Experts

Current topics explained by RUG experts

Nouri and Ajax

Last summer, football player Abdelhak Nouri started feeling ill on the field due to heart failure. His family is now suing Ajax, claiming it made mistake during the immediate medical attention he received. How does this work?
by Jurgen Tiekstra

Arvin Kolder

personal injury laywer and RUG lecturer

‘This kid suffered serious brain damage and will need intensive care and supervision for the rest of his life. That is extremely expensive. On top of that is the loss of income, because he won’t be able to make any more money. And he was probably going to have a great career as a professional football player. If a medical mistake can be determined, he also has a right to compensation. This is an injury of the highest category, which means the compensation would be very high. Compensation for a high spinal cord injury goes up to approximately 200,000 euros, but then people can still communicate with their loved one, move their head, and see, hear, and taste. From what I understand Nouri’s condition is much worse.

The question that needs answering here is whether or not the football club’s physician provided adequate care. There are protocols and guidelines in place that medical experts can use to provide information to lawyers. If it’s determined that mistakes were made, it will be difficult to determine what the compensation should be. How would Nouri’s football career have progressed if that mistake hadn’t been made? Predicting that is like gazing into a crystal ball.

What makes the case even more complex is the issue of causal connections. One important question is how Nouri would have fared if the right medical steps had been taken. Would he have recovered without any lingering symptoms, or would he still have had brain damage?

If it’s determined that the club’s physician made a mistake, but that experts say that Nouri would have experienced the same brain damage even if the immediate care he received had been adequate. A mistake has been made, but there is no causal connection between the mistake and the brain damage. But there’s also the possibility that with adequate immediate care, Nouri would have recovered with no lingering effects. In that case he would have been able to continue his football career.’

Hans Zwerver

professor of sports medicine and former club physician

‘Someone suffering from sudden cardiac arrest during a sports game is always big news. In Nouri’s case he ended up in a coma, but over the past few years, several people have suddenly died from cardiac arrest during Champions League games or international matches. I do want to emphasise that the chance of this happening is extremely small. But the UEFA, FIFA, and several other large sports associations want to prevent this happening on live television. Partially due to this they issued guidelines that sports medical examinations had to comply with.

All professional football players are examined before the start of the season. They are screened for risk factors for cardiovascular disease as well as the kinetic system. This includes a standard work-up, including an electrocardiogram and an echocardiogram.

But it’s impossible to make this screening perfect, if only because athletes’ electrocardiograms often show patterns that would be considered anomalous for non-athletes. That’s because athletes’ hearts adapt to their circumstances, which makes it harder to interpret the electrocardiogram. But the chance of sudden death by cardiac arrest is extremely small and can never be completely prevented. In the Netherlands it happens approximately one hundred and fifty times a year. But that’s to all athletes, including the amateur ones. It mainly happens to older recreational athletes, who are suffering from coronary artery blockage.

I do want to emphasise that being a club’s physician differs greatly from being a specialist in a hospital. The circumstances under which you’re working in a stadium or a dressing room ar completely different, because they’re so hectic. It’s very important for a doctor to keep everyone calm in those situations. Specialists may say all kinds of things in the news, but they don’t know what it’s like to be a physician on the football field.’

Berend Rubingh

RUG lecturer and football manager at the KNVB

‘Sports associations differ from other organisations in many ways: people can get very emotional about sports; the associations is always being scrutinised, because you’re always in the media and the public eye; and they exist in this complex sphere of influence that is ruled by these aforementioned emotions. That’s because there are so many experts involved who all want a say in the matter.

So when something like what happened to Nouri occurs, managers need to be alert. They have to quickly get an overview of everyone they’ll be dealing with. I call this ‘stakeholder management’, or ‘involvement management’, because so many people are involved. The biggest stakeholders are their athletes and their families. Then there is their own organisation and medical staff, and how they handle the situation. Then there are the supporters and the sponsors. There’s a long list of parties that want to either be informed or involved.

The main thing to remember is that managers should be transparent and honest. It can only help. You have to be open about what’s going on, immediately admit any mistakes that were made, and give people access. You can’t start off being contrary; you have to listen carefully, and analyse the situation.

Anyone who can keep their head above water managing a paid football organisation can do so anywhere. Conversely, people who have experience leading a large company aren’t necessarily suitable to work at a football club. They often don’t understand the complexity of that sphere of influence. Many business people messed up working for small clubs that only make five or ten million a year, when they used to lead companies that were worth ten billion.’

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