January

14, 2015

Joshua Starr, E.D.
Superintendent
Montgomery County Public Schools

Montgomery County Board of Education
800 Hungerford Drive
Rockville, MD

Re: Data on Student Injuries in MCPS AthleticsRequest for Follow Up

Dear Supt. Starr and Members of the Board of Education:
Back on June 3, 2014, I requested information from Montgomery County Public Schools
(MCPS) staff about the number of concussions and other injuries sustained by high
school students while participating in MCPS athletics programs in the 2013-2014 school
year.1 In my letter, I also requested information about all injuries, including those
unrelated to athletics, sustained by MCPS students in elementary, middle, and high
schools.
MCPS staff responded to my request in a letter dated June 26, 2014.2 MCPSs staff
response indicates that you lack reliable information needed to keep students safe.
Specifically, MCPS staffs response raises the following four concerns:
1. MCPS staff ignores student injury data (both for athletic and non-athletic
injuries), but closely track injury data for MCPS employees. MCPS staff wants a
parent to pay for them to analyze student injury data rather than funding such
analysis in the operating budget.
2. MCPS underreported football concussions for the 2013 Season. Staff reported 60
football concussions. In January 2014, staff informed Board members the number
was 98. In fact, the number is likely closer to 220. Keep in mind that studies
have shown that high school football involves repetitive head blows (650-1,000
blows per player, per season), so the number of concussions is an imperfect
measure of the brain trauma being sustained by students who participate in

1 https://www.scribd.com/doc/227526304/MCPS-Md-Parent-Request-for-Sports-Injuries-Data-06-
03-2014

2 https://www.scribd.com/doc/235863921/MCPS-Response-Data-Re-Concussion-and-Other-

Injuries-in-High-School-Athletics-2013-2014 ;
Attachment 1: https://www.scribd.com/doc/235686041/MCPS-Chart-Showing-Sports-Concussions-
by-Sport-and-by-High-School-2013-2014;
Attachment 2 https://www.scribd.com/word/document_edit/235685748

MCPS-organized football. This gross underreporting of football concussions

raises the specter of that MCPS staff also understated concussion figures for
soccer, lacrosse, and other sports.
3. MCPS declined to request sports injury data from athletic trainers for 2013-2014.
4. MCPS staff invokes privacy concerns to withhold concussion data needed by
parents. But staff seem to selectively invoke such concerns as they ignores
privacy issues when releasing college application/acceptance data positive to
MCPS image.
Please require MCPS staff to follow up on my request as indicated below.
1. MCPS Ignores Student Injury Data, But Closely Tracks Such Data for
Employees
MCPS Regulation EBH-RA requires MCPS staff to prepare a Student Accident Report,
MCPS form 525-2, whenever a student sustains an injury in a school athletics program
and requires the school principal to submit the completed form to a risk management
specialist at MCPSs Employee and Retiree Service Center.3
Also, MCPSs July 2013 Concussion Plan requires an athletics coach to prepare a Student
Accident Report whenever a concussion is suspected for a student participating in a
school athletics program.4
The MCPS Student Accident Form (MCPS Form 525-2) requires injuries to be coded by
the activity in which they occurred, including Varsity and Junior Varsity sports as one
of the 6 possible activities.5 The Student Accident Form also collects data about the
specific activity in which the injury occurred, e.g., football,6 and about the nature of the
injury being reported.7

3 https://www.scribd.com/doc/214108827/MCPS-Reg-For-Reporting-Student-Injuries

4 https://www.scribd.com/doc/159561150/MCPS-Md-Athletic-Trainer-Pilot-Program-for-11-of-25-
High-Schools-See-Item-M-on-p-3 See, p. 3, section (C)(2)(j).

5 https://www.scribd.com/doc/214108711/MCPS-Student-Injury-Report-Form The full list of
activity categories on the MCPS Student Accident Form are:
01 Elementary Physical Education
02 Elementary Noon Recess
03 Elementary Nonrecess and Nonphysical Education

04 Secondary Physical Education

05 Secondary Nonphysical Education
06 Varsity and Junior Varsity

6 The

full list of specific activities on Form 525-2 is as follows. The list, however, does not include
lacrosse:
101 Archery
102 Badminton
103 Balance Beam

108 Dodge Ball

109 Fencing
110 Field Hockey

116 Muscleman
123 Soccer/Field-Ball
117 Parallel/Horizontal Bars
124 Softball
118 Physical Fitness/Calisthenics 125 Swimming

131 Vaulting Box

132 Volleyball
133 Weight Lifting

My Request
In my June 3, 2014 letter, I requested that a report of all injuries that have been
documented in a Student Accident Report form for the 2013-2014 school year, breaking
out the number of injuries in each of the six possible activity codings.
For injuries coded as having occurred in high school Varsity or Junior Varsity athletics, I
requested, for each high school, please provide the number of such injuries by sport in
which they were sustained. I also requested a report of the injury information
systemwide for all 25 high schools.
MCPS Response
In the June 26, 2014 letter, MCPS responded:
MCPS Stdent [sic] Accident Report Data
A specific database, as you requested, does not exist. To provide the data
you have requested, accident would have to be reviewed and sorted by
category at the school level. We estimate this will take at least 4 hours of
staff time at each school, for a total of 100 hours. If you would like us to
proceed with this request, please see the paragraph below regarding
payment. (emphasis added)
*

Maryland law, Article 10-621, allows a government unit to recover actual

costs incurred to search and prepare records for inspection for any time
beyond the first two hours. To this point, we have spent two hours of staff
time fulfilling your request. It is estimated that it will take 100 hours of
staff time to prepare the data you have requested, at an hourly rate of
$24.50. Therefore, the cost of fulfilling your request is $2,450.
Needed Follow-Up

104 Baseball
105 Basketball
106 Cheerleader
107 Dance
7

119 Rings/Ropes
120 Skating Ice/Roller
121 Skiing

122 Slides and Seesaw

126 Swings

127 Tennis

128 Track and Field
130 Tumbling

134 Wrestling/

The full list of injury codings on MCPS Form 525-2 is as follows:

37 Abrasion/Bruise
23 Amputation
25 Asphyxiation
38 Bite

111 Football
113 Golf
114 Jungle Gym
115 Kickball

32 Burns/Scalds/Chemical
24 Concussion
21 Death
28 Dental

27 Dislocation
33 Electrical Shock
31 Foreign Body
26 Fracture/Chipped

22 Internal Injuries
29 Laceration/Cuts
34 Eye
35 Object in Mouth/Poisoning

30 Puncture
36 Sprain/Strain/

Montgomery County provides MCPS with $2.3 billion to operate the school system. Yet
MCPS staff believes that they should only create a database of student injuries if a
member of the community is willing to personally pay for the cost of it.
In contrast, the MCPS Office of Systemwide Safety closely tracks data regarding injuries
to MCPS employees and reports on progress in reducing such injuries. In January 2014,
MCPS staff prepared a PowerPoint presentation reflecting MCPSs success in reducing
injuries to MCPS employees between 2008 and 2013.8 The tracking of injuries to MCPS
employees appears to be paid out of the operating budget.
MCPS needs to develop a culture that also values reducing injuries to students. This
issue goes beyond injuries to students who participate in high school athletics.
Without the reports I have requested, you have no idea about the incidents of injuries to
students in elementary school, middle school, or high school. For example, are
elementary school students being injured on playground equipment more at one school
than another? Are students sustaining injuries in Chemistry lab more at one high school
than another?
I respectfully request that you direct staff to prepare a database of all student injuries
reported on MCPS Form 525-2 and provide you with the reports I requested in my June 3
letter of all injuries systemwide and by school as well as injuries in the high school
athletics program, systemwide and by school.
As a sign of solidarity with students, I request that each Board of Education member
abstain from seeking reimbursement for expenses such as meals, airfare, hotels, and
mileage until MCPS has prepare the database and reports that I have requested.
2. MCPS Underreport Football Concussions
Background
Repetitive Brain Trauma in High School Football
Research has shown that a high school football player sustains 650 to 1,000 hits that
shake the head each season. These blows can either be from direct hits to the students
helmet or from blows to the body where the energy of the hit gets transferred to the
students head.9
Research comparing functional MRI of high school football players taken at the
beginning of the season with imaging at the end of the season show altered brain

8 https://www.scribd.com/doc/214109142/MCPS-Systemwide-Safety-Prgm-Employee-Injury-
Report-01-16-2014

9 http://www.purdue.edu/newsroom/research/2012/120202NaumanFootball.html

functioning which can take months to resolve. And the altered brain functioning has
been seen in players who were never diagnosed with a concussion.
Serious questions remain about whether footballs repetitive head blows lead to ADHD,
depression, anxiety disorders, rage disorders, and suicidal thoughts in players, including
in those that were never diagnosed with a concussion.
Concussions occur in other contact sports such as soccer, basketball, and baseball. No
study, however, suggests that students playing these sports sustain repetitive hits that
shake the head on par with football or other combat sports such as lacrosse, ice hockey,
or boxing.
The repetitive hits that shake the head sustained by all high school football players leads
to some presenting symptoms that result in a concussion diagnosis. Sometimes these
symptoms appear after a so-called big hit, but often as much without an identifiable hit.
It is no surprise that high school football accounts for 65 percent of sports-related
concussions to boys and half of all concussions in high school sports. The number of
diagnosed concussions, however, likely gives only a partial picture of the brain trauma
sustained by students playing football.
MCPS Sports Concussion Database
MCPSs July 2013 Concussion Plan requires a high schools athletic director to enter
information into an MCPS concussion database about each concussion sustained by a
high school student playing a school-organized sport.
My Request
In my June 3, 2014 letter, I requested a report of the number of concussions in MCPS
Athletics concussion database, broken down by high school and by sport. I also
requested a report of sports concussions in all 25 high schools systemwide.
MCPS Response
In their response, MCPS staff provided me with a chart with information from the
Concussion Database.10 The chart indicates that MCPSs 25 high schools reported
that 60 students sustained concussions playing football. However, MCPSs
concussion information for each high school indicates that the number of football
concussions at just 7 of MCPSs 25 high schools also total 60. Below is a table that
shows the reported numbers at these 7 high schools.



10 https://www.scribd.com/doc/235686041/MCPS-Chart-Showing-Sports-Concussions-by-Sport-
and-by-High-School-2013-2014;



HIGH SCHOOL
Clarksburg
Magruder
Richard Montgomery
Poolesville
Quince Orchard
Sherwood
Whitman
Total

FOOTBALL CONCUSSIONS
REPORTED
8
8
9
5
8
12
10
60

While MCPS staff reported that the other 18 high schools each reported fewer than 5
football concussions, reporting 60 football concussions systemwide indicates that the 18
other high schools each reported zero football concussions.
Reporting 60 football concussions systemwide conflicts with information that MCPS
staff reported to the Board of Education in January 2014. In response to a question
during the operating budget approval process, MCPS reported to the Board that 98
students sustained concussions playing football.11
Even the 98 football concussion reported in January appears to be understated. If the 60
football concussions reported by 7 MCPS high schools were extrapolated out to the other
18 high schools, the total number of football concussions at those 18 high schools would
be 154, for an estimated total of football concussions at all 25 high schools of 214.
Given that football consistently accounts for roughly half the concussions in high school
athletics, the 214 estimated figure for football concussions appears more consistent with
the 184 non-football sports concussions that are reported, while the 60 figure, and even
the 98 figure, appear significantly understated.
The number of football concussions should also be looked at in the context of
MCPSs use of baseline ImPACT concussion testing. According to Bethesda Now
Magazine, MCPS staff indicated that only 45 MCPS high school students who
participated in Fall 2013 athletics programs underwent ImPACT concussion
cognitive testing after sustaining a concussion. 12 This number raises additional

11 https://www.scribd.com/doc/235685748/MCPS-Staff-Response-to-MoCo-BOE-Durso-Q-Re-

Concussion-Jan-Feb-2014

12 http://www.bethesdanow.com/2013/11/20/about-45-students-get-follow-up-concussion-tests-
in-first-season-of-program/

questions about the actual number of concussion in football and other fall sports in
2013.

For example, given that MCPS staff informed the Board of Education in January 2014
that 178 MCPS high school students sustained concussions playing football and
other fall sports,13 why did only 45 of these 178 students undergo subsequent
ImPACT testing? Did students who did not retake the ImPACT concussion test avoid
the test because their concussion symptoms endured through the remainder of the
fall sport season? Did students avoid retaking the ImPACT test because of concerns
about the validity of ImPACT to provide useful information about a students
recovery?14
Needed Follow Up
Please instruct MCPS staff to recheck the number of football concussions at each of the
18 high schools that reported fewer than 5 football concussions and update the reported
figures accordingly. Please also instruct MCPS staff to check the concussion numbers
reported for other sports.
As a check on the figures reported by MCPS staff, I am requesting that Montgomery
County Health and Human Services provide sports concussion data reported to school
nurses, who are funded through the HHS budget, not the MCPS operating budget.
Ideally, these numbers should track those reported by MCPS staff.
3. MCPS Staff Declined to Request Student Injury Data from Athletic Trainers
Background
In the 2013-2014 school year, MCPS staff implemented a pilot program under which
part-time athletic trainers were provided at 11 of MCPSs 25 high schools. As healthcare
professionals, athletic trainers document important information regarding each injury for
each student. For example, for concussions, athletic trainers document:
when one is suspected;
whether one has been diagnosed;
when a student has been cleared to begin the five-stage gradual return to play
steps;
when a student has completed the gradual return-to-play steps;

13 https://www.scribd.com/doc/235685748/MCPS-Staff-Response-to-MoCo-BOE-Durso-Q-Re-
Concussion-Jan-Feb-2014

14 See Concussion Test May Not Be a Panacea, August 26, 2012, ESPN Outside the Lines, Keating, P.,

http://espn.go.com/espn/otl/story/_/id/8297794/neuropsychological-testing-concussions-not-
panacea

when a student has completed return to learn, i.e., returned to full academic
participation without the need for accommodations that did not predate the
concussion; and
when a student has resumed his or her sport or whether he or she has discontinued
playing the sport.

An athletic trainer records injury-related data in a database that allows reports to be

generated about sports injuries occurring in the athletics program he or she covers. In
neighboring Howard County, the school system has a part-time athletic trainer at each of
its 12 high schools. From such a database, the Howard County Public School (HCPS)
Athletics Department generates such a report.15
My Request
In my June 3 letter, I requested a report of the number of concussions in MCPS Athletics
concussion database, broken down by high school and by sport.
MCPS Response
In the June 26, 3014 response, MCPS staff responded:
There are no documents responsive to your request. Beginning next
school year, we will be asking athletic trainers who are working in our
high schools to begin providing the type of data you are requesting.
Needed Follow Up
Please require MCPS staff to request injury data from the health care providers who made
athletic trainers available for the 2013-2014 school year and provide you, the County
Council, and me with the reports that I requested in my June 3 letter.
4. MCPS Invokes Unfounded Privacy Concerns to Hide Needed Concussion
Data
In the June 26, 2014 response letter, MCPS staff withheld certain sports concussion data,
stating:
The Federal Educational Rights and Privacy Act (FERPA) prohibits the
disclosure of information maintained by the school system that may

15 Between 2006 and 2012, the HCPS Athletics Department reported sports injuries each year to the
Howard County School Superintendent and Board of Education at an open meeting in January of each year.
https://www.scribd.com/doc/121864839/Howard-County-Maryland-Public-Schools-Report-of-Injuries-inHigh-School-Sports-Program-2006-2011 The most recent report took place at the Howard County BOEs
meeting on January 23, 2014. Going forward, Supt. Starr should ask the head of school nurses to make a
similar annual presentation to the Board of Education at an open meeting.

reasonably be identifiable to a particular student. Therefore, any cell with

less than fiveincluding those with zerohas been indicated as <5.16
Relying on these privacy grounds, MCPS staff refused to provide data where the number
of concussions in a sport at a high school were fewer than five, including when there
were zero concussions. MCPS staff also refused to provide concussion data when the
number of concussions for a sport systemwide was fewer than five, including zero.17
MCPS Releases Small-Cell Data About College Applications/Acceptances
MCPS staff appears to invoke privacy concerns about small-cell data selectively,
allowing the release of such data in other instances.
For example, the September/October 2014 issue of Bethesda Magazine releases data from
MCPS about the college application and acceptance of high school seniors who graduated
in 2014 from six high schoolsBCC, Whitman, Walter Johnson, Wootton, Churchill,
and Blair.18
For many colleges, the number of MCPS seniors at one of the six high school who
applied or who were accepted was fewer than five, including zero, and yet MCPS
disclosed such small-cell data to Bethesda Magazine. For example, Bethesda Magazine
reported that three Whitman seniors applied to Bard College, but none were accepted.
But for sports concussions, MCPS staff think small-cell data from Whitman and other
high schools cannot be released regarding students who participate in boys soccer, girls
soccer, field hockey, cheerleading, boys lacrosse, girls lacrosse.
Releasing Small-Cell Sports Concussion Data Does Not Violate FERPA

Regulations and guidance issued by the U.S. Department of Education make clear that
disclosing the number of concussions in a particular sport at a particular high school
when that number is less than five, including zero, does not represent a prohibited
disclosure of personally identifiable information (PII). Withholding such information
deprives parents and students in each schools community of information they need to
better understand the risks of participation in each sports at a high school.


16 MCPS Staff Letter, dated June 26, 2013, p. 1. https://www.scribd.com/doc/235863921/MCPS-
Response-Data-Re-Concussion-and-Other-Injuries-in-High-School-Athletics-2013-2014

17 https://www.scribd.com/doc/235686041/MCPS-Chart-Showing-Sports-Concussions-by-Sport-
and-by-High-School-2013-2014

18 http://bethesdamagazine.com/College_Chart.pdf

FERPA prohibits a local education agency like MCPS from having a policy or practice
of permitting the release of [or providing access to] education records (or
personally identifiable information contained therein other than directory
information" without a parent's prior written consent.19

Health information that a local school agency maintains about a student is part of
the student record and thus the protection of privacy is governed by FERPA, rather
than the Health Insurance Portability and Accountability Act (HIPAA).
In relevant part, the U.S. Department of Education defines personally
identifiable information (PII) to include, but is not limited to
Other information that, alone or in combination, is linked or linkable to a
specific student that would allow a reasonable person in the school
community, who does not have personal knowledge of the relevant
circumstances, to identify the student with reasonable certainty.20
(emphasis added)

In applying the PII definition, the U.S. Department of Education has provided
guidance indicating that the term school community does not include school
officials, including teachers, administrators, coaches, and volunteers. Such persons
are not included in making the reasonable person determination since they are
presumed to have inside knowledge of the relevant circumstances and the identity
of students.21

Thus, the school community for purposes of applying the PII definition appears to
include students at the school and parents of those students, excluding those with
personal knowledge of the relevant circumstances, such as teammates and parents
of teammates.

For a particular sport at a particular high school, saying 1 of 100 players schoolwide
sustained a concussion, without more detail about which grade, race or ethnic

19 12 U.S.C. 1232g(b).

20 34 CFR 99.3. The U.S. Education Departments PII definition also includes but is not limited to: (a)

the students name; (b) the name of the students parents or other family members; (c) the address of
the student or the students family; (d) a personal identifier, such as the students social security
number; (e) other indirect identifiers, such as the students date of birth, place of birth, and mothers
maiden name; and (f) information requested by a person who the education agency or institution
reasonably believes knows the identity of the student to whom the education record relates.

21 Frequently Asked Questions, Disclosure Avoidance, October 2012, Updated May 2013 p 3 of 7.
Privacy Technical Assistance Center, U.S. Dept. of Education.
http://ptac.ed.gov/sites/default/files/FAQs_disclosure_avoidance.pdf

10

background, poses little risk, much less reasonable certainty, of members of the
school community who do not have personal knowledge of the relevant
circumstancesi.e., a student who is not a teammate or friend of the injured
studentlearning the identity of that one student. In such instance, the students
health information is sufficiently de-identified to protect that students privacy
rights under FERPA.

Conclusion

I look forward to you demonstrating your priority in keeping students safe by
requiring MCPS staff to follow up on the issues I have raised in this letter.

Sincerely,


/s/

Tom Hearn

11