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March 6, 2006
Teen death at boot camp due to
blood
By Jacob Goldstein and Marc Caputo
Knight Ridder Newspapers
MIAMI - The controversial autopsy report that said
Martin Lee Anderson died from complications of a blood disorder - and
not a beating by guards at a Florida juvenile boot camp - may well be
true, according to two top experts on the condition.
But the doctors added this caveat: The 14-year-old
might have survived had he received prompt medical attention, instead of
being manhandled by guards who apparently thought he just didn’t want to
run laps.
"The biggest failure here was not recognizing that
if someone collapses during a run, that’s a very serious medical event,
and at the very least you should take that person into a medical
facility immediately," said Dr. John Kark, author of a major study of
sickle cell trait and exercise-related deaths.
"Picking him up, making him move around and beating
him are not good things for a person in this state," Kark said.
Martin collapsed while running laps at the Bay Boot
Camp on Jan. 5 and died less than a day later. An in-house video shows
at least seven guards kneeing him in the back and legs, punching him in
the arms and pushing him up against a wall.
Bay County’s medical examiner, Dr. Charles Siebert,
concluded Anderson died from complications of sickle cell trait, a
genetic blood condition that primarily affects people of African descent
and that many experts consider harmless.
Siebert’s report ignited instant controversy. Many
sickle-cell experts dismissed it out of hand, calling it "ludicrous" and
"not plausible." A special prosecutor from the Tampa area is now
handling the Panama City case and has ordered a new autopsy. Martin’s
parents said Friday their own expert, Dr. Michael Baden of the HBO show
"Autopsy," will be present.
Both Kark and Dr. Howard Pearson, director of the
Pediatric Sickle Cell Program at Yale-New Haven Hospital in Connecticut,
said Siebert’s conclusion is plausible.
Yet both doctors say someone in Martin’s situation
might have been saved had he quickly been given rest, room to breathe
and intravenous fluids.
If so, a case could be made that Martin was killed
as a result of neglect, rather than abuse, said the attorney for
Martin’s parents, Benjamin Crump.
Crump said he is prepared to accept that sickle
cell trait might have played a role in the teen’s death. But he says the
guards are to blame.
Aside from the punches and knees, Crump points to
segments of the video where guards pressed Martin’s limp body against a
pole and the ground for nearly a minute at a time. Crump said such
stress could have starved him of oxygen. Crump notes that a 1999
American Journal of Forensic Medicine and Pathology article -
co-authored by Siebert himself - shows that certain restraint holds
starve a person of oxygen, sometimes to the point of death.
Sickle cell trait can become deadly in extreme
circumstances when a person is losing oxygen, dehydrating and producing
exercise-related lactic acid, Pearson said. Left unchecked, the blood
cells transform into a sickle shape. They can scrape blood vessels,
deplete blood-clotting agents and cause a person to internally bleed to
death or suffocate, he said.
Sickle cell trait generally causes no problems
because people with it have a second gene that produces normal red blood
cells. Sickle cell trait differs from sickle cell disease, which occurs
when a child inherits two copies of the mutant gene, one from each
parent.
Still, possible deaths from sickle cell trait are
exceedingly rare, Pearson said. Many doctors have never seen any.
"The football fields of America would be full of
dead kids if this were a really frequent phenomenon," he said.
The trait occurs in one in 12 people of African
descent. Possible deaths have been observed when people are subjected to
physical exercise that they’re not used to, Pearson said. Martin
collapsed on one of the last of the 16 laps that guards made the
youthful offenders run on their first day, according to a witness,
14-year-old Aaron Swartz. He said guards thought Martin was a
"malingerer."
Pearson said a paper Kark published in the New
England Journal of Medicine in 1987 was the most comprehensive study of
the connection between sickle cell trait and exercise deaths.
In that study, Kark found that healthy military
recruits with sickle cell trait were 28 times more likely than similar
recruits without the trait to die suddenly during boot camp training.
Still, such deaths were rare.
Doctors skeptical of Kark’s findings point out that
the trait is common among professional athletes and say no other large
study has found an increased risk.
Kark, who worked for 21 years as an Army doctor,
helped design a series of reforms that lowered the rate of sudden death
nearly to zero, he said. The reforms included carefully monitoring the
temperature, forcing recruits to drink appropriate amounts of water and
immediately treating those who appeared to be suffering from
exercise-related problems. Kark criticized the Panama City boot camp for
failing to follow similar rules.
"They’re imitating military training, but they’re
not imitating any of the medical precautions that are part of the way
the military operates," he said.
"In the military if someone was doing a training
run and they said they were short of breath and collapsed to the ground,
the corpsman wouldn’t allow the people who were running the instruction
to consider the person a malingerer and a combatant. ... We’d start
cooling them down and moving them to a medical facility immediately."
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