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Doctors continue to disagree on what could have caused Lewis' death

THE BALTIMORE SUN

Doctors who examined the late Boston Celtics player Reggie Lewis say they believed his heart quite likely was damaged by cocaine before the former Dunbar High basketball star collapsed and died of heart failure near Boston in 1993.

A report in yesterday's Wall Street Journal, however, said the doctors kept silent about their suspicions under influence from the Celtics and Mr. Lewis' family, who stood to lose millions of dollars if his illness was linked to drugs.

The newspaper's report offered no proof of cocaine abuse. But it said the official cause of Mr. Lewis' death -- heart damage because of a viral infection -- has been rejected by cardiologists who examined him after a fainting spell during a game months before his death or later after his death.

Dr. Jeffrey Isner, a Boston cardiologist who assisted with Mr. Lewis' autopsy, called the conclusion of the Massachusetts state medical examiner's office "wildly improbable."

Baltimore heart experts

But two top heart experts in Baltimore disagreed. They said it was not only possible that a common cold virus known as adenovirus 2 caused the heart damage, but also that it was a logical conclusion.

"It's thought to be the most common cause of unexplained heart damage in young, otherwise healthy people. A lot of people get exposed to it, and it's unusual for it to attack the heart muscle, but it can happen," said Dr. Michael Gold, director of cardiac electrophysiology at the University of Maryland Medical Center.

Dr. Kenneth Baughman, professor of medicine and chairman of the division of cardiology at the Johns Hopkins School of Medicine, said viruses commonly cause this type of heart damage in young people.

"I have many, many examples of patients like that who had a relatively sudden onset of a viral inflammation of the heart and went on to have either sudden death or sudden heart trouble," said Dr. Baughman.

In addition, there is a history of heart trouble in Mr. Lewis' family. One of his two brothers was born with a hole in his heart and underwent open-heart surgery at age 4.

His mother, Inez "Peggy" Ritch, has had two heart attacks.

In addition, Mr. Lewis was born with a heart murmur, which

apparently went away when he was 12.

The Journal article also asserts that:

* Medical evidence uncovered after Mr. Lewis' fainting spell in April 1993 quickly led a team of a dozen noted specialists to a diagnosis of heart scarring, and they strongly suspected it was caused by cocaine. Mr. Lewis denied using drugs, but refused to allow his blood or urine to be tested. He soon left to seek care at another hospital.

* Mr. Lewis' new doctors concluded that his problem was a benign fainting condition, requiring only tests and close monitoring. The intense debate among his doctors over the cause of his heart damage and the possible role of cocaine never became public.

* The Celtics told Mr. Lewis' doctors -- incorrectly -- that National Basketball Association rules prevented them from forcing Mr. Lewis to submit to drug tests -- tests that, if positive, would have allowed him to seek life-saving medical help, but also might have forced an end to a career that was lucrative to Mr. Lewis and the team.

* The Celtics at the time were deeply in debt and in the midst of negotiations to sell a television station. They faced a public relations nightmare. The team stood to lose millions of dollars if Mr. Lewis were unable to play basketball because of drug abuse. A $15 million insurance policy on his contract would not pay off if his disability was linked to drugs.

At a Boston news conference yesterday, the team's majority stockholder, Paul Gaston, criticized the Journal for suggesting in the Page 1 article that the team sought, for financial reasons, to cover up suspicions that drug use lay behind Mr. Lewis' illness, thereby undermining his care.

"Any allegation that economic or monetary concerns could have conceivably played a role in any care that Reggie Lewis got are absolutely ludicrous," he said. "They are worse than ludicrous. .. They are shameful and disgusting.

"To me, this was an example of gutless journalism, yellow journalism -- based fully on a complete disregard for the truth. We intend to sue the reporter, Ron Suskind, the Wall Street Journal and its parent company, Dow Jones and Company Inc., for $100 million. Any and all proceeds will go to the Reggie Lewis Foundation."

L He charged further that the article was motivated by racism.

"It's something that people don't like to bring up," Mr. Gaston said. "But it just burns in the back of people's minds, when a black athlete dies, they don't believe that it is not either guns or drugs. I firmly believe that this is certainly a part of this article."

The Celtics plan to retire Mr. Lewis' uniform number during halftime of a game on March 22, a ceremony the club says will go on as scheduled.

Widow "disappointed"

Mr. Lewis' widow, Donna Harris-Lewis, said at the same news conference that she is "disappointed that a national publication would print rumors, innuendoes. Reggie did not do drugs, period.

"Reggie was a model citizen and an intelligent and wise man. That is how I will remember him," Ms. Harris-Lewis said. She also denied the Journal's report, attributed to his doctors, that her husband refused drug tests while hospitalized.

"The question of drug use is not new," said John A. Curry, president of Northeastern University, alma mater of Mr. Lewis and Ms. Harris-Lewis. "Indeed, since Reggie's death, local and out-of-town reporters have combed our campus for evidence of drug use or association by Reggie. They've found nothing, because there is nothing to find."

"It's not true. Reggie's not a drug user," Mr. Lewis' mother, Ms. Ritch, said last night. "I don't give a damn what people say. If anything was being covered up, it was the fact he had a heart condition. As far as Reggie using drugs, he never used any drugs, no kind of way, never in his lifetime did anything like that happen. He didn't do it."

Derrick Lewis, no relation to Reggie Lewis but a former teammate at Dunbar and Northeastern, said the late player had nothing to do with drugs.

"Reggie and I were really close friends," Derrick Lewis said. "I lived with him for his first two years with the Celtics, and we went everywhere together. . . . He took himself away from dealers, or people who used drugs.

"Reggie was very aware of the problems drugs could bring. He saw it with his mother and how it ruined a lot of people's careers who came out of East Baltimore. That's one reason why he never used drugs. Reggie got out of East Baltimore, he didn't want to go back."

The cause of the former Dunbar High School star's first fainting spell and his eventual death was the subject of public medical debate from the beginning.

News articles at the time described cardiac specialists as stunned by the diagnosis of a benign fainting condition by Dr. Gilbert Mudge of Brigham and Women's Hospital in Boston.

It was not much different behind the scenes, according to the Journal. Doctors at Boston's New England Baptist Hospital, where the 27-year-old Celtics captain was taken first for tests, saw three black patches, indicating dead tissue, on Mr. Lewis' left ventricle -- the main pumping chamber of the heart.

"This was something any third-year resident could have seen," said Dr. Charles Munn, the hospital's staff radiologist. "This was not subtle."

In older patients, dead tissue might indicate damage from arteriosclerosis, abnormal thickening and loss of elasticity of the walls of the arteries. Such scarring also might be caused by poison, medications, alcohol or infection.

Dr. Stanton Kessler, the deputy medical examiner, blamed the fatal damage on adenovirus 2, a virus that causes the common cold. The virus was found in Mr. Lewis' heart during the autopsy, and Dr. Kessler's conclusion was that it caused myocarditis -- an inflammation of the heart -- scarring of the heart muscle and ultimately death.

The autopsy found the heart "abnormal, enlarged and extensively scarred," but there was no trace of drugs.

One of the world's leading experts on heart viruses, however, Dr. Jangu Banatvala, told the Journal that most people carry the common cold virus dormant in their bodies, making its presence in Mr. Lewis' body meaningless.

"It's more than just very flimsy as a cause of death," he said. "There's simply no hard science, no evidence, linking adenovirus 2 and a myocarditis."

The newspaper said Dr. Kessler's office is under investigation by the Massachusetts Office of Public Safety, which oversees the medical examiner's office.

However, Dr. Baughman of Johns Hopkins said that through new molecular techniques, pathologists should have been able to test Mr. Lewis' heart tissue for remnants of the virus. Dr. Baughman said a diagnosis of cocaine use could not be made unless there was evidence of specific cocaine-induced damage to the heart -- caused by spasms in the arteries -- and evidence the person was using cocaine.

But Dr. Gold said it is difficult to tell whether cocaine, a virus, alcohol or other factors caused the heart damage. He said that, in cases of a damaged heart, the cause is often never discovered.

"From a medical perspective, looking at a heart, you can't tell what was going on," Dr. Gold said. "If there were suspicions, it was from discussions outside of the autopsy."

Not all viruses ruled out

Dr. Stephen Gottlieb, associate professor and director of the heart failure service at the University of Maryland Medical System, said that although physicians ruled out various viruses in earlier testing of Mr. Lewis, that doesn't mean they ruled all of them out. His heart damage still could have been caused by a virus.

"Basically, what the diagnosis comes down to is circumstantial evidence. If you know that somebody used cocaine, you might think that caused it, but they might have heart damage for another reason," Dr. Gottlieb said. "So it comes down to detective work, depending on age of person and what else you see, you would make that determination.

"I think we'll never know. It would be virtually impossible to prove it was cocaine that killed him."

The Journal reported that Dr. Isner, who assisted with the autopsy, said that a lawyer representing the Lewis family threatened to sue for damages if anything emerged from the autopsy about drugs. The lawyer denied the allegation.

With young people, experts say, scarring of the heart is more often associated with cocaine abuse.

In a single dose or over years, cocaine will damage the heart. A single dose can increase heart rate and blood pressure, narrow the arteries and cause a heart attack. That's because cocaine kicks into gear the sympathetic nervous system, which produces excess adrenalin. The extra adrenalin is like poison to the heart. If used consistently, cocaine can weaken the heart muscle, inflame it and ultimately kill the person taking it.

Mr. Lewis' doctors immediately began to question him about drug use after the fainting incident. He denied it.

He also refused to provide a urine or blood sample for drug tests, and that only heightened his doctors' suspicions.

Meanwhile, the Journal reported, the Celtics' chief operating officer at the time, David R. Gavitt, was telling doctors that NBA rules prevented them from forcing Mr. Lewis to submit to drug testing. However, the league permits testing when there is "reasonable cause" to suspect drug abuse.

That clause was never invoked in Mr. Lewis' case, despite the mounting medical evidence, the Journal said. Mr. Gavitt told Mr. Lewis' doctors that the ailing star "couldn't be forced into it." He also assured doctors, from his own experience with Mr. Lewis, that he was not a drug user.

Reviewing the case

Baptist Hospital, meanwhile, gathered a team of a dozen cardiologists from New England hospitals to review the case. They agreed that Mr. Lewis had a life-threatening condition called focal cardiomyopathy, caused by scarring of the heart muscle.

The Journal quoted New England Medical Center cardiologist Mark Estes as saying, "We were very unified in our view."

They also said Mr. Lewis might need to have a defibrillator implanted in his chest to shock his heart into a normal rhythm if it failed again. They also needed to know more about what really caused the damage in order to prescribe the right treatment.

Most importantly, patients whose heart problems were caused by cocaine need to be told to stay away from further drug abuse.

Doctors tried to get answers. "Reggie knew what we meant. We'd been pressing him about cocaine for days," Dr. Thomas Nessa, who was leading the medical team, told the Journal.

Before his doctors got any further with the case, however, Mr. Lewis packed up, left Baptist Hospital and checked into Brigham and Women's Hospital -- a respected affiliate of Harvard University.

There, Dr. Mudge performed further tests and concluded that Mr. Lewis had neurocardiogenic syncope, a benign confusion in the electrical signals running between the brain and the heart that was causing the heart to slow down at inappropriate moments.

Dr. Mudge told the Journal that he later had come to agree that Mr. Lewis' heart was damaged. He told the athlete privately that his career was over. He also told him that "cocaine is the only thing that would explain what we are seeing." If he was still using, Dr. Mudge warned, he had to stop immediately.

4( Two weeks later, Mr. Lewis was dead.

Basketball troubles

The newspaper's investigation found that the Celtics had plenty of reason for wanting to avoid any suggestion that Mr. Lewis was mixed up with drugs.

Pro basketball in the early 1980s was troubled by failing franchises, declining attendance and drug scandals, and the RTC Celtics were no exception.

A promising star from the University of Maryland -- Len Bias -- just had been drafted by the Celtics in 1986 when he collapsed in his dormitory and died from a cocaine overdose. Celtics center Robert Parish faced drug charges after federal investigators linked him to a shipment of marijuana.

The newspaper said the team had taken out $15 million in insurance on Mr. Lewis' contract and his life. But the money would not be paid if the star's disability or death were found to be drug-related.

After Mr. Lewis died, the insurer -- the Equitable Cos. -- launched an investigation but was blocked by Ms. Harris-Lewis from obtaining copies of his medical records from Baptist Hospital.

The Journal was told the insurance investigation since has been closed.

The newspaper also reported that the Celtics have emerged from their financial troubles. Net income more than quadrupled last year to $23.8 million, propelled by the sale of a TV station to Fox for $13.7 million. The team also received a $5.6 million settlement on Mr. Lewis' life insurance policy, beyond the more than $10 million set aside for the family.

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