THE decision by a concussion review group not to sanction Northampton over their handling of George North's latest head injury episode has been strongly criticised.
North appeared to have lost consciousness following an aerial collision with Leicester's Adam Thompstone in an Aviva Premiership match on December 3, yet he passed a head injury assessment (HIA) and returned to the field of play.
The Concussion Management Review Group (CMRG) set up to investigate the incident concluded that while there was "sufficient evidence" to end North's involvement the match, the club did not "intentionally ignore the player's best interests".
Northampton and/or individual medical staff could have been charged with misconduct by the Rugby Football Union, but the CMRG opted against referring the matter for sanction and instead outlined nine recommendations.
Brain injury charity Headway has expressed its alarm at the outcome of the review, while a sports injury lawyer described the failure to take disciplinary action as a "backwards step".
"We are concerned with these findings," Headway chief executive Peter McCabe said.
"Despite the CMRG reporting that the club followed concussion protocols and that the medical team had enough evidence available to them to make a decision, North, a player with a history of concussion, was allowed to re-enter play following the assessment.
"Serious questions have to be asked regarding the protocols: are they fit for purpose and are they being properly enforced?
"This incident sends out a confusing message around the issue of concussion, particularly for children who follow the example of famous players and favourite clubs."
Ian Christian, an expert sports injury lawyer at Irwin Mitchell who worked with the Rugby Players Association in developing their concussion protocols, is also dismayed by the findings of the review.
"It's hugely disappointing to see that Northampton have not been held to account for the handling of George North's injury as it was a chance to make a statement and remind clubs, players and fans how serious an issue it is," Christian said.
"The findings and lack of punishment feel like a backwards step with the experts stating that Northampton could and should have done more to prevent North returning to the playing field.
"This was an opportunity for the panel to make a statement about concussion and the importance of a safety first approach and it has been wasted."
North, the Wales wing, had a six-month spell out of the game in 2015 following a spate of four blows to the head in five months, two of which were incurred in an RBS 6 Nations match against England.
Replays of the incident at Welford Road suggested that North had been knocked unconscious, but Saints' have stressed that not all of the angles of the replay were available at the time of assessment.
Evidence presented by Northampton also stated that the Wales international denied any loss of consciousness, had immediate recall of events and stayed motionless due to concerns for his neck pain.
North, who has since been examined by an independent specialist, has not displayed any discussion symptoms following the incident and could return to action against Sale on Friday.
Among the recommendations outlined by the CMRG are an instruction for the full 13 minutes allocated to HIAs to be used unless there is clear reason to shorten it and that the team doctor must review video footage for permanent removal criteria both before commencing and after completing the HIA.
However, the biggest talking point arising from the review - all 17 pages of which have been published - is the decision not to sanction Northampton despite the error made by their medical team.
"The CMRG's view is that there was sufficient evidence to conclude not only from the video evidence but also North's history and risk stratification that he should not have returned to the field of play," the review findings read.
"Northampton Saints medical team has accepted that North may have lost consciousness and therefore should not have returned to play.
"The CMRG considered the welfare of North was always at the centre of Northampton's actions, and does not consider that the medical team (or the club) failed to complete the HIA protocol nor intentionally ignored the player's best interests.
"In addition and although not a determining factor, the CMRG is aware that the player appears to have had no residual effects in the short term.
"For the above reasons the CMRG will not be imposing any sanction against the club or any of its individuals as a result of this incident."
The RPA reacted to the findings of the review by describing the "breakdown in procedure" that enabled North's return to play as a "significant failing", adding that it would have preferred disciplinary action to have been taken.
"While we feel that sanctions would have sent a clear message about the gravity of concussion mismanagement, we welcome the recommendations outlined in the report," the RPA statement added.
