Has boxing become a game of Russian roulette?

When San Antonio news reports surfaced saying hometown favorite welterweight Oscar Diaz underwent emergency surgery at University Medical Center to relieve bleeding on the surface of his brain on July 17, the incident received national media coverage.

Last week, Diaz faced a competitive Delvin Rodriguez on ESPN2's Wednesday Night Fights. Like many of Diaz's other bouts, he absorbed considerable punishment, as the purple welt under his right eye proved. But at the conclusion of a demanding 10 rounds, Diaz wobbled back to his corner, obviously shaken by a powerful right-hand jab and an ensuing left strike and double hook, by Rodriguez.

As the referee approached Diaz to assess his condition, the 25-year-old fighter screamed in pain, clutching his head and keeling over from right-body paralysis.

Current medical reports are cautiously optimistic that Diaz will survive. Now, media coverage of his injury fades and boxing breathes a sigh of relief at the diminishing negative attention.

This is not a Texas issue, but something that should affect the entire sport. Sadly, we wouldn't be discussing ring tragedies if the Diaz fight had not been televised. Too many serious injuries go unheralded. But with no pressure from the media and the lack of federal oversight, boxing counts on the public's short memory to excuse the rare tragedy as uncontrollable inherent danger.

Boxers deserve more vigilance than this.

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Few understand the sport as well as famed HBO commentator Jim Lampley. In 2005, following the death of Leavander Johnson in Las Vegas, he posted an insightful blog on The Huffington Post entitled Death in the Ring. He delved into the eerie similarities between the fatal bouts of Duk Koo Kim, Jimmy Garcia and Johnson.

"It's this simple: If you can't live with Leavander Johnson's death, then you ban boxing, because this one came right out of the culture of the sport," Lampley wrote, claiming the best option is to honor a deceased fighter's memory by "... continuing to work on systems to make fights as safe as possible..."

As a neurologist, former ring physician and medical regulator with the Nevada State Athletic Commission, I have seen boxers survive and die from serious brain injury. To improve fighter safety requires a lessening of the risk factors during training and during fights. This may sound simple, but if it were, such tragedies would have been prevented years ago.

Research conducted in 2007 by West Virginia University Neurosurgeons, Vincent J. Miele and Julian Bailes analyzed possible predictive factors in ring tragedy. They examined thousands of fighters' ring history, age, experience, ability, weight class, stance, country of origin and opponents' abilities. None proved to be significant factors in fatal fights.

Miele and Bailes also examined video analysis, along with Compubox, the computerized punch scoring system, to compare fatalities in fights, "classic" bouts (ones designated "Fight of the Year" by the media) and "average" bouts (ones that resulted in no significant neurological injury).

They found little difference between fatal and classic matches. In fact, contrary to logical thought, classic bouts lasted an average of 1.7 rounds longer than fatal fights.

Before we throw up our hands, there are factors we can control.

Former Nevada commissioner and chief ringside physician, Dr. Flip Homansky, believes preventing ring tragedies needs to begin as part of a cohesive screening process when a fighter turns pro.

"You need the boxer to undergo a baseline brain MRI, echocardiogram [test using sound waves to create a moving picture of the heart], a complete passbook [record] of all his fights -- including those overseas, and an available record of every serious injury," he said. "No passbook, no fight."

Real improvements can only come through the formation of a federal commission as promised by John McCain years ago. State commissions, comprised of political appointees who often have little boxing experience, need to ramp up pre-fight medical requirements, as well as seek out medical experts to determine fitness to compete.

Today, it is absurd that boxers step into a ring and leave a fight without documentation they have a normal brain. An MRI before every fight may not be cost-effective, but it could save a life. And low prices can be negotiated. Every commission needs to require such testing or, Dr. Homansky said, they shouldn't hold fights.

If any set of factors could contribute to a ring tragedy, it is undisclosed injuries. A history of tough fights, gym wars, knockouts or knockdowns in the gym can potentially produce small unhealed hemorrhages on the brain's surface that can eventually result in ring death. And that's where the responsibility of trainers holds the utmost importance.

Being a great trainer involves more than simply teaching the game, showing a boxer how to avoid a right hand. No, a great trainer is someone who knows when enough is enough, when to cut off sparring sessions. A great trainer knows which weight class is the right one for their boxer so as to avoid profound weight gains, losses and dehydration. A great trainer can educate a boxer on recognizing the signs and symptoms of a brain injury, and acknowledge head gear protects only against cuts, not head trauma.

And, most important, a great trainer stops a fight when the boxer has no chance of a win.

Furthermore, pre-fight and post-fight examinations need expansion. It is unacceptable for a ring doctor to spend five minutes at the weigh-in with a boxer they have never met and adequately assess his neurological status during a bout.

No one is perfect, but hiring referees and doctors without training them rigorously is not only foolhardy, but also places the fighters at undue risk. In the event of a serious knockout or collapse, officials must adhere to mandatory safety protocols, along with a no-tolerance policy regarding official performance.

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Diaz was lucky to have a quick-acting referee and aggressive medical team that performed immediate assessment and emergency transport to a nearby trauma center.

This is in sharp contrast to the ringside care provided at the recent Manny Pacquiao-David Diaz WBC lightweight-title fight on June 28. Neither the doctor nor referee halted the undue punishment absorbed by David Diaz. And on the undercard, Francisco Lorenzo lay bleeding on the canvas, unattended for minutes, while the same physician had a detailed discussion with the referee as to whether or not Lorenzo had suffered a concussive blow.

When serious boxing injuries do occur, they are often too severe to save a life, but adequate pre-fight medical assessment -- including an MRI, expeditious ringside diagnosis and emergency transport could make the difference.

This is something Oscar Diaz will, hopefully, be able to attest to one day.