Gregor Paul: The uncomfortable problem with Ireland selecting Johnny Sexton

Johnny Sexton of Ireland receives treatment during the Steinlager Series match between the New Zealand and Ireland. Photo / Getty Images.

OPINION:

When it comes to head knocks, perception is just as important as process and protocol.

It doesn't sit easily with anyone that Sam Whitelock, who self-reported delayed concussion symptoms after the first test won't play again in the series against Ireland, whereas Johnny Sexton, who came off in the first half at Eden Park after taking a knee to the head and failed his first Head Injury Assessment to be denied a return to action, is back in the No 10 jersey.

New Zealand correctly followed World Rugby protocol to rule out Whitelock and Ireland correctly followed World Rugby protocol to rule Sexton available.

And that's why protocol and process are not enough. It's confusing that Whitelock is out and Sexton is in. But the rules state that a player can fail their first HIA – be denied the opportunity to return to the game – but if they then pass their second HIA two hours later, and a third 36 hours later and are, according to a medical expert, displaying no signs of concussion, they are free to play seven days later.

While World Rugby sent out a clarification statement to explain the curious case of the Irish captain, the governing body is kind of missing the point if it feels it's only purpose is to defend the protocols it has put in place in a somewhat dismissive and pompous tone.

World Rugby issued the statement in response to the lobby group Progressive Rugby, which said flaws in the HIA protocol had been "exposed" after Sexton was passed fit to play.

"It is the duty of any individual or organisation commenting on the head injury assessment process to do so using the facts," was World Rugby's response.

Johnny Sexton of Ireland during the Steinlager Series match between the New Zealand and Ireland at Eden Park in Auckland, New Zealand. Photo / Getty Images.

"Attempting to diagnose a serious medical condition like concussion from afar, without all the relevant information including a player's medical history, is irresponsible and no substitute for the world leading medical care received by elite rugby players.

"Doctors are supported by the head injury assessment and recently updated return-to-play protocols put in place by World Rugby. These protocols are developed using scientific evidence and independent expert opinion which are kept under constant review, as we never stand still on player welfare."

The point that Progressive Rugby made was that failing an HIA1 is of itself a reason to keep a player out of action for 12 days as per the new concussion rules.

"Elite players who fail an in-game HIA1 have, by definition, displayed cognitive dysfunction requiring their removal," said a Progressive Rugby spokesperson.

"In our view, this is sufficient evidence, regardless of subsequent testing, to exercise extreme caution for the good of both their short and long-term health."

It's an entirely valid point. It doesn't feel like HIA1 should be a Mulligan, but a reason to say that one failed HIA test is enough to rule out a player for 12 days.

That may be excessive, and players say that there are often reasons why they fail an HIA1 – that they may be standing, wearing their boots, on a concrete floor which would impact their balance if they had a head knock or not, but surely this is one area where it is better to have an abundance of caution.

No one is advocating a world where the Twitter-sphere determines the seriousness of a head knock or gets to be the final authority on whether a player should be passed fit or not, but likewise, the game doesn't want to be having to defend its decisions on a matter that is actually life and death.

Process and protocol are two important pillars on which to build the decision-making framework around whether a player is ready to play or not, but ultimately there also needs to be an application of a best practice policy that says if it doesn't feel right or it may not look right to the wider public, then don't pick someone.

The All Blacks have been operating this policy for a decade now – and have actively not picked players who have passed HIA tests and completed their return to play programmes. The prevailing view has been, no matter what, give it another week.

And probably, this is what Ireland should have done with Sexton. Told the world he'd passed his second and third HIA tests and has been passed fit to play, but then not picked him.

That would have cleaned up the grey area around process and protocol and just as importantly, it would have been more in keeping with the theme of their tour, which is to find out more about a wider group of players.

They are here to see who can handle a tough tour and given that Sexton turns 37 next week and wasn't picked by the Lions last year because they said they didn't think he could play three tests in a row without being injured, Ireland have spurned a golden opportunity to play Joey Carbery in a high stakes, pressure test.