By Khari Griffin, J.D. Candidate at Emory Law School
(Editor’s Note: The following appeared in Sports Medicine and the Law, a periodical published by Hackney Publications.)
Among the numerous viral sports clips, few are as disturbing as the footage of the South African Boxer, Simiso Buthelezi, who began throwing punches at an imaginary target after appearing to receive a normal punch on the chin from his opponent.[1] Due to Simiso’s disoriented condition, the referee had to promptly stop the fight.[2] Buthelezi, who was only 24 years old at the time, was hospitalized, diagnosed with a brain bleed, and ultimately succumbed to his injuries and passed away two days later.
Unfortunately, this is not the first time a situation like this has occurred in professional boxing and will not likely be the last.[3] In 2019, 27-year old American boxer, Patrick Day, died from brain injuries just four days after he suffered a 10th round knockout loss. [4] Studies have shown that traumatic brain injuries are common among boxers at the professional and amateur level.[5] Such could explain why critics of boxing, including the World Medical Association, have called for an end to the sport altogether and plead to make the sport safer.[6]
Yet, to date, professional boxing has failed to adopt universal safety measures.[7] Unlike private organizations such as the NFL or the UFC, Professional Boxing is governed and regulated by each individual State Boxing Commission or State Athletic Commission, headed by the state’s boxing commissioner. In some states, this role is politically appointed, and may not require knowledge of the sport. Nevertheless, the welfare of boxers fall in the hands of their decisions, as they establish the state’s rules and appoint referees, who are in charge of stopping a fight if it becomes clear a fighter can no longer protect themselves. For the commissioner, this arrangement can potentially lead to a conflict of interest between boxer safety and monetary gain. For example, the promoter’s role is to put together the most exciting fights, which tend to be those that end in knockouts.[8] This may lead promoters to forum shop and avoid hosting fights in states with more stringent safety requirements.
- The Professional Boxing Safety Act
In light of widespread corruption in the industry, Congress passed the Professional Boxing Safety Act in 1996 to address unethical business practices in boxing as well as boxer safety. The following safety requirements were established by the Act:
(1) A physical examination of each boxer by a physician certifying whether or not the boxer is physically fit to safely compete, copies of which must be provided to the boxing commission.
(2) Except as otherwise expressly provided under regulation of a boxing commission promulgated subsequent to October 9, 1996, an ambulance or medical personnel with appropriate resuscitation equipment continuously present on site.
(3) A physician continuously present at ringside.
(4) Health insurance for each boxer to provide medical coverage for any injuries sustained in the match.
If a commission is found to have violated one of these safety requirements, the Attorney General may pursue civil damages, as well as criminal prosecution. See 15 U.S.C. § 6309. Similarly, boxers may pursue damages against the state commission for lack of care.[9] In 2005, former heavyweight champion Greg Page filed suit against members of the old Kentucky Athletic Commission, claiming negligence on his fight night when he collapsed in the 10th round. Despite the second listed PBSA requirement, neither an ambulance or adequate medical personnel was there on-site to assist him. After collapsing, Page underwent cardiac arrest, as it took over 2 hours for him to reach an operating room. Today, Page remains severely hemiparetic and is unable to walk on his own.
- Takeaways
- Qualified, On-Site Medical Personnel
Hall of fame boxer, Sugar Ray Leonard once said, “you don’t play boxing.” This phrase is uttered often in the boxing community to reinforce the inherent danger of the sport. Thus, as a preliminary matter, state boxing commissions should ensure proper emergency personnel is onsite before the first bell is rang. Moreover, ringside physicians should also be thoroughly pre-screened.[10] In Page’s instance, the ringside physician was not licensed to practice medicine in Kentucky, had never worked as a ringside physician before, and had just had his medical license suspended in Ohio. Perhaps a qualified and experienced ringside physician would have called the bout to be ended much earlier.
- Universal Medical Documentation
Moreover, state boxing commissions should establish a universal system for collecting fighters’ histories and flagging those with extreme risks. For older boxers tasked with bolstering the records of top prospect fighters, known as “journeymen” or “professional losers”, this system would mitigate the problem of boxers suffering life-ending and life-debilitating brain injuries due to repeated head trauma over the years. Boxing purists will often utter the phrase, “the name of the game is to hit and not get hit.” For brawler-style fighters and boxers who have received several knockouts or losses in their career, it is possible they could already be suffering from a TBI.[11] Take Bradley Rone for example, who collapsed and died after the first round of a 2003 bout.[12] At thirty-four years of age, Rone had lost twenty-five consecutive fights over the past three years leading up to the fight.[13] Nevertheless, the Utah Athletic Commission granted Rone a license to fight, which ultimately led to his death.
- Hydration Monitoring and Less Stringent Weigh-Ins
Dehydration can have serious consequences for boxers, both in terms of physical performance and long-term health. In the short-term, dehydration can lead to fatigue, muscle cramps, and impaired decision-making, all of which can impact a boxer’s ability to compete effectively in the ring. In the long-term, dehydration has been linked to an increased risk of brain injury in boxers, as well as other negative health outcomes.
Boxers typically lose a significant amount of water through sweat during training and competition, and it is important for them to replace this fluid in order to maintain their physical and mental performance. However, some boxers may intentionally dehydrate themselves in order to meet weight requirements or to gain an advantage over their opponents. This practice, known as “weight cutting,” can be dangerous and can increase the risk of dehydration-related health problems.
One of the most significant risks of dehydration in boxers is the potential for brain injury. Studies have shown that dehydration can lead to a decrease in blood volume and blood pressure, which can in turn reduce the flow of oxygen and nutrients to the brain. This can impair brain function and increase the risk of brain injuries such as concussions.
To protect the long-term health and well-being of boxers, it is important for the sport to prioritize hydration and to discourage the practice of weight cutting. Boxers should be provided with the necessary dietary resources and support to ensure that they are adequately fueled and hydrated before and during competition. Many of the elite professional boxers hire nutritionists to ensure they can “make weight” in a safe and proper manner. In addition to promoting proper nutrition and hydration, penalties should be put in place for those who engage in unsafe weight cutting practices. This will encourage fighters to take a more proactive and calculated approach to meeting weight requirements and discourage fighters from fighting in weight classes that are way below their natural weight. By taking these steps, the sport of boxing can work to reduce the risk of dehydration-related health problems, including brain injury.
Unfortunately, as a sport premised on heart and toughness, fighters often need protection from themselves. Beyond the fighters’ corner, whose job is to throw in the towel if their fighter is in danger, state boxing commissions must be compliant and proactive in protecting the men and women who keep the sport of boxing alive.
[1] Ben Church, Boxer Simiso Buthelezi dies after collapsing at end of fight in South Africa, ESPN, https://www.cnn.com/2022/06/09/sport/simiso-buthelezi-south-africa-boxer-death-spt-intl/index.html
[2] Id.
[3] Dan Rafael, Patrick Day dies of brain injuries four days after knockout, ESPN, https://www.espn.com/boxing/story/_/id/27861877/patrick-day-dies-brain-injuries-four-days-knockout.
[4] Id.
[5] Julian Savulescu & Ingmar Persson, Should boxing be banned?, TLS, https://www.the-tls.co.uk/articles/should-boxing-be-banned/
[6] Id.
[7] Melissa Neiman, Protecting Professional Boxers: Federal Regulations with More Punch, 15 SPLAWJ 59, 91 (2008)
[8] Id. at 79.
[9] Id. At 82.
[10] Melissa Neiman, Protecting Professional Boxers: Federal Regulations with More Punch, 15 SPLAWJ 59, 82 (2008)
[11] Id. At 83.
[12] Id.
[13] Id.
