DEATH OF LOUISVILLE HIGH SCHOOL FOOTBALL ATHLETE HAS NOT BEEN IN VAIN

During the ‘Bear’ Bryant and Vince Lombardi Sports era, Athletes, teams and spectators were accustomed to ‘severe old fashioned’ traditions, coaching methods and win-at-all-costs-to-Athlete attitudes. One reason, not as many sports’ tragedies and deaths occurred during that era was that air conditioning was not widespread and Athletes were acclimated to the inclement weather. Children and youth played outside in the heat most of the summer and fall and probably, reflexively, knew how to stay hydrated.

During the same era, various parents, guardians and Coaches, pushed and punished Child and Youth Athletes beyond their physical and emotional limits causing or allowing to be caused directly or indirectly Preventable, Not Accidental overuse and other injuries. Sport fatalities were not widely reported.

The electronic era was in diapers. In 1975 MITS Altair reached retail stores and Bill Gates and Paul Allen established Microsoft. Steven Jobs and Stephen Wozniak began Apple Computer in 1976.

The Department of Health, Education, and Welfare (HEW), Department of Health and Human Services (HHS), Communicable Disease Center (CDC), Office of the Inspector General (OIG), Office of Surgeon General and other health related agencies plodded along during that same era.

All along and into the current era, Doctors failed to initiate an awareness campaign against Preventable, Not-Accidental sports injuries and deaths and failed to report the injuries and deaths to authorities when they examined and treated the injured Athletes and into the current era Preventable, Not Accidental overuse and other injuries continued. [Athlete Safety 1st, http://www.cappaa.com/]

Health and welfare, accountability, prevention, promotions and advocacy were infantile during that Bryant-Lombardi era and into the current ‘modern’ era, even though Athletes were becoming bigger, stronger and faster and thousands more Athletes were participating in Sport, Recreation and Exercise (SRE).

Suddenly, the worst imaginable high school football tragedy happened. Everyone tried their best to save Max Gilpin, but he died 3 days after his collapse, August 20, 2008. On that day the Heat index (HI) was 94* and the Air Quality Index (AQI) was near 106, an index which was unhealthy for sensitive groups. Max was a 15-year-old Louisville Pleasure Ridge High School football player. He looked like a football lineman should look, but wasn’t old enough to drive a car; legally he was just a child.

The sorrowful news of Max Gilpin’s death rippled throughout Louisville, the state of Kentucky and the nation.

Many expressed their sympathies and bewilderment. Those close to the tragedy, including some family members, expressed their hope that his death would not be in vain, not to no avail, not forgotten, but serve a significant purpose, the prevention of additional tragedies.

Doctors and hospital staff desperately attempted to save him during his 3 days of hospitalization, but the relentless complications from heat stroke were beyond the best modern medicine could provide.

Unfortunately, further complicating the tragic death, Coach Jason Stinson was then charged with his death. Stinson was the first coach ever charged criminally in the U.S. for the death of a football athlete, in a contact sport no less. He was indicted and tried for reckless homicide and wanton-endangerment in connection with the heat-stroke death Max Gilpin. Coach Stinson was acquitted on all criminal charges in adult criminal court September, 2009.

Stinson played football at the University of Louisville under then head Coach Howard Schnellenberger, who was end at Kentucky under Bear Bryant in 1953 and then head Coach Blanton Collier 1954 and 1955 and an All-American end (AP, 1955). Schnellenberger was offensive coordinator under his college coach at UK Bear Bryant at Alabama, helping Alabama win three national championships in 1961, 1964 and 1965 before leaving in 1966 to take a job in the NFL.

Superintendent of Jefferson County Schools, Dr. Sheldon Berman, fully understood the circumstances of Max Gilpin’s death. He connected the dots few others were able to connect. Dr. Berman fully understood the dangerous heat index and air quality index and was “extremely troubled” by Coach Stinson telling players they would “run until someone quits that day in practice” August 20, 2008.

“During the civil wrongful death suit, insurers for Jefferson County Public Schools and its employees agreed to pay $1.75 million to the parents of 15-year-old Pleasure Ridge High School football player Max Gilpin, who died from heat stroke three days after he collapsed at a practice in August 2008.” The final settlement was reported to be $1.74 million [http://www.courierjournal.com/apps/pbcs.dll/article?AID=2010309160053]

And then it happened. Nine years following his collapse, August 8, 2017, the Korey Stringer Institute announced their high school sports study revealed that Kentucky was the second safest state in which to participate in high school sports. This was truly a remarkable turnaround in statewide accountability. Max Gilpin’s tragic football death was not in vain, not to no avail, but was a key factor in the prevention of additional tragedies, among other primary contributory factors.

Korey Stringer Institute research concluded that number 1 North Carolina and number 2 Kentucky were the safest states to participate in high school sports.

“The Korey Stringer Institute (KSI) is a not-for-profit organization housed at the University of Connecticut (Uconn) dedicated to the prevention of sudden death in sports, with a focus on exertional heat stroke (EHS).

“After Korey Stringer’s death in August 2001 from Exertioanl Heat Stroke (EHS), Korey’s widow, Kelci Stringer, settled her lawsuit against the National Football League (NFL) in January 2009.[1]

“KSI stems from this settlement, with Kelci Stringer teaming up with EHS expert, Dr. Douglas Casa, from the University of Connecticut, and the NFL. The purpose of KSI is to minimize preventable deaths in sports through awareness, education, and research in the ways to accurately prevent, recognize, and treat symptoms quickly by being a resource to the entire sports community.[1. NYTimes Korey Stringer Settlement] [2.University of Connecticut News] [3.ESPN NFL news] [4.USA Today: Heatstroke Awareness]

“Gary Gertzog, who is the NFL’s senior vice president of business affairs said that “We all thought this was a terrific opportunity to increase the education at all levels of sports, particularly at the youth level, so that they understand how to prevent heat illness. We all have been parents or coaches for youth sports and we all have seen kids playing in very extreme weather conditions. They wanted to make sure everyone understands how important it is to be properly hydrated.”[5.ESPN News]

“A high school sports study conducted by the Korey Stringer Institute shows that many individual states are not fully implementing key safety guidelines to protect athletes from potentially life-threatening conditions, including heat stroke.

“The state-by-state survey of all sports played in high school showed North Carolina with the most comprehensive health and safety policies at 79%, followed by Kentucky at 71 %. At the bottom were Colorado (23 %) and California (26 %).

“Those scores were based on a state meeting best practice guidelines addressing the four major causes of sudden death for that age group: cardiac arrest, traumatic head injuries, exertional heat stroke and exertional sickling occurring in athletes with sickle cell trait. See complete story: [Sports study: High school athletes not being fully protected by Barry Wilnerap, AP, Aug 8, 2017, Herald Leader,
http://www.kentucky.com/living/health-and medicine/article166001297.html]

So what was it about North Carolina and Kentucky? Both experienced Child Athlete saving histories along the timeline way. The following were found when North Carolina and Kentucky were compared and contrasted with thought-to-be relevant factors that aligned and held different these 2 leading states, which met the best practice guidelines addressing the four major causes of sudden death for that high school age group, who participated in sports.

‘*Primary contributory factor’ denotes the major differences in NC and KY and the relevant events that led to the esteemed KSI recognition.

North Carolina is ranked 9th in state population with 10,146,788 people, 36th in educational attainment, unemployment 4.2%, poverty rate 17.2% and Kentucky 26th with 4,436,974, 15th, 5.1%, 19.0%.

*Primary contributory factor: “North Carolina is home to two universities that share a legendary rivalry, particularly in basketball: Duke University and the University of North Carolina–Chapel Hill. Sports are a big deal at many of the dozens of colleges and universities located throughout North Carolina. Students in North Carolina have a variety of higher education options, including large research universities, midsize colleges and small private liberal arts colleges. Several colleges and universities are publicly funded and have locations in cities including Charlotte, Greenville, Greensboro, Wilmington, Durham, Asheville and the capital, Raleigh.”

*Primary contributory factor: Duke is ranked number 8, Wake Forrest 27 and North Carolina 30 among national universities. Excellent education was concluded a difference maker and thus a *Primary factor in NC’s court. Education was/is key for understanding medical and legal concepts.

College basketball is a big deal in Kentucky, especially at two of its largest universities: the University of Kentucky and its rival, the University of Louisville. These two universities are among the few publicly funded colleges and universities in Kentucky. Most colleges and universities are privately funded, including several nationally ranked, small liberal arts schools. University of Kentucky is ranked number 133 and University of Louisville 171 among national universities. [Higher Education, USNews]

The Kids Count Data Center rank North Carolina 33 and Kentucky 34 in overall child well being. These are not lofty rankings and essentially the same rank, therefor not considered a *Primary contributory factor. The aforementioned are examples of how factors are/were considered that separate the 2 from each other and the best from the rest *Primary factors, as we continue.

*Primary contributory factor: The fiscal health of America’s states affects all its citizens. North Carolina ranks number 15 economically and Kentucky 47, a huge difference.

*Primary contributory factor: “At least 9 Kentucky children died from child abuse or neglect over the past fiscal year June 30, 2015 to June 30, 2016 and another 41 suffered life-threatening injuries at the hands of adults, according to an annual report produced by state child welfare officials.” [Ky kids still dying from abuse and neglect by Deborah Yetter, Sept. 27, 2016 Courier Journal]

*Primary contributory factor: During the Kentucky state fiscal year 2016, there were 15 victims of fatal or near fatal neglect maltreatment and 11 findings of physical Abuse. [Child Abuse and Neglect Annual Report of Child fatalities and Near Fatalities, DCBS, Cabinet for Health and Family Services, Sept 1, 2016]

25 children died at the hand of a parent or caregiver in North Carolina in 2013 (the latest data available). [State Fiscal Year North Carolina 2015-2016, Prevent Child Abuse NC]

In 2015, parents—acting alone or with another parent—were responsible for 77.7 percent of child abuse or neglect fatalities. More than one-quarter (26.7 percent) of fatalities were perpetrated by the mother acting alone, 14.7 percent were perpetrated by the father acting alone, and 22.3 percent were perpetrated by the mother and father acting together. Nonparents (including kin and child care providers, among others) were responsible for 18.7 percent of child fatalities, and child fatalities with unknown perpetrator relationship data accounted for 3.6 percent of the total. [Child Abuse and Neglect Fatalities 2015: Statistics and Interventions https://www.childwelfare.gov]

*Primary contributory factor: “National Center for Catastrophic Sport Injury (NCCSIR) long history dates back to 1965 when the American Football Coaches Association funded Dr. Carl Blyth at the University of North Carolina at Chapel Hill to continue its research on football-related fatalities. In 1977, data collection was expanded to non-fatal football injuries. Due to the success of these programs, a national center was created in 1982 to expand data collection to all sports under the direction of Frederick O. Mueller, PhD. Dr. Mueller and Dr. Robert Cantu (Medical Director) have led the NCCSIR for the past 30 years and have written the annual reports on catastrophic sports injuries and illnesses which have helped various sporting organizations develop health and safety policies.

“Traditionally, NCCSIR has tracked injuries through newspaper clipping services and internet based search engines. The NCCSIR is supported by annual contributions from the National Collegiate Athletic Association (NCAA), American Football Coaches Association (AFCA), the National Federation of State High Schools, the National Athletic Trainers’ Association (NATA), and UNC Department of Exercise and Sport Science (EXSS).

“Dr. Mueller retired in 2013 and the NCCSIR has expanded to include a research Consortium and is now directed by Dr. Kristen Kucera.” [National Center for Catastrophic Sport Injury, University of North Carolina at Chapel Hill]

*Primary contributory factor: The Thin Thirty, a book by Shannon Ragland, published in 2007 by Set Shot Press, was a monumental action toward Child and Youth Athlete Safety and Prevention of Child Athlete Abuse. TTT was also historic in the definition of Child Athlete Abuse Syndrome. The Thin Thirty enabled our team to find our teammates from our 1962 University of Kentucky Football Team that resulted in our reunion in 2008 and discussion and research of our football tragedy. TTT told our tragic football story of brain-washing brutality that reduced our squad from 88 to 33 athletes. Our thanks to Shannon Ragland and his family. So should the thanks of all Child and Youth Athletes.

*Primary contributory factor: In 2007 Women’s Sports Foundation began setting policy on verbal, physical, psychological and sexual abuse in an attempt to decrease these offenses. [Addressing the Issue of Verbal, Physical and Psychological Abuse of Athletes: The Foundation Position Oct 7, 2007 By Women’s Sports Foundation]

*Primary contributory factor: Child Athlete Abuse Syndrome (CAAS) Forensic definition by Micheal B. Minix Sr,. M.D. began following preparation in 2007 for the June 14, 2008 UK Football Reunion, 1961 freshman class. We surveyed our teams’ injuries: “The Longitudinal and Retrospective Study of The Impact of Coaching Behaviors on the 1961-1962 University of Kentucky Football Wildcats” by Kay Collier McLaughlin, Ph.D., Micheal B. Minix Sr. M.D., Twila Minix, R.N., Jim Overman, Scott Brogdon.

*Primary contributory factor: Micheal B. Minix, Sr., M.D., was trained and certified with many other doctors by C.A.R.E. for the instruction of physicians and their office staff in their community based offices about the recognition of Child Abuse. C.A.R.E. is a division of Prevent Child Abuse Kentucky.

CAPPAA, (Child and Adult Physical and Psychological [Emotional] Athlete Abuse), a Public Health Crisis, was prepared for Presentation to Deputy Secretary Steven Nunn, the Kentucky Cabinet for Health and Family Services April 24, 2010 by mbmsrmd and the CAPPAA Team. To the CAPPAA team’s amazement, Nunn at that very time had a restraining order brought by his girl friend, whom he soon thereafter murdered. The Team’s testimony before the Secretary was, of course, for naught. mbmsrmd soon surmised that Child Athlete Safety 1st promotion and advocacy at the Kentucky state and organization level was an exercise in futility. One team member commented, from the KCHHS on down, the state was filled with ‘paper tigers’ and continued to suggest that the GAO and Federal Government were the only reliable sources.

*Primary contributory factor: Child Athlete Abuse was discussed during break-out session during mbmsrmd C.A.R.E. training. C.A.R.E. is Child Abuse Recognition Education. In the past Child Athletes have been overlooked. C.A.R.E. staff reported after a pointed question from mbmsrmd, concerning the investigation of Coaches for Child Abuse 1 month following training after the question had been submitted up the ladder to DCBS top ranking officials:

*Primary contributory factor: “The Child Safety Branch of DCBS (Department of Community Based Services which has a branch in each Kentucky county) has responded to the question regarding coaches as caregivers”……“Our agency [DCBS] investigates abuse and neglect allegations involving situations where a person is providing care, has custody or has control of a child. Teachers, camp counselors, bus drivers, babysitters, grandparents, coaches etc. fit in to that category if they are left to care for a child and the parent is not present (for supervision and caregiving). To my knowledge we are investigating these type situations in this manner across the state. If [DCBS] staff have questions about whether a person falls into these categories, they can consult with Central Office or their regional attorney.” [C.A.R.E. Coordinator, Feb. 27, 2009]

*Primary contributory factor: “A bill aimed at improving safety for high school athletes won initial legislative approval.” House Bill 383 became Kentucky Law: 2009 Ky. Acts ch. 90, sec. 2, effective March 24, 2009. Kentucky Medical Association and KHSAA were the primary authors of the bill. They cooperated and worked diligently on the details. Congratulatons to both for their great work.

*Primary contributory factor: Many advocates, including “Dr. Michael Minix Sr., a physician and former University of Kentucky football player, testified in favor of HB 383 before the KY House of Representatives, Education Committee that coaches don’t always abide by medical guidelines and that they need to be better educated about risks to players.” [Panel OKs Athlete Safety Bill, Feb 25, 2009, by Stephenie Steitzer Courier Journal Newspaper, Louisville, KY]

mbmsrmd has been a member of the Brunel International Research Network for Athlete Welfare (BIRNAW) since Nov19, 2010/ BIRNAW is a group of international researchers who are working together to promote athlete welfare through research and consultancy. Brunel University is in East London, UK. Members are provided article and updates, periodically, concerning international Child Athlete Welfare.

In Suite 101, Terry Zeigler reported, “While 2010 has become known as the “Year of Concussion Awareness”, 2011 needs to become the “Year of Child Athlete Abuse Awareness”

As reported in the ‘Sports Digest’: “In the Emergency Department Max Gilpin’s body temperature was 107* after IV fluids and traveling 40 minutes in an air-conditioned ambulance. His core body temperature had exceeded 107* when he collapsed on the practice field. 109* is fatal absent proper cooling. A kiddy iced pool appears the appropriate, rapid cooling method. When he presented to the Emergency Department on stretcher, he could not breathe, had to be intubated (tube placed in his trachea and lungs for assisted breathing), was in cardiovascular/circulatory shock and had an impaired Central Nervous System from Exertional Heat Stroke. He required life support in Intensive Care. [Exercising to Exhaustion in Heated Ozone is a Formula For the Death of an Athlete by Micheal B. Minix, Sr., M.D. United States Sports Academy, America’s Sports University, The Sport Digest Volume 18 Number 2, 2010 – ISSN: 1558-6448]

*Primary contributory factor: April 29, 2011, forty-nine years after the report of Battered Child Syndrome, Micheal B. Minix, Sr., M.D., this mbmsrmd, presented the Forensic Definition of “Child Athlete Abuse Syndrome, A New Disease” at the Athlete Abuse Summit, Omni Parker House, Boston, MA. Battered Child Syndrome, the first report describing Child Abuse in the U.S., was reported in 1962. It evolved into Child Protection Laws. [“The Battered-Child Syndrome”, C. Henry Kempe, M.D.; Frederic N. Silverman, M.D.; Brandt F. Steele, M.D.; William Droegemueller, M.D. ; Henry K. Silver, M.D., JAMA. 1962;181(1):17-24.]

This was the first public conference report of mbmsrmd’s CAAS’s definition, following his scholarly inquiry, investigation, interpretation of facts and correction of accepted theories and laws because of new facts. The keynote speaker was Robert Cantu, M.D, leading sport related concussion authority and other speakers Frederick Mueller, PhD, Herb Appenzeller EdD Kimberly Archie, and Micheal B. Minix, Sr., M.D.

During this conference the main researchers and advocates for the promotion of Child Athlete Safety were convened in one place.

“Dr. Andrews is the father of modern sports medicine and one of the most influential figures in the world of athletics. In his new book (2013) “Any Given Monday”, he distills his practical wisdom and professional advice to combat a growing epidemic of injury among sports’ most vulnerable population: its young athletes.”

It appears, from mbmsrmd opinion that Dr. Andrews in his new book, Any Given Monday, (Jan 2013) has called out: Doctors, Parents and Coaches.

*Primary contributory factor: (a.) the case against Coach Jerry Sandusky, a former Penn State assistant football coach, who was convicted for sexually preying on and abusing boys. (b.) The Judge ruled Tuesday, July 30, 2013, that Penn State’s then-president Graham Spanier, retired university vice president Gary Schultz, then-athletic director Tim Curley will be tried on charges of cover-up, perjury, obstruction, endangering the welfare of children, failure to properly report suspected abuse, hiding evidence from investigators and lying to the grand jury, and conspiracy from [By Tim Polzer, July 30, 2013 Sports Illustrated Wire]

The following are the facts of the case for Morbidity and Mortality case review and study.

August 20, 2008, the day 15 year old Max Gilpin collapsed, the Heat index (HI) was 94* and the Air Quality Index (AQI) was near 106, unhealthy for sensitive groups. He wasn’t even old enough to drive a car 3 days later when he died in the hospital.

•The Air Alert for August 20, 2008 was announced publicly in Metro Louisville.
•Young physically fit Athletes can and most of the determined will continue exercising despite not feeling well, over heated and having difficulty breathing.
•In the meantime, no one reported an investigation of the potentially hazardous (was it investigated?) increase in ground level ozone from activity diesel school busses, parked near the PRP football practice field, waiting for practices to end, that might have created an ‘ozone hot spot’ on the already inclement Aug. 20th, which also might have been the weather inclemency difference from the other preceding conditioning practice days.
•If the high heat load from exercise and climate is not removed the heat load might progress into heat stroke, where the extreme body temperature (above 40.5 ºC, 104 ºF) will lead to damage to cellular structures and damage to the thermoregulatory system eith a high risk of mortality. [08 September 2003 The health impacts of 2003 Summer Heat Waves Briefing, Delegations 53rd session of the World Health Organization Committee]
•The 20th was not the first day PRP practiced in a Dangerous Heat Index.
•The PRP High School football team had practiced about 4 weeks prior to Max Gilpin’s Collapse. They were acclimated to the heat.
•Heat alone was not the Predisposing Risk Factor. Max was in the heat for 4 weeks prior to his collapse.
•Increased Ground Level Ozone might have been the difference in Aug. 20th and the other preceding practice days.
•Max Gilpin’s urinalysis revealed a normal Specific Gravity. That was inconsistent with Dehydration. Max Gilpin was not Dehydrated.
•There was no evidence that Max Gilpin was taking Creatine Enhancement drugs.
•Creatine kinase (CK), aka creatine phosphokinase (CPK) or phospho-creatine kinase, is an enzyme expressed by various tissues and cell types when damaged. CK catalyses the conversion of creatine and utilizes adenosine triphosphate (ATP) to create phosphocreatine (PCr) + adenosine diphosphate (ADP). CK is frequently analyzed in the blood, but CK is not the same as Creatine Enhancement drugs.
•“No changes were observed in blood CK assay results following oral Creatine Supplementation by idividuals researched. There were No significant effect on CK assay results. CK blood assay increased after resistance exercise, while creatine supplementation produced no difference in the muscle cellular integrity nor compromised assay methodology.” [Creatine supplementation: effects on blood creatine kinase activity responses to resistance exercise and creatine kinase activity measurement, Marco Machado et al, Brazilian Journal of Pharmaceutical Sciences vol. 45, n. 4, oct./dec., 2009]
•Myoglobin is a skeletal muscle protein present in muscle cells. Myoglobin is expressed by muscle cells into the blood and urine when muscles are damaged.[“Myoglobinuria”. eMedicine. Medscare. Retrieved 10 September 2015]
•Elevated blood creatinine (not creatine, note the difference) is secondary to kidney disease, kidney obstruction and rhabdomyolysis.
•“CK is a better predictor of acute renal failure (ARF) due to rhabdomyolysis than creatinine and urinary myoglobin (UM). Initial creatinine is a better predictor of ARF due to rhabdomyolysis than UM. UM assay is not a good investigation for early prediction of ARF in rhabdomyolysis.[Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients Preetish Bhavsar, Kirtikumar Jagdish Rathod,corresponding author Darshana Rathod, and C. S. Chamania Indian J Surg. 2013 Feb; 75(1): 17–21]
•The elevated Creatinine in his blood was accompanied by an elevated Myoglobin in the blood analysis, secondary to Rhabdomyolysis, muscle breakdown, secondary to Exercise to Exhaustion associated with Anaerobic Metabolism in Heated Ozone. His elevated Creatinine was not secondary to oral Creatine (note the different spellings) Supplementation.
•Muscle damage during exercise in the heat is best assessed by myoglobin and creatine kinase (CK / CPK).[ Beasley KN, Lee EC, McDermott BP, et al. The effect of oral vs intravenous rehydration on circulating myoglobin and creatine kinase. J Strength Cond Res. 2010;24(1):60-67, PubMed]
•Creatine doping would not cause increased Myoglobin in the blood.
•Max Gilpin had been taking a minimal normal dosage of Adderall (an amphetamine) while playing football several years prior to collapse on Aug 20, 2008.
•He took the same dosage of Adderall during the 4 weeks of prior practice.
•Detectives counted the pills remaining in his bottles and the pill-count added up to his taking one 20 mg XL dosage pill per day as attested by his parents and the detective.
•No bottles of Creatine Enhancement Drugs were found
•It is virtually impossible to have toxic effects of Adderall or any other amphetamine as the Predisposing Risk Factor to Max Gilpin Exertional Heat Stroke without an abnormally high urine specific gravity, evidence of dehydration, in mbmsrmd medical opinion. When toxic, Amphetamines speed up the heart rate and dry out the mouth, urine and body.
•He had a Normal Urine Specific Gravity. Amphetamine toxicity is inconsistent with normal urine SpGr in a heavily sweating football athlete.
•Amphetamine Toxicity and Normal Urine SpGr are incongruous, contradictory. Can’t have one with the other at the same time.

•This reporter has testified as a medical expert witness during depositions and on the witness stand during trials, many, many times. When deposed and questioned during the civil case, this reporter replied, “No”, “I am not an Adderall research medicine expert.” As this reporter awaited the next anticipated question, the obvious next question never was asked on cross examination by the attorney, which should have been, “Dr during your practice of medicine, do you have any experience prescribing amphetamines?” This reporter then would have answered, “Yes, I have considerable experience examining, treating and monitoring obese patients, treated with prescribed amphetamines, during my general practice of medicine, prior to ophthalmology training and practice.

“In 1968-1971, during general practice of medicine and 1969-1974 emergency medicine practice, this reporter examined, treated and monitored obese patients in the office setting, who were treated with amphetamine diet pills, which were the standard of care for obesity weight loss, and even selected Diabetes mellitus patients. And examined patients in the emergency department, who were prescribed amphetamines, but could not remember an amphetamine toxic patient, when taken as prescribed by the Doctor. But several patients who did not follow Dr’s instructions and took too many Diet pills developed dehydration, increased heart rate, dry mouth and concentrated urine from high urine specific gravity. Diet pills for obesity were not controlled substances then and perfectly legal and made significant weight control differences for obese patients at that time.”

Amphetamines became schedule II, by prescription with refills, under the Controlled Substances Act passed by the 91st United States Congress 1971.[1] Schedule II became a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act (21 USC 301 et seq.) Before that time amphetamines could be dispensed by practitioners without prescription. This reporter never dispensed without prescription amphetamines.

“Along with growth in amphetamine use for psychiatric indications, the war years also saw an explosion of amphetamine consumption for weight loss. The 1960s are rightly remembered for excessive minor tranquilizer consumption, around 14 standard doses per person per year on the basis of retail prescription sales. 34 It is rarely appreciated that in the early 1960s, amphetamines were actually consumed without prescriptions at a higher rate than tranquilizers. 35”

“Large quantities of amphetamines were also dispensed without prescription in the 1960s directly by diet doctors and weight loss clinics. The FDA’s crude population-level amphetamine consumption estimates based on manufacturing surveys (80000–100000 kg of amphetamine salts produced for a total population of around 200 million in 1969, or up to 50 10-mg doses per person) were supplemented with prevalence estimates from the first modern drug use surveys. A national survey conducted in late 1970 and early 1971 found past-year usage of amphetamine-type drugs by 5% of American adults.”

“When a drug is treated not only as a legal medicine but as a virtually harmless one, it is difficult to make a convincing case that the same drug is terribly harmful if used non-medically. This is what happened in the 1960s.

Please review the excellent report: [ Rasmussen N., America’s First Amphetamine Epidemic 1929–1971: A Quantitative and Qualitative Retrospective With Implications for the Present. American Journal of Public Health. 2008;98(6):974-985]

•ARDS and Ozone Toxicity were not entertained in Max Gilpin’s differential diagnosis. ARDS, Ozone and Air Alert were never mentioned in the Criminal Trial. The diagnosis, ARDS, was on the Chest X-Rays and scans. Max Gilpin’s diagnoses on presentation to the Emergency Department (not after hours in the hospital after secondary organ systems failed), in this reporter’s medical opinion (ITRMO), were Exertional Heat Stroke, ARDS secondary to Ozone Toxicity from the synergism of Ozone and dangerous Heat and Rhabdomyolysis, severe muscle damage, from Exercise to exhaustion.
 The transient increased lymphocyte cell count in the emergency department was typical for Exercise to Exhaustion 1-3 hours after weight lifting and 1-3 hours after running gassers. Not a viral infection.
 The second blood count had a typical granulocyte cell count. A viral infection would not have changed the white count in those few hours.(ITRMO)[Many References]
 Approximately 10 football athletes had the same condition, retching and difficulty breathing near the end of practice, Hallmarks of Exercise to Exhaustion in Heated Ozone.
 Another Athlete from football practice was transported in the same ambulance and hospitalized at the same time as Max Gilpin with Severe Asthma, which must have been from the same Synergism of Heat and Ozone (ITRMO), but never considered similar during legal proceedings. The second Athlete like Max couldn’t breathe, but didn’t take Adderall and had no viral infection. The only difference in the 2 was that Max was more severely affected and died. When a Doctor hears a stampede of hoof beats, the Doctor should think horses, not zebras!

Scientists the month before Max Gilpin collapsed during the 2008 Beijing Olympics described the hazardous effects on Athletes from the Synergism of dangerous Heat combined with increased ground level Ozone.

Synergism is an interaction of discrete agents (as drugs), or conditions (as weather) such that the total effect is greater than the sum of the individual effects. Example Climate Synergism: Dangerous Heat Index + Air Pollution (Ozone) = Death“Particulates, ozone and smog coupled with extreme temperatures form a more dangerous health threat than these problems would be for each of these individually, researchers have found.

“The combined threat is apparent in both hot and cold ends of the temperature spectrum. Scientists have long understood that air pollution is a serious health threat. The World Health Organization reported that in 2012, 1 in 8 deaths worldwide stemmed from air pollution.

“However, researchers are still mapping out the combined effects of air quality and climate. “Most studies focus on one or the other,” said Alexandra Schneider, a senior scientist and team leader at Helmholtz Zentrum München, a federal health research institution in Germany.

“The study on pollution showed that ozone, which tends to form on hotter days, changes the risk profile of heat stress. However, particulate matter didn’t seem to have any impacts on the links between temperature and deaths.

“The exact mechanisms for an increased temperature effect associated with increased ground level ozone and/or increased ground level ozone effect associated with increased ambient environmental temperature remain unclear. The mechanisms linking temperature, pollution and death remain murky. There are several hypotheses, but nothing is really 100 percent clear. What is clear, however, is increased effects secondary to their symbiotic relationship.”[Air Pollution and Extreme Weather Combine to Kill, Researchers find a mix of pollution and extreme temperatures can be deadly, Sep 3, 2014 by Umair Irfan, Scientific American] [Air Pollution, Heat and Mortality in Urban Populations, Cho Kwong Charlie Lam[1], School of Geography and Environmental Science, Monash University, Volume 7, Issue 1, 8 May 2014, International Journal Undergraduate Research] [Air Pollution and Extreme Weather Combine to Kill, Researchers find a mix of pollution and extreme temperatures can be deadly, Sep 3, 2014 by Umair Irfan, Scientific American] [Association of weather and air pollution interactions on daily mortality in 12 Canadian citiesJ. K. Vanos, S. Cakmak, L. S. Kalkstein, and Abderrahmane Yagouti Air Qual Atmos Health. 2015; 8(3): 307–320.] [Part 2. Association of daily mortality with ambient air pollution, and effect modification by extremely high temperature in Wuhan, China.Qian Z1, He Q, Lin HM, Kong L, Zhou D, Liang S, Zhu Z, Liao D, Liu W, Bentley CM, Dan J, Wang B, Yang N, Xu S, Gong J, Wei H, Sun H, Qin Z; HEI Health Review Committee. Res Rep Health Eff Inst. 2010 Nov;(154):91-217.Please see Sports Digest: Exercise To Exhaustion In Heated Ozone Is A Formaula For Death Of An Athlete, http://www.thesportdigest.com/archive/article/exercising-exhaustion-heated-ozone-formula-death-athlete

•The smog and Ozone during the 2008 Beijing Olympics were widely publicized in KY and the U.S.
•“Jefferson County Schools Superintendent Dr. Sheldon Berman is commended for his appropriate reactions the summer of 2009 to the death of Max Gilpin in 2008. He was the 2nd reaction to the Death of Max Gilpin. He got it right.
•Dr. Sheldon Berman got it and Connected the dots few others have.
•He was “extremely troubled” by (Coach) Stinson telling players they would run until someone quits that day in pracitce.
•There were public and legal outcries from the Witnesses to the grueling Practice the day Max collapsed. One witness actually told the Coach, as reported in court testimony, “quit abusing those kids”
•“Such motivational tools are not acceptable,” Berman said.
•In other words, Child Athlete Verbal (Psychological) and Physical Abuse are not acceptable.
•“Berman said the Jefferson School District is planning training sessions later this month for coaches, with the goal of teaching them how to use positive motivation with athletes.”
•“Dr. Berman and Jefferson County Public Schools to begin relaying air pollution warnings to coaches and had a plan in place to modify outdoor practices according to pollution levels.”
•In other words, Dr. Berman was considering that Air Pollution, Ozone, probably contributed to the death of Max Gilpin.
•KHSAA had a Heat Index Plan in place for modifying football practice
•The Partnership for a Green City with partners Louisville Metro Government, the University of Louisville, and the Jefferson County Public Schools that began in August 2004, was the first in the country
•The Partnership for a Green City received an award in 2007“that represented a collaborative effort to improve environmental education, environmental health, and environmental management by three of Louisville’s largest public entities: Louisville Metro Government, the University of Louisville, and the Jefferson County Public Schools.”
•But all that Partnering Education failed to prevent the Death of Max Gilpin, because those responsible overlooked or ignored environmental hazards.
•JCPS teachers, students and classes were actively participating in Air Pollution Health Education at the time.
•The Grand Jury Indictment of Coach Jason Stinson was because he practiced his PRP team in a dangerous environment according to one of the detectives who investigated and testified, that caused Child Endangerment that resulted in serious injuries and death.
•Activity diesel school buses arrived before the end of football practice according to testimony that fatal day. Diesel school busses have been known to create “hot spots” of increased ground level Ozone from their exhaust emissions. Did a hot spot develop that fatal day on or near the practice field?
•Did the Diesel School Busses push the already dangerous environment over the edge and contribute to the dangerous Football Environment Illness Epidemic? No one knows. No one investigated the school busses that day.
•No one notified Coach Stinson about the Air Alert Aug 20, 2008The death of Max Gilpin had a profound effect on this mbmsrmd. Hence, mbmsrmd began a relentless research into Child Athlete Abuse Syndrome (CAAS) and ultimately rendered a Forensic definition. Following preparation in 2007 for the June 2008 UK Football Reunion.
•Max Gilpin’s death was reported to Child Protective Services and CPS refused to investigate the death, citing criminal court’s investigation despite “In cases where criminal charges arising out of the same transaction or occurrence are filed against an adult alleged to be the perpetrator of child abuse or neglect, such charges shall be tried separately from the adjudicatory hearing held pursuant to this chapter.” [The person, who remains in anomnimity who reported to the CPS cited KRS 620.120] ‘Child Athlete Abuse Syndrome’ was ‘blind-eyed’ by even the CPS at the time.

We surveyed our teams’ injuries: “The Longitudinal and Retrospective Study of The Impact of Coaching Behaviors on the 1961-1962 University of Kentucky Football Wildcats” by Kay Collier McLaughlin, Ph.D., Micheal B. Minix Sr. M.D., Twila Minix, R.N., Jim Overman, Scott Brogdon.

We found startling results that have been published. Readers can google the report. http://www.cappaa.com/kentucky-football-tragedy-and-bradshaw-forgiveness

Max’s death occurred 2 months after our 1961 UK class football reunion, June 14, 2008. This mbmsrmd became determined to uncover the reason for his death and others like him, in hopes of promoting Athlete Safety 1st. The First Reaction to the Death of Max Gilpin was The Grand Jury Indictment of Coach Jason Stinson, because he practiced his PRP team in a dangerous environment according to one of the detectives who investigated and testified, that caused Child Endangerment that resulted in serious injuries and death COACHES are shocked to learn they can be investigated, indicted and tried in Court after a Report of CAAS. Coach Jason Stinson, former Coach of Louisville PRP, was tried and acquitted for the Death of Football Athlete, 15 year old Max Gilpin. The Criminal Trial was Sept. 2009.

During the Civil Wrongful Death Suit Insurers for Jefferson County Public Schools and its employees have agreed to pay $1.75 million to the parents of 15-year-old Pleasure Ridge High School football player Max Gilpin, who died from heat stroke three days after he collapsed at a practice in August 2008.”[http://www.courierjournal.com/apps/pbcs.dll/article?AID=2010309160053] mbmsrmd was deposed in Coach Stinson’s Civil Wrongful Death Suit prior to the suit settlement.

•Max Gilpin’s death has not been in vain, not ineffective or without proper positive reactions. Many sports safety improvements have been accomplished.
•mbmsrmd with teammates first positive reaction to Youth Athlete Abuse, physical and psychological maltreatments and physical assaults was “The Longitudinal and Retrospective Study of The Impact of Coaching Behaviors on the 1961-1962 University of Kentucky Football Wildcats” by Kay Collier McLaughlin, Ph.D., Micheal B. Minix Sr. M.D., Twila Minix, R.N., Jim Overman, Scott Brogdon.
•mbmsrmd, a physician and former University of Kentucky football player, testified, as requested by Rep Joni Jenkins, in favor of House Bill 383, a reaction to his death, which was introduced by Representative Joni Jenkins, Louisville, KY. It became Kentucky Law Ky. Acts ch. 90, sec. 2, effective March 24, 2009 and provided new rules for improved school sports safety including rules for air pollution, heat index, concussion and many other improved sports safety rules.“ [Panel OKs Athlete Safety Bill, Feb 25, 2009, by Stephenie Steitzer Courier Journal Newspaper, Louisville, KY]
•mbmsrmd, presented Child Athlete Abuse Syndrome, ‘A New Disease’, a reaction, at the Athlete Abuse Prevention Summit, April 29, 2011 at the Omni Parker Hotel in Boston, Mass.[Cheerleading Ranks First in Catastrophic Sport Injuries, The United States Sports Academy, April 8, 2011]
•*Primary contributory factor: New ICD-10 medical diagnostic codes and activity definitions have been implemented and became effective Oct. 1, 2015. The new ICD-10 codes appeared to be enhanced by the GAO. mbmsrmd realized after many frustrating encounters with state, federal, congressional, and other governmental and health officials that dealing with them concerning the Adverse Childhood Experiences of Child and Youth Athlete Abuse was an exercise in futility. mbmsrmd initiated another level of operation and found that the Child Abuse Prevention and Treatment Act 2010 was on a 4 year review cycle and due to be re-evaluated and reauthorized in 2014 and delivered research and findings to the Government Accountability Office (GAO). The GAO had been charged with investigating Child / Youth Athlete Sexual Abuse by Rep George Miller, California.
•*Primary contributory factor: mbmsrmd, therefore, first communicated with the GAO May 2, 2014, by email and telephone because “U.S. Rep Miller asked the GAO to Expand Investigation into Child Abuse Reporting Laws to Include Athletics, Extracurricular Activities Jun 18, 2013.” GAO officials communicated with mbmsrmd and disseminated the Athlete Safety 1st website information to other investigators according to a GAO communicator. [U.S. Rep Miller asks GAO to Expand Investigation into Child Abuse Reporting Laws to Include Athletics, Extracurricular Activities Jun 18, 2013 Issues: Labor, Wages and Benefits Committee on Education and the Workforce http://democrats.edworkforce.house.gov/press-release/miller-asks-gao-expand-investigation-child-abuse-reporting-laws-include-athletics ][http://www.cappaa.com/u-s-rep-george-miller-d-calif-asked-gao-to-investigate-youth-athletic-clubs-child-abuse-allegations]

It was apparent that the language and definitions in the resultant investigation report to Rep Spier, who replaced Rep Miller in receipt of the report, was nearly identical with minor changes, that was exclusively used on the Athlete Safety 1st website. As mbmsrmd UK Coach Bill Arnsparger said, in his book ‘Coaching Defensive Football’ with a forward by Coach Don Shula, “you can get a lot of things done if you don’t care who gets credit for it” which was more than perfect with mbmsrmd. The main objectives were accomplished. Amen.
•*Primary contributory factor: Other new Child and Youth Athlete Abuse and Athlete Safety 1st prevention regulations since 2009, reactions to the death of Max Gilpin and other Athletes have been implemented both on the federal and state levels.
•May Max Gilpin Rest in Peace. Condolences to and Prayers for the family. His death was not in vain because we have learned many lessons that might save others. What are the lessons learned?

Everyone must do their part to prevent non-accidental, preventable physical and psychological endangerment and maltreatment that cause serious injuries and deaths, negligence, substandard care, human rights violations and sexual abuse of Child and Youth Athletes.

We must prevent the blindsiding of uninformed Coaches with civil and legal punishments, because they don’t know about their legal relationship with Child and Youth Athletes, whom they supervise during Sports, Recreation and Exercise (SRE) participation.

The current Coaching Generation and Child and Youth Athletes are sandwiched together in the middle of win-at-all-costs motivations and record setting SRE non-accidental, preventable injuries and deaths. Money is in the drivers’ seat.

The United States and other Nations have many Great, Dedicated, Trustworthy, Reliable, Teacher Coaches. But a small percentage of Coaches, just like Doctors, Attorneys, Judges, Teachers, Construction Workers, and other professions and trades, have problematic Coaches that need better Education and Awareness.

*Primary contributory factor: Unfortunately, Coach Jason Stinson was the first coach that was ever charged criminally for the death of a football player. He was charged for the death of Max Gilpin, a Louisville PRP football athlete. Who would have ever imagined that a Coach could and would be tried for the death of a football player in a contact sport? That never happened before this tragedy. But it made a difference.

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