FIGHT DOCTOR THE “UNOFFICIAL” TEAM MEMBER By Dr. Margaret Goodman
way to the ring demonstrating an off- balance gait. He was immediately sent to the hospital, where they discovered a brain bleed. His life was saved. At the venue, doctors meet with emergency medical services (EMS). Dr. Schwartz’s team has a code to signal them in case of emergency. There is nothing more important than time to save a fighter’s life. EMS must have proximity to the ring and dressing rooms, and they must make certain that emergency equipment is easily accessible ringside. No fight can take place unless at least one ambulance is present – at larger events, often there are at least two. This includes ensuring the physician and/or ambulance crew have ACLS (Advanced Cardiovascular Life Support) certification. If a fighter requires transport and only one ambulance is present, the event is halted until the ambulance returns or another comes. Nearby Level 1 Trauma Center hospitals with a neurosurgeon who can perform emergency brain surgery are alerted. Beyond medical tests and examinations, it’s crucial for doctors to meet with the assigned referees and share opinions on their match. Referees always have pertinent information, such as which fighter typically comes on late or more readily recovers from a punch or knockdown. “I ask the referee, ‘Are you concerned about anybody?’” says Sethi. I always reviewed fight films and fighter interviews – as do Schwartz and Sethi. It helps to know how a fighter historically walks and talks, how they look when tired or how they handle punishment. Such minor changes during a bout could point to stopping the contest. It was always the fighters I couldn’t find films/videos on that raised more concern when they were taking a beating. New York may have up to seven physicians at an event. At least one works each corner, and one or two are in the back conducting post- fight exams and triaging fighters with injuries. There’s nothing more important than placing the ring physician in the corner so they can listen to what the corner is saying between and
during the rounds. Like the referee, the commission inspector watching the cornermen can alert the doctor regarding an injury or fighter complaint. The referee and I would always make eye contact after each round and trade signals regarding concerns. “Working ringside is a lot of pressure; you get a lot of heat,” says Sethi. “In New York, the doctor can stop a fight, but how do you stop a fight at the right time? Everyone at ringside has their own threshold in stopping a fight – the corner is their family; they have their own idea, and like the fighter they have a high threshold. The ringside doctor always has the lowest threshold, as they have an unbiased objective. That improves with experience.” Examining the fighter between rounds carries its own pressure for the ring physician. No one wants you there. The crowd boos; the corner tries to shoo you away; and the fighter always says he/she is OK. I’ve also had the corner urge me to stop a bout when their fighter had a cut from a clash of heads and they believed he was leading on the scorecards. The physician won’t get up on the ring apron unless there’s an indication the fighter is hurt or the referee/ inspector has signaled the doctor to take a look. Often, I would use that moment to insert my presence when I thought a stop should be imminent. Before leaving the ring, I’d share a few words with the referee. This also gives the referee more courage to let a bout go or pull the trigger when a fighter is taking unnecessary punishment and has little chance of success. Every ring physician could write a book on cuts. Dr. Schwartz comments, “Cuts seldom stop a fight unless the fighter can’t see or defend himself/ herself. Blood is not the issue, so it depends on where the cut is. We always try to give the corner a chance to stop bleeding. What the public doesn’t understand is the location can indicate potential injury to facial nerves and muscles. If the fighter can no longer see, the physician must intervene.” He understands why a physician’s decision could be criticized, but in truth, only
that physician can appreciate the implications of not acting. Irrespective of a loss or win, every fighter undergoes a post-fight exam. That may begin in the ring. A suspension is given as to indicate when the fighter can schedule another bout. There are automatic suspensions relating to the number of scheduled rounds, but a boxer could receive 30 or even as many as 180 days, depending on their injuries. If it appears there could be an undiagnosed hand injury or facial fracture, the suspension could be lessened once the athlete is cleared by a specialist. If he/she took considerable head shots or was kayoed, then they are immediately transferred to undergo a brain CT/MRI as well as additional neurological tests before the suspension is removed. Before fighters are discharged from the venue, they are handed paperwork describing symptoms requiring emergency attention and where to seek care. Ringside medicine is training on the job. However, several years ago, Dr. Schwartz – also co-chair of the Association of Boxing Commissions Medical Committee – created the Association of Professional Ringside Physicians, where ring doctors meet, advance protocols and receive certification in an effort to expand uniformity. Yes, there have been positive changes to better protect boxers inside and outside the ring, but it’s after the crowd and lights disappear for good when fighters desperately need continued care and support. Sadly, that too often remains a problem for many. Dr. Margaret Goodman is a former Nevada State Athletic Commission chief physician, co-hosts the Fighter Health and Safety Podcast and is president of the Voluntary Anti-Doping Association. Note: The opinions and comments of the physicians who contributed to this feature are their own and don’t necessarily reflect the views of the organizations they serve.
W orking a fight can often seem like going into battle for officials. The ringside physician, an independent contractor appointed by the commission, is there to enable a bout to safely proceed to its natural conclusion. In that way, they are an “unofficial” part of the fighter’s team. Their involvement isn’t just ringside but begins long before the athlete steps between the ropes. Many question how doctors can be part of a sport where the “intent” is to injure the opponent. Thirty-year Connecticut chief ringside physician Michael Schwartz notes, “My view changed when I started looking at outcome, not intent, and looked to create protocols where we can improve the safety of boxing and MMA before the competitor enters the ring.” Professional boxing has no national/ international governing body like the National Football League, National Hockey League or international soccer. So it has always been up to the physicians working combat sports to place their own safety measures when it relates to injuries. “I believe the sport in general is more aware in preventing the acute and
chronic injuries associated with combat sports, including chronic headaches, dizziness, orthopedic and brain injuries,” says Nitin Sethi, the New York chief physician. Prefight testing has expanded through the years. In most jurisdictions, to be licensed, fighters must undergo yearly private physicals, brain scans (MRI/CT), eye exams, EKG, lab work that includes HIV/hepatitis B and C and a more extensive stress test for those over 40 years of age. Drs. Schwartz and Sethi, who have also worked Riyadh Season events, review these medicals – and that includes matchups. “I look to see how many times a fighter has been stopped and when,” says Schwartz. “I also review numerous anonymous messages to look into a fighter who might be suffering from chronic damage or has been knocked out in the gym.” Dr. Sethi, an experienced, board- certified neurologist, reviews more detailed and often repeated testing for brain injury: “In New York, we advise the promoter why an MRI needs repeating due to an abnormal finding, or why you are denying licensure – like for an aneurysm (ballooning of an artery). Yes, we get pushback, but
Knowing when a fight should be stopped is just one of many crucial roles played by the ringside physician.
your goal should always be the safety of the athlete.” That pushback can be strong. As a former Nevada medical advisory board chair, there were times when a promoter campaigned against me working ringside when I recommended one of their fighters be denied a license. At the weigh-in, ringside physicians complete an exam that includes asking the athlete about their training history. They review medical tests and medications the fighter might have taken leading up to the event. “We have a duty to not ‘rubber stamp’ a fighter,” notes 23-year Nevada ring physician Damon Zavala. “I have called off fights at the weigh-in if the athlete looks too ill from trying to make weight. I ask those tough questions and know I will be backed up by the commission.” But the evaluation doesn’t stop there. Boxers are also briefly checked when they arrive at the venue. Years ago, a fighter in a Nevada event was on his
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