Sep 302014
 

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By Michael Abramowitz
September 30, 2014

Students from the Brody School of Medicine at East Carolina University who joined Monday’s recreational outing had a blast.

About 25 students turned out at the Pitt County Wildlife Club in Falkland to shoot an assortment of shotguns and small caliber rifles under the guidance of club members and officers with the N.C. Wildlife Resources Commission.
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For Brandon Lyon and his fellow wildlife enforcement officers at the club, the student outing was an excellent opportunity to expose people to the fun and excitement of safe firearms use.

“We’re always looking for different ways to reach out to the many sectors of our diverse population,” Lyon said.

The event was a natural fit for Lyon because his wife, Kayla, is a Brody student. The idea was hers, he said.

“They have a recreational program for the medical students called, ‘Teach Your Talent,’ and that’s what Kayla wanted to teach,” Brandon Lyon said. “We both really enjoy firearms recreation and it was a way for her to share her pastime in a safe and enjoyable environment.”

The idea also made sense to Brandon Lyon for other reasons, he said.

“These people have devoted their lives to studying medicine, and this gives them an opportunity to widen out into something they might not otherwise be doing,” he said. “And it lets us instruct them properly to provide a good first-time experience.”

Kayla Lyon said she was a bit surprised that so many of her classmates responded to the invitation.

“There were a lot more who wanted to join us, but they had other obligations today,” she said. “Our faculty encourage us to be well-rounded, and the Teach Your Talent program is something that our diversity counselor, Bianca Patel, began to diversify our interests.”

Second-year medical student Justin Smith was fired up after firing off a few 20-gauge shotgun rounds at some clay pigeons.

“I’m just trying to blow off some steam and relax with my classmates a bit after a tough round of exams last week,” Smith said. “It was fun, a lot of fun.”

Jason Yan came off the range beaming, despite “narrowly” missing his targets, according to his instructor.

“It was a great experience, even though I didn’t hit any of the targets,” Yan said. “I’ve never shot a gun before. I thought the noise and recoil would be tough, but it wasn’t anything I couldn’t handle. I never thought I’d be doing this in med school.”

Kayla Lyon said a safe firearms experience could very well enhance a doctor’s bedside manner.

“There are a lot of folks in Pitt County who hunt, and this commonality could be a good way to gain patient trust and get an insight into their lives,” she said.

Several of Lyon’s classmates agreed, with some taking the experience a step further. Augustine Dusablon is an experienced shooter who took advantage of the opportunity to practice with his classmates. He saw some practical value in having experience with firearms.

“There’s a good likelihood that many of my classmates will have exposure to firearms injuries,” Dusablon said. “Having some idea what it’s about will serve them as a doctor. It’s also good to know about safety rules.”

The Wildlife Resources enforcement officers were able to participate in the event with funding from the agency’s hunter education program. There are eight firearms ranges and an archery range available to members and their guests at the Pitt County Wildlife Club on N.C. 222 in Falkland, member and certified hunter safety instructor Kim Tavasso said.

The club hosts several events each year that are open to the public, including ladies’ and youth events, Tavasso said. For more information about firearms safety training at the club, visit online at pittcountywildlifeclub.org/rangerules.

“It’s interesting to see the rising number of women who now are becoming interested in hunting, and who want to learn how to safely and correctly handle a firearm,” Tavasso said.

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Sep 302014
 

ap

The Associated Press
September 30, 2014

GREENVILLE, N.C. — East Carolina University is getting a grant from the N.C. Department of Health and Human Services to provide mentoring and evaluation to pre-kindergarten teachers in 46 counties in the region.

The school was selected to receive $1.3 million.

Barbara Brehm, coordinator of ECU’s birth to kindergarten undergraduate program in the Department of Child Development and Family Relations, will oversee the Early Educator Support, Leadership and Professional Development project.

Licensed teachers at more than 500 schools in eastern North Carolina have had to rely on state agencies for mandated Pre-K mentoring and evaluation, which led to an extensive waitlist from a lack of resources.

Independent consultants will be hired, contracted, trained, supported and monitored out of ECU. They will each be assigned a caseload of schools to mentor and evaluate.

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Sep 302014
 

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By Fred Clasen-Kelly and Ames Alexander
September 29, 2014

RALEIGH — Acknowledging that North Carolina’s medical examiner system has been chronically understaffed and underfunded, state officials on Monday told lawmakers of a plan to overhaul the way the state investigates suspicious deaths.

The program needs more investigators, training and money, officials with the state Department of Health and Human Services told a legislative panel that is studying ways to improve death investigations.

“… The system has been ignored and diminished,” DHHS secretary Wos told the committee, which oversees the department.

The medical examiner’s office has struggled with overworked pathologists and medical examiners who fail to perform basic investigative steps.

An Observer investigation published this year found that medical examiners routinely take shortcuts when probing suspicious deaths. Medical examiners don’t go to deaths scenes in 90 percent of their cases, and they violate a state requirement to view the bodies in 1 of every 9 deaths.

Faulty investigations can compromise criminal investigations and leave families without the insurance payments they deserve.

During a four-hour hearing Monday, lawmakers grilled state officials about why the decades-old problems haven’t been fixed. They questioned why DHHS had not brought the issues to their attention before the Observer series.

“I have the feeling of being irritated, being here in 2014 based primarily on a journalism article…,” said State Sen. Tommy Tucker, R-Union County. “In death, people should have the dignity to receive a correct death certificate.”

In sometimes tense exchanges, state administrators said they have pleaded with lawmakers for more money but were ignored.

At one point, an official read through nearly two dozen recommendations from a 2001 report on how to improve investigations. Almost none of them were implemented.

The state system isn’t accredited by the National Association of Medical Examiners, but DHHS officials say they are trying to change that. Accreditation will require significant changes and substantially more money.

Dr. Lou Turner, a DHHS official who helps oversee the medical examiner’s office, said the agency is considering whether to add 50 death investigators. The salaries and benefits would cost $2.8 million, she said.

State Chief Medical Examiner Dr. Deborah Radisch told lawmakers more training money is needed.

“No matter who you appoint, I don’t care how smart a doctor or how smart a nurse you are, you have to be trained to do this,” she said.

Lawmaker ‘disappointed’

Most medical examiners are doctors and nurses who perform death investigations on the side. The state pays them $100 per case, which experts say is little incentive to get up at night or travel to a death scene.

The Observer found that the state doesn’t require examiners to be trained or to visit death scenes, even in homicide cases. And when medical examiners break the rules, they’re rarely disciplined.

Sen. Tucker criticized Radisch and other medical examiner leaders for waiting so long to ask lawmakers for help. Radisch, who previously worked as associate chief medical examiner, assumed the agency’s top job in 2010.

“I am disappointed,” Tucker said. “Every one of these questions was raised in 2001.”

DHHS officials on Monday proposed that the state increase the fee paid to medical examiners from $100 to $250 per case.

But Tucker questioned why agency leaders didn’t do that earlier. “It’s amazing to me,” he said.

Wos defended Radisch, saying she has been busy doing autopsies and taking other steps to keep the understaffed system afloat.

DHHS: We’re making progress

The Observer’s investigation found that pathologists in the state’s chief medical examiner’s office in Raleigh routinely do more than 250 autopsies a year – heavy caseloads that experts say can lead to mistakes.

After the series, the General Assembly asked an independent research unit to examine ways to improve the system. The legislature’s Program Evaluation Division should wrap up its study and recommendations in early 2015, said Director John Turcotte.

Legislators also approved an additional $1 million for the medical examiner’s office. The money represents a roughly 24 percent increase in state funding for the system.

Lawmakers credited the Observer for bringing the issue to the attention of politicians. But, said Sen. Don Davis, D-Greene: “It shouldn’t take the media to encourage us to be visionary.”

Wos, who was appointed to run DHHS in 2013, said the department has made progress on hiring, reducing caseloads, and fixing problems in a regional autopsy system “that was at risk of falling part.”

But Tucker criticized Wos, saying her department has been at the center of several controversies, including computer problems that last year left thousands of families waiting months for food stamps.

Search for solutions

North Carolina has one of the most poorly funded medical examiner systems in the country.

Even with the additional $1 million, North Carolina spends about 93 cents per capita on death investigations. That’s significantly less than most states. A 2007 study found that the average state medical examiner system spent $1.76 per capita on its death investigation system.

Many leading systems send trained, professional investigators to the scene of every suspicious death to search for clues.

Radisch pointed to Virginia’s well-regarded medical examiner system as a possible model for North Carolina. There, four regional centers oversee investigations and perform autopsies.

Radisch said her goal is to have every autopsy performed by board-certified forensic pathologists, as nationally accredited systems do. Now, she said, 19 percent of autopsies in the state are done by general pathologists, who specialize in natural disease, not violent deaths.

Under the DHHS plan, state officials would pay to expand Mecklenburg County’s office and to build new offices in Winston-Salem and Greenville. They would also open two new autopsy centers in the eastern and western parts of the state.

Lawmakers referred to the largely ignored 2001 report and promised that they would not let history repeat itself. Sen. Jeff Tarte, R-Mecklenburg, cited personal examples. He said his father drowned at age 49. His mother was killed at age 65 in a car crash. And his sister died at age 36 of complications from a hospital-acquired infection.

“The status quo is completely unacceptable,” he said.

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Sep 302014
 

newyorktimes

SEPT. 29, 2014

By Charles Ornstein, Ryann Grochowski Jones and Eric Sagara

On Tuesday, the federal government is expected to release details of payments to doctors by every pharmaceutical and medical device manufacturer in the country.

The information is being made public under a provision of the 2010 Affordable Care Act. The law mandates disclosure of payments to doctors, dentists, chiropractors, podiatrists and optometrists for things like promotional speaking, consulting, meals, educational items and research.

It’s not quite clear what the data will show — in part because the first batch will be incomplete, covering spending for only a few months at the end of 2013 — but we at ProPublica have some good guesses. That’s because we have been detailing relationships between doctors and the pharmaceutical industry for the past four years as part of our Dollars for Docs project.

We’ve aggregated information from the websites of some large drug companies, which publish their payments as a condition of settling federal whistle-blower lawsuits alleging improper marketing or kickbacks. Today, in cooperation with the website Pharmashine, we’ve added data for 2013, which now covers 17 drug companies accounting for half of United States drug sales that year.

Here are some facts we’ve learned from the data:

Many, many health professionals have relationships with industry.

Dollars for Docs now includes 3.4 million payments since 2009, totaling more than $4 billion, of which $2.5 billion was for research. For 2013 alone, there were 1.2 million payments valued at nearly $1.4 billion.

It’s not possible to calculate the exact number of physicians represented, because drug companies haven’t used unique identification numbers that cross company lines. But it’s clear that the figure is in the hundreds of thousands.

Excluding research payments, the drugmaker Pfizer appeared to have interactions with the most health care professionals last year — about 142,600. AstraZeneca came in second with about 111,200. Johnson & Johnson and Forest Labs each had nearly 100,000. There are an estimated 800,000 to 900,000 active doctors in the United States.

“Most physicians that are in private practice are touched in some way” by the industry, said George Dunston, co-founder of Obsidian HDS, the creator of Pharmashine. “You add that up and it’s a pretty significant number.”

Surveys conducted in 2004 and again in 2009 showed that more than three-quarters of doctors had at least one type of financial relationship with a drug or medical device company. The figure dropped from about 94 percent in 2004 to 84 percent in 2009, said the lead author, Eric Campbell, a professor of medicine at Harvard Medical School and director of research at the Mongan Institute for Health Policy at Massachusetts General Hospital.

Dr. Campbell, who has been critical of physician-pharma ties, says he hasn’t conducted a follow-up survey but suspects that the percentage of doctors receiving payments has probably decreased somewhat since then.

“The old approach was just to try to get as many docs as you can, blanket coverage, and establish relationships,” he said. “I think they’re being much more targeted and specific.”

Some doctors have relationships with many companies.

Those who read the fine-print disclosures accompanying medical journal articles know that doctors often have relationships with several companies that compete in a drug category (such as heart drugs or those for schizophrenia). Our data bear that out.

Some highly sought-after key opinion leaders, as they are known in the industry, work for half a dozen or more companies in a given year.

Dr. Marc Cohen, chief of cardiology at Newark Beth Israel Medical Center, received more than $270,000 last year for speaking or consulting for six companies listed in Dollars for Docs. He is a prolific researcher and author.

In an interview, Dr. Cohen said he works only with companies whose drugs are backed by large clinical studies. “In general terms, the science behind the product is very strong,” he said. “These are the companies that I’ve chosen to work with.”

A California psychiatrist, Gustavo Alva, earned $191,000 in 2013 for speaking or consulting for four companies, our database shows. Alva did not return a phone call for this article, but last year he told ProPublica, “I actually enjoy the aspect of educating my counterparts about developments in the field.”

The biggest companies aren’t always the ones that spend the most. Some smaller drug companies spend big, too.

Consider Forest Labs, a midsize drug company that was acquired in July by Actavis, a larger company based in Dublin. Forest’s $3.8 billion in United States drug sales in 2013 placed it on the edge of the top 20 companies, according to IMS Health, a health information company.

Its sales were far lower than those of Novartis and Pfizer, the top two companies by sales last year. Yet Forest easily outspent these competitors on promotional speaking events last year.

Forest spent $32.3 million on paid talks in 2013, compared with $12.7 million for Novartis and $12.6 million for Pfizer.

An Actavis spokesman declined to comment on the company’s strategy, but a Forest spokesman said last year that the company spent more on speakers because it didn’t use pricey direct-to-consumer TV marketing. It also had more new drugs than its competitors.

Companies with newer drugs or newly approved uses for their existing drugs often seem to spend more. Companies that don’t have many new products or have lost patent protection on their drugs, or are about to lose it, tend to pull back.

“A lot of this has to do with where companies are in their development cycle of new products or emerging products, rather than an industry-specific trend,” said John Murphy, assistant general counsel at the Pharmaceutical Research and Manufacturers of America, an industry trade group.

Meals vastly outnumber all other interactions between drug companies and doctors. But they account for a much smaller share of costs.

Food accounted for nearly 50,000 of Amgen’s 55,000 payment reports, excluding research, in 2013, or roughly 91 percent. But at a cost of $3.1 million, those meals represented only about 20 percent of its payments. By comparison, the company spent almost double that amount, $6 million, on just 600 physician speakers.

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Sep 302014
 

newsobserver4-e1380198214776

By RICARDO ALONSO-ZALDIVAR
Associated PressSeptember 30, 2014

WASHINGTON — Striving to shine a light on potential ethical conflicts in medicine, the Obama administration is releasing data on drug company payments to tens of thousands of individual doctors.

As conceived, the so-called Open Payments program was intended to allow patients to easily look up their own doctors online. That functionality won’t be ready yet. And although preliminary data to be released Tuesday will be incomplete, it’s expected to be useful for professional researchers.

President Barack Obama’s health care law requires manufacturers to report payments and gifts to physicians, unless they are valued at less than $10. It’s part of a shift under his administration, supported by lawmakers of both parties, to open the books of the medical profession. A few months ago Medicare released its massive claims database, showing program payments to more than 825,000 providers for 2012.

Drug companies traditionally have prized their relationships with doctors, the gatekeepers between patients and prescription medications. But consumer groups see a built-in conflict of interest that could influence prescribing decisions.

Some doctors’ offices have started curbing pharmaceutical marketing, which can include anything from free pens and pizzas to paid speaking engagements and golf outings at fancy resorts. But many doctors also receive significant payments to help drug companies conduct clinical research.

The investigative journalism website ProPublica says it has tracked 3.4 million payments to health professionals since 2009 totaling more than $4 billion. More than half that amount was for research.

The American Medical Association says it is “extremely concerned” about release of the payments file, adding that the data may contain inaccuracies and lacks context to help the average person evaluate the information. The federal Centers for Medicare and Medicaid Services provided individual doctors an opportunity to inspect their data prior to release, but the AMA says the window was short and the process cumbersome.

Consumer groups call the disclosure program the “Sunshine Act,” and say it’s overdue.

“Research has shown over and over that these financial relationships influence doctors, even a meal,” said John Santa, medical director for health projects with Consumers Union. “Studies also show that doctors believe it does not affect them, but strongly believe it affects other doctors.”

AMA President Robert Wah said in a statement that some financial dealings between doctors and the drug industry help patients, particularly when it comes to research. There are “appropriate relationships in this realm that can help drive innovation in patient care,” Wah said.

The information being released Tuesday covers payments by drug and medical device manufacturers to doctors and teaching hospitals. Also to be reported are doctors’ ownership stakes in “group purchasing organizations” that buy drugs and devices for a broader community.

The program covers doctors, dentists, podiatrists, optometrists and chiropractors.

It’s unclear how many clinicians will be included in the initial release. The administration has estimated that about half of the 897,700 medical professionals potentially covered have industry transactions that must be reported. Of those, it estimated about 224,000 would want to review their reports — indicating significant financial payments.

The disclosure provision was championed in Congress by Sen. Charles Grassley, R-Iowa, who said Monday that he hopes the data will become a resource for consumers over time.

“The patient who is prescribed a drug that might be beneficial yet risky will be able to learn whether the prescribing doctor accepted drug company money to study the risks.” Grassley said in a statement. “The information might not change the outcome, but it’s something a patient might like to know.”

Others worry it will discourage doctors from participating in research sponsored by drug companies.

“My biggest concern is it will have a chilling effect and physicians will say ‘I don’t want to see my name on a list,’” said Mary Grealy, president of the Healthcare Leadership Council, an umbrella group that includes doctors, hospitals and drug companies. She would like to see the $10 reporting threshold increased, and more context on payments for research.

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Sep 302014
 

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By Brian Haines
September 30, 2014

GREENVILLE — During his recruitment, Zeek Bigger promised ECU recruiting coordinator/inside receivers coach Donnie Kirkpatrick that if the Pirates gave him a shot they would not regret it.

“I told him you won’t be making a mistake,” Bigger said. “I’m going to come out and give you all I got each and every day.”

Bigger, the defensive leader for the No. 22-ranked Pirates, proved to be a man of his word, long before his breakout performance against North Carolina. The junior inside linebacker racked up a career-high 17 tackles and picked off a pass for a touchdown to lead ECU to a 70-41 victory over North Carolina to propel the Pirates into the Top 25 for the first time since 2008.

“Zeek was everywhere,” said fellow inside linebacker Brandon Williams. “Everywhere I looked he was right there with me. Whenever I would make a play he would come back and make five more. He’s a great player.”

Bigger’s trip to the end zone was his first since he doubled as a running back/linebacker at Ashbrook High School in Gastonia, and the 6-2, 228-pounder enjoyed the visit.

“It’s been a while since I’ve been in the end zone,” Bigger said. “… But it felt great.”

Bigger’s TD, along with his 17 stops, helped him score the Walter Camp Defensive Player of the Week award.

“I didn’t know I had 17 tackles until the end of the game,” Bigger said. “I’m really blessed. … That D-line and this defense, man, I got to give all the credit to them. I had more assisted tackles than solos, so that tells you that we’re all flying around.”

Bigger’s ability to seize the moment against the North Carolina should come as no surprise. Ever since he was thrust into the starting lineup last season, he has wrapped both arms around every opportunity.

In 2013, both Bigger and Williams made their first starts in a Week 4 matchup against Virginia Tech, when linebackers Jeremy Grove and Kyle Tudor were sidelined with injuries.

Bigger finished with nine tackles. He finished the season with 77, third on the team.

“He’s really just a great kid and our leader on defense,” ECU defensive coordinator Rick Smith said. “He really stepped up last year when Jeremey got hurt, and even when Jeremy came back, he still played about 50 percent of the time.”

While he showed flashes as a sophomore, Bigger has been a constant light for an under appreciated Pirates defense that ranks 33rd against the run (120.3 ypg) and total defense (360.8 ypg). Bigger has set or tied a career-high for tackles in each of the ECU’s first four games and leads the Pirates with 54 tackles.

Bigger’s strength and speed have increased since that Virginia Tech contest, but his knowledge has allowed him to play fast and furious.

“I think being able to read offenses, being able to read guards, read quarterbacks and knowing the things they are going to do before they do them (has been the biggest change since last year),” Bigger said. “… Last year I can say I played well, but I wasn’t as experienced as I am now. When you get more experience and everything starts flowing. The game is quicker and faster to you and you start making more plays.”

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Sep 302014
 

newsobserver4-e1380198214776

By Brian Haines
September 29, 2014

GREENVILLE — After playing three consecutive Power Five opponents, East Carolina will go from one extreme to the other Saturday when it hosts a winless Southern Methodist team that has had more head coaches than touchdowns this season.

The No. 22 Pirates (3-1) picked up consecutive wins against then-No. 17 Virginia Tech and rival North Carolina before heading into a bye week.

ECU will return to action against the struggling Mustangs (0-4) in a game in which the drop in buzz will be partially negated by the fact that it’s the Pirates’ first American Athletic Conference contest.

“It’s a historical moment for us, East Carolina University, our program. I know our fans will come out and support that,” East Carolina coach Ruffin McNeill said. “It’s been a move that has been in the making for a lot of years, before (the current coaching staff) came here.”

McNeill likes to break his season up into quarters, and said the upcoming quadrant is crucial.

“We know this is what it’s about here, this quarter here is all we look at,” McNeill said. “The rest of our entire season is American Conference play. The first quarter was good, but the second quarter will be more vital.”

It’s been a debacle of a season for SMU, highlighted by the surprise resignation of coach June Jones for personal reasons after a 43-6 loss to North Texas in Week 2.

It was a move that shocked McNeill, a longtime acquaintance.

“I know coach Jones left, I’m not sure for what reason. I’d like to find out, but I haven’t had a chance to talk to June,” McNeill said. “June has always been special to me from (his) Hawaii days and me at Fresno State days. I think a lot of June Jones.”

Defensive coordinator Tom Mason was named the SMU interim coach, but the results have not changed much. Facing No. 7 Baylor, No. 6 Texas A&M and Texas Christian, the Mustangs have scored one touchdown and kicked two field goals.

SMU has been outscored 202-12 for an average loss of 50.3-3. The Mustangs have rushed for 177 yards and given up 1,039.

SMU’s lone touchdown came when Kolney Cassel hit Nate Halverson for a 33-yard pass on the final play against North Texas.

Time to look in the mirror: Though ECU had an extra week to prepare for SMU, the Pirates spent a good portion of that time focusing on themselves.

“With our schedule, you find out quick what your strengths and weaknesses may be,” McNeill said. “So we approached last week as a chance to correct some things on all three sides of the ball, get some guys that were nicked up a little bit closer to healthy, and then we got a lot of young guys some needed reps.”

One of the more pressing concerns for the Pirates, who rank 108th in penalties per game (8.5), was cutting back on the flags.

“I felt like we needed to get better overall on making sure we cut down our penalties as a team,” McNeill said. “We want to be a better team in the second quarter (of the season) at eliminating penalties.”

Injury report : Inside linebacker Davarus Brunson will remain sidelined with a knee injury, and receiver Jimmy Williams, who hurt his ankle during the UNC game, is listed as probable.

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Sep 302014
 

newyorktimes

By MARK VIERA and MARC TRACY
SEPT. 29, 2014

ANN ARBOR, Mich. — Criticism of how Coach Brady Hoke and his staff handled a potentially concussed player, coupled with the Wolverines’ 2-3 start, has raised questions about Hoke’s future as coach of the proud Michigan program.

Michigan’s failure to remove the sophomore quarterback Shane Morris in the fourth quarter of the Wolverines’ 30-14 loss to Minnesota on Saturday has become a flash point for criticism. The episode has appeared to heighten the uncertainty surrounding Hoke’s coaching tenure in this football-crazed town.

“I think there’s things that should be criticized, when you talk about performance and coaching,” Hoke said Monday at a news conference in which every question in the 15-minute session centered on the handling of Morris. “But when your integrity and character is attacked, I think that’s really unwarranted.”

With Morris hobbled by an ankle injury he sustained a few plays earlier, Minnesota defensive end Theiren Cockran delivered a crushing hit on Morris shortly after he released a pass. Morris stumbled and leaned on a teammate after the hit, appearing dazed. Hoke said Morris indicated he was wobbly because of the ankle injury, but according to a statement from Michigan Athletic Director Dave Brandon released early Tuesday morning, subsequent medical evaluations found Morris to have “a probable mild concussion,” as well as a high ankle sprain, as a result of the hit.

Brandon said in the statement that Hoke, who suggested that Morris would have practiced with the Wolverines on Sunday were it not for the ankle injury, spoke Monday without having received Morris’s updated diagnosis.

Michigan’s coaches let Morris remain in the game for one play after he was hit and then removed him. Shortly after, they reinserted him for one play when Morris’s backup, Devin Gardner, had his helmet knocked off.

The episode raised the issue of whether there should be a formal concussion protocol at the college level that bars teams from allowing players with concussionlike symptoms to compete before being tested. The N.F.L. has such a protocol, but the N.C.A.A. merely follows nonbinding concussion guidelines.

Through a proposed settlement in a class action over concussions, the N.C.A.A. would be required to prevent athletes who have sustained concussions from returning to play the same day.

“This example cries out for our settlement and why litigation is needed to make the N.C.A.A. and its members take proper action to protect their student-athletes,” said Steve Berman, the chief lawyer for the plaintiffs in that case. “Shame on Michigan — and I went there.”

In his statement, sent in an email at 12:50 a.m. Eastern on Tuesday, Brandon offered a detailed account of the hit on Morris and of Morris’s medical care.

Brandon said that neither the medical staff nor the coaching staff saw the hit on Morris and that the trainers believed that he stumbled after the play as a result of his ankle injury.

After Morris left the field, Michigan’s head athletic trainer assessed the ankle injury because he had not seen the hit to Morris’s chin and was not aware that a neurological evaluation was necessary, Brandon said. The trainer then cleared Morris for one additional play.

Brandon said a neurologist and other team physicians were not aware that the coaches had asked Morris to return to the field to fill in for Gardner.

“In my judgment, there was a serious lack of communication that led to confusion on the sideline,” Brandon said in the statement. “Unfortunately, this confusion created a circumstance that was not in the best interest of one of our student-athletes. I sincerely apologize for the mistakes that were made. We have to learn from this situation, and moving forward, we will make important changes so we can fully live up to our shared goal of putting student-athlete safety first.”

Hoke said he did not see the hit happen live, but Michigan submitted the tape of the hit to the Big Ten because Hoke believed it merited a targeting penalty.

Michigan has a neurologist on the field for all home and away games. Hoke said he assumed that the medical staff had checked out Morris on the sideline on Saturday “because they do every other time.”

In Brandon’s statement, he pledged that Michigan would make two changes to its protocol: to keep a member of the medical staff in the press box or a video booth to provide a bird’s-eye view of the game action and to “reinforce” sideline communication processes.

The N.F.L.’s concussion protocol, instituted in late 2009, bars players with significant signs of a concussion from returning to a game or a practice on the same day.

In July, the N.C.A.A. released guidelines regarding treatment of concussions during practices and games. The “inter-association consensus,” which was endorsed by a number of groups, including the American Academy of Neurology and the N.C.A.A. Concussion Task Force, lacks the binding power of legislation.

Dr. Brian Hainline, the N.C.A.A.’s chief medical officer, did not respond to a request for comment.

Michigan hired Hoke in January 2011 from San Diego State. At the time, Hoke represented a return to Michigan’s roots for a program that was reeling after the tumultuous three-year tenure of Rich Rodriguez, who was perceived by fans as an outsider.

In the 2011 season, Hoke helped shepherd the Wolverines to a victory over Virginia Tech in the Sugar Bowl in New Orleans. Those heady days might seem like a generation ago for restless Wolverines fans, and Saturday’s incident has inspired criticism from seemingly all corners.

Ed Cunningham of ESPN said during the broadcast of the game that Michigan’s allowing Morris to remain in the game was “appalling.” On social media, observers similarly expressed outrage at what they perceived as Michigan’s failure to protect an injured player, and Hoke’s comments immediately after the game further stoked ire over the issue.

“Well, I don’t know if he had a concussion or not,” Hoke told reporters. “I don’t know that. Shane’s a pretty competitive, tough kid. Shane wanted to be the quarterback.”

In a statement Sunday night, Hoke made no mention of a potential head injury.

“Shane Morris was removed from yesterday’s game against Minnesota after further aggravating an injury to his leg that he sustained earlier in the contest,” Hoke said. “He was evaluated by our experienced athletic trainers and team physicians, and we’re confident proper medical decisions were made.”

The Michigan Daily, the university’s student newspaper, published a column Monday that called for Hoke’s firing. It appeared under a bold headline: “The Last Straw.” The four reporters who penned the piece wrote that Hoke made “a move that jeopardized Morris’ health” and that they “can no longer stand behind his employment at Michigan.”

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