'Rugby’s dirty secret’ claims another life

On January 29th, 2011, 14-year-old Ben Robinson played rugby for his school. After being treated three times for blows to the head and sent back to the field on each occasion, he collapsed and later died in hospital. Behind his tragic story is another of a sport in denial, where authorities at all levels dither over treating concussion while all the time, players grow stronger, heavier and the hits get bigger

The house is silent, but the silence speaks. It tells a story. Once, a boy lived here, who was loud. Not like his sister. Their mother seldom knew whether the girl was in or out, but she could always tell when her son was home. She could hear him, even when he was holed up in the front room playing computer games. He filled the house. Now he is gone, and in his absence, there is silence.

Awesome. Loving. Vibrant. These are the three words Karen Walton and Peter Robinson chose to describe their son, Benjamin. They are carved in stone in a cemetery outside the small town of Carrickfergus. Ben was 14 when he died, from brain injuries inflicted while playing for his school, Carrickfergus Grammar, against Dalriada. In September a coroner determined the cause of death was the rare Second Impact Syndrome. But behind those words is a simpler one, a word Karen describes as "rugby's dirty secret". Ben Robinson died because of concussion.

Ben took too many blows to the head in too short a space of time. His death could, and should, have been prevented. “For something like this to happen,” Peter says, “there have to be so many failings. And on that day, unfortunately for Ben, there were so many failings.”

There should have been a chain of health-and-safety procedures in place, one that included players, coaches, referees and parents. If just one link in that chain had worked, Ben’s concussion would have been spotted. He would have been removed from the pitch, and he may have survived.

The coroner said Ben was the first person in the UK to die of Second Impact Syndrome while playing rugby. Karen says she is certain Ben will not be the last.

“Will this happen again?” she asks. “Yes. I would say without a doubt another family will go through what we have been through.”

Since 2006, at least five children and one adult have died from brain injuries suffered while playing rugby. Second Impact Syndrome is rare. Concussion is not. Neither are the injuries it causes.

Karen's house is silent, but the silence speaks. It tells of a boy's death and a family's grief. Of a sport in denial about the risks being taken by those who play it, struggling to square the blood, guts and glory attitude of its amateur days with the brutal power of the professional game, and riven with disagreement about how to deal with its single most important issue – concussion.

Preferred football
Before Ben Robinson went to Carrickfergus Grammar, he didn't care for rugby. His father, Peter, had played it, and his stepfather, Steven, still did. Ben preferred football. But he found himself in the school team all the same, playing at centre, because he had some talent for it.

“This was a kid,” his mother says, “who would miss rugby training after school, because he wasn’t that keen, but still be on the team sheet at the weekend anyway.”

As Ben got older, and learned a little about the sport from his dad and stepdad, he began to enjoy it more. Until, in his third year, he won a prize for most improved player. “Things,” Karen says, “were falling into place for him.”

Ben loved the rough and tumble. There had been a time when he wanted to be a stuntman. Karen once looked out of the window and saw him in the street, tied to a skateboard attached to his sister’s bike, ready for some daredevil trick.

She told him there wasn’t much calling for professional stuntmen and wondered if he might want to become a physio. When his stepfather broke his leg playing rugby, Ben would massage it for him, and ask him where it hurt. He was fascinated by the pins put in to hold the bones together.

Carrickfergus wasn’t a rugby school, not like Campbell or Methody, but they took the game seriously. Ben was on a conditioning program to help him bulk up. He would come home with a sheet of exercises he should be doing: how many miles he should run in how many minutes, which weights he should lift and how often.

The match against Dalriada mattered more than most. It was in the second round of the Medallion Shield, the Ulster Under-15s competition. The winter had been cold and the game had been postponed over and again because of frozen ground. Finally it was pencilled in for January 29th, 2011. “That’s great,” Karen said to Ben. “I’ll be able to go and watch you.”

She went to most of his home games and a few away ones, too. She didn’t know much about rugby – “You pass it back to go forward, and that’s about it” – but she understood what the match meant to her son. That week he had forgotten his kit for after-school training but he took part anyway, holding the rucking pads while the other kids hit them.

The day before the game, Ben watched Invictus, Clint Eastwood's film about the South Africa side that won the 1995 World Cup. Karen was out watching Ben's sister play football. She called him home to ask what he wanted for supper. Pasta. That, after all, was what the professionals ate before a match. But Karen was late back. She didn't have time to cook, so she picked up some Kentucky Fried Chicken.

When she got in, Ben was standing at the top of the stairs in his rugby kit. “What are you doing?” she asked. “Do I look the part?” Ben replied. “Do I look okay?” Steven started to snigger, but Karen shushed him. “Don’t laugh, this is an important thing for him.”

Ben came down to the kitchen to eat, still in his kit. Talk turned to tomorrow’s game. He was nervous, said he didn’t want to let anyone down. “It’s just rugby. Just do your best, and if you do your best no one can ask anything more of you,” Karen told him. “I want to do my best,” he said. That night he slept in his kit.

In the morning Karen dropped Ben's sister at school for a hockey match. When she got back, she made him some scrambled eggs, because all he'd eaten for breakfast was a banana. On the way to the ground they stopped at the garage to pick up supplies. Ben had a little ritual after every match, he liked to settle down with the Sun and a Pot Noodle. He had his iPod on, one earphone in, the other hanging free so he could talk to his mum. They were close and called each other Mummy Bear and Baby Bear.

Baby Bear and Mummy Bear
As they drove down to school, Ben said: "You know, I am going to have to stop being Baby Bear, because when I'm 15 I will be playing against 18-year-olds."

“Okay,” she said. “But you know you’ll always be Baby Bear to Mummy Bear?” “Yeah,” Ben said. “Yeah, yeah.”

The car stopped. Ben just sat there. “I thought: ‘He is not going to get out of the car,’ so I said: ‘Right, well, I am just going to go back to the house, collect Steven, and then we’ll be back up to watch’.” He finally got out. “Okay.” He flashed her a thumbs-up as she pulled away.

Have you ever heard of the Scat? If you haven’t, you are in good company. The acronym stands for Standardised Concussion Assessment Tool. The pocket version is a card that lists the nine “red flag” symptoms. If any one of those nine is detected, the Scat says in red text, “the player should be safely and immediately removed from the field”.

The Scat was drawn up at the Zurich International Consensus Conference for Concussion in Sport, which is held every four years. The IRB is represented at the Consensus Conference, as is Fifa, the International Olympic Committee, and the International Ice Hockey Federation.

It takes seconds to download and print a Scat card. Every rugby coach, every rugby referee, should have the latest edition – the Scat3 – in their pocket. But most club and school players, coaches, and referees have never heard of it. To get a Scat card from the IRB, you have to find it on their website and download it. As Peter Robinson says, it feels as if “the IRB ask people to go online and educate themselves”. They do not issue Scat cards as standard.

In fact, the edition of the Scat available from the IRB is four years out of date. The referee in charge of the match between Carrickfergus Grammar and Dalriada admitted at the first hearing, a year after Ben’s death, he hadn’t heard of the Scat. Neither had the Carrickfergus coach.

Karen arrived at the ground just in time to see Ben running into a ruck. “The force of it shocked me,” she says. “He hit those boys and his whole upper body just whipped back.”

She had never seen him play with such energy, such ferocity. “He seemed to be involved in everything. It was just hit after hit after hit.” She started to worry. “You take away that fancy name, ‘rugby’,” she says, “and you have got a group of 30 boys slamming and banging off each other for 80 minutes. In the street, at what stage are you going to say: ‘Sort that out, somebody is going to get hurt?’ But you put the ball in, and you call it sport.”

At half-time Karen turned to Steven and said: “Ben has done his bit, I want him off.” She wanted to go on to the pitch herself, to check on her boy. She had done it before. But she knew it embarrassed him. “Don’t come on, Mum,” he’d say. “Nothing is going to happen to me.” So she sent Steven instead. “Did you speak to him?” Karen asked. “No, but I chatted to the referee.” “And what did he say?” “He said he is a great wee player, very enthusiastic.”

That didn’t calm Karen. “The referee is there,” Steven said. “The coach is there. He seems fine.”

The coroner found there were no “major incidents” involving Ben in the first half, but Karen thinks there were many minor ones.

There is video footage of the match. It was a key piece of evidence, because, as the coroner said, the “frailty of the human memory when recalling traumatic events” meant “many of the witnesses were confused regarding timings”. It was filmed by one of the Dalriada boys. Peter made himself sick watching it, but now he has seen the tape so many times he has become desensitised to it.

“I realised that the first time I showed it in court, and heard the gasps from all the other people. I realised again that I was watching Ben’s last moments.”

Larking around
In the video, the action takes place in the background. In front, the schoolboy spectators are larking around, telling jokes and pulling faces. Over their shoulders, you catch sight of Ben, conspicuous in his distinctive body armour, one arm black, the other white. You see him accelerating into a hard tackle. He is knocked to the ground. He stays there for 90 seconds.

At the inquest, the Carrickfergus coach remembered that Ben stood up on his own, one of a series of misremembered facts Peter and Karen disproved by showing the video. Ben was helped to his feet. Soon after he is hit again. It looks like there is a clash of heads. These two blows happened in the first four minutes of the second half.

The video cuts. You see Ben holding his head. He walks over to the coach, who does a concussion test on him and decides he can play on.

The coach didn’t remember how that conversation went. The video cuts again.

Now Ben is hobbling, holding his head, walking away from play. The coroner found Ben continued to “play enthusiastically”, and “displayed no immediately obvious physical signs that anything was amiss”, but in the video, his symptoms clearly tally with those on the Scat card.

Again, you see the coach giving him a concussion test, holding up fingers in front of his face. Ben was checked for concussion three times during the match, and each time he was allowed to play on.

There was a doctor at the match, the father of a Dalriada player who hurt his leg in one of the collisions with Ben. He missed the symptoms too. “In court he said by the time he got over to Ben he was already up on his feet,” Peter remembers. The video showed he too was mistaken.

Karen was pacing up and down now. “There were stoppages, and I knew they were for Benjamin. I saw the coach doing the fingers test, moving them from left to right.” Once, she was sure she saw the referee rolling his eyes. He admitted as much in the inquest, saying he thought some of the players were being “prima donnas and drama queens”. Ben was heard to say: “I am not remembering this.” The video shows Ben talking to his fellow centre, who said at the inquest Ben had told him: “I can’t remember the score.”

“He had this very confused smile on his face,” Karen remembers. “And I was thinking: ‘That’s not right’. But I was also thinking: ‘He has been checked. He has been assessed. He is okay’.” She started to cry out to him: “Benjamin! Benjamin!”

The referee told her to calm down. It made her think she was being silly. Just another over-protective mother.

“I could see Ben, away to the left of me.” He started to stagger. She cried again: “Benjamin! Benjamin!” and he turned to her and said: “I don’t feel right”. As she walked towards him, the ball came his way and he was sucked back into play. The game was almost over. People were shouting for the referee to blow his whistle. Karen told herself: “Just another minute” .

Then there was another stoppage. Karen turned to Steven. “Is it Benjamin?” She started running. She was halfway across the pitch when she passed the Carrickfergus captain. “It’s Ben,” he told her. “He is out cold.”

On the video Ben is flat out. One of the witnesses remembered Ben made a tackle, stood up, then collapsed backwards.

'He didn't regain consciousness'
"That was it," Peter says. "He didn't regain consciousness."

“I got there and he was lying flat on his back. The whites of his eyes were looking up at me, and he was gasping for breath,” Karen says. “And everything clicked into place.” All the doubts slipped away. “He had been involved in too many hits, too many tackles.”

She got down on her knees, held his arm, told him “Benjamin, Mama’s here”, and wrapped him in her coat. Karen was a policewoman. She had an idea of what to do, and tried to put him into the recovery position. But he kept slumping forward.

“And I just knew. I just knew. I was hit with the very cold, hard, realisation that the son I love and adore, my only son, my youngest, had gone. My world fell apart. It really did come crashing down.”

For Karen, it’s as though the clock stopped on January 29th. “People tell me time is a great healer,” she says. “It isn’t. It only gets harder. My yesterday will always be January 29th. Benjamin is missed every second of every day.” She struggles to remember what she did yesterday, the day before, or the week before, but recalls every little detail of the last days of his life.

“That whole day, the days leading up to the game, I remember the conversations we had, the jokes we shared, the laughs.” Then things begin to fracture. There are pieces of memories, isolated images, clips of conversation. The interminable ambulance ride. Pacing the waiting rooms. A nurse saying: “He is going to be okay.” A consultant offering no such assurances.

The sight, through a door window, of a neurologist talking to a nurse, and when the nurse hung her head, Karen knew what was coming. “I kicked, punched, screamed, fought. I do remember periods of that.”

It wasn't the first blow that killed Ben Robinson. It was the fact he played on, and was hit again. Dr Willie Stewart is one of Britain's leading neuropathologists. He has become one of the key figures in the campaign to reform rugby's concussion rules. He explains: "Second Impact Syndrome is incredibly poorly understood."

The significant point, Stewart says, is that adolescent brains can swell uncontrollably after a single bang on the head. “The first one causes the blood vessels to become a bit leaky,” he says. “The second one cause them to become much worse, and that leads to brain swelling.”

The second blow does not have to be concussive. A glancing blow, a jar, is enough to exacerbate the swelling. Which is why it is essential to remove a player as soon as signs of concussion are detected.”

At first, Peter and Karen were told by the hospital staff and representatives of the Ulster branch of the Irish Rugby Football Union it was probably a freak accident, the result of one bad tackle and a single blow to the head. "He had more chance," one nurse said, "of being hit by lightning."

It was only six months later, when the pathologist’s report came back, they learned a little of the truth. They would have to fight to uncover its entirety.

“When we were first told about what happened, Ben’s injuries were described as a one-off collision,” Peter says. This, he feels, was the explanation that the authorities were most comfortable with. “It meant there was no comeback.”

“I am so grateful to that pathologist,” Karen says. “Because he refused to accept the theory that it was just one blow. He went on his gut instinct: that Ben was a young, fit, healthy, boy, and the idea that it was just one blow didn’t make sense.”

The pathologist found Ben had three brain injuries, and it was probable they had all been inflicted in that one match.

“He likened Ben’s injuries to those you’d see in somebody who had been involved in a car crash.”

The school declined to be interviewed for this article. In a statement, Carrickfergus Grammar said: "Benjamin Robinson was a highly popular, outgoing and able young man whose tragic death in January 2011 remains keenly felt both in and beyond the Carrickfergus Grammar School community. The board of governors extends its continued heartfelt condolences to his parents and family."

That October, Karen was visiting Ben’s grave, as she does every day, when one of his old school team-mates came jogging past. He stopped, and as the two spoke he started to cry.

He said Ben’s friends still didn’t understand why he was dead. He said that during the match he knew Ben had been knocked out. “This,” says Peter, “is where it started to come out.” Karen asked the boy: ‘Why didn’t you didn’t tell the police that?’

“These are kids who have had no dealings with the police,” she explains. “It is a very daunting experience. And it was very brave of them to speak out. It was a huge, huge thing for them to do at that age. I am grateful to those boys for coming forward and saying: ‘Look, Benjamin didn’t look right, he didn’t remember the score’.”

Uneasy with the way the investigation was going
Peter and Karen, hired a solicitor because they felt so uneasy with the way the investigation was going. "I suppose because I was in the police and I know how investigations should work, especially where kids are subjected to trauma. And it wasn't going the way I would have conducted it."

Then, when they arrived at the inquest, they discovered that the school had hired a barrister. The process became, Peter says, “adversarial”. They had to fight to prove Ben should have been taken off the pitch, that he could have survived. It was, Karen says, “a very difficult time”.

The inquest was scheduled to run for a day in September 2012. It lasted six. Representatives from the Ulster branch of the IRFU arrived on the fifth day, when it became apparent the referee, whom they had trained, was giving evidence without legal representation. The Ulster branch asked for a delay to prepare a report. The inquest was postponed for a year.

When it was finally over, the coroner ruled that Ben had died of SIS, the first diagnosed case in Northern Ireland and, probably, in the UK.

The coroner found Ben was concussed in the first four minutes of the second half, and that “unfortunately neither the team coach or the referee were made aware of his neurological complaints”.

The coroner would be sending her findings to the head of the IRFU and the education minister for Northern Ireland, John O’Dowd. The IRFU issued a statement in which it expressed its “deepest condolences”, stressed that “injuries of this nature are highly unusual in rugby” and insisted that it observes “all international best practices, as set out by the IRB”.

The inquest was supposed to provide answers. But when it was over, Peter and Karen had more questions. Why hadn’t the coach or the referee spotted the symptoms of Ben’s concussion? Why hadn’t they known about or followed the Scat protocol? Why hadn’t they removed him from play when his team-mates said he had been knocked out?

Why, a year later, were those same team-mates still unsure why he had died? Why hadn’t the parents themselves been told about the risks of concussion? Why hadn’t the players? If the IRFU was following the “international best practices as set out by the IRB”, why was their son dead? And if those “best practices” had failed once, what was to stop them failing again?

After the inquest, Peter assumed “people would be saying what happened? How do we prevent this?” Instead, he realised “unless you went looking for information about concussion, you wouldn’t find it.”

What scared him about rugby, he says was “the complete lack of awareness” about concussion, how to spot it, how to treat it, and how seriously to take it.

“For me,” Peter explains, “something positive has to come out of this.” What worries him is the idea that “Ben was another statistic”. He read about the three players who died from similar injuries since his in 2011, and he realised: “No one has learned anything.”

Shortly after the inquest, the Ulster branch sent a coach to the school to talk to the students about strength and conditioning, and a talent scout too. Karen was shocked they weren’t sending anyone to talk about concussion.

"This could have been avoided," she says. She has to live with the knowledge she knew Ben should not have played on. "I got it right. If only I had gotten it right sooner. If only I hadn't ignored it. But I thought he was in good hands . . . . Now it is all about getting his story out there. I don't want it to have been in vain." –
Guardian Service