Dr. Margaret Goodman

Fight Doctor: N.Y. commission failed miserably when it licensed Margarito

Witnessing Antonio Margarito’s licensing process unfold in New York, I could not hold back pangs of nausea. 

As a former Nevada State Athlete Commission medical advisory board chairman and chief ringside physician, I understand the pressure to license a medically unfit fighter. I contend that this fiasco was not the fault of the commission’s medical board and physicians, who were placed in an untenable position. It was a politically motivated, tax-money-hungry commission folding to make a big fight — Margarito vs. Miguel Cotto on Dec. 3 — happen.

altIn his November 2010 loss to Manny Pacquiao, Margarito sustained at least four separate injuries to his right eye that required multiple surgeries for an orbital floor fracture, a giant retinal tear, cataract and vitreous detachment.

The orbit is the bony socket protecting the eyeball and surrounding nerves, muscles and vessels from damage. The retina is the clear tissue in the back of the eye enabling you to see images. A cataract clouds the lens of the eye. The lens focuses rays of light that enter the eye. The vitreous is a gel-like substance that fills the interior of the eye, which helps it maintain its round shape.

Each of Margarito’s eye problems can cause blindness. And the type of treatment he received in many ways placed him at more risk — not less!

I contacted several renowned ophthalmologists, including Dr. Jack Dodick, professor and chairman of the Department of Ophthalmology at New York University and Philadelphia retinal specialist Dr. Alexander J. Brucker regarding Antonio Margarito’s documented medical history.  After learning of Margarito’s conditions and treatment, not one specialist believed he should be allowed to fight.

Dr. Brucker said he wouldn’t let the fighter drive to the bank, let alone fight.

“There are a variety of types of (retinal) detachments and repair procedures,” said Dr. Brucker, who has extensive experience with boxers. “Someone with a giant retinal tear and a vitrectomy shouldn’t box again.”

A vitrectomy is surgery to remove some or all of the vitreous of the eye. The size of Margarito’s retinal tear, and the lengths it took to repair it, placed him at risk of recurrence. 

Following Margarito’s vitreous repair, silicone oil was inserted. Intended as a protective measure, the oil is not compressible, meaning that sufficient pressure from a punch will rupture the eyeball. The boxer also received a lens implant. These carry significant risk in someone who is routinely hit in the face, including infection, rotation or dislocation of the lens. When combined with a repair to his socket, how could he receive a license to box?

In late November, New York’s eight-member medical advisory board recommended that Margarito could not be medically cleared. In the past, the commission has turned down a number of fighters with only one or two of Margarito’s eye problems. Dr. Alan Crandall, an ophthalmologist, testified that he approved Margarito only on the surgery he performed but admitted that the fighter had poor peripheral vision. Although all commission hearings are public, New York held a closed meeting and decided that the fighter should undergo an independent exam by Dr. Michael Goldstein.

Dr. Goldstein is a corneal expert, meaning his area of expertise is more on the outside of the eyeball. Dr. Goldstein submitted a lengthy report outlining Margarito’s history that somehow never made its way to the commission meeting. The tenor of the report certainly was not a glowing recommendation to approve a license.  However, when Goldstein testified before the commission, his attitude seemed to change. If we accept Goldstein’s opinion on Margarito’s cornea, where were the rest of independent experts concerning Margarito’s other injuries and ocular surgeries? 

I contacted Dr. Goldstein, who is also an attorney, about the difference between his written report and commission hearing testimony.

“My written report was based on my views under New York’s guidelines,” said Goldstein, referring to detailed guidelines regarding fighters competing with certain ocular conditions.

Margarito’s application approval was based on outdated guideline language that would have been difficult to defend in court, according to a reliable source. His ability to compete was “contraindicated” but “not prohibited.”  Goldstein noted that based on that language he was able to recommend the fight go forward, although his testimony was based only on the cataract surgery.

In the end, New York took the position that its antiquated statute needs to be overhauled to prevent such cases in the future. In layman’s terms, they gave in to the pressure. 

Commissioner Edwin Torres issued the following statement in defense of New York’s decision:

“Evidence has been introduced, including by the applicant himself, detailing the rehabilitative steps taken to ensure that all the rules of the commission will be followed. After due consideration of the evidence of rehabilitation, the commission finds the issuance of a license to the applicant not to be contrary to the best interests of boxing. Further, following the thorough examination by Dr. Goldstein, and his testimony that it is his opinion that the condition of Mr. Margarito’s eye is such that he’s fit to be in the ring, the commission rules that Mr. Margarito’s petition for a license in New York is granted.”

If New York had done the right thing and denied Margarito a license, sadly there were nine commissions, including Colorado, Texas and Mississippi, lining up to accept the fight without so much as an exam by medical experts.

“The fight was going to happen somewhere,” said Goldstein. “I believed that New York was the safest place for him to fight and that Margarito would receive the proper medical care after the fight.”

Federal law mandates that a medical suspension or revocation be reciprocally enforced. A fighter on suspension by one jurisdiction cannot travel to another until the initial suspension has been lifted. License denials are treated differently. Many commissions believe that a license denial should be honored, but it was thought that this gave too much power to an individual commission. This law is repeatedly bastardized when unfit fighters are “commission-shopped” to less-strict jurisdictions.

A classic counter argument is: “If the boxer understands the risk, it’s his life.”  This is absurd. Besides generating tax revenue for their state, the role of an athletic commission is to protect the fighters they oversee. The athletes must prove they are fit to compete. New York has a qualified medical board that determined the boxer was not fit. Shockingly ignoring its own medical board, the New York commission failed miserably.

The solution is simple. When RingTV.com reporter Lem Satterfield recently asked Top Rank chief Bob Arum what changes he would make to boxing, Arum replied, “I would have a federal boxing commission that would have overall supervision of the sport in the United States, and I would minimize the role of state athletic commissions with regard to physicals.”  Mr. Arum and I may not always agree, but we certainly are on the same page on this one.

After the Cotto bout, two of the experts who cleared Margarito were present while the ringside physician and an ophthalmologist pried open the eye. One gasped, saying “Oh my god.”

What did he think would happen in a fight? 

 

Photo by Chris Farina – Top Rank

Around the web

Leave a Reply

XHTML: You can use these tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>