Evidence of meeting #11 for Subcommittee on Sports-Related Concussions in Canada in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was players.

A video is available from Parliament.

On the agenda

MPs speaking

Also speaking

Gary Bettman  Commissioner, National Hockey League
Bill Daly  Deputy Commissioner, National Hockey League

4 p.m.

Liberal

The Chair Liberal Peter Fonseca

I'd like to call this meeting to order.

On October 4, 2018, the House of Commons Standing Committee on Health adopted a motion to create a subcommittee to study sports-related concussions in Canada. Since November 21, 2018, the subcommittee has heard from a variety of witnesses from different perspectives, including amateur and professional athletes, parents, researchers, doctors, equipment manufacturers and sports organizations—the entire sports family—because we love sport and we want to grow sport.

Today the committee will hear from NHL commissioner Gary Bettman on the final day of testimony in this study.

I want to thank Commissioner Bettman and Deputy Commissioner Daly for appearing today. We know it's a busy time for the NHL with the second round of the Stanley Cup playoffs just getting started. We appreciate your taking the time out of your busy schedule to be with us today.

Congratulations on your tenure as NHL commissioner. As I understand it, you were named commissioner in 1993. It was the first time that the National Hockey League had a commissioner. Since then, the league has grown into new markets and has strengthened traditional markets in Canada and the U.S.

Our vision is not too dissimilar: We want to grow sport through more participation. The responsible way to do that is by making our sports safer.

Commissioner Bettman, the floor is yours.

4 p.m.

Gary Bettman Commissioner, National Hockey League

Thank you, Mr. Chair.

Thank you, honourable members. I appreciate your invitation to be here to discuss the important matter of concussion in sports. Recognizing that my time for remarks is limited, the NHL is also providing a written submission to the subcommittee today that contains further details with regard to the matters I'm about to discuss.

For over 26 years, I've had the privilege of serving as the commissioner of the National Hockey League. NHL hockey, as you all know, is played in an enclosed environment at high speeds by players of different heights, weights and skills. By its very nature, professional hockey is a collision sport and contact is sometimes unavoidable. In some circumstances, injuries, including concussions, may inevitably occur. Consequently, during my tenure as commissioner, the health and safety of NHL players has been a top priority for the league, its member clubs and the players' association. In fact, the NHL has pioneered a number of player safety initiatives that have served as a model for other sports entities.

For example, since 1977 the NHL and the NHLPA have had mandatory league-wide neuropsychological baseline testing as part of its concussion program. This was the first program of its kind in professional sports. The NHL was also the first professional sports league, in any sport, to adopt league-wide electronic medical record systems for tracking player injuries, and the first to create a department of player safety, which, among other things, monitors games and assesses player compliance with NHL playing rules. Over the years, we have built on this work by remaining current with medical and scientific developments regarding concussions, and have fostered a culture in our sport in which players, teams and their respective medical staffs work co-operatively to manage these injuries.

Today I will describe for you the current landscape in the NHL related to concussion management. For additional specifics, please refer to our written submission. The NHL has already shared extensive information regarding this topic with representatives of all levels of hockey. We have organized collaborative summits. They were organized, sponsored and hosted by the NHL. We conducted them in 2018 and 2019. In addition, the NHL participated in conferences with other so-called collision sports leagues and governing bodies from all over the world in 2017 and 2018, which were organized as forums to share best practices regarding concussion management and to align on data collection and research to aid in that effort.

For obvious reasons, not all initiatives undertaken at the NHL level will be applicable or appropriate at other levels of hockey or for other sports. Nevertheless, I am pleased to share our practices and approach, and to provide you with information that I hope may help this subcommittee fulfill its mandate. The NHL's policies and procedures relating to head injuries are set forth in a comprehensive concussion protocol that was first codified in 2010 and has been updated regularly. The concussion protocol addresses the provisions of education to players, on-ice officials, athletic therapists and trainers, and club medical staff. It requires baseline testing for all players, sets forth the procedures surrounding the identification and evaluation of possible concussions, and establishes the process for diagnosis, management and return to play following a concussion. Our clubs are committed to compliance with the protocol and actively support and follow it.

The first step under the concussion protocol is ensuring that adequate efforts are being made to identify potential concussions. To that end, the protocol includes a list of, quote, “visible signs” of potential concussions, and authorizes and directs various parties to remove a player from play if one or more of these visible signs are detected. For example, there are two league-appointed individuals who watch each NHL game with the sole job of identifying players who exhibit visible signs of possible concussion—a central league spotter and an in-arena league spotter.

The protocol also tasks each club with the responsibility to identify and remove players who exhibit visible signs, for an acute evaluation for possible concussion. On-ice officials are also instructed to remove players for evaluation if they observe players who exhibit visible signs of possible concussion. The ultimate result of our protocol as designed and executed is a multi-layered system that is intended to ensure the removal of players from the game for evaluation as soon as possible.

Ultimately, all concussion diagnoses must be made through an individualized assessment drawing on the clinical expertise of club medical staff, following administration of a standardized concussion assessment tool that reflects the latest consensus in the international community of concussion experts.

While the NHL is fortunate to rely on highly qualified medical professionals and benefits from the use of a standardized concussion assessment tool, input from the player remains a critical factor in concussion evaluation and diagnosis. To this end, players are provided with extensive education by the NHL and the NHLPA on the identification of symptoms and the importance of promptly and accurately alerting club medical personnel if they are experiencing any symptoms of possible concussion.

Once a player has been diagnosed with a concussion, the protocol establishes specific criteria that must be met before a club physician can clear a player to return to play.

One, we require that there be a complete recovery of concussion-related symptoms at rest.

Two, we require that there be no emergence of concussion-related symptoms at exertion levels that are required for competitive play and that a graded return to play progression be completed.

Three, we require that the player be judged to have returned to his neurological baseline by the club physician, and to a neurocognitive baseline following an evaluation by a club consulting neuropsychologist.

The protocol does not permit a player who has been diagnosed with a concussion to return to practice or a game on the same day that the event occurred, irrespective of how quickly his symptoms resolve. This reflects the current approach set forth in the “Consensus statement on concussion in sport” as promulgated at the most recent international conference on concussion in sport, which was held in Berlin in 2016.

The NHL's baseline testing program plays a critical role in the return-to-play decision and is worth highlighting here. Under the protocol, each player undergoes pre-season neuropsychological testing to establish a baseline score, which is compared to a player's score on an identical battery of tests administered during the player's recovery process. If a player has not returned to his cognitive baseline, he will not be cleared to return to play under the protocol.

Turning next to building awareness and providing education, which is a central component of our protocol, it is a required element of the protocol that education is provided to all relevant members of the NHL community on the identification, diagnosis and management of concussions, emphasizing the importance of taking this injury seriously.

As others have noted, hockey players are fiercely competitive and often instinctively want to return to play as soon as possible, regardless of whether they have fully recovered from injury. Accordingly, the NHL and the NHLPA have developed a number of educational initiatives to inform players about the common signs and symptoms of a possible concussion; the importance of reporting symptoms to medical experts; what to expect once a player is diagnosed with a concussion; what players can do to assist in their recovery from concussion; and the scientific debate regarding the possibility of long-term consequences of concussion.

Our education program to players is robust, and it starts on the first morning of training camp each season. Clubs are required to begin with a meeting where players and club medical personnel watch and discuss an educational video on concussions. The protocol's education program continues at multiple intervals throughout the season and is provided to players, and in some cases their families, using many mediums, such as posters, videos, direct presentations and brochures.

Our education efforts are not limited to the players. We provide common messaging on our protocol to all important stakeholders at each club and to the NHL's on-ice officials. Club management, coaches and on-ice officials all watch the same video that the players view at the beginning of training camp. In addition, NHL on-ice officials receive in-person education and training on the protocol prior to each season and the league provides regular concussion program updates and education to general managers, coaches and the NHL board of governors.

With regard to educating the broader hockey community outside of the NHL, our league has played a leadership role in organizing, sponsoring and hosting hockey safety summits in each of 2018 and 2019, with representation from and participation by decision-makers at all levels of amateur, collegiate and professional hockey. These summits have facilitated the important exchange of information regarding best practices and key learning from each group on safety-related initiatives, including concussion-related matters. As already noted, the NHL has also participated in international collision sports conferences in each of 2017 and 2018, and we will be the host of the 2019 conference. The 2017 conference focused on each league's implementation of the Berlin consensus statement.

In addition, the NHL and the NHLPA are currently producing a concussion education video that is being specifically crafted for the larger hockey community, which we anticipate distributing later this year. In past years, the NHL and the NHLPA have contributed to a number of other videos illustrating the potential dangers of concussions and recommending the best ways to play the game of hockey safely. In those efforts we have worked with two individuals who have already testified before this committee, Dr. Charles Tator and Eric Lindros.

The NHL has also contributed to the scientific literature addressing concussions through numerous articles published by expert members of the NHL and NHLPA concussion subcommittee.

I would also like to highlight several of the concrete steps the NHL and the NHLPA have adopted to make NHL hockey safer for our players. The NHL and the NHLPA have taken a collaborative and proactive approach to achieve this critical goal and will continue to do so moving forward.

With regard to our playing rules, the NHL and the NHLPA have worked diligently to adopt changes to the game that reduce the incidence of concussions while working to preserve the essential physical nature of our sport.

One such rule that the NHL and the NHLPA have adopted is rule 48, which prohibits all hits to an opponent's head where the head was the main point of contact and such contact was avoidable. Since implementing rule 48, there has been a demonstrable drop in the percentage of concussions resulting from body checks involving head contact.

There are some individuals who have called for a blanket rule prohibiting all hits that result in head contact, whether intentional or accidental, including some who have testified before this subcommittee. Such a rule is very easy to propose but is difficult, if not impossible, to implement and apply in practice. The prevailing view of stakeholders associated with rules development in the NHL, including the NHLPA with whom any such rule would need to be negotiated and agreed to, is that it would not be possible to consistently and fairly enforce a rule that prohibits head contact of any kind or nature if the NHL is to be maintained as a physical contact sport.

That view has informed our approach and while we will continue to monitor and evaluate this important issue, as we do with respect to all issues concerning player health and safety, we believe that the current iteration of rule 48 strikes the correct balance for NHL hockey.

Enforcement of playing rules through supplemental discipline further promotes player safety and represents an important deterrent to player conduct that is inconsistent with the physical contact permitted in NHL hockey. The NHL department of player safety monitors every game and assesses every hit to ensure adherence with the league's standards for safety. When those standards are violated, the department issues supplemental discipline, which can include significant player suspensions and/or fines.

Before I wrap up, I would like to address the issue of fighting, which has been brought up before this subcommittee and has been a topic of public debate for decades, and well before I became commissioner.

Fights in the modern game are at an all-time low. Eighty-five per cent of regular season games are fight free, which is the highest percentage of fight-free games since the 1964-65 season.

That said, many involved in our game, including numerous players and the NHLPA, continue to adhere to the belief that fighting, while penalized—or, more specifically, the threat of fighting—actually deters and reduces the incidence of other types of dangerous and potentially injurious play. Moreover, many current and former NHL players have stated that the threat of fights helps protect the most highly skilled players from being inappropriately targeted.

With respect to concerns about fighting, and concussions specifically, it is worth noting that relatively few concussions result from fighting. For example, based on video analysis of our games, there have been an average of 2.6 diagnosed concussions per season over the last five seasons that were arguably caused by a player's participation in a fight with an opponent.

Mr. Chair, I know that your subcommittee has focused on concussions among younger athletes in youth hockey. Through our research, educational videos and hockey summits, the NHL is committed to sharing best practices with all hockey organizations, but I understand and agree that not everything done at the NHL level should apply to younger non-professional players.

Our players like the way the NHL game is played and understand the implications of playing a physical contact sport at the highest professional level in the world. Hockey organizations at each level of the sport must make appropriate rule-making decisions for themselves and their constituents and, as I mentioned, we firmly believe our rules are appropriate at the NHL level.

In conclusion, the NHL and the NHLPA have worked collaboratively to change the culture of the game in a positive way. On a nightly basis, we see examples of players making the extra effort to avoid dangerous plays and unnecessary contact. This cultural shift in the game has resulted from an increased awareness of the seriousness of concussions, appropriate diagnosis and management of concussions and greater player willingness to report symptoms and seek out medical care.

The NHL and its member clubs, together with the NHLPA, will continue to work together to address all aspects of game safety while remaining committed to preserving the core elements of our sport. At the same time, we will continue our work with hockey organizations at all levels to assist with their best practices and awareness campaigns.

Mr. Chair, I want to thank you and the honourable members for your time, and I look forward to answering your questions.

4:20 p.m.

Liberal

The Chair Liberal Peter Fonseca

Thank you for your testimony, Commissioner Bettman.

We will now move to members' questions. We will be starting with the Liberals.

Mr. Fisher, I believe you're first, for seven minutes.

May 1st, 2019 / 4:20 p.m.

Liberal

Darren Fisher Liberal Dartmouth—Cole Harbour, NS

Thank you very much, Mr. Chair.

Thank you, folks. I appreciate your being here, Commissioner Bettman and Deputy Commissioner Daly. Thank you very much. You are our last witnesses.

Mr. Bettman, you probably recall that U.S. senator Richard Blumenthal wrote a letter to you regarding the link between concussions and CTE. He cited the deaths of NHL players Boogaard, Fleming, Probert, Martin and Montador, whose brains all contained strong evidence of CTE.

When you responded, your letter said that the science regarding CTE and the link to the concussions suffered by the players, which Senator Blumenthal referenced—and I'll quote—“remains nascent, particularly with respect to what causes C.T.E. and whether it can be diagnosed by specific clinical symptoms”.

It appears the evidence now is overwhelming in showing a link between concussions in hockey and other sports. What is your belief now and what is the league's position these days on whether there is a link between CTE and concussions?

4:20 p.m.

Commissioner, National Hockey League

Gary Bettman

I'm glad you asked me that question, but I'm not sure that the premise that the link is clear now is one that the scientific and medical communities have embraced. I am not a physician. I am not a scientist. My views are informed by experts in the field. In fact, if you referred to the Berlin consensus statement, the systematic review of the literature published in support of it, it explained:

The causes of mental health and cognitive problems in former athletes, like the general population, are broad and diverse including genetics, life stress, general medical problems (eg, hypertension, diabetes and heart disease), chronic bodily pain, substance abuse, neurological conditions and disease (eg, cerebrovascular disease) and neurodegenerative diseases (eg, Alzheimer’s disease, Parkinson’s disease and ALS).

Accordingly, the systematic review concludes that the extent to which repetitive neuro-trauma contributes to these issues “is poorly understood and requires further study”.

In addition, the consensus statement, which was subscribed to by 36 practitioners in the field, again has continued to say that there has yet to be the ability to draw the conclusion that one will lead to the other.

In fact, Dr. Cantu I believe stated under oath—he is the co-founder of the Concussion Legacy Foundation with Mr. Nowinski, who I believe was here—that we don't know the incidence or prevalence of CTE currently; we don't know the incidence or prevalence of CTE within NHL hockey, and we don't know what the exposure levels of head impacts are for hockey, and that he doesn't have any knowledge to say that three concussions puts you at substantial risk over the course of a career, and that he doesn't have the knowledge to know what the risks are for 15 years of hockey.

In short, based on everything I've been told—and if anybody has information to the contrary, we'd be happy to hear it—other than some anecdotal evidence, I don't believe there has been that conclusive link.

4:20 p.m.

Liberal

Darren Fisher Liberal Dartmouth—Cole Harbour, NS

Thank you for that.

The NFL feels there's a link. I know you've said that NFL football is not the same as NHL hockey, and I get that, but they're both very fast, high-energy sports.

4:20 p.m.

Commissioner, National Hockey League

Gary Bettman

There are two aspects to that. One, I'm not sure what the NFL's position is. A vice-president who is neither a doctor nor a scientist made that comment, and I believe a week or so later at least one or two NFL owners disputed that statement, so I don't know what the NFL's position is.

Dr. Ann McKee, who also works with the Boston University group, told me in my office that hockey and football are not the same. We don't have the repetitive head contact and impact that some of the other sports do. While we understand that this is an issue that needs to be constantly followed and focused on, there have not been conclusive determinations.

4:25 p.m.

Liberal

Darren Fisher Liberal Dartmouth—Cole Harbour, NS

Going to your concussion protocol for a second, you talked about visible signs of distress. I'm not sure if this is up to date, but the concussion protocol doesn't require the removal of a player who is slow to get up from a hit to the head from a goalpost, the boards, the glass, or even another player's elbow. Has that been changed?

4:25 p.m.

Commissioner, National Hockey League

Gary Bettman

I believe that is non-mandatory, but it is something that may cause you to say, if you're looking for other visible signs, then you do it. It doesn't mean you automatically get to stay in. The trainer and medical staff may yet conclude that it's appropriate to have a player come in and be evaluated.

Our goal is to get players who may be at risk from concussion off the ice as quickly as possible and evaluated.

4:25 p.m.

Liberal

Darren Fisher Liberal Dartmouth—Cole Harbour, NS

I appreciate that clarification.

4:25 p.m.

Bill Daly Deputy Commissioner, National Hockey League

It actually has been changed as well. It's been updated. Contact with the end boards or glass and slow to get up is a mandatory removal.

4:25 p.m.

Liberal

Darren Fisher Liberal Dartmouth—Cole Harbour, NS

I got you. Thank you.

We think about the trickle-down effect. We think about NHL up here. A lot of young kids would emulate the things they see in the NHL. Do you think the NHL has a responsibility to boys and girls playing the game?

4:25 p.m.

Commissioner, National Hockey League

Gary Bettman

I believe we can use our visibility and platforms to make sure that young people are taking the right messages from our game. What is done and is appropriate at the NHL level may not be appropriate at the youth level, but there are things that go on in our game that send the right message, for example, with respect to dangerous hits, making sure that people at all levels of the game avoid them, if at all possible.

With respect to acknowledging that you're not feeling well.... If you think you have an injury, particularly a concussion, not trying to play through it to be tough, but understanding.... Our culture for our players has changed over the years, with education and the concussion protocol. We've had buy-in from the players and the players' association, to make sure the culture of the game is one where if you're not feeling right, you're willing to acknowledge it and get help. That is something that permeates it.

You see it in our games on a regular basis. There will be coaches who tell players to leave the bench and go to be evaluated. You will see players telling trainers that other players should be looked at. That's now all part of acknowledging that in our game, if you're injured, it's okay to acknowledge it and get help. It's not only okay, it's important.

4:25 p.m.

Liberal

The Chair Liberal Peter Fonseca

Thank you, Commissioner.

That moves us over to the Conservatives now.

Dr. Kitchen, you're on for seven minutes.

4:25 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Thank you, gentlemen, for being here. It's much appreciated.

As you've indicated, a lot of what we're talking about here is not only for professional hockey, but also for sport in general, and not just hockey. I appreciate your comments and some of the information that you've provided for us.

One of the things that we've heard a lot about is education. It's great to see that you've got that base there on education. It's great to see that you put in baseline scores, and then test as appropriate. The problem with some of these testing procedures is that if you continue to do the same test, you actually learn from repeating that same test.

Do you look at that, and do you discuss that with your medical personnel?

4:25 p.m.

Commissioner, National Hockey League

Gary Bettman

With respect to the message we send to young people, which is responsive to both questions, in the concussion video we are currently making, which will have widespread distribution, star NHL players will be talking to young players about the importance of being truthful when they are talking to trainers and physicians about their current medical state.

The testing we use has been updated. It gets changed periodically. I think we're in what's called the SCAT5.

4:25 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

We're aware of the SCAT5.

One of the things you mentioned in your presentation was data collection. We've heard from a lot of organizations at this committee about the lack of data collection. It's great to hear that you have that data. I'm wondering if you are in a position to share that data you've collected on the types of hits, and any information that you have, without names, obviously. Could you share that with the committee, as we go forward?

4:30 p.m.

Commissioner, National Hockey League

Gary Bettman

To the extent that we are legally permitted to do it, we're happy to do it. There is a variety of rules, including HIPAA in the United States. Having said that, I think the data collection point is particularly important on medical conditions for young people. If there were more data collection at lower levels—grassroots hockey, and the other levels of hockey being played in leagues—we would be able to collectively make sure, as we bring everybody together periodically, that we are gathering as much information as possible, to learn about what actually happens in the sport that may or may not cause injuries. We are working to build a platform that will allow access for all levels of hockey to put in that information. We will make that available once it's built.

4:30 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Thank you.

On the education issue, you talked about feedback. Do you get feedback from your players? You provide them with the education. You teach them at the beginning of the season. You educate them, and go through your protocol to do that. What's the feedback you've received from your players on how valuable they see it to be? Do they see it as useful to what they're learning, or do they just say, “ Okay, thanks,” and move on?

4:30 p.m.

Commissioner, National Hockey League

Gary Bettman

We interact with players on a regular basis. Anecdotally, based on conversations we have with players, they understand the value and importance of it. In a particular case, you'll have a player who just doesn't want to get pulled from a game, but in the final analysis they recognize the importance. They all buy into it. The players' association has bought into it, and as I said before, there is a change in the culture with respect to the need to be candid, accurate and willing to be evaluated when you have a visible sign of concussion and you need to be treated appropriately. You can see it now across the league in terms of the compliance with the program.

4:30 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

I've been involved with minor hockey since my kids were little and since I was in university, and I've watched the progression that has happened over the years in coaching, not only for that four-year-old who, at four, is saying to himself that he wants to be an NHL superstar and he wants to be Tuukka Rask in goal, or whoever it may be. You watch that progress throughout peewee, midget and junior, and everybody is going to the NHL and everyone is going to be that superstar.

A lot of things have changed, not only for them but we've seen that in the game, which has become faster and quicker.

As you've said, you've been involved with the league for 26 years. What changes have you seen specifically when we're dealing with head injuries, and what do you see for the next 26 years?

4:30 p.m.

Commissioner, National Hockey League

Gary Bettman

That's a terrific question.

I've seen a variety of changes. First, the medicine and knowledge about injuries, particularly concussions, is vastly different now from when I first took over. People didn't have the same knowledge. Concussions didn't get the same level of attention.

It's one of the reasons I decided in 1997 that we would be the first sports league to create a working study group of players of the league, trainers and doctors, to try to get everybody focused together to make sure that what we were doing on a unified basis would maximize the amount of knowledge that we could have and share within the NHL, and to make sure there was uniformity of treatment. Therefore, our ability to understand concussions and treat them is much better. That has been transferred to the players, as we've discussed, with education. What has also happened, for a variety of other reasons, is that there is more emphasis now in the game on skill, so you see far fewer teams that have hardly any players who are really not skilled hockey players and have other skills that were separate and apart from the game: fighters.

At the end of the day, what we're seeing is a healthier game, players more focused on player safety, and a game that is more entertaining and more competitive because the players are more skilful.

4:30 p.m.

Liberal

The Chair Liberal Peter Fonseca

Thank you, Dr. Kitchen.

We're moving over to the NDP now, to Ms. Hardcastle, for seven minutes.

4:30 p.m.

NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Thank you, Mr. Chair.

Thank you very much, Mr. Bettman.

I want to continue on this theme. You've been there for 26 years and you've seen some changes in the game. We heard you comment that you're still waiting for more evidence, obviously, more decisive evidence about the link between concussions and some of the other symptoms that are experienced in CTE. That's evolving.

However, you mentioned the implementation of rule 48, so I know that somewhere there was the interest and the engagement in current information to say that we want to do something to reduce the percentage of concussions, and this has proven successful, right?

4:35 p.m.

Commissioner, National Hockey League