From: Thomas Hearn <..

_ Subject: Fwd: Updated Annual Sports Physical Exam Form Date: June 1,20129:23:22 AM EDT

To: William Beattie <William_Beattie@mcpsmd.org > Cc: Joshua Starr <Jostiva_ Starr @mcpsmd.org >, "Joan Click RN-C, MSN" <joan.glick@montgomerycountymd.gov >, Uma Ahiuwalia <uma.ahluwalia@montgomerycountymd.gov >, boe @mcpsmd.org , county.council@montgomerycountymd.gov , Mary Jo Harris <mjharris@msde. state. md.us >, "Cheryl D. DePinto MD" <cdepinto@dhmh.state.md.us >, Alan Goodwin <Alan_S_Goodwin@mcpsmd.org > 3 Attachments, 577 KB

Duke, Thank you for the reply. I appreciate your willingness to engage in a dialogue about how to keep the 21,500 Montgomery County Public School high school student athletes safe. Below are some thoughts about the issues you raised regarding the health exam forms that doctors should be using when examining MCPS students. Maryland New Student Health Exam Form Thank you for the background about MCPS staff also using the sports health exam as the form for students who are new to MCPS. Maryland State Board of Education does require a physical examination of each child entering the Maryland public school system for the first time. COMAR 13A.05.05.07(A)(1). http://www.dsd.state.md.us/comar/getfile.aspx?file=1 3a. 05.05.07.htm The COMAR regulation, however, mandates: The physical examination form designated by the Department of Education and the Department of Health and Mental Hygiene shall be used to meet [the new student health exam] requirement. Attached is the form that the public health professionals at the State Board and the DHJvI}l developed, which is required to be used for new students throughout Maryland--including in Montgomery County. Here are links to the form at the websites of the State Board of Education and the Maryland Department of Health and Mental Hygiene. health services/ http://tha. clhmh.marvland.govimch/SitePages/ochschoolhealth.aspx Again, MCPS appears to be an outlier as a quick survey shows that the State-mandated new-student form is being used in Baltimore and Howard Counties. I am not aware of staff of any other local school system in Maryland that has decided to ignore the State new-student form in favor of combining two non-complying forms into a hybrid the way MCPS staff have. There are significant differences, beyond the added questions for interscholastic sports, between the

State-mandated new student form and the one that MCPS staff has been using. In some cases, questions that the State wants asked are not included in the MCPS hybrid. Board Member Phil Kaufman: your bio at the MCPS website indicates that you are a supervisory attorney for U.S. Department of Veterans Affairs. Several other members of the Board of Education are also attorneys. Perhaps one of you could step in here and explain that the above-cited regulation has the force of law, and that MCPS is in violation for not using the health form that the public health professionals at the State Departments of Education and Health and Mental Hygiene have developed. Dr. Starr: your statutory duties include "explain[ing] the true intent and meaning of the [Maryland] school law." The above regulation is clear. Please explain to staff. If MCPS staff, who lack a public health background, believe the Maryland new-student form does not serve the needs of Montgomery County students, I think the proper course is to try to convince the public health professionals at the State-level to change it. Not just ignore it. 2010 Annual Sports Physical Form As to the form for the annual sports physical--what doctors call the pre-participation exam (PPE)--it is hard to believe that MCPS is not required to follow the Maryland Public Secondary School Athletic Association (MPSSAA) on this, as every surrounding county that I have checked has done. The MPSSAA website link to the form calls it the "MIPSSAA Physical Form." http://www.mpssaa.org/HealthandSafety/Forms.asp (I have also attached the 2010 PPE form as well as the MCPS staff hybrid.) I think the medical doctor drafters of the 2010 sports form might have issues with the layout of the MCPS hybrid form: part one asks students and parents to answer questions about heart condition and head injuries, and these questions are repeated slightly differently in the part 3 questions for athletes. Also, part three questions about injuries to a list of "paired organs," i.e., eyes, ears, lungs, kidneys, testicles/ovaries, might strike the doctors as odd in a distracting way. I think questions about "paired organs" usually only appear in forms used to apply for a military disability. The 2010 form is not just "endorsed by several reputable groups," as you put it. These groups happen to be: *the American Academy of Pediatrics; *the American Academy of Family Physicians; *the American College of Sports Medicine; *the American Medical Society of Sports Medicine; *the American Orthopaedic Society for Sports Medicine; and *the American Osteopathic Academy of Sports Medicine.

And these medical groups did not just endorse the 2010 form; they wrote it. Doctors working collaboratively and carefully to incorporate their professions best practices so that pediatric athletes can get the best service about medical issues that affect them. The doctors groups wrote the 2010 PPE form with the knowledge that the annual sports physical may be a students only contact with the health care system all year. With all due respect, the good doctors did not devote such effort to develop a health exam form so that an Athletic Director would take it as a first draft from which to pick and choose for a form he thought was best for what coaches need their student athletes doctors to ask and avoid asking during the annual examination. Think about your own frustration if the doctors thought it was their place to rewrite Maryland high school interscholastic sports rules to provide for their novel ideas about tournaments with an odd number of brackets or teams playing back-to-back games in opposite ends of the State. I am belaboring using the most recent 2010 PPE form because, among other things, it asked better questions about concussions and head injuries. In Massachusetts, the Department of Public Health learned that when you ask high school student athletes if they ever had a concussion, the responses were fairly low. However, when the Massachusetts DPH asked student athletes, as part of the 2009 Youth Health Survey, a question like question 35 on the 2010 PPE whether the student had ever had every had a blow to the head that caused confusion, prolonged headache or memory problems-1 8 percent answered affirmatively; for boys its was 21 percent and for girls it was 14 percent. The Massachusetts DPH 2011 Youth Health Survey resulted in even higher affirmative responses from student athletes about blows to the head. So having doctors ask Montgomery County high school athletes the right question is important to identifying those student athletes who may still be recovering from a recently-sustained concussion and who may need restrictions to avoid getting a potentially deadly second one. When I pointed out that MCPS was using the outdated sports form 4 weeks ago, I thought it would be a no-brainer getting it fixed long before the Physical Day at Walt Whitman High School next Saturday, June 9. But it has become a "brainer" that, four weeks later, is still unresolved. Actually it is resolved to the extent that Andy Wetzel, Whitmans Athletic Director, has indicated that the 2010 PPE form will be accepted. It is just that few doctors will know about it because the Whitman Athletics website continues to link to the link at the MCPS Athletics website to the outdated hybrid form. Apparently, Andy and Whitman Principal Alan Goodwin think they need your okay to link to the 2010 PPE form at the MPSSAA website. Other Sports Concussion Safety Issues That Need to Be Addressed There are several other weaknesses in sports safety in the MCPS Athletics Department that I had hoped to address with you after the form issue was put to bed*MCPS Athletics is not using the Concussion Parent Notification Form that MPSSAA requires (one coach said that he was not aware that it existed);

*MCPS Athletics is not notifying coaches or student athletes or parents of the graduated return-to-play protocol that MPSSAA guidelines include; *the current practice of raising awareness among students and parents by handing out an information sheet is far behind what nearby counties, including Fairfax, are doing; *the number of MCPS sports concussions is being grossly underreported; *Massachuse tts has procedures and additional forms specifically for concussions that MCPS should adopt; But we have been stuck for four weeks in this delay on updating the health examination form. I have to say that this rejecting of the collective wisdom of medical and public health professionals seems to be a pattern for the MCPS Athletics Department. For example, two years ago, in March 2010, the MCPS staff recommended that the Board of Education oppose the Maryland sports concussion legislation. Based on staffs recommendation, then-Superintendent Dr. Weast warned the Board that requiring student athletes who are suspected of having a concussion to be removed from play could lead to unintended consequences of students hiding their symptoms. COO Larry Bowers passionately argued to the Board at that time that a removal-from-play requirement would cause lower-income students who are without access to medical care to hide their concussion symptoms because they would not be able to afford the doctor fee to get clearance to return. No serious sport safety or public health professional would have taken these positions. Luckily, several level-headed board members rejected this advice and convinced most, but not all, or their fellow board members to support the legislation. (Even though the Board officially supported it, no letter of support was sent to the General Assembly or the Senate to reflect that support.) So the current delay on adopting the doctors organizations 2010 form seems to be a continuation of the lax attitude about sports safety issues by senior MCPS officials.

Role of Montgomery County HHS in Deciding on MCPS Sports Forms

I am copying Joan Glick, RN-C, MSN, the Montgomery County Health and Human Services public health professional in charge of school health services. MCPS is suppose to coordinate with County public health officers at i-il-IS on health issues like the exam form and other health issues. I would be surprised if HHSs public health staff went along with the flawed hybrid form that MCPS has been using. (Dr. Starr: note that each County has the discretion to locate the school health function in either the school system or in the County HHS. The common factor in other Counties that use the correct health forms for new students and for athletes PPE exams is that they have the school health function located within the school system, where it is headed by a public health professional, e.g. Debbie Sommerville, RN, MPH at Baltimore County Public Schools. As you begin the second year of your term, you should explore with HHS whether MCPS students health needs might be better served by reorganizing the

health service function into MCPS. At the very least, going forward, Montgomery County HHS needs to be more of a partner in setting sports safety policy for high school sports. Right now it looks like it is being implemented by people without public health training or background who dont reach out to HHS for input.)

Conclusion
Duke, if there is still an issue of whether to immediately change the MCPS web links for the the Statemandated form for new students and the 2010 doctors-organization form for annual sports physicals, I would like to set up a meeting with you, Ms. Glick, Uma Ahluwalia, the HIHS Director, and Dr. Staff to resolve this. Sincerely,

Tom Hearn

MSDE-MDH .. ents (133 KB)

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MCPS Staff Ham (332 KB)

MPSSAA Spo ... orm (112 KB)

Begin forwarded message:

From: "Beattie, WiHiam" <WilHam Beattie@mcnsmd.org > Date: May 21, 2012 3:21:15 PM EDT To: Thomas Hearn - Subject: RE: Updated Annual Sports Physical Exam Form
Tom - The form on the state website is simply a sample it does not belong to the state, it was not designed by the state, and there is no requirement that counties use it. If a county has a form that it feels better suits its purpose, then it may use that form. That being said, the form on the state website is endorsed by several reputable groups. MCPS is not certain which form will be most appropriate for the school system - we are comparing them, including on whether to create an entirely different form that utilizes aspects of both forms. The MCPS form includes information that the sample state form does not have, and vice versa. Also, whereas the sample form on the state website is exclusively for athletic participation, the MCPS form serves multiple functions - it is used for a

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student entering the school system, and is also used for athletic participation. It includes immunization records and related information, for instance. That a form is older than another does not necessarily make it outdated Another issue regards the nature of some of the information that is requested on the form that is on the state website, and whether some of this information potentially violates a students privacy - very personal questions that do not necessarily provide a coach with meaningful information. In essence, the school system is in the process of analyzing the two forms. As I indicated previously, thank you for bringing the form to our attention. Whether or not MCPS determines that a new, or adjusted form, is in order, it is easy for us to make the form available in multiple languages. I agree that the school system should use a form that it considers the most appropriate for it purposes.

From: Thomas Hearn [mailto: Sent: Monday, May 21, 2012 2:27 PM To: Beattie, William
Cc: BOE; Starr, Joshua P Subject: Fwd: Updated Annual Sports Physical Exam Form Duke. before this evenings Board of Education meeting, I was wondering if there is any update on getting the MCPS Athletics website to link to the current pre-participation health examination form for student athletes. As I pointed below nearly 3 weeks ago, MCPS is still linking to the outdated pre-1997 form even though the Maryland State Athletic Association adopted the 2010 version two years ago. Also, the State Athletic Association has a link to a Spanish version of the form and there is no link to any Spanish form at the MCPS website. Finally, the same doctors groups that developed the 2010 English and Spanish preparticipation exam forms also developed a supplemental form for Special Education students. http://www.aafp.org/online/en/horne/cl inical/publichealthlsportsmed/preparticipation-evaluationform sO.htrnl Many Special Education students participate in school-sponsored athletics so I think it is important that doctors who clear them for participation in MCPS athletics use the best form possible. Thanks. Tom

From: "Beattie, William <William Beattie@mcpsmd.org > Date: May 3, 2012 9:05:05 AM EDT To: Thomas Hearn < _I Cc: "Goodwin, Alan S." <Alan S Goodwin@mcpsmd.org > Subject: RE: Updated Annual Sports Physical Exam Form
Thanks for the info - I will look into it. Begin forwarded message:

From: Thomas Hearn < Date: May 2, 2012 6:07:41 AM EDT

To: William Beattie <William Beattie@ mcpsmdorg> Cc: Alan Goodwin <Alan S Goodwin @mcpsmd.org >
Subject: Updated Annual Sports Physical Exam Form
Hi Duke, Since July 2010. the MPSSAA website has linked to the annual physical forms adopted that year by the American Academy of Family Physicians, American Academy of Pediatrics and other medical organizations. The newer form has more granular questions about previous concussions and head injuries and has helpful suggestions to the doctor to inquire about other health issues such as dietary supplements. http://www.mpssaa.org/HealthandSafety/Forms.asp The MCPS Athletics website link for health forms is to an earlier outdated form, and the Whitman High School website links to the MCPS link for the outdated forms. Other MCPS school websites probably do this also. hnp ://www. montomeischoo1smd .oru/departments/athletics/ With the annual physicals coming up in June, it would be helpful if the MCPS website could be updated to eliminate the potential for confusion about which form schools should be using. Best regards, Torn Hearn