The AFL has received the final report of the independent review it commissioned into Associate Professor Paul McCrory and allegations against him relating to plagiarism and other issues connected with research and medical work on sports-related concussion in the AFL. 

The independent review Panel was chaired by senior lawyer Bernard Quinn KC and included Professor of Neuroscience at the University of Queensland and Royal Brisbane and Women's Hospital Michael O'Sullivan and Jane Lindgren of Counsel. The AFL acknowledges and thanks the Panel for its work over the past six months in undertaking the review and in preparing the detailed 260-page report. 

The AFL has published the Independent Review's report in full today, and has provided a copy to the State Coroner who is conducting the Coronial Investigation of the death of former Richmond footballer, Shane Tuck. 

>> DOWNLOAD THE FULL REPORT HERE

In summary, the review Panel made a number of significant findings:

Plagiarism by Associate Professor McCrory

• The Panel found that Associate Professor McCrory informed the review of seven editorials which contained plagiarised text and the independent Panel identified plagiarism in a further two editorials, one article and two book chapters.  It found that the identified plagiarism constituted an embarrassing blemish on Associate Professor McCrory's professional/academic reputation. 
• However, the Panel also found the identified instances of plagiarism do not affect or taint the work that Associate Professor McCrory had undertaken for the AFL, in particular the AFL's guidelines on concussion, in large part because they do not involve the falsification or fabrication of relevant research.

Undertakings to the Medical Board of Australia by Associate Professor McCrory

• The Panel found that the undertaking Associate Professor McCrory gave to the Medical Board of Australia did not stop him from generally practising as a neurologist but prevented him from performing certain neurodiagnostic procedures, nerve conduction studies and/or electromyography in respect of which he had elected not to undertake the necessary training.  Associate ProfessorMcCrory informed the Panel that the undertaking was given at the conclusion of an Australian Health Practitioner Regulatory Agency (AHPRA) investigation, although he declined to provide any information in relation to that investigation, as did AHPRA.
• The Panel found that given the limited scope of the undertaking, Associate Professor McCrory was not required to disclose the undertaking to the AFL and the Panel did not identify any other person who reasonably ought to have been informed about the undertaking. The Panel neither sighted nor heard evidence which suggested that Associate Professor McCrory had acted inconsistently with the undertaking, although it acknowledged its ability to investigate that issue was limited.

 Past Player Study/Project

• The Panel was critical of the AFL and Florey Institute's handling of the major historical AFL concussion research project known as the Past Player Project (which over time had research and clinical components) and which involved a large number of past players by virtue of their response to an online screening survey. It found the research project was under-funded and under-resourced and suffered from a lack of governance, stewardship and coordination in how it was rolled-out and implemented, and how it simultaneously accommodated clinical and research objectives.  These problems manifested in there being no published research from the study which explained the results of the research imaging undertaken on retired AFL players and confusion on the part of the past player participants as to what tests or procedures related to clinical treatment as opposed to being purely for research purposes. 
• In the Panel's view, research participants were entitled to expect that projects would be pursued through to completion, so that their voluntary contributions of time and effort were not wasted and there was also an ethical principle that participants should be given the option of being informed of the general outcome and results of a study. The Panel considers that the Florey Institute should ensure this project can be completed if that is possible and that participants are informed of the outcome, as appropriate.
• The Panel also found that there were significant delays in the communication of the progress of the research and in reporting clinical results and advice from medical practitioners back to the past player patients.  The review found that these failings were "a function of poor planning and governance and under-resourcing rather than being attributable to inaction by individual officers with the AFL, who were attempting to manage the project with limited time and resources as best they could".

Relationship between the AFL and Associate Professor McCrory

• The Panel examined the relationship between Associate Professor McCrory and the AFL and found he was neither an employee nor contractor to the AFL and rather was an advisor on an informal and mostly unpaid basis (although he was remunerated for his provision of neurology services provided to present and past AFL players referred to him by the AFL, Clubs and others).  The Panel found that aspects of the relationship were problematic, in particularly the absence of clear reporting lines and protracted periods of no or delayed responses to correspondence by Associate Professor McCrory in particular.  It found that more active oversight by the AFL may have helped to mitigate reporting problems associated with his and the Florey's research.
• Whilst the Panel found "the informality of the arrangement and lack of structure and sophistication in reporting lines created the potential for impropriety and detracted from the levels of accountability and transparency that could be expected of an entity of the AFL's size and public profile", it had not found any examples of conduct that constituted impropriety.
• The Panel also found that whilst the relationship between the AFL and Associate Professor McCrory started off well, the relationship deteriorated from approximately 2017 onwards and formally ended in early 2021 with Associate Professor McCrory's resignation from the AFL's scientific committee (as it is now known).  Associate Professor McCrory informed the Panel that he had become increasingly frustrated by the lack of action by the AFL on players' safety around concussion which reached a tipping point in the formulation of the 2021 concussion management guidelines.
• The Panel found that in early 2021, Associate Professor McCrory disagreed with the working draft of the proposed AFL and AFLW concussion guidelines and in particular the proposed return to play protocol which he said "did not reflect the current and evolving science".  In the course of the review, the Panel sought an explanation from Associate Professor McCrory as to the "current and evolving science" that he was referring to in early 2021 and Associate Professor McCrory referred the Panel to 57 academic articles.  Having reviewed the articles, the Panel observed that "there is no single biomarker which can presently be relied on for a return to play policy and that individuals should return to play after following a graded rehabilitation program which involves the resolution of clinical symptoms together with a buffer period at the end". Further, the Panel found that the early 2021 proposed return to play protocol "was not inconsistent with the literature Associate Professor McCrory directed us to".  Following Associate Professor McCrory's resignation from the AFL's scientific committee, the AFL and AFLW Concussion Guidelines adopted – for the first time – a minimum 12-day post-concussion rest and rehabilitation period (which remains in force to the present day).  

Other significant findings on sport-related concussion management and research

• The Panel acknowledged that there are several areas of ongoing uncertainty in the research and management of sport-related concussion which add layers of complexity to the management of player health and regulation of contact sports.  The Panel observed that "[i]t is generally accepted that players should not return to play when they have residual clinical symptoms for various reasons including that there is an increased risk that they will be reinjured and suffer a more severe brain injury [but] less is known about the impact of return to play before the resolution of physiological changes to the brain and, accordingly, there is less acceptance that return to play rules should account for the possibility of residual physiological change and uncertainty as to how they should do so".
• The Panel considered in detail the workings of the Concussion in Sport Group  (CISG) (which produces the Consensus Statements on sport related concussion relied on by the AFL and leading contact sports globally) and the criticisms that have been made of it, including as a result of recent controversies involving Associate Professor McCrory (who, until recently, was Chair of the CISG and co-author of its Consensus Statements).  Whilst acknowledging that improvements could be made to the CISG's processes to further improve transparency, the Panel found that "[m]any of the criticisms are framed at a high level and seek to impugn each of the Consensus Statements without, in our view, appropriately considering the state of scientific knowledge at the relevant points in time at which the statements were published; or grappling with the practical problems facing sporting bodies, athletes, sports doctors and sports rule-makers seeking to balance numerous conflicting considering to reach an appropriate response to head injury risk found in a wide range of contact sports". 
• Further, in respect of the recurring criticism that the Consensus Statements do not recommend a sufficiently long period of rest and rehabilitation post-concussion on the basis of the "precautionary principle" (by which decision-makers may adopt precautionary measures when scientific evidence about an environmental or human health hazard is uncertain and the stakes are high) the Panel observed:
  • While we consider sporting organisations should have regard to the precautionary principle, the precautionary principle cannot be considered in isolation from the potential adverse consequences of taking an overly precautious approach. For example, as we observe above, under-reporting of concussion symptoms is well recognised and if minimum exclusion periods are perceived as being overly long, this might lead to an increase in the amount of under-reporting, making it more difficult for doctors to diagnose and treat players. This does not mean that caution should be thrown to the wind; but rather that all consequences of conservative decisions based upon precautionary principles ought to be considered.

Associate Professor McCrory has no ongoing role with the AFL, is not employed by the AFL and during his association with the AFL whilst an important and long-standing advisor to the AFL he was not the only provider of medical advice on concussion to the AFL.  The AFL no longer refers past or present AFL or AFLW players to Associate Professor McCrory and he will not be listed in the "AFL's Neurology Network", being an appendix to the AFL and AFLW Concussion Guidelines, when the next iteration of those guidelines is released in early 2023.

AFL General Counsel Andrew Dillon welcomed the report and thanked the independent Panel for their work.

"The AFL accepts the principal criticism of the Review directed to it of underfunding and under-resourcing of some of its historical concussion research and clinical care.  This criticism relates to a number of inadequacies in AFL concussion research between 2014 and 2019 and notes that there have been very significant improvements in both the resources devoted to this area within the AFL and lines of accountability since that time," Mr Dillon said.

"The Panel has recommended that the AFL take steps to improve the clinical care aspects for past players and we will act on that recommendation as soon as possible and will consider and respond to all other recommendations in the Report.

"Whilst we regret that these controversies have occurred and that caused concerns particularly to the many current and former players who were treated by Associate Professor McCrory over several years, we take comfort knowing that plagiarism by him has been found not to have affected the concussion science which underlies our concussion guidelines at the elite and community football levels.

"Our current 11-step, minimum 12-day return to play protocol continues to be an important tool in the best practice of ensuring a safe return for players who suffer a concussion.  The AFL will shortly undertake its annual review of the elite and community football concussion guidelines with the benefit of the research learnings that will be presented at the Concussion in Sport Group's conference in Amsterdam in late October.

"The AFL apologises to the past players who gave up their time in the hope of better understanding their own conditions and to assist with the research for the benefit of current and future players and were let down by the manner in which some of the research and clinical programs were at times conducted. We will continue to invest, engage, resource and do better on this type of research and the facilitation of care going forward."

"The welfare of our past, current and future players is of paramount importance to the AFL and we continue to take the necessary steps to improve safety at all levels of the game and to expand our research in this area.

"The AFL will continue to progress numerous initiatives under the strategic objectives it has adopted in its soon to be released Strategic Plan for Sport-Related Concussion Australian Football (2022-2026) which will deliver further understanding of concussion and head trauma and improved health and safety outcomes for our players at all levels."

The Panel also evaluated the AFL's current approach to concussion and supported the AFL's ongoing evolution in this area, making necessary changes to best protect the health and safety of players, 

In mid-2021, under the stewardship of the General Manager Legal and Regulatory, Stephen Meade, the AFL introduced a new governance structure including the creation of the AFL Concussion Steering Group.  The Steering Group has representation from across the AFL industry, including the AFLPA,  and oversees the AFL's concussion management and research activities with expert input from the AFL Concussion Scientific Committee (made up of AFL and external medical research experts in the field of concussion and head trauma). The new structure also includes five working groups with responsibility for progressing specific initiatives in concussion management and research (Research & Innovation, Medical, State & Community Football, Risk, Insurance & Legal; and Communications & Media).

The Panel described the introduction of this new structure "as a significant and positive shift from the informality of the past" and considered the introduction of working groups focussing on different aspects of concussion management as being sensible and appropriate. Each working group has its own business plan setting out the group's annual objectives and plans to help clarify each group's role. 

The Panel has made numerous recommendations to improve the structure and workings of the AFL's new concussion management and research governance structure.  The AFL will immediately commence a process of consideration and response to all of those recommendations.

In addition to the new governance structure the AFL has committed investments of up to $1m a year on concussion research projects and up to $2.5m a year on a large-scale, 10-year longitudinal research project that would be multimodal in focus and involve AFL and AFLW players from talent pathway to the elite game competition and through to retirement.

In 2021 the AFL appointed two key executives, Head of Concussion Innovation and Research – Adjunct Assoc. Professor Catherine Willmott and Head of Concussion and Healthcare Governance – Rachel Elliott who continue to lead the development, research, education, innovation and governance of the AFL's ongoing concussion strategy. More recently Dr Jonathan Reyes, a clinical and research neuropsychologist, has joined in the role of AFL Concussion Research Lead. Adjunct Associate Professor Willmott, Ms Elliott and the AFL's Chief Medical Officer, Dr Michael Makdissi, are attending the Concussion in Sport Group conference in Amsterdam this week.

The Panel has also made recommendations as to the conduct of that longitudinal research project and research of concussion and head trauma in the AFL generally and again the AFL commits to consider and respond to all such recommendations.

The AFL has also asked Gordon Legal to continue to consult on the design of a no-fault financial assistance scheme for players who have suffered debilitating head injuries in the course of their VFL/AFL playing careers.

"The other commitment the AFL will make, is to better facilitate the provision of expert care and assistance to players who have been or may in the future be seriously injured; because even with best practice, we cannot eliminate the risks of traumatic brain injury from playing AFL football.  We have been working hard on this all year and we expect to be able to make a major announcement about further support for seriously injured past players in financial need soon," Mr Dillon said.