Concussion Management in Hawai‘i Schools

Queen Liliuokalani Building, Hawai‘i Department of Education headquarters in Honolulu

concussion-coachAll fifty states currently have some form of concussion management policy instituted to protect athletes 18 and below. Hawai‘i law (HB 2273/SD1 Act 197 of 2012) requires the Hawai‘i Department of Education and the Hawai‘i High School Athletic Association (“HHSAA”) to develop a concussion educational program.

The law ensures that there is education for students, parents, officials, faculty, coaches, and administrators about the signs and symptoms of a concussion, annual programs for coaches about the warning signs, education on the need for mandatory removal of students from activities if demonstrating the signs, education on the need for a licensed health care professional to evaluate the student and the monitoring of the student.

Every public and private school that is a member of the HHSAA must develop the school’s concussion awareness program, and every program must require:

Annual concussion training for all coaches, faculty and staff

A clinic is held to present information on signs and symptoms of a concussion, the need for obtaining proper medical attention, and information on the nature and risk of concussion. It’s necessary to have an integrated approach including teachers and administrators—not just coaches or athletic trainers.

Written authorization for any concussed student to return to the activity

Written authorization to return must be provided by a licensed health care provider, including a statement that the student is eligible to resume participation in the sport. The student’s return requires monitoring by the school’s trainer, and may require the student to follow a recovery plan like rest/reintroduction to activity.

Immediate benching of any student who show signs of a concussion

A problem with undiagnosed concussions is the threat of a second hit to the head—a phenomenon called “the Second Impact Syndrome.” Students will be evaluated and cleared by a licensed health care provider before they can return to athletics or academics.

Mandatory parental signatures

To verify parents acknowledge the risks associated with concussions, a standard form is issued including up-to-date information and resources. A parental signature is required, which ensures at least a cursory understanding.

More Junk Science & Disinformation from the NFL

In a report for the US House of Representatives this week, new evidence came to light that shows the National Football League continuing to fit the name “The League of Denial.”

“Democratic Committee staff received evidence to support the allegations that the NFL inappropriately attempted to influence the selection of NIH research applicants funded by the NFL’s $30 million donation to NIH,” reads the report. Such attempts are in violation of NIH policy.

This policy is the NIH’s way of excluding bias or inappropriate influence, ensuring the integrity of its findings. The report found that the NFL’s attempts to influence who received funding failed, and that the integrity of the process was preserved. Still, as the report has it, “the NFL did not carry out its commitment to respect the science and prioritize health and safety.”

Instead, the league attempted to strip Boston University of a $16 million project by meddling with the selection process, proposing league-affiliated doctors, and threatening to withdraw its donation to the NIH. The latest article from ESPN outlines numerous other interfering tactics and conflicts of interest: “NFL donations to brain research benefit league-linked doctors, raise worries about influence on science.”

The consequences for these transgressions amount to not so much as a slap on the wrist, as the NIH and its foundation currently have no process to address concerns about donors acting improperly. At least the NFL winds up with egg on its face, so to speak, as the embarrassment spreads through the press.

We cover sports-related traumatic brain injury extensively on our site. Visit our Sports-TBI Knowledge Center and gain an understanding of the science of sports-related TBI and your legal rights.

Reimagining the Future of Sports

As we enter the Golden Age of neuroscience, the public is slowly becoming aware that seemingly minor head injuries can cause serious, long-term damage to the brains of young people playing football and other contact sports.

When an athlete strikes his or her head hard enough to cause a concussion, it leaves contusions (bruises) on the brain. This can produce immediate physical, cognitive and emotional symptoms such as headache, nausea, balance problems, emotional imbalance, short-term memory loss, sleep disturbances and irritability. Repeated head injuries can cause serious long-term cognitive and emotional changes and brain disorders such as Chronic Traumatic Encephalopathy (CTE).

Unfortunately, knowledge of these hazards has not been shared with the public until recently. Sports leagues like the NFL and the NCAA have minimized or denied the risks rather than working to change the rules of the game to protect athletes. Helmets which have been marketed as protecting young athletes have only increased the dangers of traumatic brain injury.

Galiher DeRobertis & Waxman is extremely concerned with protecting the brains of our young athletes, and ensuring justice and accountability for those who have been injured. If you or a loved one has suffered from cognitive impairment which you believe to have been caused by sports-related concussions, please call our office for a free consultation.

Sports competition is one of the mainstays of our society. Sports have the potential to improve health, bring communities together, teach teamwork, and incite a special exhilaration that moves us deeply and emotionally. Athletes are pillars of strength in our community, showing us what is possible as human beings if we strive together to achieve a goal.

The Big Problem

Everyone knows that athletes can be at risk for physical injuries. However, the public is slowly becoming aware that there are other, hidden dangers which face our athletes.

Over the past decade or so, a new awareness of athlete brain health is emerging due to controversy in the National Football League. It turns out former professional football players’ brains have been at great risk since the game’s origins in the late 1800s without their knowledge, and it is not just football players who are at risk for undiagnosed concussions in sports. Studies done on soccer, basketball, judo, lacrosse, cheerleading, and other sports show there are incidents of concussions across the board.

During the complicated process of recovery from a concussion, everyone on the “team” (including coaches, teachers, medical support, friends and family) must be aware of the best possible outcome as well as the worst. Not all recoveries will heal within the average 2-3 weeks. Additionally, unlike a broken ankle, for example, a brain injury is not physically obvious. Signs such as personality changes (including depression and irritability) may indicate the need for medical attention.

The issue demands serious consideration in a society where millions of children participate in sports every year.

Athletes Have Important Legal Rights

Hawai’i is committed to athlete safety, and so is Galiher DeRobertis & Waxman. The State of Hawai’i passed legislation passed to ensure concussion awareness and management for our athletes, coaches, parents, teachers and administrators. Still, there are inherent risks to playing sports, especially football. Brain injury in football is not incidental—it is built in to the game—and many other sports have a significant risk of brain injury. Today, our youth athletes are in danger of severe and frequent blows to the head that could produce lifelong changes in mental processes.

Galiher DeRobertis & Waxman is part of a legal strategy to ensure safety for our athletes. Following the class action lawsuit against the National Football League (NFL), Galiher DeRobertis & Waxman filed a lawsuit against the NFL alleging they knew the damaging affects of repetitive brain injuries but hid this fact from players, instead encouraging them back onto the field. Wrongful death suits against the National Collegiate Athletics Association (NCAA) have also spurred action toward managing and monitoring concussions at the college level. Litigation is helping NCAA’s live up to their mission to “protect young people from dangerous and exploitative athletic practices.”

You May Be Entitled to Damages

You may have a legal claim if you or an athlete you know is suffering from:

  • Frequent headaches
  • Personality changes such as depression, or increased irritability
  • Inability to focus (staring off into space)
  • Short-term memory loss

If you or someone you know has had sports-related concussions at the high-school or college level, there may be legal grounds for a lawsuit. Long-term effects of repeated mTBI include ALS, dementia and other costly disease.

Galiher DeRobertis & Waxman is dedicated to protecting the brains of our young athletes so that children can participate in sports without risking serious injury. Supporting concussion awareness is key, but so is maintaining accountability and justice.

Act Without Delay

Prompt action is required. The laws vary from state to state, but the statute of limitations in every state requires that lawsuits be filed within certain time periods. In Hawai’i, an injury lawsuit must be brought within two years of the incident. To successfully bring a lawsuit against those who were responsible, it is important to act quickly so that none of your legal rights are lost.

Signing a retainer with Galiher DeRobertis & Waxman costs nothing upfront, and ensures that you and your family are protected in the future.

The Concussion Recovery Plan

It takes an integrated team to heal a brain. Everybody on your team should understand the game plan for recovery.

Explain the Injury

managing-symptomsTo Family:

Sleep hygiene means maintaining a regular wake and sleep pattern. You might need help to stay on a normal sleep schedule, especially in the beginning.

To Friends:

Mood changes are normal during recovery. Don’t be embarrassed to ask for support—or to explain you need alone time.

To Teachers:

A student athlete who has suffered a concussion may need school adjustments for a short period, usually for a couple weeks (but possibly even for months). Such adjustments include breaks as needed in a quiet place; pre-printed class notes; additional help, tutoring and time for assignments; and untimed or no testing until tolerating a full day of schooling.

To Coaches:

Talk to your coach about how to maintain a connection with your sports team during the time of recovery, even if you can’t physically play.


There are 7 steps to recovery after a concussion:

  1. Complete Physical and Cognitive Rest
  2. Full Return to Academics
  3. Light Aerobic Activity; Walking, Exercise Bike
  4. Running in the Gym of on the Field
  5. Sport-Specific & Non-Contact Training
  6. Return to Full-Contact Practice or Training
  7. Full Clearance (No Restrictions)
Behind The Symptoms


1) Trauma damages and stretches neurons, and also results in chemical changes.

2) The sudden movement cause the brain to bounce around or twist inside the skull.

3) The damage leads to breaks in the blood-brain barrier, causing inflammation.

4) Chronic inflammation may be linked to longer-term damage, perhaps even chronic traumatic encephalopathy.

Plays to Counter Your Symptoms
  • Pain & Physical Sensation: Put a cold compress on the eyes; take deep breaths to keep your heart rate low.
  • Memory & Cognition Problems: Take things 15 minutes at a time; set a timer on your phone; rest if you feel uncomfortable.
  • Vision & Sleep Disturbances: Wear sunglasses; be mindful of keeping healthy habits of sleep hygiene.
  • Changes in Personality: Talk to your friends when you don’t feel good; use this guide to help explain what you’re going through.

New Rules Show Tides Turning Against Forced Arbitration

In a blow to Wall Street today, the Consumer Financial Protection Bureau proposed new rules that would give customers back the right to file class-action lawsuits against financial firms.

The rules seem certain to take effect because they are not subject to congressional approval. When implemented, they would apply to bank accounts, credit cards, and other types of consumer loans.

Under the new rules, lenders would not be able to force customers to agree to mandatory arbitration that prevents class-action lawsuits when those customers sign up for financial accounts. The rules would overturn decades of machinations by the credit card companies, banks and other lenders to deny their clients a fair day in court through the fine print of the agreements they sign. Lacking the right to band together in a lawsuit, most claims never make it to arbitration.

Because no federal database tracks arbitration, The New York Times created one in a yearlong investigation which found that entering arbitration was rare without the possibility of class-action.

We have covered arbitration on our blog previously, and are much in favor of the new proposal. The rules will be a step in the right direction toward protecting the consumer from harmful, one-sided practices.

In fact, we would like to see the law taken further, to provide people with protection from being coerced into forced arbitration agreements and preservation of their right to file lawsuits. According to the Wall Street Journal, “The Centers for Medicare and Medicaid Services is considering restricting arbitration clauses in long-term care facility contracts.” We hope to see such restrictions enacted soon, to give elders a much-needed line of legal defense in an industry rife with abuse and negligence.

The Gary Galiher Law Hour — Episode 13: Act FAST!

(Pictured above: Our host Mike Buck with Dr. Matthew Koenig from The Queen’s Medical Center.)

Do you know how to recognize the signs and symptoms of a stroke? Knowing could save someone you know from suffering a disability.

Our guest on today’s show is Dr. Matthew Koenig, Director of Telehealth and Associate Director of Neuro-Critical Care at The Queen’s Health Center. He’s an intensivist, which is a medical doctor with special training and experience in treating critically ill patients. Dr. Koenig stresses that it’s really important to be able to recognize a stroke.

One big difference between strokes and heart attacks is that heart attacks are painful. Because of the pain, people suffering a heart attack know right away that something is very wrong, so they get emergency care.

On the other hand, people having a stroke are having an injury to the brain that affects how the brain functions. They often don’t realize they’re having a stroke because they’re not thinking as normal. Failure to seek emergency care during a stroke worsens its effect, which results in more serious disabilities for the person affected.

We have a simple way to identify a stroke: Act FAST.

Face droopiness on one side of the face
Arm (or leg) weakness, or weakness on one side of the body
Speech problems, either slurred or garbled speech
Time to call 911

Time is of the essence when someone is having a stroke. The sooner they get to a hospital, the better their chances of recovery. If someone is feeling unwell and they can’t quite explain exactly what the problem is, check the first three of the items above. If any of them are a problem, it’s time to call 911 right away.

We talk about more than strokes in this episode. As a neuro-intensivist, Dr. Koenig can offer a unique perspective on repetitive concussive and sub-concussive injuries. “It’s a cumulative problem,” he says, “which means that the sum and severity of injuries that the brain receives over a lifetime really will have an additive—and probably multiplicative effect, as well—to produce chronic traumatic encephalopathy.”

We also learn about advances in the field of telemedicine, which allows doctors and patients in different locations to connect through technology. Dr. Koenig is at Hawai‘i’s forefront in this field.

Tune in, and join host Mike Buck and guest host Clarisse Kobashigawa for a fun and interesting show!