A North Carolina Public Health & Public Safety Initiative

A Policy + Legislative Hybrid Draft for the North Carolina General Assembly 

SECTION 1. TITLE

This act shall be known and may be cited as the “Brent Bill: Brain Health Screening and Safety Act.”

SECTION 2. PURPOSE

The purpose of this Act is to prevent tragedies like the documented case of Officer Brent Simpson, who experienced years of cognitive decline, personality changes, and neurological symptoms without receiving appropriate brain injury screening. Despite repeatedly stating that “something is wrong with my brain,” he was misdiagnosed, untreated for underlying neurological disease, and ultimately died by suicide. Postmortem analysis revealed early-stage chronic traumatic encephalopathy (CTE) and other neurological issues.

The purpose of this Act is to ensure that individuals who present with sudden behavioral, cognitive, or personality changes — and who have a history or reasonable likelihood of brain injury, concussion, head trauma, blast exposure, or other high‑risk activities — receive timely, evidence‑based screening for underlying brain injury, vascular conditions, infectious or inflammatory processes, and other medical causes of altered brain function.

This Act integrates brain health into behavioral health, reduces misdiagnosis, improves treatment accuracy, and strengthens public safety and public health outcomes across North Carolina.

SECTION 3. LEGISLATIVE FINDINGS

(1) The General Assembly recognizes the documented case of Officer Brent Simpson of Charlotte, North Carolina, who repeatedly told his wife, “Something is wrong with my brain,” during the final years of his life, as reported by The New York Times. His sudden behavioral and cognitive decline reflects symptoms consistent with brain injury.

(2) Officer Simpson experienced profound behavioral and personality changes. His wife described that “he became a different person,” reflecting symptoms consistent with a brain and neurological dysfunction.

(3) Officer Simpson sustained repeated head impacts during his years as a defensive tactics instructor, including defensive tactics training, where he sparred with dozens of recruits multiple times per year, known as “ground & pound”.

(4) Officer Simpson sought extensive medical care, undergoing multiple MRIs, EKG, 3D imaging, numerous blood tests, EMDR, EEG and months of inpatient treatment, as documented by his wife in her statement at his celebration of life.

(5) He was evaluated by an Internist, Psychologist, Psychiatrist, Therapists, Dentist, Orthodontist, Ophthalmologist, ENT, and Neurologist, yet “there was no magic pill that could cure him or even alleviate his suffering.”

(6) Despite this exhaustive medical workup, no provider screened him for brain injury. “An explanation for his cognitive decline remained elusive” until after his death, demonstrating a systemic failure to screen for underlying brain injury.

(7) For almost two years, Officer Simpson experienced unbearable head pain, medication‑induced visual disturbances, and severe sleep disruption, consistent with organic neurological disease. Officer Simpson received psychiatric therapy and medications that may have worsened his condition.

(8) Following his death by suicide, neuropathologist Dr. Ann McKee identified lesions in the frontal and temporal lobes of Officer Simpson’s brain, diagnosing him with early-stage CTE, making him the first publicly known law enforcement officer with the brain disease. These lesions, along with documented structural abnormalities, could explain his behavioral and cognitive symptoms.

(9) Many of the neuropathological findings present in Officer Simpson’s brain — including vascular injury, white‑matter degeneration, and regional atrophy — are detectable in living patients through appropriate clinical evaluation, neuroimaging, and vascular and inflammatory diagnostics. Individuals in high‑risk populations — including law enforcement, first responders, veterans, athletes, domestic‑violence survivors, and abused children — experience elevated exposure to head trauma, blast forces, and repeated sub concussive impacts.

(10) Officer Simpson’s case demonstrates the urgent need for structured brain health screening when individuals present with sudden behavioral, cognitive, or personality changes, particularly in high-risk professions such as law enforcement. Officer Simpson’s case demonstrates that even individuals who seek help, undergo imaging, and follow medical advice may remain undiagnosed if providers are not required to screen for neurological causes of sudden behavioral change.

(11) Brain injury (BI) is significantly underdiagnosed in North Carolina. Research shows that:

• Up to 20% of high school athletes in contact sports sustain a concussion annually.

• Up to 75% of domestic‑violence survivors have sustained at least one brain injury, often undiagnosed.

• More than 450,000 U.S. service members have been diagnosed with BI since 2000, with many more undiagnosed.

• Studies indicate that 40–60% of incarcerated individuals have a history of BI.

• 2.1 million North Carolinians live with a disability — many related to neurological or cognitive conditions

(12) The General Assembly finds that earlier identification of brain injury may prevent misdiagnosis, reduce suicide risk, mitigate drugs and alcohol use as self-medication, and improve treatment outcomes for individuals experiencing similar symptoms.

SECTION 4. DEFINITIONS

For purposes of this Act:

1. “Brain Injury (BI)” means an injury to the brain caused by external force, including concussion, blast exposure, repeated sub concussive impacts, or assault.

2. “High‑risk populations” include:

   • Athletes in collision or contact sports

   • Domestic violence survivors

   • Children with suspected abuse

   • Military personnel and veterans

   • First responders

   • Individuals with repeated head trauma exposure

3. “Sudden behavioral or cognitive change” means a rapid or unexplained shift in mood, personality, cognition, impulse control, or functioning.

4. “Tiered diagnostic screening” means a structured, stepwise evaluation process beginning with low‑cost screening tools and escalating to clinical and medical diagnostics only when indicated.

5. “Clinically indicated” means justified by accepted medical standards and professional judgment.

SECTION 5. BRAIN HEALTH SCREENING REQUIREMENTS

(a) Tier 1: Mandatory Screening in High‑Risk Cases

Any licensed mental health professional, primary care provider, emergency department clinician, or school‑based health provider conducting an evaluation for sudden behavioral or cognitive change shall administer:

1. A validated BI screening tool

2. A structured history of:

   • Head trauma

   • Concussion

   • Blast exposure

   • Strangulation

   • Repeated impacts

   • High‑risk occupational or athletic activity 

3. A brief neurocognitive screening instrument

(b) Tier 2: Clinical Evaluation

If Tier 1 screening indicates possible brain injury or medical cause, the provider shall refer the individual for:

• Neurology, physiatry, or neuropsychology evaluation

• Additional cognitive testing as clinically indicated

(c) Tier 3: Medical Diagnostics

If Tier 2 evaluation suggests a medical etiology, the evaluating clinician may order:

• MRI, CT, or PET imaging

• Vascular imaging

• Infectious or inflammatory laboratory testing

• Other diagnostics as medically necessary

(d) Clinical Judgment Preserved

Nothing in this Act shall be construed to require imaging or advanced diagnostics when not medically indicated.

SECTION 6. PILOT PROGRAMS

(a) Establishment

The Department of Health and Human Services (DHHS) shall establish four pilot programs to implement and evaluate the screening framework described in this Act.

(b) Required pilot sites

At minimum, pilots shall include:

1. A domestic violence shelter or family justice center

2. A public school athletic program (middle, high school, or collegiate)

3. A veterans or first responder clinic

4. An inpatient clinic serving psychiatric patients

(c) Pilot program components

Each pilot shall include:

• Training for staff

• Implementation of Tier 1 screening

• Referral pathways for Tier 2 and Tier 3 evaluation

• Data collection and outcome tracking

(d) Duration

Pilot programs shall operate for three years.

SECTION 7. TRAINING AND EDUCATION

DHHS shall develop training modules for:

• Mental health professionals

• Primary care providers

• School nurses and athletic trainers

• Domestic violence advocates

• First responders

• Correctional and court personnel

Training shall include:

• Recognizing signs of brain injury

• Administering Tier 1 screening tools

• Referral pathways

• Privacy and consent requirements

SECTION 8. INSURANCE AND MEDICAID COVERAGE

(a) Coverage Requirements

Private insurers and Medicaid shall provide coverage for:

• Tier 1 screening

• Clinically indicated Tier 2 evaluations

• Medically necessary Tier 3 diagnostics

(b) Parity

Coverage shall be consistent with federal and state mental health parity laws.

(c) No blanket denials

Insurers may not deny coverage solely because the evaluation arises from behavioral or psychiatric presentation.

SECTION 9. PRIVACY AND CONSENT PROTECTIONS

1. All screenings and diagnostics shall require informed consent, except where otherwise permitted by law for emergency medical care.

2. Diagnostic results shall not be used in criminal prosecution without the individual’s written consent.

3. Data collected under this Act shall be de‑identified for reporting purposes.

4. No individual shall be compelled to undergo imaging absent medical necessity or court order.

SECTION 10. REPORTING AND EVALUATION

(a) Annual Report

DHHS shall submit an annual report to the General Assembly including:

• Number of screenings conducted

• Number of positive Tier 1 screens

• Number of Tier 2 and Tier 3 referrals

• Diagnoses identified

• Treatment changes resulting from screening

• Cost analysis

• Public safety and health outcomes

(b) Final Report

At the conclusion of the pilot period, DHHS shall submit a comprehensive evaluation with recommendations for statewide expansion.

SECTION 11. EFFECTIVE DATE

This Act becomes effective July 1, 2026.