Stuck in Standoff over Chris Bosh's Future, NBA to Create New Medical Panels

Howard Beck@@HowardBeckNBA Senior WriterDecember 21, 2016

TORONTO, ON - MAY 03:  Chris Bosh #1 of the Miami Heat looks on from the bench in the first half of Game One of the Eastern Conference Semifinals against the Toronto Raptors during the 2016 NBA Playoffs at the Air Canada Centre on May 3, 2016 in Toronto, Ontario, Canada.  NOTE TO USER: User expressly acknowledges and agrees that, by downloading and or using this photograph, User is consenting to the terms and conditions of the Getty Images License Agreement.  (Photo by Vaughn Ridley/Getty Images)
Vaughn Ridley/Getty Images

A steady September rain pelted Biscayne Bay on the afternoon Chris Bosh grabbed a film crew and broadcast his plight to the world.

He was angry, confused, determined.

"You always have to fight for the things you really want to do and the things that you love," Bosh told the camera, as part of an UNINTERRUPTED series. "So when does that stop?"

The 32-year-old Bosh had just been barred from playing basketball, his chosen profession, by his employer, the Miami Heat. The cause: a failed physical examination.

Though the Heat announced no details, the reasons were understood. Bosh is a two-time survivor of blood clots, living on a full-time regimen of blood thinnersmaking him an extreme health risk in the judgment of team doctors.

A blood clot can kill you. Playing contact sports while on blood thinners is dangerous.

So the Heat shut down their best player, and Bosh slipped into an uncomfortable limbo: under contract but unable to play.

Three months have passed, and little has changed.

Bosh wants his release so he can join another team. It is far from certain he will get that chance. Indeed, his career might already be over.

While no one can offer certitude, sources who spoke with Bleacher Report in recent weeksincluding team executives, medical experts, sports ethicists, player advocates and other league personnelpainted a grim picture.

There are doubts that any team doctor will clear Bosh to play—or that it would be wise or even ethical to do so.

There is a belief that Heat officials would not have taken the drastic step of barring Bosh without the tacit consent of the league.

And there is a strong suspicionwidespread, though not universalthat the NBA would reject any new Bosh contract, based on the risks associated with his condition.

Neither the NBA nor the Heat would comment for this story, citing medical privacy laws.

The Bosh case is a first for the NBA, and it's fraught with ambiguity. The league has no uniform policy governing blood clots and no process for resolving medical disputes of this gravity.

That is about to change.

The NBA's new labor deal, agreed upon last Wednesday, will create for the first time an independent medical panel to settle life-and-death cases, according to details obtained by Bleacher Report.

When a player is declared medically "unfit" to play, his case can be referred to the panel by his team, by the league or by the players association.

If the panel determines the player has a life-threatening condition, it could bar him from playing in the NBA again.

If, conversely, the panel determines the player's team wrongly disqualified him, it could compel the team to make a choice: play the individual, trade him or waive him within a set period of time.

The panel's decisions will be final and binding on all parties.

Had the program been in place this season, Bosh's fate might be clear by now.

Could the new policy still help? That, apparently, is up to Bosh.

Because his condition predates the new labor deal, Bosh will be exempt from the new protocolsi.e., his case cannot be submitted without his consent, sources said.

However, Bosh himself can initiate the process. He could even do so before the new labor deal takes effect on July 1, with the agreement of league and union officials.

It involves some risk.

If the panel ruled against Bosh, it could end his career. Alternatively, it could find in his favor and force the Heat to play him or set him free.

Under the rules of the new program, a player who is deemed unfit to play cannot resubmit his case for six monthsand only if his condition has significantly changed, or a new medical advance is introduced.

Chris Bosh has not played since Feb. 9 this year, when he scored 18 points and grabbed five rebounds against the San Antonio Spurs in Miami.
Chris Bosh has not played since Feb. 9 this year, when he scored 18 points and grabbed five rebounds against the San Antonio Spurs in Miami.Issac Baldizon/Getty Images

Bosh's alternative is to wait for the Heat to cut him, and to hope that another team is willing sign him. Even then, the NBA could conceivably block his return, setting up a potential legal battle.

Bosh's intentions are unclear. He has not commented publicly since releasing the series of videos before the season on the UNINTERRUPTED platform. Attempts to reach him for this story were unsuccessful. His agent, Rob Pelinka, declined to comment.

The new collective bargaining agreement is set to be ratified by owners and players in January. Some details could change, sources cautioned. But the key points in the fitness-to-play program are in place.

The program will begin with two medical panels, covering heart issues and blood clots. Each panel will have three membersone appointed by the NBA, one by the players association and a third jointly selected by the first two. Additional panels could be created as needed.

Adoption of the fitness-to-play program comes after years of consideration by league and union officials. The Bosh case alone did not spur its creation, sources said, but it certainly helped.

The key facts in Bosh's case are not in dispute. He has been hospitalized at least twice for blood clotsonce in February 2015 and again this past Februaryand consequently will be on prescription blood thinners for the rest of his life.

There is no dispute, either, that it is extremely dangerous to play contact sports while on blood thinners. An otherwise minor blow to the head could cause fatal internal bleeding.

But Bosh, citing the experiences of other athletes, insists there is a safe way forward: a disciplined regimen in which he would cycle off the blood thinners prior to each game and resume taking the drugs between games.

"It's not like I'm the first guy ever to do this," Bosh said in one of his videos, noting that other athletes "have been playing for years" after being prescribed blood thinners.

"So it wasn't a matter of if I'm going to play again," Bosh said. "It's when."

It sounds reasonable. But Bosh's view is not shared by prominent experts in the field.

"The general recommendation is that anybody on a blood thinner should not participate in contact sports," said Dr. Jack Ansell, a member of the medical and scientific advisory board for the National Blood Clot Alliance. "And basketball is a contact sport."

An athlete who competes once a weeka wrestler, say, or a sprintercould cycle on and off the blood thinners. But NBA teams routinely play four or five games in a seven-day span.

"If he were willing to play one game a week or something like that, it might be potentially possible," said Ansell, a professor of medicine at the Hofstra Northwell School of Medicine. "But it's still difficult, and there's still risk involved."

For instance, the risk of another blood clot would increase while the drugs are out of Bosh's system, Ansell said.

"The risk of having a recurrent blood clot by being treated intermittently is less than not being treated at all," Ansell said. "But it's not as good as being treated continuously."

Ansell has not examined Bosh, but he's basing his assessment on what is in the public recordspecifically, the fact that Bosh has survived at least two known blood clots.

Mirza Teletovic missed half of the 2014-15 season after he was diagnosed with blood clots in his lungs. He returned for the 2015 playoffs and has not had any problems with the condition since.
Mirza Teletovic missed half of the 2014-15 season after he was diagnosed with blood clots in his lungs. He returned for the 2015 playoffs and has not had any problems with the condition since.Nathaniel S. Butler/Getty Images

A person can overcome a single clotting event with a temporary regimen of blood thinners and then return to normal. That was the case with Mirza Teletovic, who suffered a blood clot while playing for the Brooklyn Nets in January 2015. Teletovic, now with the Milwaukee Bucks, no longer needs the drugs.

But once a patient has experienced a recurrence, as Bosh did, he needs to be on thinners for the rest of his life, Ansell said. Asked if Bosh's condition could change, Ansell flatly said no. Nor is it likely that a new drug could change his outlook.

The best-case scenario for Bosh, in Ansell's view, would be to play twice a weekwhile skipping all full-contact practicesbecause of the need to take blood thinners between games.

"Anything more than that would be, in my mind, too risky," Ansell said. "And I think most of my colleagues would think the same."

Ansell added: "The ideal situation, in terms of not having another blood clot, would be not to play anymore, and stay on the blood thinner."

Playing twice a week would translate to about 45-50 games.

This raises an obvious practical matter: Would any team want Boshand all of the inherent risks that come with himif he can only play half the schedule and never practice?

"There's no way I would take that risk," said an Eastern Conference general manager who asked to remain anonymous while discussing another team's player.

A Western Conference GM said he would "investigate it heavily" if Bosh becomes available but added, "I'm anticipating our team doctor will rule him out."

"I'm worried for him," the GM said of Bosh, because the Heat "have the most incentive of anyone to play him right now, and they're not. It must be bad. It just seems unlikely if Miami is not going to clear him that anyone will."

The NBA has not given teams any guidance on Bosh's status, nor has it offered any public indication about how it views his condition.

Still, several people who spoke to B/R expressed doubt that the league will allow Bosh to return. Their views are speculative, but they're based on a combination of precedent and common sense.

Though no one knows for sure, many executives believe Heat officials at least consulted the league before barring Bosh from playing. It's a logical assumption, given the life-and-death nature of his condition. A team taking such a drastic step would want the league's backing in the event the player challenged the decision.

"I think everything they do would be in conjunction with the league," said a person with extensive experience in NBA player health and league policy. "I think the league would support them."

If that is the case, then it is hard to see the NBA allowing Bosh to sign with another team.

Some sources believe there is already a precedent for that stance.

Cuttino Mobley retired soon after Knicks doctors diagnosed him with a heart condition following his trade to New York in November 2008. Mobley tried to make a comeback the next year but found no takers for his services.
Cuttino Mobley retired soon after Knicks doctors diagnosed him with a heart condition following his trade to New York in November 2008. Mobley tried to make a comeback the next year but found no takers for his services.Nathaniel S. Butler/Getty Images

Cuttino Mobley retired in 2008 after the New York Knicks determined he had a potentially life-threatening heart condition. But Mobley later changed his mind, began playing in summer pickup games and tried to mount a comeback in 2009. Several teams invited him in for workouts. None offered a contract.

Andy Miller, Mobley's longtime agent, believes the NBA effectively barred his client.

"No team would say to me, 'Hey, the league said forget about it,'" Miller said, "but there was some overture about…'We're never going to get this contract approved by the league.'"

The NBA never explicitly ruled out Mobleyi.e., it did not issue a directive to teams, sources saidbut it would not be unusual for team executives to consult league officials before considering a player with a known health concern.

"I think that there was probably a hypothetical," Miller said, referring to conversations between team and league officials, "and the hypothetical ended with 'The contract is going to come back void or vetoed.'"

The league does reserve the right to void contracts, sources confirmed, if it considers a player a fatality risk. The players association would likely challenge that stance, however.

NBA officials declined to respond to Miller's remarks, citing medical privacy laws.

Mobley sued the Knicks in 2011, alleging that the franchise's actions and public statements had prevented him from securing another contract. A judge dismissed the suit in 2012.

The Mobley case underscores the NBA's quandary with Bosh. To wit: Can you allow a player to sign with Franchise B after Franchise A has declared him a fatality risk? Is it morally or medically sound to do so?

The league has been down this road before, too.

Eleven years ago, the Chicago Bulls publicly declared they would not re-sign Eddy Curry, their talented young center, because they feared he had a potentially fatal heart condition. The Knicks concluded otherwise. They agreed to a sign-and-trade for Curry on a six-year, $56 million contract.

Eddy Curry spent five seasons with the Knicks after the Bulls refused to sign him when their doctors diagnosed him with what they felt was a dangerous heart condition.
Eddy Curry spent five seasons with the Knicks after the Bulls refused to sign him when their doctors diagnosed him with what they felt was a dangerous heart condition.Nathaniel S. Butler/Getty Images

It was an awkward episode for the league, which at the time had no uniform protocols for dealing with cardiac issues. Coincidentally, that same month, a young center for the Atlanta Hawks, Jason Collier, died from an enlarged heart.

Spurred in part by those two incidents, the NBA in 2006 instituted standardized cardiac screening for all playersensuring every team would apply the same standards.

Now, when the next Curry or Mobley case comes along, the NBA will refer the matter to the fitness-to-play program.

But Bosh, exempt from the program, presents a potential nightmare for the NBAmorally, ethically and legally.

There is nothing to stop another team from signing Bosh once the Heat cut him loose. If the NBA rejects the contract, as some sources predict, Bosh could sue.

The league would be violating Bosh's rights under the Americans with Disabilities Act, said Alan Milstein, a sports attorney who teaches bioethics at Temple University.

"I think they're interfering with a player's essential privacy concerns, and the ability of the player to make his own medical decisions, along with his own physicians," said Milstein, who represented Curry during his heart ordeal.

Milstein noted Bosh is a paid spokesman for Xarelto, a prescription drug for treating blood clots, and is therefore in a unique position to have his physicians work with the drugmaker to tailor his treatment.

"The right thing to do is to rely on physicians who have only one person's best interests at heartand that's Chris Bosh," Milstein said.

Isn't that what Heat officials are doing? Looking out for Bosh's well-being? Milstein views such claims as suspect.

"Is their concern the health of Chris Bosh? No, their concern is that in one of their arenas, with a room full of fans, one of their players is going to die on the court, and everybody's going to freak out," Milstein said. "That's not a concern for Chris Bosh. That's a concern for the business of the Miami Heat. And that's where the conflict of interest arises."

Team and league executives would surely disagree with that cynical assessment.

There are, of course, both legal and ethical concerns for the Heat. They could be held liable if Bosh died while playing, given their prior knowledge of his life-threatening condition.

Indeed, any team that might sign Bosh is obligated to consider the same risks, said Arthur Caplan, the head of the medical ethics program at New York University's Langone Medical Center.

"You are at risk legallythe next team, the next employer," Caplan said, because "you let him play, despite knowing that the Miami medical staff said he could have a clot."

"You have a duty to heed appropriate caution," Caplan added. "You can't just rely on an athlete who's got millions of dollars at stake and may not even understand the risk fully. So the liability danger for the employer is big."

It is unclear when, or if, teams will confront that moment of truth.

Bosh is under contract through 2019 and needs the Heat to release him before he can even consider making a comeback.

In hiring a new agent, Chris Bosh appears intent on pursuing his career should the Heat release him this season.
In hiring a new agent, Chris Bosh appears intent on pursuing his career should the Heat release him this season.Gary Dineen/Getty Images

It's been widely assumed that Miami would waive Bosh after Feb. 9the one-year anniversary of his last gamebecause that date is the trigger for applying for salary-cap relief. But the Heat can wait, and it might be in their best interests to do so for cap purposes.

Some sources expect the Heat to waive Bosh after the season. His only recourse in the meantime would be to file a grievance through the players association, or to sue.

Ultimately, this all comes back to Bosh. How determined is he to play? How much risk is he willing to assume? Would he sign a waiver holding the league blameless if the worst should happen? Would he submit to the fitness-to-play panel? Would he fight the league in court?

"He has all the resources, the money, to be able to exhaust all possibilities," said Dwyane Wade, Bosh's longtime friend and former Heat teammate. "And he still loves playing the game. ... His goal was to play until he was like 38. It's hard to just say, 'Let me just walk away, because I've been diagnosed with something.'"

This much is known: Three months ago, Bosh fired his longtime agent, Henry Thomas, and hired Pelinka, whose clients include Kobe Bryant and James Harden. The sense around the league is that Bosh would not have made the move if he were not plotting a comeback. And maybe even a fight.

"I'm a basketball player," Bosh said in his web series, before describing his current plight as "like purgatory."

"You're not on Earth, you're not in heaven," he said. "You're just somewhere in between, and that's the part that drives you crazy. Because you're in nothingness."

A more succinct summation can be found in his Twitter bio, where his location is aptly notated with three letters, separated by periods:



Howard Beck covers the NBA for Bleacher Report. Follow him on Twitter, @HowardBeck


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