Source: Bloomberg by Steven Sellers -
Zena “Zeke” Upshaw, a rising star for a minor league NBA affiliate of the Detroit Pistons, collapsed and died in March as he played in the final minute of his team’s final game of the season.
His death, and others like it, show the National Basketball Association and its G League teams aren’t prepared to treat sudden cardiac arrest, a condition prevalent among male African-American players, a lawyer for Upshaw’s estate told Bloomberg Law.
It also demonstrates that concussion protocols may have gotten in the way of proper treatment of cardiac emergencies, Bob Hilliard, of Hilliard Martinez Gonzales LLP in Corpus Christi, Texas, said.
Such protocols have become a focus of sports leagues in the wake of brain injury litigation against the National Football League and the National Hockey League.
Videos of the event, Hilliard said, suggest rescuers believed Upshaw was unconscious from a concussion.
“It’s head-shaking to me that they didn’t take a pulse or do CPR,” Hilliard said. “There was no sense of urgency.”
“If you use a concussion protocol for a sudden death event, you’ve basically sentenced a player to death,” Hilliard said.
Unlike most concussive injuries, cardiac emergencies require immediate cardiopulmonary resuscitation or use of electric defibrillators to restart the heart.
Zeke’s mother, Jewell Upshaw, says in her suit against the NBA, the Detroit Pistons, and the DeltaPlex Arena in Grand Rapids, Mich., that the team physician for her son’s team left the arena before his collapse.
Zeke also was given no life-saving measures for at least 40 minutes, her complaint says.
The NBA declined to discuss the complaint or comment on the steps it takes to ensure on-court medical care for its minor league players.
“The NBA family continues to mourn the tragic passing of Zeke Upshaw and we won’t comment on pending litigation,” NBA spokesman Mike Bass said.
The National Basketball Players’ Association also declined to comment.
Other Recent Player Deaths
The Upshaw complaint cites other, similar on-court deaths among young basketball players, and alleges “the NBA still fails to adequately prepare for and protect its players from sudden cardiac death, a risk allegedly known to the league since at least 1993.”
Upshaw’s death is part of a trend and “it’ll happen next season, and every season, at every level,” Hilliard said.
It has happened at least twice in the last three months.
Darrell Rogers, a 16-year-old high school basketball player, reportedly suffered a sudden cardiac arrest during a May 21 Amateur Athletic Union league practice, but was saved by cardiopulmonary resuscitation.
But, five days later, rescuers were unable to revive 19-year-old James Hampton, a member of Team United in Nike’s Elite Youth Basketball League, after he collapsed during a game in Hampton, Va.
Sudden Cardiac Death
Sudden cardiac death, or SCD, is relatively rare in the general population of the U.S., but is more prevalent among young athletes, particularly men.
A study by researchers in Minnesota found SCD from undiagnosed cardiovascular disease occurred in one of every 200,000 high school athletes who participated in organized sports.
But the condition is three times more common in African-Americans and other minorities than in white players, according to data from the U.S. National Registry of Sudden Death in Athletes.
The issue gained national prominence in 1993 when Reggie Lewis, then a star guard for the Boston Celtics, collapsed and died during an off-season practice.
A thickening of the walls of the heart, known as hypertrophic cardiomyopathy, is a common cause of SCD in young athletes, researchers say.
Other causes include arrythmias, structural defects in the heart, and Marfan syndrome, a genetic disorder that can affect the heart’s connective tissue.
All on-court cardiac arrests require the same emergency response.
“An athlete experiencing cardiac arrest can be effectively resuscitated with prompt recognition, and application of an automated external defibrillator,” also called an AED, researchers at Indiana University’s School of Medicine said in a recent study published in Heart Failure.
Emergency action plans require “integration of adequate training (including coaches), rapid access to functioning AEDs, and effective communication with local EMS as well as the regular review and rehearsal” of the plan, the researchers said in January.
Athletic trainers are often the first to assess stricken athletes, and they are trained to implement emergency action plans to address any incident, whether on a court, field, or pool, said Tory Lindley, president of the National Athletic Trainers’ Association, in Carrollton, Texas.
Clinical training for athletic trainers is governed by standards set by the Commission on Accreditation of Athletic Training Education, and is facilitated by resources provided by NATA, Lindley said in an email.
“These resources include evidence-based and clinical research as well as peer-reviewed position and consensus statements on the prevention and management of a number of health conditions, including sudden cardiac arrest in young athletes,” said Lindley, who declined to comment on the Upshaw litigation.
Upshaw’s complaint, however, portrays the NBA’s policy on SCD as “startlingly poor,” affecting athletes “at every level of team play, for every single team.”
But the NBA has taken steps to identify at-risk players before they set foot on a court, including through a standardized cardiac screening program.
The program began in 2006 and is the first among major league sports. It mandates three electrocardiograms and a medical evaluation before a player may attend training camp each season.
The NBA also formed a medical advisory board in 2015 to promote research into player health, including cardiac health, according to league press releases.
Among the board’s work has been a 2016 study funded by the league and the NBA Players Association that examined “cardiac remodeling” in NBA players resulting from the rigorous training required for the sport.
Despite those, and other, efforts aimed at preventing cardiac arrests among NBA players, it remains unclear who decides proper emergency care protocols for the association’s minor league affiliates, or the arenas in which they play, when a player is stricken.
An overarching concern, Hilliard said, is whether the NBA has any emergency protocol for its minor league treams, such as staff trained in CPR, readily available AEDs, and coordination with local emergency service providers.
“Seconds matter,” Hilliard said. “If concussions are serious enough to require a set protocol, shouldn’t they have one for sudden death?”
The case is Upshaw v. Nat’l Basketball Assoc., S.D.N.Y., No. 18-cv-04740, 5/30/18.
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