By Thomas Hauser

At 10:00 pm on November 2nd, Russian heavyweight Magomed Abdusalamov entered the ring at Madison Square Garden to fight Mike Perez. The following morning, Abdusalamov was in a coma following the removal of a portion of his skull and other surgical procedures to treat bleeding and swelling in his brain. As of this writing, doctors don’t know whether or not he will survive. If he does, it’s possible that he will never talk, see, or walk again.

Everyone agrees that what happened to Abdusalamov is a tragedy. How it happened has been distorted in the retelling.

An unnamed source at the New York State Athletic Commission (which had jurisdiction over the fight) told the New York Daily News, “We did everything we were supposed to do that night. He never said anything was wrong. After the fight, he went back to the audience and was watching the main event.”

The Wall Street Journal reported that Abdusalamov congratulated Perez and then “was whisked off to Roosevelt Hospital to get patched up.”

As questions proliferated, the New York State Inspector General’s Office launched an investigation to determine whether state athletic commission officials handled the fight and its aftermath properly. The interview notes from the investigation are likely read like Roshomon, with participants offering alternative, contradictory, and sometimes self-serving versions of the same events.

When a tragedy of this nature occurs, there’s a need to examine what happened with an eye toward asking whether proper procedures were in place and whether those procedures, if appropriate, were properly implemented.

This writer has interviewed twenty-two people who were involved in the events of November 2nd. Some of them, including five individuals affiliated with the New York State Athletic Commission, spoke on condition of anonymity. Others were willing to go on the record.

This is what happened.

Magomed Abdusalamov was born on the western shore of the Caspian Sea on March 25, 1981. After turning pro in 2008, he moved to Florida, where he lived with his wife and three daughters. He learned some English but only enough for limited conversation.

In his first five years as a fighter, Abdusalamov compiled an 18-and-0 record against undistinguished opponents. All of his wins were by knockout. Mike Perez was undefeated in nineteen bouts against comparable opposition.

Anthony Curreri (an ophthalmologist) was the ring doctor assigned to Perez’s corner on November 2nd. Osric King (who is board certified in family medicine) was in Abdusalamov’s corner.

The bout began with both fighters throwing heavy punches and Perez getting the better of it. With eighty seconds left in round one, Perez landed what has been referenced in fight reports as a straight left hand that appeared to break Abdusalamov’s nose. A look at the replay in slow motion suggests that it was a forearm to the face, not a legal punch, that caused the damage.

Had referee Benjy Esteves called a foul, subsequent events might have unfolded differently.

Accidental foul, broken nose. At that point, Abdusalamov could have chosen to not continue and the bout would have been ruled “no contest.”

That didn’t happen. The full extent of the damage caused by the blow to Abdusalamov’s nose is unclear. What’s very clear is that he acted strangely thereafter.

At the end of the first round, Abdusalamov walked slowly to his corner but did not sit on his stool. Instead, he stood for a full thirty seconds, touching the already-swollen left side of his face with his glove and asking (in Russian), “Did he break my nose?”

Finally, he sat. That would have been a good time for the commission doctor assigned to Magomed’s corner to increase his vigil.

Thereafter, Abdusalamov was slow getting off his stool and moving to the center of the ring at the start of each round. After the second stanza, he gestured for his corner to put an icepack on the back of his head. After round four, he looked to be in distress, gestured again for the icepack, and slumped on his stool to the point where trainer John David Jackson told him, “Sit up.” When the one-minute break ended, Magomed grabbed onto the ring ropes to pull himself up off his stool.

The fight was competitive through four rounds. In round five, Abdusalamov began to fade. After that round, Jackson asked his charge, “How do you feel?”

Magomed didn’t answer.

“Good?” Jackson pressed.

Again, no answer.

“I didn’t hear from you,” Jackson said.

But the fight went on.

After round six, Magomed stood for a full fifteen seconds before sitting on his stool.

After round seven, Jackson asked, “Are you okay?

There was no response.

“How do you feel?”

No answer.

“You gotta let your hands go,”Jackson told him.

Meanwhile, the left side of Abdusalamov’s face was becoming increasingly disfigured, and what had once been a good action fight was turning ugly.

On at least two occasions, Dr. King stood on the ring apron near Abdusalamov’s corner and looked on between rounds. But he was standing outside the ropes to Magomed’s left, and the fighter’s head was turned to the right so he could hear one of his cornermen (Boris Grinberg Jr) convert Jackson’s instructions to Russian. Thus, Dr. King could see little more than the back of the fighter’s head. There is no indication that he tried to communicate verbally with the fighter.

Adbusalamov fought courageously after the bell rang to start each round. There was never a time in the fight when he seemed defenseless. That said; by round eight, he was clearly a beaten fighter. His face was horribly swollen. There was a gash on his left eyelid. It appeared as though his nose, cheekbone, and jaw might be broken.

The fight went the full ten rounds. Perez won a unanimous decision.

After the fight, Abdusalamov was examined cursorarily in the ring by Dr. King and Barry Jordan (a neurologist who serves as chief medical officer for the New York State Athletic Commission). Then he went upstairs to his dressing room. His father, brother, John David Jackson, cutman Melvin “Chico” Rivas, manager Boris Grinberg, Boris Grinberg Jr, and promoter Sampson Lewkowicz were with him.

“Everybody was sad,” Boris Jr (who is fluent in English and Russian) recalls. “Mago looked at his face in the mirror and said, ‘Oh, man.’ The doctor [Gerard Varlotta, an orthopedic surgeon] checked him out. He took some time with him; it wasn’t quick. The doctor checked Mago’s nose and the bones in his face and asked Mago if he was in any pain. Mago told him his head hurt a little. Then the doctor gave him a test with numbers on cards. Mago did it quickly. But on the first card, he missed two numbers and, on the next card, he missed three numbers. Then another doctor [Dr. Curreri] came in and stitched Mago up. While he was stitching, Mago started crying. When that was done, the doctor who did the stitching told Mago to get the stitches taken out in a week and his nose was broken and there might be other bones broken, and he should see a doctor to check it out. None of the doctors said to go right away to the hospital.”

Lewkowicz has a similar recollection and says that one of the doctors told him that Magomed had “a broken nose for sure” because there was blood in both nostrils.

The best indications are that Dr. Varlotta’s post-fight examination was conscientiously administered and that Abdusalamov was alert and responsive with one open issue.

The “test with numbers” that Boris Jr. referred to is known as the “King-Devick test.” It’s a short exercise that requires a person to read single-digit numbers displayed on several differently-formatted cards. The examining physician then compares the speed with which the subject has read the numbers to the time taken on a baseline test (in this case, a test administered at Abdusalamov’s pre-fight medical examination). If the time needed to complete the test is significantly longer than the person’s baseline test time, the person is presumed to have suffered some type of head trauma that requires further observation.

No one at the New York State Athletic Commission has offered an explanation regarding the “missed numbers.”

There are also conflicting accounts as to whether Abdusalamov was advised to go to the hospital that night.

One commission source has aligned with the fighter’s camp and says that Magomed was told he should go to the hospital because of his nose and other possible fractures, but that he was not told it was important to go immediately.

Whatever advice was given, there appears to have been little urgency attached to it. Nor was there an offer of help regarding transportation.

“I’m one hundred percent sure that he was told to go to the hospital that night,” another commission source says. “How would he have gone to the hospital? You don’t need an ambulance for a broken nose. You need an ambulance for an acute injury, which no one knew he had at the time.”

Magomed’s cutman, Mevin “Chico” Rivas, says, “It was like, probably, you should go to the hospital tonight. But do it on your own. No ambulance or anything like that.”

At the close of Dr. Varlotta’s examination, he gave Abdusalamov’s camp the paperwork detailing insurance coverage that would be applicable if Magomed went to the hospital or an independent doctor that night or at a later date.

Meanwhile, because of dehydration, Magomed was unable to give the required post-fight urine sample, which was to be collected as a matter of course by the commission inspector assigned to the fighter’s dressing room.

The inspector was Matt Farrago, a former fighter. Farrago waited until Abdusalamov had showered and asked him to try again. This time, Magomed was able to urinate.

Boris Grinberg Jr recounts what happened next.

“The inspector looked at the urine and told us, ‘There’s a lot of blood in his urine. There might be some kind of internal problem. You should take him to the hospital now.’ I asked, ‘How do we get to the hospital? Where is the nearest hospital?’ The inspector said, ‘I don’t know. Let me find out.’ He left the locker room and came back and said, ‘I couldn’t find anyone to ask. Take a taxi. The driver will know.’ I asked Mago, ‘So, Mago; what do you think? Should we go to the hospital?’ Mago said ‘yes.’ That was when we decided to go to the hospital. The inspector was the only one from the commission to tell us to go to the hospital now. And we didn’t even know where to go.”

There was still no sense of urgency. Abdusalamov’s face was now grotesquely swollen as the beating he’d taken began to fully show. But he’d answered questions cogently, showered, and dressed himself after the fight. At no time did he seem to be struggling mentally.

“We walked down the stairs that go onto the stage and then down some more stairs to where the ring is,” Boris Jr recalls. “Mago started having a little trouble walking then, so we stopped for a moment. There was a fight going on, but Mago wasn’t watching it. Then we went out onto the street to look for a taxi.”

Sampson Lewkowicz picks up the narrative.

“When the doctors said that Mago was all right, I went downstairs to watch the next fight [Gennady Golovkin vs. Curtis Stevens]. Then Boris [Boris Grinberg Sr] came to me and said, “We should take Mago to the hospital.’ I went to Melvina [New York State Athletic Commission chairperson Melvina Lathan] and said, ‘We need to take Mago to the hospital. He doesn’t feel well.’ Melvina told me, ‘Talk to Dr. Jordan.’ So I went to Dr. Jordan. And while we were talking, I got a call from Boris [Sr], saying he was outside with Mago on the street. I went outside. We stopped a cab. While we were there, Mago threw up. The cab driver told us that Roosevelt Hospital was the nearest hospital, and Dr. Jordan on the phone said the same thing. So Mago, his brother, and Boris Jr got in the cab and went to the hospital.”

When Abdusalamov arrived at Roosevelt Hospital, he was told to wait in line at a receiving window before he was treated. Boris Jr tried to explain the urgency of the situation and was advised that, if he went outside and dialed 911, an ambulance would then pick Magomed up and bring him to another admitting station where he could be treated more quickly.

Boris Jr went outside to make the call. Meanwhile, Boris Sr and Sampson had arrived at the hospital, and Magomed vomited again. Boris Sr shouted, “He is fighter from Madison Square Garden.” Finally, the hospital staff began to move quickly.

Abdusalamov was given a CT-scan that revealed swelling and bleeding in his brain. The doctors operated and placed him in a medically-induced coma. The following day, he suffered a stroke and his temperature rose to 104 degrees. He has been kept alive by life-support machines since then.

There are numerous issues to be addressed in examining what happened on the night of November 2nd. The threshold issue is whether the fight should have been stopped before the full ten rounds were contested. If Abdusalamov had been healthy after the fight, there would be little discussion regarding that issue. But he’s not healthy; he’s hovering near death. Thus, it’s imperative to ask whether proper procedures were in place to determine whether the fight should have been cut short and, if so, were those procedures properly implemented.

Fighters are expected to go out on their shield. That standard runs counter to self-preservation and common sense, but it’s part of boxing. If Abdusalamov had opted out of the fight, he would have been derided by many fans and members of the media as a quitter.

Given that reality, there are three lines of defense to protect a fighter when he crosses over the line that separates bravery and courage from unacceptable risk: (a) the referee (b) the ring doctor, and (c) the fighter’s corner.

The referee is the first line of defense. He can intervene to stop a fighter from taking punishment on split-second notice. The referee shouldn’t become overly involved in the flow of a fight. But he is more than a spectator.

In New York, a ring doctor as well as the referee can stop a fight. Unfortunately, some referees take this to mean that stopping a fight because a fighter has suffered sustained punishment is no longer their call. Meanwhile, some ring doctors believe that, absent a dangerously placed cut or apparent neurological impairment, it’s the referee’s call. The fighter falls through the cracks.

Here, it’s worth noting that Benjy Esteves (who refereed Abdusalamov-Perez) also refereed the February 26, 2000, fight at Madison Square Garden between Arturo Gatti and Joey Gamache. That fight resulted in two first-round knockdowns, a brutal second-round knockout, and career-ending brain trauma for Gamache.

A fighter’s trainer also has the responsibility to stop a fight when risk outweighs possible reward. After the fact, cutman Melvin “Chico” Rivas recalled, "Mago was responding to everything we were saying. We never felt like we had to ask him if he wanted to continue. He's such a warrior."

John David Jackson should have asked. And more important from a procedural point of view, the referee and ring doctor should have been more proactive insofar as Abdusalamov’s physical condition and state of mind were concerned.

Often, a fighter doesn’t say directly that he wants to quit. But it shows in his face and body language in the corner between rounds. After the first round, and after many subsequent rounds, Abdusalamov looked like a man who would have been happier if someone said “that’s enough.” All one had to do was look at his face. Not the swelling and bruising, but the haunting “I don’t want to be here” look in his eyes. Yet round after round, the corner kept sending him out to fight while the ring doctor and referee passively looked on.

After round one, Dr. Osric King should have stepped onto the ring apron to ascertain precisely why Abdusalamov wasn’t sitting on his stool and what his condition was.

Further in that regard, Dr. Michael Schwartz (founder of the American Association of Professional Ringsde Physicians) observes, “The doctor can always ask the referee during the one-minute break to call a time out immediately after the bell rings to start the next round. Then the doctor can call the fighter over to the ropes and conduct a quick face-to-face examination. We do that sometimes when a fighter is cut. You can do the same thing in a situation like this.”

There’s no way to know when the bleeding in Abdusalamov’s brain began. What we do know is that each punch afterward made it worse. One can assume that, if he hadn’t been hit in the head in rounds two through ten, Magomed’s brain bleed wouldn’t have been as serious as it was. It might not have occurred at all.

If better procedures had been followed, the decision might still have been made to allow Abdusalamov-Perez to continue. But there’s no way to know that. We do know what happened in the absence of better procedures being followed.

Here, one can look to the fight that was contested immediately after Abdusalamov-Perez, when Gennady Golvkin defended his middleweight title against Curtis Stevens. After some competitive early action, Stevens took a fierce beating. At the end of round eight, referee Harvey Dock followed Curtis to his corner and told trainer Andre Rozier, “That’s it.”

“Okay,” Rozier responded.

If Golovkin-Stevens had been allowed to go twelve rounds and Abdusalamov-Perez had been stopped after eight, the respective fates of both Curtis and Magomed might have been vastly different from what they are now.

There’s also an issue regarding the quality of post-fight medical care that Abdusalamov received.

Let’s start with some basic facts: (1) Doctors try to help people; (2) No one in the dressing room after the fight knew that there was bleeding in Magomed’s brain.

That said; there’s a point at which common sense has to prevail. Abdusalamov had suffered a sustained beating. He’d been punched more than three hundred times by a 235-pound man trained in the art of hurting. There were broken bones in his face, which was bruised and swollen to the point of being disfigured. In any context – whether the beating was administered in a prize ring, on the street, or in someone’s home – he should have been taken to a hospital.

As earlier noted, there are conflicting accounts as to whether or not commission doctors told Abdusalamov that he should go to the hospital immediately after the fight. Everyone agrees that there was no offer of help to get him there

A fighter is less likely to go to the hospital on his own than if a doctor says, “We think you should go to the hospital. An ambulance is waiting downstairs to take you.”

If New York State Athletic Commission medical personnel thought that Abdusalamov should go to the hospital, they should have facilitated his getting there. The availability of an ambulance would have (1) made it more likely that Magomed would go to the hospital; (2) gotten him there more quickly; and (3) ensured that he was treated in a timely manner once he arrived.

Here, the thoughts of Michael Schwartz (who now serves as chief ringside physician for the State of Connecticut, Foxwoods, and Mohegan Sun) are instructive.

“I meet with the ambulance crew to discuss protocols before every fight,” Dr. Schwartz says. “We notify the hospital that a fight card is taking place. We notify the on-call neurosurgeon at the hospital that a fight card is taking place. If a fighter has to go to the hospital, we send him by ambulance, even if it’s just for sutures. We give the insurance form to the paramedic before the fights start. That way, if a fighter goes to the hospital, the form automatically goes with him without delay.”

At the very least, if New York State Athletic Commission personnel don’t want to send a fighter to the hospital in an ambulance, the fighter and members of his team should be transported to the hospital in an on-site motor vehicle reserved by the commission solely for that purpose. Let’s assume that a fighter has no facial damage, just a broken hand. Doesn’t he deserve that transportation, rather than being sent out onto the streets of Manhattan to fend for himself on a Saturday night?

There are other issues that also have the potential to shade the way a fighter is treated after a fight. One of these issues relates to medical insurance.

As a general rule, boxing promoters purchase several types of insurance. There's signal insurance on big fights in case satellite transmission fails. A promoter who pays a large signing bonus to a fighter might purchase insurance to cover losses should the fighter be injured and permanently unable to fight. But the most common forms of insurance purchased by promoters are:

(1) General liability insurance: This covers personal injury to individuals other than the fighters (for example, fans in attendance at a fight). The per-event coverage limitation on these policies for major promoters is generally between $2,000,000 and $5,000,000.

(2) Cancellation insurance: This coverage is usually in place for major fights. It reimburses the promoter for out-of-pocket expenses should an event be cancelled for reasons other than a breach of contract (for example, an injury to one of the fighters or a natural disaster that renders holding the fight impossible).

(3) Boxer medical insurance: This coverage is mandated by the Muhammad Ali Boxing Reform Act and is purchased by the promoter on a card-by-card basis. Its purpose is to pay a fighter's medical expenses for injuries sustained during a bout, or to pay the fighter's estate if a fighter is killed during a bout. But the Ali Act doesn’t specify a coverage minimum. That decision is left to the individual states.

At the upper end of the spectrum, California, Nevada, and Texas require a $50,000 medical insurance policy for each fighter and death benefits ranging from $50,000 to $100,000. Some states require as little as $2,500 in medical coverage with no death benefit.

New York has the highest medical costs in the nation. But the New York State Athletic Commission requires only a $10,000 medical insurance policy for fighters and no death benefit.

Some promoters purchase a $50,000 medical insurance policy and matching death benefit regardless of the state in which a fight card is held. As a practical matter, most insurers won’t write a medical policy for more than $50,000. The risk is too great.

K2, which promoted Abdusalamov vs. Perez, purchased a $10,000 medical insurance policy with no death benefit.

When a fighter goes to the hospital, someone has to pay for it. In New York, $10,000 won’t cover the cost of an ambulance ride to the hospital, a CT-scan, and fixing a badly broken nose. One has to ask, “Does New York’s low minimum-insurance mandate mitigate against a fighter being sent by the commission or going on his own to the hospital after a fight?”

There’s also an issue relating to the number of ambulances that were at Madison Square Garden on November 2nd.

New York law states that a fight cannot begin unless there’s an ambulance on site. The promoter is responsible for providing the ambulance, which generally costs between $500 and $750. When a fight card is headlined by an HBO or Showtime bout, the promoter usually arranges for two on-site ambulances to avoid the possibility of a costly delay in starting one or both of the televised fights.

Abdusalamov-Perez was the opening bout on an HBO telecast.

Tom Loeffler (managing director of K2) says it’s his understanding that Madison Square Garden arranged for two ambulances to be on site on November 2nd.

Madison Square Garden did not respond to a request for confirmation on that point.

Two New York State Athletic Commission officials who were on duty on November 2nd say they believe that there was only one ambulance on site with a second ambulance “on call.” On-call ambulances in New York generally arrive within twenty minutes.

There’s no suggestion that any of the doctors who treated Abdusalamov in the ring or in his dressing room after the fight were influenced by the possibility that sending Magomed to the hospital in an ambulance would delay the start of HBO’s main event, thereby adding tens of thousands of dollars to satellite transmission fees and Madison Square Garden overtime costs. But others who were in attendance were likely to have been aware of those contingent costs.

In the aftermath of the Abdusalamov tragedy, NYSAC spokesperson Lazaro Benitez declared, “Our primary concern is the health and safety of all athletes licensed by the New York State Athletic Commission. The Department of State [which oversees the commission] is conducting a thorough inquiry into whether existing health and safety protocols were followed by the NYSAC and its employees and licensees in attendance at the event. Should our investigation reveal a need, DOS stands ready to implement immediate corrective action.”

That investigation is now under the control of the New York State Inspector General’s office.

The Inspector General will find that, by and large, New York has more stringent pre-fight medical testing than most jurisdictions. Except for the absence of a serious effort to halt the use of illegal performance-enhancing drugs, the pre-fight testing is pretty good.

But everyone who works for a state athletic commission has a responsibility to the fighters to be vigilant on fight night. That applies to the chairperson of the commission on down. Too often in New York, no one steps in and takes charge to save a fighter when intervention is called for. The classic example of that occurred when Yuri Foreman fought Miguel Cotto at Yankee Stadium three years ago.

Forty-five seconds into round seven, as Foreman was moving laterally along the ring perimeter, his right knee gave way and he fell hard to the canvas. He rose in obvious pain, hobbling when he tried to walk. Forty-five seconds later, again with no punch being thrown, his knee buckled and he fell once more to the canvas. The following round, while trying to move laterally, he staggered and almost fell again.

At that point, following proper procedure, Foreman’s trainer asked the New York State Athletic Commission inspector assigned to Yuri’s corner to tell the referee that he wanted to stop the fight. The referee inexplicably refused to stop it. Then Foreman’s trainer threw a white towel into the ring. Both camps came through the ropes to embrace their respective fighters. But the referee ordered everyone out of the ring and, bizarrely, instructed the fighters to resume fighting. Foreman’s knee gave way and he staggered several more times before the end of the round. Finally, Cotto landed a hook to the body. Yuri’s knee gave out again, he fell to the canvas, and the referee stopped the bout.

The ringside physician in Foreman’s corner should have stopped that fight. The chief medical officer at ringside should have stopped the fight. The commission chairperson should have stopped the fight. But no one stepped in to protect the fighter.

That culture has to change.

Tragedies happen in the boxing. It’s inherent in the nature of the sport. But when a tragedy happens, it’s essential to look back and ask what should have been done differently to minimize the likehood of future tragedies.

Flip Homansky served as chief ringside physician and medical director for the Nevada State Athletic Commission for more than a decade. During that time, he was widely regarded as boxing’s foremost advocate for fighter safety.

Reflecting on Magomed Abdusalamov, Homansky says, “When incidents like this happen, you look at the process, not the end result. The process isn’t about, ‘We now know that there was bleeding.’ The process is about, when someone looks like this and you know he has broken bones in his face, you send him to the hospital. The benefit in going to the hospital is that trained professionals can observe the fighter over time and precious time is saved if medical intervention becomes necessary. That’s not a criticism of any specific doctor because I wasn’t there. But I doubt that the fighter had anything more important than going to the hospital to do after the fight that night.”

Thomas Hauser can be reached by email at . His most recent book (Straight Writes and Jabs: An Inside Look at Another Year in Boxing) has just been published by the University of Arkansas Press.