Are there any lessons from the death of Donshay White?

It’s impossible to make mixed martial arts completely safe via regulation because it is an inherently dangerous sport. However, at the professional level, there is a fair amount of uniformity around the regulations that potentially have life and death implications. At the amateur level that is less true.

Amateur heavyweight Donshay White died at the age of 37, shortly after his fight vs. Ricky Muse was stopped in Round 2, at Hardrock MMA 90, in Louisville, Kentucky, on July 25, 2017. In layperson’s terms, White had a heart attack in the middle of a fight.

The Jefferson County Coroner’s Office identified the cause of death as a “cardiac event” linked to hypertensive/atherosclerotic cardiovascular disease. Plaque had built up in the arteries leading to White’s heart, a common issue in untreated high blood pressure. White was being treated for high blood pressure; it is unknown if the fighter was taking his medication at the time of his death.

This was not in any way a case of a dirtbag promoter with irresponsible regulation. It was a fair match up – Muse was a debuting fighter, while White was 1-0. There was an MD present, and an ambulance, and a pre-fight physical, and a medical professional cleared White to fight. There is no medical evidence that the fight caused his death. People die from hypertensive/atherosclerotic cardiovascular disease while sitting in a chair.

However, the death of Donshay White may offer some lessons for the regulation of amateur bouts. Reporters Laura Ungar and Gentry Estes for Louisville’s Courrier Journal looked into the issue in depth.

Regulations in twelve other states might well have prevented White from fighting, as:
•White suffered from high blood pressure;
•White was not required to get an EKG that might have detected his heart issues; and,
•White did not train for the event beyond hitting a friend’s heavy bag.

The Kentucky Boxing and Wrestling Commission should not be singled out; in a majority of states, White would have been allowed to fight. In seven states there is no regulation of amateurs and in five, regulation is handled by an independent sanctioning body. Independent sanctioning bodies have varying standards even within a state, as do differing state commissions from state to state.

According to Barry Dunn, executive director of Kentucky’s Public Protection Cabinet Office of Legal Services, the circumstances of White’s death were reviewed but no regulations were changed as a result.

“We looked, and for example, our regulation requires that there be an ambulance on the scene. Well, there was,” said Dunn. “Our regulation requires an EMT on scene. There was. Our regulation requires a physician there at the ring. He was. Everything was there. It was one of those things that is just so unfortunate because it was all there. There was just nothing that could be done.”

Health and safety rules come first and foremost, of course. But you also have to make sure that individuals who are just getting their start have that opportunity.

There are three factors that if regulated different could have made a difference: requiring training; disallowing fighters with high blood pressure; and requiring an EKG.

Required Training

Prior to the fatal fight, White called up coach Billy Smith, who trained him successfully for his first bout.

Look, man, you haven’t been training and it’s six weeks away and you’re going to start now? Smith recalled telling White. If you haven’t been doing much, I wouldn’t suggest it.

“People are getting injured all the time from lack of preparation,” said the coach. “They ain’t dying, but people are getting injured a lot in Kentucky. These guys don’t train … and are getting in there with little knowledge. They get injured or they get hurt. And the athletic commission is letting it happen. We need to do what we can [to ensure] the people who are going to get hurt for your entertainment [are] a little bit more protected.”

“A lot of these people will be beat up for your entertainment because they had a dream, or they didn’t have the money or things they need to do what they wanted to do in life — besides work at McDonald’s maybe. So they go out and they try to put together this image of being a fighter, thinking that they would make bigger money in the future and change the future of their life. If it means they are going to get hurt, beat on, whatever, for everyone’s entertainment, they will.”

Although it is not explicit in the regulations, Dunn said if commission inspector Todd Neal is unfamiliar with a fighter, “I know he starts picking up the phone and reaching out and calling other people and finding out what he can about them.

Still, the ad hoc response is not perfect.

“A lot of times, you know, [untrained fighters] slip through the cracks,” said Hardrock MMA media director Gary Thomas.

High Blood Pressure

Dr. Larry Lovelace, president of the Association of Ringside Physicians, who also serves on the Oklahoma State Athletic Commission, said high blood pressure, or hypertension, is “probably the most common reason to disqualify a fighter” nationally.

Kentucky does not statutorily prohibit fighters with high blood pressure from fighting, but instead leaves the decision to a physician.

White was cleared by multiple medical professionals. A nurse practitioner conducted a physical examination weeks before the fight and recorded his standing blood pressure as 148/90, above the normal 120/80. The nurse also noted a high result after a test of 100 hops. A physician queried by the Courrier team said a reading of 148/90 would likely result in a request to avoid strenuous activity until the cause was determined, and towards that end, an EKG or heart ultrasound would likely be requested.

Tragically, that did not happen.

EKG Requirement

Massachusetts and Kansas are among the states that require EKGs or “cardiac testing” for all competitors, and other states including Utah, Texas, and Pennsylvania require it for older fighters, which White was at 37. Kentucky screens for cardiovascular issues through blood pressure checks, letting the fighter’s physician determine what’s too high.

Dunn noted that the state must consider costs.

We’ve had a lot of pushback on that front,” said Dunn. We have to draw the right balance in making sure the public safety is met while not making it so cost-prohibitive that it’s impossible to fight.”

Like Kentucky, Alan Taniguchi, executive officer of Hawaii’s regulatory body, does not require EKGs, because they are very expensive, more than $500 for some patients.

I personally wish we could have them all take the test,” said Taniguchi. “But then no one would fight.”

The only way to make MMA completely safe is to ban it. Health and safety issues always must be balanced against cost. It is not irresponsible for an AC to determine that an EKG for amateur fighters is cost-prohibitive for that state. It is not irresponsible for an AC to allow a physician to make a determination around what blood pressure is disqualifyingly high. However, requiring an athlete to be trained before attempting a dangerous sport is not unreasonable.

Taniguchi summed it up perfectly.

It would be stupid to step into an MMA fight if you don’t know what you’re doing,” he said.

Unfortunately, some fighters are stupid. That’s why MMA needs regulation. This may not even need to be handled via explicit changes in regulation. It’s possible that the best course is simply letting promoters and fighters know that the practice of untrained fighters competing is no longer acceptable, and why – it may have killed Donshay White.