FORT LAUDERDALE, Fla. - The autopsy performed yesterday on Orioles pitcher Steve Bechler uncovered several factors that contributed to his death from heatstroke, but Broward County medical examiner Dr. Joshua Perper placed significant blame on a weight-loss drug containing ephedrine.
Perper reported that Bechler was suffering from moderate hypertension and found some evidence of liver dysfunction. The 23-year-old pitcher also had little food in his digestive system, which caused the medical examiner to conclude that he had been on a strict diet.
Though the results of toxicological studies will not be available for two weeks or more, Perper said that he had determined through interviews that Bechler was using an over-the-counter weight-loss drug called Xenadrine RFA-1 and had ingested three capsules before he collapsed during a workout Sunday afternoon.
The product contains ephedra, an herbal substance that contains the stimulant ephedrine. The drug is banned by the International Olympic Committee, the NFL and most major sports federations, but it is not on the list of controlled substances prohibited under Major League Baseball's drug policy.
"It says very clearly on the label that individuals with heart problems, hypertension and liver problems should not take this medication," Perper said. "He was probably on a diet and ate very little. He was taking part in conditioning exercises in hot, humid weather. All of these factors may have contributed to his unfortunate death."
Perper said it would be impossible to quantify the effect of each factor in the catastrophic case of heatstroke that caused Bechler's major organs to shut down, but that didn't stop him from joining the chorus of criticism directed at Major League Baseball for failing to effectively restrict the use of ephedrine-based products.
"The National Football League, the Olympic Committee and other sports organizations have banned the use of ephedra among their athletes," Perper said. "Suffolk County, N.Y., has passed legislation to ban the sale of ephedra. There have been a number of deaths reported from ephedra. I would like to think that this very unfortunate death would wake people up and [baseball officials] would ban its use by their athletes."
Major League Baseball did attempt to include ephedra and ephedrine on a list of banned substances during the labor negotiations that led to the sport's new steroid-testing policy, but met with resistance from the Major League Baseball Players Association.
It will be years before the next round of collective bargaining, but union and ownership officials could revisit the drug policy earlier by mutual agreement.
The new drug policy calls for survey testing to determine if a significant number of players (5 percent) are abusing anabolic steroids and allows testing to detect controlled substances only with cause.
Bechler's death may provide some impetus for a more comprehensive approach to both illegal and over-the-counter supplements, but Penn State sports medicine expert Dr. Chuck Yesalis isn't convinced professional baseball has ever made a sincere attempt to address steroid and supplement abuse at the big-league level.
"If all that was going on last summer [at the height of baseball's steroid scandal] wasn't a wakeup call, I don't know what would be," Yesalis said.
"They are going to handle this as a public relations issue. In great part, I think what's driving this is that they realized much more quickly than the NFL that their fan base didn't care. What I mean by don't care is that they [the fans] are not upset about drug use.
"Let's say for the sake of argument this young man died because of ephedrine. While fans may be upset about it, from the business side of the sport are they upset enough to not watch on TV or go to the ballpark?"
Orioles officials say that the club does care, and that it has made a major effort to educate players about the dangers of a variety of supplements. Baseball's labor agreement may limit their ability to restrict the use of over-the-counter products by major-league players, but the minor leagues are another story.
"We do not only discourage [ephedrine], we ban it," said Orioles team physician Dr. William Goldiner. "When we do our drug testing, individuals with that in their system are referred to our EAP [Employee Assistance Program].
"We are restricted at the major-league level by the collective bargaining agreement, not that we don't have the ability to educate individuals. We do.
"We believe that these types of nutritional supplements are really just chemicals ... medicines. We do not allow them in the training room. We don't prescribe them. We have an educational program to inform players about them."
Ephedra has become very popular among athletes who wish to lose weight and pick up energy. Though available at health food stores, it is similar to amphetamines - "speed" - and works by speeding up the body's metabolism and thus its production of heat.
Dr. Bill Howard, a sports medicine expert at Union Memorial Hospital, said it can turn deadly when taken by someone who is exerting himself heavily on a humid day, when sweat cannot dry fast enough to keep the body cool.
Though he didn't have direct knowledge of Bechler's death, Howard said he was struck by reports that the pitcher reported to camp overweight and out of shape - factors that could also contribute to excessively high body temperature.
"It's an absolute tragedy that a guy 23 years old is gone," said Howard. " ... "I think this is a dangerous product."
When the body's internal temperature reaches 108 degrees, as Bechler's did, the brain can't properly regulate the heart, kidneys and other organs.
A person first becomes confused, but ultimately dies of multiple organ failure.
Perper drew his strongly worded conclusions from interviews with those close to Bechler and decided to make his findings public because of growing "rumors and speculation."
He conceded that a bottle of Xenadrine reportedly taken from Bechler's locker may have been discarded before it could be included in the investigation, but Orioles officials said last night that they were able to recover the original bottle.
Sources said yesterday that a teammate had taken the bottle out of Bechler's locker in an ill-advised attempt to protect him. The unidentified player later admitted to discarding the bottle and led club officials to it.
Perper seemed unsure whether he'd gotten the original bottle or an identical substitute, but there appeared to be little motive for anyone to misrepresent the substance.
Teammate Larry Bigbie, one of Bechler's closest friends, would not identify the product, but he also confirmed that Bechler had been taking a weight-loss supplement - apparently against the wishes of his wife, Kiley.
"She seemed to be pretty on top of things," Bigbie said. "I don't think she was for it."
Bigbie knew Bechler was feeling intense pressure to prove he was in decent physical shape. He had gotten a lecture from manager Mike Hargrove the day before because he was having trouble keeping up with the other pitchers.
"There's a lot of pressure on someone like that," Bigbie said. "You want to come in, and the last thing you want is to not be able to get through a workout."
Sun staff writer Jonathan Bor contributed to this article.