It's official. The 49ers changed their injury report this morning, moving Alex Smith from questionable to out after an examination by 49ers medical director Daniel Garza. Colin Kaepernick will start and he will be backed up by No. 3 quarterback Scott Tolzien and emergency backup Kyle Williams.
Garza, who is affiliated with Stanford Hospital, is considered an authority on concussions, and he is among the physicians on hand at 49ers games who keep an eye out for players who have suffered concussions. Smith was cleared for non-contact work last week by an independent neurologist who also works at Stanford Hospital, but the final clearance was in the hands of the 49ers' team physicians, primarily Garza.
In that way, the NFL's new protocol for handling concussed players was a success. The NFL Players Association has been pressing to have more input from independent experts. In this case, it was the 49ers' own physician who didn't allow Smith to play tonight.
According to a credible source, Smith never was given the so-called "contact test" which is the last step a player must take in being cleared from a concussion. Symptoms from a concussion can arise and reappear at any time, and it may be that Smith experienced symptoms -- a headache, for example -- in the last day. Smith also suffered a concussion last season, although he did not miss any games.
Earlier this month, Garza and 49ers owner Dr. John York, who chairs of the NFL Owners Committee on Health and Safety, attended the Fourth International Consensus Conference on Concussion in Sport in Zurich, Switzerland. An earlier conference in 2008 led to the post-concussion protocol the NFL currently uses.
-- Matt Barrows