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What ever happened to injured NFL referee forced to leave Bills' TNF loss to Texans?

In addition to three Buffalo Bills' players leaving and not returning due to injury on Thursday Night Football, the head referee, a UB alumnus, was carted off in the third quarter
Ralph Ventre|
Aug 13, 2022; Pittsburgh, Pennsylvania, USA; NFL referee Adrian Hill (29) makes a note during the game between the Seattle Seahawks and the Pittsburgh Steelers in the second quarter at Acrisure Stadium
Aug 13, 2022; Pittsburgh, Pennsylvania, USA; NFL referee Adrian Hill (29) makes a note during the game between the Seattle Seahawks and the Pittsburgh Steelers in the second quarter at Acrisure Stadium | Charles LeClaire-Imagn Images

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It's certainly not something Buffalo Bills' fans see every week. Unfortunately, the same can't be said for ill-timed jet sweeps and repeated flanker screens, but those issues warrant separate posts of their own.

In what was likely a first for many of the fans watching the Bills battle the Houston Texans on Thursday Night Football, head referee Adrian Hill pulled up lame while running toward the ball at the end of a third-quarter play. The injury forced Hill out for the remainder game with umpire Roy Ellison taking on referee duties for the under-manned crew.

The incident happened on a 3rd-and-6 play for the Bills' offense, which was backed up inside its own 15, midway through the third quarter. Running from the end zone toward the 9-yard line, where quarterback Josh Allen was sacked, Hill sustained an injury before making it across the goal line and immediately grabbed for his left leg.

RELATED: Bills' short week underscores NFL scheduling disadvantages in race vs. Patriots

Seemingly unable to put pressure on his left leg, Hill needed help getting to the sideline where he was met by a cart and driven off to the locker room. He passed his white hat to Ellison, who led a six-man officiating the rest of the way in the November 20 primetime matchup.

Adrian Hill signals intentional grounding
Oct 8, 2023; Detroit, Michigan, USA; Detroit Lions defensive end Isaiah Buggs (96) signals safety as the referee Adrian Hill calls an intentional grounding penalty on Carolina Panthers quarterback Bryce Young (9) (not pictured) near the goal line in the third quarter at Ford Field. | Lon Horwedel-Imagn Images

Hill wasn't the lone casualty of the evening, either. The Bills lost linebacker Terrel Bernard, right tackle Spencer Brown and cornerback Maxwell Hairston to injuries. While Hairston is in the concussion protocol, there's some uncertainty as to the severity of Bernard and Brown's issues.

Hill injury analysis

As for his health status moving forward, Hill may be able to return at some point later this season.

MORE: Expert opinion as Josh Allen dismisses injury concerns after Texans batter Bills' QB

In the injury's immediate aftermath, Dr. David Chao, who has specialized in video evaluations after spending 17 years as San Diego Chargers' team physician, speculated that the official spared his Achilles while injuring his left calf.

On Friday, NFL Network insider Tom Pelissero reported that Hill's Achilles was indeed "intact" and the 15-year NFL officiating veteran is "believed to have avoided a major injury."

Background info on UB alumnus

Coincidentally, Hill has a connection to Western New York, having earned his bachelor's degree from the University at Buffalo. Outside of officiating, he serves as an accomplished software engineer for the Johns Hopkins Applied Physics Laboratory.

The 61-year-old Hill reached the NFL officiating ranks in 2010, eventually working his way up to a referee position in 2019. Prior to Thursday's loss, the Bills were 5-0 all-time in games refereed by Hill.

Josh Allen sacked
Nov 20, 2025; Houston, Texas, USA; Houston Texans linebacker Henry To'oTo'o (39) sacks Buffalo Bills quarterback Josh Allen (17) in the second half at NRG Stadium | Troy Taormina-Imagn Images

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Ralph Ventre
RALPH VENTRE

Ralph, a former college football conference administrator, brings 20+ years of media experience to Buffalo Bills ON SI. Prior to focusing on the Bills, he spent two years covering the New York Jets. Ventre initially joined the ON SI family in 2021, providing NCAA Football Championship Subdivision for NFL Draft Bible on FanNation. Ventre remains as an official voter for the Stats Perform FCS Top 25 and the annual legacy awards. The Fordham University graduate is a member of the Pro Football Writers of America.