Do Colleges and the NCAA Have a Heightened Duty of Care for Student-Athletes with Sickle Cell Trait?

Jennifer Price and Dusty Luthy have an extensive piece in the Columbia Missourian on the recent deaths of two college football players: Devaughn Darling of Florida State University (died at age 18 in February 2001) and Aaron O'Neal of the University of Missouri (died at age 19 in 2005). (Price & Luthy, "Autopsy Results Probed," Columbia Missourian, 9/11/2005). Both players died immediately after partaking in rigorous training sessions that were supervised by their teams' coaching and training staffs. The sessions were also conducted in very hot and humid conditions, and both players complained of chest pain and dizziness while exercising.

In futilely attempting to treat their infirmed players, neither Florida State University nor the University of Missouri were aware of a critical piece of information: Both Darling and O'Neal carried the sickle cell trait, meaning they inherited from one parent a normal hemoglobin gene (hemoglobin is a protein within red blood cells that carries oxygen throughout the body), and a sickle hemoglobin gene from the other parent. In practice, sickle cell trait can have little or no effect on a person's life activities, although some with sickle cell trait may develop blood in their urine, and others may feel pain while flying in unpressurized planes at high altitudes. Sickle cell trait should be distinguished from sickle cell disease, which refers to when a person inherited a sickle hemoglobin gene from each parent. Sickle cell disease may cause a blockage of blood flow, a phenomenon that can trigger serious complications, such as stroke, kidney damage, and lung blockage. Importantly, since a person with sickle cell trait inherited a normal hemoglobin gene, his sickle cell trait cannot develop into sickle cell disease. In striking contrast to the dire effects of sickle cell disease, the primary drawback to sickle cell trait pertains to child-rearing: when both a man and woman with sickle cell trait have children, their children have a 25 percent chance of being born with sickle cell disease.

As noted in the preceding paragraph, serious health complications are thought to be rare with sickle cell trait. Nevertheless, David Craig, the medical examiner of Devaughn Darling, concluded that while there was no definitive cause of death, Darling had developed red cell sickling in most of his blood vessels. This condition can lead to a fatal cardiac arrest: “Although rare, sudden unexpected death has been associated with healthy, athletic males with sickle cell trait." Craig's observation suggests that the stress imposed on Darling's body during practice may have morphed his sickle cell trait from a benign condition into a deadly infirmity. Valerie Rao, the medical examiner of Aaron O'Neal, concluded otherwise with her examinee: lymphocytic meningitis, and not sickle cell trait, had caused his death. However, subsequent medical opinions disagreed with Rao, contending that she too quickly dismissed the salience of sickle cell trait in O'Neal's death, particularly given Craig's examination of Darling.

The notion that athletes with sickle cell trait may be at great risk is a developing theme in medical and science literature. Indeed, new research suggests that taxing training conditions can exacerbate the danger of sickle cell trait. According to Michael Bergeron, an applied physiologist at the Medical College of Georgia and American College of Sports Medicine fellow, "given the right conditions of strenuous exercise, dehydration and heat strain, sickling can occur and that can lead from mild symptoms of discomfort to severe pain to significant organ damage and ultimately to death.” Similarly, Dr. John Kark, M.D., a former professor at Howard University Medical School and a leading expert on sickle cell research, contends that those with sickle cell trait have a multiple-fold increase of dying from sudden death whenever engaged in strenuous, high-heat activities (such as military boot camp or demanding football practices).

Not surprisingly, both Darling's and O'Neal's deaths triggered legal action. Last year, Darling's parents filed a wrongful death suit against Florida State University, alleging that the school had failed to treat their son after he complained of dizziness and chest pains. As a matter of background, a wrongful death lawsuit usually entails an allegation that a person was killed as a result of the negligence on the part of the defendant. The Darlings and Florida State University settled, with FSU agreeing to pay the Darlings $2 million. As to O'Neal, his parents recently filed a wrongful death suit against the University of Missouri, alleging that the Missouri athletic staff were negligent in waiting too long and doing too little to respond to O'Neal's symptoms. As noed above, neither FSU nor the University of Missouri were aware the players had sickle cell trait.

The schools' lack of awareness as to the players' sickle cell trait may pertain to NCAA philosophy. Namely, the NCAA appears unconcerned by the risk of sickle cell trait to student-athletes. In fact, it describes sickle cell trait as a “benign condition that does not affect the longevity of the individual” and not a barrier to “outstanding athletic performance.” Moreover, the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports does not recommend that colleges ask applicants if they have sickle cell trait.

Adding to the question of legal liability is the sociological question of race. Sickle cell trait and sickle cell disease disproportionally afflict African-Americans and, to a lesser extent, those of Arabian, Indianan, Turkish, and Greek ancestry. In fact, one in 12 African-Americans has the sickle cell trait, and 1 in 500 has sickle cell disease. For that reason, apparent indifference by team and NCAA officials to the health concerns of athletes with sickle cell trait might trigger questions of racial insensitivity. Of course, the counter-argument is that coaches have a vested and selfish interest in seeing all of their players healthy; otherwise, their team may not perform as well. Moreover, even if limited resources forced coaches into calibrating levels of therapeutic care among players, such levels would presumably be based on expected performance, rather than on race -- the team's star player would likely get the best care (since the coach wants him back and back healthy ASAP), while the team's version of "Rudy" would likely get the worst.

It will be interesting to watch if potential tort liability and sociological concerns encourage colleges and the NCAA to modify their treatment of players with sickle cell trait. It appears plausible that colleges will soon begin to request that information from student-athletes prior to their engagement in team practice, particularly if those practices require heavy exertion in warm, humid weather. In addition to obtaining such information, college trainers and medical staff might modify their standard operating response to players with sickle cell trait that exhibit any dizziness, stomach aches, or related conditions. In other words, there would be an elevation of the "legal duty" owed by colleges to their student-athletes who carry sickle cell trait.

Moreover, though the NCAA was not sued by either Darling or O'Neal, one suspects that their official position on sickle cell trait -- that it is not a threat or an impairment -- might trigger liability should future deaths arise that involve sickle cell trait. On the other hand, there remains a scientific debate as to whether sickle cell trait actually increases the likelihood of death for those players, and perhaps colleges and the NCAA will resist acting until that debate is resolved.

Posted in: