cleveland Storm team, a preseason favorite to win state, posted an undefeated record.

The Nietos said the school never gave any training related to concussions, but they were given an informational sheet and required to sign a form.

The team breezed through the season, and despite his size, Shawn emerged as a key contributor. In the team’s playoff semifinal game, Shawn says he remembers everything. The Storm led and were charging down the field. Coaches called for an option play, and Shawn took the ball and began to make a cut. He saw an open field.

“I thought I was gonna score,” he said.

But Shawn was yanked down by a horse-collar tackle and before he hit the ground, another player crashed into him, their helmets colliding.

Shawn lay still on the ground. Trainers hovered over him. They say he was unconscious. Shawn says the wind was knocked out of him and was merely catching his breath.

He eventually rose to his feet and when he reached the sidelines, he gave his mother a thumbs up. Team trainers administered a memorization test, and he correctly recalled two of the three words he was told to remember. He said he was distracted watching the game and missed one. He was given a balance test, too, and says he passed.

After the game, Shawn told his parents he felt fine. He didn’t have a headache and didn’t ask for medicine. He rode a bus three hours back to school, and coaches then allowed him to drive home alone from there.

“If it was that serious, I’d hope they’d notify the parents that there’s some major concern,” Erica said.

Shawn said he was told the next day at school that he was in the concussion protocol and would be unable to play in the state championship game.

Peter drove straight to the school when he heard the news. He talked to coaches, the athletics director and the school’s athletic trainer. The trainer explained Shawn was unresponsive and had been knocked unconscious. The parents say they were never given any paperwork to support the school’s assessment and they never observed any symptoms that Shawn had suffered a head injury in the game.

“We’re not rookies,” Peter said. “We know what a concussion is.”

‘There’s no wiggle room’

While concussions and the degenerative disease CTE has made headlines and been linked to football greats such as Junior Seau and Frank Gifford, researchers are still trying to understand the risks football might pose to young people.

“The younger we go, the less science there is,” said Harry Kerasidis, a neurologist who authored the recent book “Concussionology: Redefining Sports Concussion Management For All Levels,” “and we have kind of extrapolated from studies that were done on older individuals.”

Kerasidis explained that there are two schools of thought: (1) a child’s brain is still developing and any trauma can be especially harmful; (2) children are smaller, slower and perhaps unable to deliver as much force in their collisions as older players. While recent research has found CTE widespread in a former player who was 25 years old at the time of his death, researchers are working to understand definitively the long-term effects of head trauma suffered by young players.

“We really don’t yet have the level of science that we need,” said Gerard Gioia, who heads the division of pediatric neuropsychology at Children’s National Medical Center in Washington and directs the Safe Concussion Outcome Recovery and Education Program. “We don’t know what the difference is between a 7-year-old brain taking a blow or hit versus a 13-year-old versus a 17-year-old. We really need those studies to be done.”

Nieto’s family was eager to learn Shawn’s condition and made a doctor’s appointment for the following day. Shawn met with a doctor and exhibited normal cognitive ability, orientation, memory recall and concentration, according to the family’s court filing.

Backed by the doctor’s recommendation, the Nietos became even more determined for him to play in the state title game and explored their legal options.

“If something looks bad, it doesn’t mean it’s really that bad, you know,” Peter said. “This just happened at an emotional milestone in our son’s life, so we were gonna do whatever we thought we could to get his voice heard, to not lose this opportunity.”

The school district, meantime, was just as adamant that Shawn had been injured and state law required he sit out seven days.

“There’s no wiggle room,” said Bruce Carver, the school district’s athletics director. “If somebody thinks it is [a concussion], we go the safe road and keep him out.”

All 50 states, including the District, have passed laws that address concussion safety in youth sports, but the particulars vary. A concussion might be diagnosed differently in South Carolina than Colorado, and the required recovery might be different in California than Pennsylvania. Arkansas allots money for a program but has no standards in place. Wyoming doesn’t require parents to sign a consent form. Only a handful, such as New Mexico, have a mandatory waiting period before a player can return to action.

While New Mexico’s statute was hailed as one of the toughest when it was signed into law in 2010, opinions vary as to whether a mandatory waiting period is effective. A 2009 study looked at 635 high school- and college-aged concussed football players and found that the waiting period “did not intrinsically influence clinical recovery or reduce the risk of a repeat concussion in the same sports season.”

“This concussion law is just one size fits all,” Erica said of New Mexico’s statute. “It’s expected to fit every situation, and it really does not allow for how to address a conflict — how do you get an independent evaluation? There’s no wiggle room at all and I think there needs to be.”

Still at odds

State district Judge Alan Malott scheduled a hearing for Dec. 4, barely 24 hours before the championship game was schedule to kickoff. Neither the school nor the school district showed up in court, and Malott had at his disposal one key piece of evidence: Shawn’s doctor clearing him to play. Malott granted the injunction.

“The fact that the doctor said he was fine and never was hurt was obviously pretty substantial evidence,” Malott said in a phone interview. “The school didn’t even show up, so I didn’t have the benefit of a coaches’ report or anything like that.”

The morning of the title game, though, Karen Ortiz, the physician who examined Shawn, sent a letter to the school district, rescinding her opinion and saying the family was not forthcoming with the extent of Shawn’s injury.

“Had I understood that there was a loss of consciousness, I would have never provided medical clearance,” Ortiz wrote in a letter first published in the Albuquerque Journal.

A spokesperson for Ortiz’s employer, Lovelace Health System, said the doctor could not comment on the case, citing privacy concerns. Neither the Nieto family nor the judge say they’ve ever seen the letter.

The Cleveland Storm took the field that night and Shawn was in uniform alongside his teammates. But he’d missed the entire week of practice and coaches didn’t use him in the game. Shawn’s lone appearance was for brief a fourth-quarter kickoff. His Storm team posted a 48-35 win to capture the title and cap a 13-0 season. Shawn’s replacement ran for 200 yards and scored a touchdown.

Shawn said watching his teammates win the state championship without him was bittersweet. Many students at his school didn’t understand why his parents took to the courts, and the school hallways this winter have not always pleasant. His wrestling season has since started, though, and he hopes to regain his starting running back job next fall as a senior.

The Nietos remain upset with the letter of the law and the school’s application of it. They’re still confident Shawn never suffered a concussion. School officials overreacted, they say, and Shawn suffered because of it. They plan to write a letter to the local school board suggesting ways the rules could be improved.

Carver, the school district’s athletics director, said the school and team officials “could’ve done a better job communicating,” but they still support the spirit of the law.

“We feel like we did what’s best for the kid and trying to protect him,” he said.

ORIGINAL ARTICLE

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New Mexico Concussion Confusion Continues

The doctor whose opinion a district court judge cited as a key basis for his decision to allow Cleveland running back Shawn Nieto to play in the Class 6A state championship football game, despite suffering a blow to the head a week earlier, rescinded her initial recommendation on the morning of the game, the Journal has learned.

Dr. Karen Ortiz said in a letter sent to Rio Rancho Public Schools and the New Mexico Activities Association – dated Dec. 5 – that she would never have cleared the first-team tailback to play had she known he had lost consciousness a week earlier after suffering a blow to the head.

That letter was dated one day after Judge Alan Malott ruled that Nieto could participate in the Storm’s title game against Eldorado.

Cleveland’s team physician, Dr. Laurence Laudicina, also wrote a letter to school officials, dated the day of the game, setting out the possibility of dire consequences should Nieto be allowed to play.

“Allowing Mr. Shawn Nieto to return to play at this time may result in a wide range of long-term neuropsychologic disorders as well as possible catastrophic brain injury, unfortunately,” the letter concludes.

Nieto was allowed to suit up and was inserted for one play, despite the new letters concerning medical risk.

RRPS Athletic Director Bruce Carver said district officials were concerned about the conflict posed by Malott’s order and the doctors’ opinions.

“My superintendent (Dr. V. Sue Cleveland) and I felt like a court order supersedes everything,” Carver said. “We’re in a real tough pickle here.”

Ortiz evaluated Nieto, Cleveland’s starting junior tailback, on Tuesday, Dec. 1. This was three days after Nieto suffered a severe hit to the head during the Storm’s semifinal win at Mayfield on Nov. 28.

Cleveland’s veteran trainer, Jeff Archuleta, said Nieto was knocked unconscious and had suffered a concussion.

Ortiz did not come to the same conclusion in her evaluation three days later, based on an examination and discussions with Nieto and his father.

Laudicina spoke with Ortiz on Friday, Dec. 4, and that conversation apparently convinced Ortiz to change course.

Ortiz in her Dec. 5 letter said Nieto and his father, Peter, insisted the player had not lost consciousness.

“Had I understood that there was a loss of consciousness, I would have never provided medical clearance,” Ortiz wrote to RRPS and the NMAA.

That letter was received in the NMAA office, at Rio Rancho Public Schools, and at Cleveland, at 9 a.m. Saturday. NMAA executive director Sally Marquez and Cleveland athletic director Larry Chavez both confirmed this.

Carver said he became aware of the letter soon thereafter.

In the letter, Ortiz writes that she was told by Laudicina – via Archuleta, who was on site for the Mayfield game and rendered medical aid to Nieto – that Nieto had a “significant loss of consciousness.”

“Shawn is 100 percent adamant that he never lost consciousness,” countered Nieto family attorney Jake Vallejos on Friday. “He (said he) lost his air, couldn’t breathe – but he certainly was stunned by the hit. He was aware of what was going on.”

AD Chavez said he informed Cleveland head coach Heath Ridenour of Ortiz’s Dec. 5 letter as soon as it was discovered. This was about four hours before kickoff on that Saturday. Ridenour last week told the Journal that he had made the decision to keep Nieto on the sideline and not have him run the ball for safety reasons.

The Storm did insert Nieto into the game for one play, a kickoff late in the fourth quarter. It is unknown if Nieto had any major contact on that play.

Ortiz’s initial recommendation from Dec. 1, which said she found no proof of concussion, was cited specifically by Malott, who in essence said he accepted her opinion over Archuleta’s, despite the trainer’s being the one who attended to Nieto in the stadium.

The Journal left a phone message on Friday with Malott, who earlier defended his decision in a letter he submitted last week to the Journal for publication. The call was not returned.

In his letter to RRPS and the NMAA on Dec. 5, Laudicina said Ortiz’s initial decision on Dec. 1 to clear Nieto “reflects inaccurate history and evaluation.”

There is a third letter the Journal has obtained, dated Dec. 4 from Archuleta and addressed to officials at Cleveland High, RRPS and the NMAA.

“While attending to (Nieto on Nov. 28),” Archuleta wrote, “I observed him displaying numerous signs and symptoms of a concussion including an extended period of unconsciousness. Due to this, he was removed from participation, his helmet was taken to prevent him from playing, and he was evaluated numerous times.”

Waiting period

Cleveland, following Archuleta’s and Laudicina’s lead, told Nieto he would not be allowed to play against Eldorado, as he would have to sit out a week per the state’s concussion law, which was created in 2010 to protect athletes from competing again too soon, and also before they have cleared protocols.

As she rescinded her first opinion, and in what seems to be a nod to Archuleta’s first-hand observation, Ortiz said the athlete should “follow the policies and protocols set by the Sports Medicine Team.”

Archuleta’s letter said both he and Laudicina felt it was “highly ill advised” that Nieto play in the game.

The Journal also gained a copy of the concussion evaluation form from this injury, filled out by Archuleta. Contained within that document is mention that Nieto already had a concussion history (one occurrence) even before this episode.

Vallejos said Nieto did not learn that he would be unable to play against Eldorado until Monday, Nov. 30. Vallejos further said that no one from the family was told anything about an evaluation that the player was unconscious before they went to see Ortiz.

“Nobody told the family anything,” Vallejos said. “Prior to seeing the doctor (Ortiz), the family was not informed by anyone at Cleveland.”

Vallejos said the family did not have an issue with Nieto getting into the game for only one play. “They were fine with it,” Vallejos said. Their larger concern, he said, was “making sure there was adequate process.”

As Cleveland said it would keep Nieto out of action, the player and his family went to court to get a temporary restraining order, saying the junior would be irreparably harmed and his college scholarship chances diminished if he wasn’t allowed to compete in the state final.

Nieto, a 5-foot-4, 135-pound running back, ran for 931 yards and 18 touchdowns during the season, which culminated in a 48-35 victory over visiting Eldorado in the 6A final. Cleveland senior running back Landry Hayes ran for 203 yards and four touchdowns in that contest.

The NMAA, Marquez has said, intends to appeal Malott’s ruling, using the aforementioned three letters to help present their case. The NMAA wants the temporary restraining order overturned to dissuade others from taking the same recourse as did the Nietos.

ORIGINAL ARTICLE:
http://www.abqjournal.com/693937/news/warning-came-after-judge-ruled-back-could-play.html

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New Mexico Judge has poor opinion of athletic trainers

The judge in the Shawn Nieto concussion case on Thursday strongly disputed comments by both Rio Rancho Public Schools and the New Mexico Activities Association regarding last week’s hearing on whether Nieto should be allowed to play in last Saturday’s state high school football championship.

District Judge Alan Malott, in a letter to the Journal, said there were “at least two glaring falsehoods” regarding information that appeared in a Thursday morning story about Nieto, the Cleveland High School running back whose eligibility to play in the Class 6A state title game reached Malott’s courtroom last Friday afternoon.

Malott granted a temporary restraining order against RRPS and the NMAA, making Nieto – whose health was in dispute – eligible to compete in the Storm’s 48-35 victory over Eldorado on Saturday in Rio Rancho.

Cleveland officials had said he was ineligible to play in the game because training staff diagnosed a concussion after Nieto suffered a hit to the head in a state semifinal game Nov. 28.

Rio Rancho Public Schools public information officer, Beth Pendergrass, told the Journal on Wednesday that the district did not receive sufficient advance notice to appear at the hearing in Albuquerque seeking the restraining order.

Malott said in his letter that was not true.

“A review of the record shows in fact, RRPS’ lawyers were aware of the pending hearing here in the 2nd Judicial District for several hours and took the opportunity to file documents disqualifying Judge Victor Lopez from proceeding with the hearing,” Malott said.

The letter goes on to say that Rio Rancho did not ask for a telephonic appearance or “otherwise communicate with the Court to further advance their position.”

The Santa Fe-based counsel for Rio Rancho Public Schools, Charlotte Hetherington, said the district was unaware which judge had been assigned the case after Judge Lopez was disqualified. She also said she didn’t receive the email notice from Nieto’s attorney regarding the time of the hearing until the hearing was beginning, 55 miles away. This was about 2:30 p.m. Friday, Hetherington said.

“From the school’s perspective and from my perspective, we did not know judge Malott was the assigned judge until the hearing began,” said Hetherington, who said she was in Santa Fe when the email arrived.

Hetherington said there was “a disconnect between what the judge understood to be happening and what we understood to be happening.”

The second piece of information that Malott said was incorrect was a statement to the Journal by NMAA executive director Sally Marquez, who said the organization did not argue in front of Malott and was there simply to support Rio Rancho Public Schools. NMAA counsel Mark Geiger “strongly” argued against the requested restraining order, Malott said.

Marquez told the Journal on Thursday that there was a miscommunication about the NMAA’s role in last week’s hearing.

“Mark was there supporting Rio Rancho,” Marquez said Thursday. “When no one (showed) up, he had to testify on his own.”

Marquez was adamant that the NMAA was there to help uphold the integrity of the state’s concussion law, a 5-year-old law that, in essence, says an athlete must sit out one week after being diagnosed with a concussion. Part of the Nieto family’s challenge involved when the one-week time frame starts, arguing he should have been eligible regardless of whether he had suffered a concussion or not.

“We were shocked (that Rio Rancho didn’t show up),” Marquez said. “Mark was there and Rio Rancho never showed, so Mark had to fight – without any documents. Because those are Rio Rancho documents. Rio Rancho had them all. Mark tried to fight, but didn’t have anything in writing.”

Nieto left the Nov. 28 Mayfield game and did not return. Cleveland said Nieto was knocked unconscious, but the junior running back disagreed.

Several days later, after being told he would have to miss the final against Eldorado because of the concussion protocol, Nieto consulted with a private doctor for a neurological evaluation. According to court documents, that doctor reported that it was unlikely Nieto “ever sustained a brain injury.”

That evidence was presented to Malott on Friday.

Malott said he determined that the doctor’s opinion “was more reliable than the opinion of the team’s trainer in giving effect to the statute’s purpose of protecting student athletes.”

Thus, Nieto was eligible to compete. But he only appeared on the field once, on a kickoff team near the end of the game. Cleveland head coach Heath Ridenour said he held Nieto out over safety concerns.

ORIGINAL ARTICLE:
http://www.abqjournal.com/689516/sports/judge-in-cleveland-case-disputes-rrps-nmaa-comments.html

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New Mexico Athletic Association to Challenge Concussion Ruling

A district court judge decided to allow a star running back for Cleveland High School to participate in last Saturday’s Class 6A state championship game even though the school district had said he was ineligible due to receiving a concussion in the playoff game the week before.

As it turns out, coaches only put him in for one play, but school officials and the New Mexico Activities Association are worried the judge’s decision could have an effect on the state’s concussion law protocol.

Shawn Nieto, the Storm’s junior starting running back for both of the school’s first two playoff games, suffered a concussion – according to Cleveland – in the second half of a Nov. 28 semifinal playoff game at Mayfield following a head-to-head hit.

“Our trainer (Jeff Archuleta) identified him being unconscious for a period of time. That’s an automatic concussion (protocol),” said Rio Rancho Public Schools athletic director Bruce Carver.

Nieto, who did not return to that game, argued that he did not lose consciousness. He further argued that he was not advised to get an independent medical evaluation, and that he was allowed to drive home from Cleveland after the team returned to the school from Las Cruces that night.

The family had a private examination conducted of the player a few days later. That doctor, listed in a court filing as Dr. Karen Ortiz, said Nieto “exhibited normal cognitive ability” and she concluded that it was “unlikely” that Nieto had suffered a brain injury, according to documents.

Cleveland informed Nieto that he would not play in the state final against Eldorado, basing the decision on the standard, minimum “one week” waiting period, per the law, that must occur before an athlete may return to action after receiving a concussion.

The family went to court Friday – first in Sandoval County, but after learning that the court was closing at noon and thus would be unable to get an emergency hearing, attorneys filed in Bernalillo County – and received a temporary restraining order against Rio Rancho Public Schools. Nieto would suffer irreparable harm if he was kept off the field, the TRO request maintained.

No one from RRPS appeared for the court hearing in Albuquerque late Friday afternoon, so no proof was offered that Nieto had, in fact, suffered a concussion. Consequently, Judge Alan Malott ruled Nieto could participate.

“The suit wasn’t brought in the right county, in our opinion,” RRPS public information officer Beth Pendergrass said. Asked why the district failed to show up for the hearing, she said, “We weren’t notified about the change of venue in time to be present.”

The New Mexico Activities Association was listed as a co-defendant along with RRPS and was in court Friday to back up Rio Rancho Public Schools, executive director Sally Marquez said. The NMAA did not argue in front of the judge, but does plan to challenge the court’s decision to grant the TRO.

“We will fight for the law,” Marquez said, adding that the NMAA doesn’t believe a court should have allowed Nieto to play. Marquez was emphatic that the NMAA is not trying to retroactively find Nieto to be ineligible, thereby leaving Cleveland vulnerable to a forfeit.

“We just want to make sure the rule stands up, that this doesn’t happen again,” she said, adding that she wants the TRO overturned to dissuade others.

The family, through its attorneys, is declining comment.

Cleveland coaches kept Nieto off the field during the championship game on Saturday, with one exception. He was inserted late in the fourth quarter, on a kickoff team following the final score of the game, a Cleveland field goal with 2:23 remaining.

Landry Hayes started at running back Saturday, rushing for more than 200 yards and four touchdowns in Cleveland’s 48-35 victory. He had started at the position early in the season, but was sidelined due to an injury. He returned for the championship game.

“Ultimately, the decision was I was just looking out for Shawn’s safety,” Storm head coach Heath Ridenour said, adding that he felt it wasn’t worth the risk that Nieto might be injured if Cleveland handed him the ball.

One of the results of Nieto challenging his diagnosis in court is how the state’s concussion law might be interpreted.

There is no specific language that dictates when the one-week protocol begins. The NMAA said it believes the one week is defined as seven days that begin the day following an injury.

In this case, that would be the Sunday after Cleveland beat Mayfield in the semifinals. Carver said Cleveland’s trainer also felt strongly that the seven-day waiting period starts the following day.

Nieto’s attorneys argued that the concussion protocol period would have concluded before the title game.

As for the harm Nieto was caused because he didn’t play, the family stated that his chances at a college scholarship are put in jeopardy since this was such a high-profile event. Nieto is listed as a 5-foot-4, 135-pound running back on MaxPreps.com. He ran for 931 yards and 18 touchdowns during the season.

Carver said he wants to revise the wording in the Rio Rancho district handbook to be far more specific about when the seven-day period begins. The state law is five years old.

“You could see why a kid would want to play in a state championship game, and you want to do the right thing,” Carver said. “But our trainer is a very experienced trainer. They (the family) were looking for a loophole.”

ORIGINAL ARTICLE:
http://www.abqjournal.com/688680/sports/nmaa-to-challenge-ruling-that-circumvented-concussion-decision.html