Disclaimer: The views expressed by Nitin Sethi in this article are his alone and do not reflect the views of the NYSAC.
When the State of New York agreed, in 2017, to award a $22 million settlement package to Magomed Abdusalamov, the Russian heavyweight who incurred life-threatening brain damage during a fight at Madison Square Garden in 2013 and whose subsequent treatment called into question the policies and procedures of those who supervise combat sports, his lawyer, Paul Edelstein, was far from satisfied. No amount of financial compensation, after all, was going to change the fact that Abdusalamov would never be able to do the simplest tasks on his own, much less hold a normal conversation with his wife and three daughters. The state, which oversaw the fight, was sensitive to this, “which is why they paid what they did,” Edelstein said.
But there was still the matter of the ringside doctors to consider, specifically the three individual practitioners whose responsibility that fateful night was to make sure that Abdusalamov was cared for properly during and after the fight. So, on behalf of Abdusalamov and his family, Edelstein also sued the three ringside physicians for medical malpractice and negligence. (At the time, ring doctors were hired by the state as independent contractors and thus were not indemnified from lawsuits; that changed in September 2016, when legislation, at the urging of then-executive director David Berlin, was passed making them employees of the state. Maryland is the only other state that offers such protection.) The lawsuit’s chances for success seemed to dim, however, when, in September 2017, a judge dismissed the case against one of the defendants, Gerard Varlotta, an NYC-based orthopedic surgeon. Edelstein quickly appealed, and in a remarkable turn of events that took place last week, nearly two years later, the same judge who threw out the case against Varlotta had now reversed her initial decision. Varlotta, as Edelstein put it, must now “either pay or get on the stand and face a jury.”
The efforts of Edelstein and Abdusalamov’s family were not limited to the courtroom. At a press conference in front of the steps of Madison Square Garden just weeks after the settlement, Edelstein appeared with a wheelchair-bound Abdusalamov and his wife to make a passionate plea to New York state to pass “Mago’s Law,” a proposed bill that seeks to raise the level of post-fight care, so that what happened to Abdusalamov does not happen to another fighter. Specifically, the bill calls for the treatment of any combat sports participant as an emergency room patient.
“If you walk into any emergency room in the country,” Edelstein explained to Hannibal Boxing in a recent phone interview, “and told them that you had been hit in the face, they would do one or two things: They would either give you a CT exam to rule out brain injury or they would hold you or monitor you for long enough so that they can rule out the brain injury. The assumption is going to be that the fighters have a brain injury until they can safely rule it out. Neither of these things happened to ‘Mago’ and I guarantee you they don’t happen to a large percentage of these boxers.”
Though there were varying accounts about happened that night, an investigation by the Inspector General found there to be a general lack of urgency on the part of the inspectors and physicians to account for the fighter’s health. Most conspicuously, instead of being ushered to an ambulance (provided for at every prizefight in the state), Abdusalamov and his team found themselves outside the arena trying to hail a cab to the nearest hospital. “[The inspectors and doctors] didn’t know what to do,” Edelstein recalled. “They put Mago in a position where they abandoned him. With this bill, we hope to use the spotlight that is on Mago to help other guys in much more subtle situations get a better chance.”
Edelstein has ambitions to see Mago’s Law one day adopted on the federal level, though he is aware that there are tremendous challenges in the way: the innately fractured nature of the business notwithstanding, boxing occupies a relatively low spot on the Beltway totem pole. “You’ve got to catch the eye of a legislator that will champion a bill and bring it to the Senate floor,” Edelstein said, with the late Senator John McCain, a fan of the sport who helped pass the Muhammad Ali Act, in mind. “And that’s where lobbyists’ money and publicity comes in. The best chance I have is if the case (against the ringside doctors) goes to trial and the media spotlight will be on it again.” Still, if Edelstein remains highly optimistic it is because he believes strongly that the kind of life-altering head trauma inflicted on Abdusalamov is ultimately preventable. “Not all the time. We understand that,” Edelstein said. “A guy could die in the ring. We get that. That’s not what we’re talking about here. We’re talking about guys that receive head trauma and somehow in a boxing match are not treated as trauma victims as in any other place. That’s crazy.”
For comparison’s sake, Edelstein points to the changes effected in sports with significant head trauma injuries, such as the NHL and NFL, the latter of which has implemented a comprehensive concussion protocol policy even as it struggles with what is essentially an existential threat. Whereas once a linebacker may have dusted himself off after getting brutally tackled on a play, players today suspected of head trauma are pulled out the game and subjected to a battery of tests. If a player does poorly in the exams, or if one of the doctors has the slightest misgiving, he must sit out the rest of the game and be subject to checkups later in the day and an evaluation on the following day.
The irony, Edelstein says, is that a sport whose aim consists of two competitors seeking to batter the other’s head, the discussion on head trauma is relatively mute. Asked if he has spoken to promoters and other industry figures about the proposed bill, Edelstein responded with a laugh, “I’m not so sure other promoters would love talking to me. I’m probably not the guy you want to deal with.”
As a direct consequence of the Abdusalamov case, the state adopted new policies, some of which have been roundly criticized by those in the industry as ineffectual and shortsighted, like the bill for an insurance policy introduced in 2016 that requires promoters to put up $1 million in the event a fighter suffers traumatic brain injury. The policy has made it prohibitive for local promoters to put on club shows. “It’s something,” Edelstein said, “but it really hurts the boxers who are trying to earn a living. And it does nothing to prevent brain trauma.” Hence, the need for formal regulation, Edelstein pointed out: something like Mago’s Law.
But there have been positive changes, too. “We have really ramped up fighter safety,” said Nitin Sethi, the chief medical officer for the New York State Athletic Commission and a neurologist at Weill Cornell. By the time Sethi was appointed to the position in 2016, the NYSAC under the direction of ex-director Berlin, who was instrumental in improving the functions of the commission in the wake of Abdusalamov, began to offer a more stringent pre-fight medical evaluation that includes, among other policies, checking to see if a fighter took any anti-inflammatory, blood-thinning drugs such as ibuprofen, within a few days before the weigh-in. “The whole idea is to try to determine which fighters we have to pay more attention to before they get in the ring,” Sethi said. Another new practice has been the use of medical timeouts — implemented under the Berlin regime — during a fight, though many observers have criticized them for inadvertently giving the troubled fighter a breather. Cognizant of the complaints, Sethi says they are now working to keep such exchanges no more than five to eight seconds.
Sethi has also sought to improve the flow of communication between the referees, the inspectors, and the ringside physicians during a night of fights. “I don’t know the fighters as well as the referee does. But referees don’t know TBIs (traumatic brain injuries) and concussions as well as I do. So if we complement that knowledge between a referee and ringside physician, I feel that’s the way you make the sport a little bit safer.”
The goal is to close all available loopholes “so that the fighters don’t slip through the cracks.”
“When you have a failure like [Abdusulamov], it’s not the failure of one person, it’s a systemic failure,” Sethi stressed. “There were multiple points when some concern could have been raised, when the fight could have been stopped, but nothing was done and finally the boxer slips through.”
“We’re trying to plug systemic failures.”
Thanks to Sethi, the commission has also tightened up many of its lax postfight protocols left over from the previous regime headed by former chair Melvina Lathan. An unstable fighter, say, after a fight at Madison Square Garden, will be sent directly to the Bellevue hospital in an ambulance—not in a taxi flagged on 8th avenue as Abdusalamov had done. And as for fighters who do not show visible signs of distress but had nevertheless been in a tough fight, they are closely monitored—or “red-flagged”—for a period of time. “In New York, we are doing this now all the time,” Sethi assured.
To this end, Sethi finds a proposal like Mago’s Law well-intentioned but ultimately impractical and financially unrealistic. Promoters already pinched by other expenses may not be so willing to take on the extra burden. But Edelstein does not buy that excuse. “It’s painfully ironic that this sport can generate this kind of money and yet my guy can just get sent home,” Edelstein said. “And he was the B-side fighting in Madison Square Garden on a Saturday night on the undercard of a championship fight. What’s going on in Buffalo? That’s the problem.”
Sethi also raises the concern that a fighter that undergoes multiple CT tests throughout a year will be exposed to an inordinate amount of radiation. “Let’s assume this fighter fights eight or ten times a year.” Sethi conjectured. “That’s a lot of radiation to the head. Who answers to that? I’m not sure that’s a practical solution.”
Edelstein clarifies that Mago’s Law “does not mandate that a fighter get a CT following every fight.” “Let’s keep it very simple,” he stated. “Any boxer with a confirmed head trauma cannot leave the arena unless and until he is given repeat neurological examinations, the last one being not less than one hour following the conclusion of the match or he is sent directly to the ER. One or the other. As an aside, I think any boxer would gladly trade the radiation exposure of a CT scan or even multiple ones to the alternative: severe brain damage.”
Added Edelstein, “What New York is doing led by Dr. Sethi shows improvement. However, [his plan] is not codified in a simple straightforward manner such that any physician at any boxing match anywhere in the State would know the requirements.”
But the biggest challenges to improving fighter safety, as Sethi sees it, are the cultural mores and expectations that govern the sport and that are shared by everyone from the fighters to the fans. Given that concussions are so difficult to diagnose objectively, much less in the heat of a fight, doctors have to rely on the fighter to offer an honest medical answer. Fighters, taught early on to go out on their shield and to win at all costs, are not usually inclined to give an answer that would otherwise threaten that mission. Boxing, after all, is a competition.
“Everything is deny, deny, deny, deny,” said Sethi, citing the hostility that fighters and their corner have for doctors anytime they step up to the canvas. “At some point in time, people have to be educated that initially, mild concussions can become severe TBIs if you don’t identify them in a timely fashion.” The problem, however, is “how do you know when a fighter has been concussed in a fight?” In such cases, it will not matter if a fighter is monitored for an hour or sent to the hospital for a CT scan. “By the time that we have a few seconds with a fighter and shine a bright light into their eyes and the pupils aren’t equal, it’s too late,” Sethi said.
At the same, Sethi understands that there is no changing the fundamental nature of sport in which the objective is to hurt the other man, to knock him out. The recent tragedy of Canadian fighter Adonis Stevenson, one of the best light heavyweights in recent years, is a sobering reminder of this harrowing paradox. “We all have to accept that boxing cannot be made 100 percent safe,” Sethi said. “That’s what the irony is. I’m acutely aware of that.”
But, like Edelstein, Sethi operates from the belief in the premise that professional boxing, in its present state, can be made safer—if only in the slightest of degrees. “Obviously boxing is not good for the brain, but I should look back and hope that I did right by these fighters, that I tried to protect their brain health as best as I could.”
“I know you can’t prevent a guy taking a massive punch and dying in the ring,” Edelstein said. “But you can prevent what happened to Mago. The fact that it has not yet happened yet is just outrageous. Somebody else is going to get hurt. Do you want to spend a little money now or do you want to deal with a guy like me later? Twenty-two million dollars and then some.”