Unanswered questions

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The moment MMA fans were dreading occurred Friday night at a Houston hospice when a 35-year-old fighter named Sammy Vasquez slipped out of his medically induced coma and into the afterlife.

Vasquez, an aging and seemingly untested fighter who had no amateur experience and only two pro fights on his record, succumbed to blood clots, brain swelling and a massive stroke brought on by head trauma suffered in a lightweight bout in Houston on Oct. 20. Vasquez left behind a wife and a 7-year-old son.

He also left the MMA community asking questions. Was it fair of Saul Soliz, Tito Ortiz's striking coach and the promoter who runs Houston's Renegades Extreme Fighting, to pit Vasquez against a younger, more experienced fighter in 21-year-old Vince Libardi, who had six pro fights and two amateur fights? Did the Texas Department of Licensing and Regulation adequately screen Vasquez for a condition that might have led to his injury? Should the ref have stopped the fight sooner? And, above all, would MMA critics seize upon Vasquez's death to light into the sport anew?

In the blogosphere where hardcore MMA fans have dwelled for years, fear that the sport might be re-banished to the dark ages is almost palpable.

"This is the test," wrote John Philapavage at MMA Opinion. "It's been coming for years. ... Sadly, the story will not be of this man's death, but that there was a death in MMA, and we'll finally see if the sport can weather the storm and stay in the mainstream." Adam Swift at MMA Payout had similar worries: "[T]he story can easily be worked into what may be an emerging doom and gloom narrative that the UFC, and with it MMA, was simply a fad that ran out of steam in 2007." And there was this from MMATattoos in the mmajunkie.com forums: "Look for some dumb politician to use this as a political platform."

Over its 14-year history in the United States, MMA has been the hated stepchild of the American sporting scene. It has faced withering criticism from politicians and pundits who have branded the sport a bloody gladiatorial contest, too brutal for public consumption. It has been held up as nothing short of the downfall of civilization, while critics studiously ignored the numerous deaths and catastrophic brain and spinal injuries that occur every year in boxing rings and on football fields around the country.

But promoters like UFC president Dana White worked tirelessly to wash the sport of its stigma. They pointed to MMA's sterling safety record -- only one death in an unsanctioned fight in the Ukraine in 1998, when American Douglas Dedge collapsed after his bout. (He is believed to have had a pre-existing medical condition.) And for the most part, they succeeded. In recent years, the outcry over the evils of MMA -- voiced almost entirely by geriatric boxing columnists -- had quieted to a monthly outburst or so.

Let's hope that doesn't change with Vasquez's death.

"The most important aspect here is that a guy lost his life," says MMA expert Luke Thomas, editor of the Bloody Elbow blog. "[But] the sport will be OK. The UFC has done a pretty good job of building up positive equity in the media bank."

The anonymity of Vasquez and the promotion for which he fought will help stave off the critics, according to Thomas. "[But] what happens when a well-known fighter does die in a well-known show? Does the UFC have enough positive equity for that? I don't think so."

Maybe not, and hopefully the theory will never be tested. But scrutiny should certainly be applied to the circumstances surrounding Vasquez's death. It's unclear how raw Vasquez was when he stepped into the cage in Houston's Toyota Center. He trained at Revolution Dojo in Houston and, fighting in his hometown, surely wanted to give the crowd a good show. In the third round, he weathered a couple hard punches to the head from Libardi, who fights out of San Antonio. Vasquez gamely battled on. But he couldn't continue, collapsed in the cage and was stretchered out of the arena, suffering a seizure as he went.

That sight more than anything -- far more than a person choked unconscious or stiffened by a KO -- is one that, over the years, has frightened the MMA community. Head trauma has always been the real danger in combat sports and MMA fighters have, for the most part, escaped the ravages that afflict boxers.

But like Dedge, there has been some talk that Vasquez may have suffered from a pre-existing medical condition, one that slipped past the pre-fight physical administered by the Texas Department of Licensing and Regulation (state athletic commissions also require fighters to pass extensive health checks before being licensed.) Cageside observers say nothing out of the ordinary happened during the fight. Vasquez was hit. There was a scramble against the cage. Vasquez got to his feet, then collapsed.

"Just hearing that would really make me wonder if he had a very small subdural or epidural [bleeding in the brain] from training in his fight that went unnoticed on his physical exam," says David Watson, a ringside physician with the Nevada Athletic Commission. Subdurals and epidurals can be tough for doctors to diagnose without taking a CAT scan or an MRI, neither of which are standard before fights because of their risks and costs. "You can be completely lucid," Watson says. "It's literally undiagnosable."

But fighters who pride themselves on being tough and don't want to miss out on paydays are reluctant to complain about ailments. Watson says that's the worst thing they can do: "If you have even a slight headache, make sure you tell a doctor. It may be the only warning sign that you're about to die."

On the forums of TXMMA, a local site about the sport, Vasquez's wife, Sandra, described some of her husband's medical travails, including two blood clots. "The blood clot that was removed on Sunday, was not from the initial injury," Sandra wrote. "The second blood clot formed sometime after the first blood clot was removed. The doctor said this is unusual. Sammy now has two injuries that need to heal." Attempts by SI.com to reach Vasquez's family were unsuccessful.

The Harris County Medical Examiner hasn't released the cause of death but said an autopsy is underway. The results, however, won't be ready for months.

According to Bill Kuntz, executive director for the Texas Department of Licensing and Regulation, the state is looking closely into Vasquez's death. Kuntz's agency has already checked to see that the fighter and promoter licenses were in order and analyzed the medical care Vasquez received before and during the fight. The state has also gone over video of the event to determine what happened. "From the pre-fight review conducted by the referee to the actions of the physician on duty and the emergency medical technicians, everyone involved with the October 20 card conducted themselves accordingly and adhered to all procedures," said Kuntz in a press statement.

"We want to commend the ringside officials who presided over this event for their professionalism and quick actions. The referee immediately stopped the fight when he saw that Sammy was hurt. The doctors and paramedics worked quickly to give Sammy the medical attention he needed and to get him to the hospital."

On Saturday, the day after Vasquez's death, Texas officially altered its "combative sports" rules. The rules increase the cost of health insurance promoters are required to pick up for seriously injured fighters, covering "medical, surgical and hospital care with a minimum limit of $50,000 for injuries sustained." Promoters will also be required to pay $100,000 (up from $50,000) to a fighter's estate if the fighter dies in competition. If Vasquez was like the majority of MMA athletes out there, he didn't have insurance and collected only a handful of dollars per fight.

For now, there are few answers about the first death in a sanctioned MMA fight. But Sammy Vasquez and the sport deserve some.