No Written Medical Clearance After Concussion = $5.8 M Settlement

Second-impact syndrome

Don’t ignore critical return-to-play protocol

The lawsuit

In 2013, Brett Baker-Goins suffered a concussion while playing basketball for First Baptist School in Charleston, South Carolina. First Baptist is a private school under the jurisdiction of the South Carolina Independent Schools Association (SCISA). SCISA has a return to-play-protocol, which requires a signature by a physician on a written medical clearance form. Baker-Goins returned to play basketball five weeks later and suffered a second concussion. This allegedly resulted in a permanent traumatic brain injury, including delayed emotional, social, and educational development. Furthermore, Baker-Goins alleged being rushed through the return-to-play protocol and that the return-to-play decision was made too soon. First Baptist disagreed and claimed that they followed the return-to-play protocol. The court issued a $5.87 million settlement in favor of Baker-Goins.

Second impact syndrome

Second impact syndrome is a serious medical condition. It develops when a second concussion occurs Head injury settlementbefore the brain has been allowed to fully heal after a first concussion. The result can be significant brain swelling, which can occur even if the second concussion is mild.

Sadly, second impact syndrome can result in death or in serious and permanent neurocognitive injury. The current brain injury risk management practices adopted by state legislatures and sports governing bodies are primarily designed to prevent second impact syndrome through gradual return-to-play protocols. The state laws that include return-to-play protocols are known as Lysted Laws for Zachary Lysted, who suffered a fatal second impact injury in Washington state. It resulted in a $14.6 million settlement.  

What went wrong in this case for First Baptist

According to the allegations in the pleadings:

  • Baker-Goins was under the care of a physician who diagnosed a concussion. The doctor ordered him to remain home from school until his symptoms improved.
  • When Baker-Goins returned to school, he continued to suffer headaches, tire easily, and experience sensitivity to light and sound.
  • The school allowed Baker-Goins to return to basketball practice without being medically cleared in writing by a physician.
  • The coaches knew that symptoms persisted but allowed him to continue at practice.
  • Baker-Goins returned to play in two basketball games, despite continuing to exhibit symptoms at rest and exertion.
  • During the second basketball game, Baker-Goins was struck in his head in the right frontal temporal region by another player and saw stars.
  • Baker-Goins experienced worsening symptoms and was diagnosed with a second concussion.
  • It is alleged that Baker-Goins suffered serious and permanent injuries.

Alleged basis for negligence

  • Failing to get written medical clearance from a physician before allowing Baker-Goins to return to practice or play.
  • Failure to exercise reasonable care in returning Baker-Goins to practice and to play in games before he was symptom free at rest and exertion.
  • Failing to supervise a gradual return to play protocol
  • Negligence per se in violating SCISA’s return-to-play protocols.
  • Negligence in failing to adequately train coaches in concussion prevention and return-to-play protocols.


Schools and sports organizations must follow both their governing body and state law pertaining to return-to-play protocols after a concussion. Most require written permission by a physician. Some may allow written permission from a licensed healthcare professional.

Undoubtedly, the school could have shielded itself from the majority of its liability had it only followed its own rules and received written medical clearance. Of course, even with written medical clearance, coaches who observe continuing symptoms must remove the athlete from practice and play. They then must enter the progressive return-to-play protocols supervised by a licensed healthcare professional.

Source: Failure to Follow Protocol Results in Liability; Athletic Business; February 2019
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