NEWPORT BEACH, Calif. — Buffalo Bills coach Joe Brady said that there have to be “consequences” for running back James Cook’s fumbling issues if they persist and that they could include taking away carries or playing time.

Cook had two fumbles in Monday’s 37-34 win over the Los Angeles Rams, losing one in overtime. That brings his total to four on the season and 11 since the start of 2025, including the postseason. Cook is the NFL’s leading rusher over that span with 245 more yards than the closest runner, but his 11 fumbles are also the most of any non-quarterback.

“Look, he’s doing so many good things running the football,” Brady told reporters from the Bills’ hotel outside Los Angeles on Tuesday. “I don’t want to lose sight of how great he is running the ball right now. But putting the ball on the ground, it’s negating all the positive. I have all the confidence in him. That’s why I put him right back out there. But obviously, at some point there has to be consequences to when we’re putting negative stuff out there.

“It’s going to cost us football games. It almost cost us one. We can’t confuse because we won the game that that’s OK. It’s got to improve or the carries are going to decrease.”

Cook’s lost fumble came in about as costly a situation as possible. Two minutes into overtime, he coughed up a carry just outside the red zone, turning a drive that likely would have given the Bills a lead in the extra session into an opportunity for the Rams to win with any points on the ensuing possession. Had it not been for edge defender Greg Rousseau’s heroics in blocking the Rams’ would-be winning field goal, Cook’s fumble could have meant disaster.

After Rousseau’s block, though, Brady called Cook’s number on the next offensive scrimmage play. Cook carried twice for 3 yards on the Bills’ winning drive, though Brady took the ball out of his running back’s hands in the final moments.

Coming out of the two-minute warning, the Bills had a second-and-10 from the L.A. 27-yard line. Brady could have handed twice to Cook to drain clock and prevent the Rams from getting the ball back if kicker Tyler Bass were to miss. But Brady didn’t do so, citing the circus-act ending of Sunday’s Giants-Commanders game as a back-of-mind consideration.

With hindsight, Brady said he probably should have let quarterback Josh Allen kneel down twice before attempting the field goal rather than even consider Cook as an option in those moments.

“James understands when you hold the football, you’re holding the whole entire organization in his hands,” Brady said. “When he’s running the football, there’s nobody else I want when he’s running it. But look, we’ve got to be able to come up with the football. Right now, he’s putting it out there.”