‘Clubs don’t trust each other’: NRL explains reasoning behind use of independent doctor

Graham Annesley has cited distrust amongst NRL clubs as a key factor behind why an independent doctor was introduced into the Bunker in the first place to help deal with matters pertaining to concussions.  

“It used to be left to the clubs and they were screaming for us to introduce independent doctors,” he said. “The primary reason they were calling for us to introduce independent doctors is that the clubs don’t trust each other.”

NRL defends the use of an independent doctor in the Bunker following contentious weekend

Annesley highlighted how under the previous system to deal with head injury assessments [HIA’s] clubs complained how others may have been cheating to gain an advantage through additional interchanges.

MORE: NRL Round 1 Likes & Dislikes – Harry Grant the hero in golden point while Bulldogs disappoint 

“There were all sorts of claims about ‘They are rorting the system’ or ‘They took that player off and he didn’t need to come off with a head injury,’” Annesley stated.  

“I’m not casting any dispersions on club doctors…but whether the claims were accurate or not- this is what clubs think. They didn’t trust each other. Forget about not trusting anyone else.

“The reason the clubs wanted independent doctors was to take that away [possibility of rorting the interchange system through false injury assessments].

“The NRL’s motivation for introducing independent doctors was to make sure we don’t miss incidents like that,” Annesley added while pointing his finger to the screen where he had just reviewed footage of an incident involving Jacob Kiraz.The Bulldogs winger took a hit-up into the jaws of Manly’s pack during his side’s loss on the weekend before offloading and getting up.  

At least this was the footage viewers got on the broadcast with the camera panning away from the Lebanese international as play moved down field.

Kiraz instantaneously bounced to his feet but made just a slight misstep on his way back to the right wing, spotted in wide angled vision the independent doctor viewed, which was identified as a sign he needed to be assessed.

Kiraz was puzzled by the intervention at the time but has since commended the safety-first approach. 

Although this wasn’t the only incident relating to concussion that raised a few eyebrows across the weekend with the actions taken on Kalyn Ponga and Sebastain Kris drawing criticism from Adam O’Brien and Ricky Stuart post-match.

MORE: ‘Jumping at shadows’ – Adam O’Brien questions decision to remove Kalyn Ponga for a HIA

Meanwhile, Andrew Johns questioned the input from the independent doctor on the Sunday Footy Show.

“The doctor’s got to be at the ground,” he said.

“This is all happening because we’re terrified of getting sued. 

“That’s why it’s happening but there’s got to be an independent doctor at the ground who assesses the player, face to face.”

On Monday night, Phil Gould added to the chorus of dissenting voices around the use of the independent doctor in the Bunker on 100% Footy, labelling it “the greatest abomination perpetrated on our game in history.”

However, Annesley argued that the majority of the decisions around HIA’s didn’t actually emanate from the independent doctor.

“I want to dispel this myth that all of these decisions are made by the independent doctor in the Bunker because nothing could be further from the truth,” he said.

“Of the 19 HIA’s that we had across the course of the weekend, 14 of the 19 were initiated by the club’s doctor.”

What does the independent doctor do in the NRL Bunker? 

Annesley claimed there was widespread misunderstanding in the game about how the independent doctor actually operates and what they do in the Bunker. 

“They’re there as a support mechanism for the doctors on the ground at the venue- the club doctors,” he said.

“They’re there to try and make sure that if something falls through the cracks, it’s picked up by the Bunker where they have the benefit of all of the camera angles.

“The whole objective of this is to try and capture them all, or as many as possible between the club doctors and the independent doctor in the Bunker.”

Independent doctor role and duties:

  • Independent doctor in the Bunker and club doctors at the venue
  • Independent doctor has final decision on category 1 or 2 HIA’s
  • Club doctor makes final assessment on category 2 HIA’s
  • Two injury spotters in the Bunker assisting

Annesley explained how the independent doctor in the Bunker, along with two fellow spotters, review the impact of tackles and observe reactions from players in the aftermath of this through a range of different camera angles.

In its most basic form, if a player lies motionless on the ground for more than five seconds this means they will be identified as having suffered a category 1 concussion.

But they also assess whether there has been motor incoordination, seizures, a lack of bracing themselves for falling to the ground or tonic posturing.

If a player is adjudged to have shown any of these severe symptoms, the independent doctor will identify it as a category 1 concussion with the player unable to return to the field.

Category 2 incidents share much of the same signs which are looked for in video with key differences such as lying motionless for two to five seconds and being slow to stand.

“The club doctor bases their decision on a physical assessment rather than a video sign from the independent doctor,” Annesley noted around how players are able to return after undergoing a HIA with the club doctor.

“Signs of possible head injury could be missed because of the helter skelter going on in the game itself,” Annesley said when discussing the benefits of the independent doctor.

“They look at the impact of the incident and observe how they reacted after it.

“The club doctor is then alerted to the footage and can review themselves at the venue and determine what to do.

“A judgement call will be made either by the independent doctor or the club doctor whether it was category 1 or 2.”

‘I’m not going to second-guess a judgement call from a doctor’ 

There is also a third option on the table for doctors who can send out somebody to complete a ‘trainer check’ if a possible incident has been picked up during a match.

“Every incident doesn’t automatically fall into category 1 or 2,” Annesley said.

“They’ll see something, but it might not fall into the criteria, but the doctor thinks it’s worthwhile to send someone out just to check with the player.”

Although while Annesley admitted there were flaws in the system that was first introduced last season, he was satisfied with how all of the incidents had been handled during the opening round.

“Every HIA every week is reviewed in great detail by the NRL chief medical officer on a Monday,” Annesley said. 

“I’m not going to second-guess a judgement call from a doctor when it comes to the health and safety of a player.

“Do they err on the side of being conservative? Maybe. But wouldn’t we all rather that when it comes to the health of a player?

“We’ve seen too many players retire prematurely because of head injuries – no one does this to be a narc. We do it to ensure players are safe.

“I’m the first to admit that there is no good time for this to happen…there is no convenient time for it to happen. But we can’t have doctors making decisions based on the game.

“It’s no different to losing a key player at an inopportune time to any other type of injury. A player could have a knee injury or an ankle injury. They could pull a hamstring or have a cramp that they can’t recover from- all of those things are part and parcel of our game.” 

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