Ireland-France HIA decision was ‘wrong’, claims expert

The decision to remove Antoine Dupont for a HIA four minutes from the end of Ireland’s victory over France in Paris has polarised opinion.

For those doctors in the firing line of having to make real-time rulings on the health or otherwise of injured players, the decision of the pitchside doctor to call the HIA followed by the decision of the HIA review process to agree that there was “no evidence of anyone within the FFR seeking to gain a competitive advantage” has already left a legacy.

Prof Maurice Stokes, who is the honorary medical officer with Old Belvedere RFC, disagrees with the decision of the French doctor to call the HIA and disagrees with the findings of the review panel. Those are his opinions.

Prof Stokes knows all about the practice of HIAs and rugby injuries because he is on duty for every home game at Anglesea Road and has performed that role for many years.

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But more important than his disagreement is his concern that the impartiality of doctors all over Ireland, who act as medical officers for their clubs, may now be called into question.

When the Dupont incident occurred four minutes from the end of the match, acting Irish captain Johnny Sexton queried the decision to call an HIA with referee Nigel Owens.

Sexton immediately understood the import of that decision as it meant France could bring back on scrumhalf Maxime Machenaud for the crucial closing stages.

That would not have been the case if Dupont was removed from the game with a knee injury, which is the actual injury he turned out to have suffered.

What the panel said was although the match day doctor and the video doctor should not have simply accepted the indication of the match official (Owens) that an HIA was required, it was understandable that they called for an HIA in those circumstances.

“It is my view that the HIA panel, in absolving the doctor, has done more harm than good,” says Prof Stokes. “I think the HIA panel should have been critical of that decision . . . coming out and saying it didn’t have an effect and all the rest of it I think is baloney. It is. It was wrong.

“My opinion on the matter is that it is negative for rugby that they were supporting the doctor. I don’t think that is good.

A tactic

“The reason is that now leads to my motives being questioned, when I am fulfilling the same role for my club. Then potentially that could lead to harm to players. It does not help the image of the game either.”

Based on his experience of refereeing rugby at junior level and acting as team doctor for many years, Prof Stokes watched the incident and believes the doctor should not have ‘awarded’ the HIA to Dupont. Furthermore he believes the French team should have been questioned about using the HIA as a tactic, which goes to the heart of his disagreement.

Last year France were reprimanded for an incident involving a change of props during the conclusion to their 20-18 win over Wales in Paris.

In the 81st minute referee Wayne Barnes allowed France to replace Uini Atonio with Rabah Slimani, who had earlier been replaced, with the France team doctor insisting Atonio needed an HIA.

"There is evidence to suggest the integrity of the game has been brought into disrepute," said interim Welsh coach Rob Howley afterwards.

“In the AIL each team has to produce its own doctor and I can remember spending weekends travelling around the country to various venues when there were a lot of better things I could be doing. Then we decided the home team would provide the doctor,” says Prof Stokes.

“From a domestic point of view that works. The respect is there that we do look after each other’s players. If I say to a referee I think he has a head injury, that opinion counts. But am I being professional in that opinion or am I being partisan in that opinion.

“Certainly I’ve been teased for stopping opposition players getting back on the pitch. One team would say why did you keep him off? You’d stitch one of your own players and get him back on the pitch. You stitch one of the opposition and get him on the pitch. You do that equally. Your own supporters don’t necessarily understand that. But that’s your professional role.”

What happens at national level often filters down to grass roots rugby. The obvious irony now is that the latest conversation has centred around taking a player out of a match for an HIA, whereas before team management were being criticised for not removing players from the game for suspected concussion.

Used tactically

The integrity of the game is front and central to World Rugby and now they might find that the latest conclusions from the Stade de France game will have a knock-on effect. Even if people believe the French did not break any rules, as the HIA Review claim, the idea that an HIA may be used tactically is now in the public domain.

In the middle of it all are the doctors.

“I’d have been happier if they had come out and said that they all need to go away and relearn the HIA rules,” says Prof Stokes.

“I would have been happier if there was some sort of admonition like that rather than saying they were happy with the decision. My fear is that it makes our role as team doctor seem more biased and less neutral. Just like a referee we should be neutral.

“We are there to look after the players’ interests – all 46 of them. You don’t want your decisions to be questioned that you might be partial. That’s the problem. We have to trust our doctors not to be partial.”