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Saturday, Mar 04, 2006

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Posted on Sat, Mar. 04, 2006

BOOT CAMP

Doctors: Fast help could have saved teen's life

Two experts said sickle cell trait may have contributed to Martin Lee Anderson's death, but prompt medical attention might have saved the teen.

BY JACOB GOLDSTEIN AND MARC CAPUTO

jgoldstein@MiamiHerald.com

expert on sickle cell trait

The controversial autopsy report that said Martin Lee Anderson died from complications of a blood disorder -- and not a beating by guards at a 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.

NO ILL EFFECTS

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.

MILITARY PROCEDURE

``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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