By Doyice Cotten
Facts and Relevant Procedural History:
Henry White, III was given a scholarship to play basketball at Grambling State University in the fall of 2009. Henry arrived on campus three days past the mandated reporting time for basketball players. Players who reported to campus late were required to attend an “unorganized” practice on August 14 which would include weight lifting and conditioning.
The weight training/conditioning practice started at 2 p.m. on August 14. After the two hour weight lifting portion of the workout, which involved each player “maxing out” on various exercises, players were required to run a 4.5 mile conditioning run around the campus in 45 minutes or less. The alternative was suspension from the team. The temperature was 91 degrees with a heat index of about 100 degrees. Coach Stephen Portland followed the runners in a golf cart. Henry finished the required 4.5 mile run in the top half of the runners. After the race another teammate carried Henry into the gym unconscious and the players tried to revive him and tried to give him water and splashed him with water. Coach Portland was still about ten minutes away supervising the remaining runners. Coach Stitt had called the head athletic trainer, who called 911 and hurried to the gym. She observed that Henry was pale and clammy and unresponsive; she and several players tried to cover him with ice to lower his temperature. Henry was critical when EMS arrived and started an IV. He was rushed to the hospital suffering from Disseminated Intravascular Coagulation caused by heatstroke.
When he arrived at the medical center his core temperature was above 104 degrees. As the DIS worsens the body loses all of its clotting factors and begins to bleed horribly. At the that time, the body continues to clot throughout, which deprives the body of oxygen.
Henry underwent kidney and liver dialysis, and he was put on a ventilator in the ICU. He was confused and disoriented, he could feel pain, and he had difficulty breathing even while on the ventilator. By the fifth day of his hospitalization, Henry had a swollen stomach and eyes, jaundice, and bloody fluid coming out of his feeding tube. An exploratory laparotomy on his bowels showed that a large portion of Henry’s small intestine had become necrotic and was beyond saving, so that portion was removed. On the eighth day, doctors cut holes in the upper and lower parts of Henry’s abdomen, pulled the remaining bowel through the skin, and attached bags to drain the fluid accumulating in his stomach. At that time, five cups of blood were taken out of Henry’s abdomen. He had blood clots in his mouth, and there was blood draining into his ostomy bags. On day 12, a repeat exploratory laparotomy showed that Henry’s bowel was completely gangrenous. Henry died the next day, which was August 26, 2009.
Ms. Robinson, the athletic trainer stated that the “Tiger Mix” (the name given to the run by the basketball coaches) was dangerous. No one with the basketball program told her beforehand about the run, which should have been done as she is to be informed of all athletic practices beforehand. Had she known about the run, she could have been prepared to assist. She also testified that before the EMTs could even leave the gym, there was another athlete, Jacoby Lee, down with heatstroke symptoms. She and the players began icing him down, and because the first unit had already left with Henry White, another ambulance had to be called.
Coach Stallworth, the strength and conditioning coach, stated that the coaches did not consult him about the conditioning/running aspect of the workout. He said that a proper conditioning program includes 1) consideration of where (indoors or outdoors), 2) when (time of day) to conduct the run, 3) distance or time, 4) frequency, 5) proper hydration, 6) proper supervision, and 7) the intention (conditioning or disciplinary) behind the workout. He said if he had been in charge the players would not have run outdoors for such a distance in those temperatures; also, that the run would have been on a different day than the strength training. He would have conducted it in the early morning or late afternoon with a shorter distance – and would have been done only after players were acclimated to the heat.
Risk Management Take-aways
1) Don’t risk players health when administering discipline.
2) Always have water available.
3) Make use of the expertise that you have available.
Worthy of Note!
There is a relationship between rhabdomyolysis (an ailment discussed twice previously on Sportwaiver.com). Rhabdomyolysis is breakdown of muscle fibers. Muscle breakdown causes the release of myoglobin into the bloodstream. Myoglobin can cause kidney damage. Symptoms include dark urine, muscle weakness, and fatigue. This is frequently brought on by very strenuous exercise by a person who is not in good shape. Disseminated intravascular coagulation is a frequent complication of rhabdomyolysis.
Coaches, personal trainers, and others involved in conditioning athletes should learn all they can about each of these conditions. This Williams case should serve as a heads-up to all professionals who are not already familiar with these conditions.
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Photo Credit: Thanks to the Mennonite Church USA.
 Disseminated intravascular coagulation or DIC, is a condition in which blood clots form throughout the body’s small blood vessels. These blood clots can reduce or block blood flow through the blood vessels, which can damage the body’s organs.
In DIC, the increased clotting uses up platelets and clotting factors in the blood. Platelets are blood cell fragments that stick together to seal small cuts and breaks on blood vessel walls and stop bleeding. Clotting factors are proteins needed for normal blood clotting.
With fewer platelets and clotting factors in the blood, serious bleeding can occur. DIC can cause internal and external bleeding. http://www.nhlbi.nih.gov/health/health-topics/topics/dic/