Deaths of Dawkins, Malone raise health concerns for NBA, retirees

— -- NBA commissioner Adam Silver loved seeing Darryl Dawkins in his official role as an NBA Legend. Steeped in his Chocolate Thunder persona, the indestructible dunking force that earned cult status in the late '70s and early '80s, Dawkins toured the country in recent years to entertain league sponsors.

"We had some great conversations," Silver said. "I really enjoyed getting to know Darryl."

When Dawkins died suddenly from a heart attack in August at age 58, the news literally took Silver's breath away.

Across town, National Basketball Players Association executive director Michele Roberts mourned the player she celebrated as a young basketball fan growing up in the Bronx.

"When I heard about Darryl, I thought, 'That's not supposed to happen,' Roberts said. "It's too soon."

Seventeen days later, Moses Malone, who had spent the weekend enjoying the annual Hall of Fame festivities in Springfield, Massachusetts, was found dead in a hotel room in Norfolk, Virginia.

Those close to Malone say the 60-year-old exercised regularly after his NBA career and eschewed drugs and alcohol. An autopsy concluded the cause of death was coronary artery disease.

Subsequent reports revealed Malone had complained of an irregular heartbeat and was wearing a heart monitor when he died.

A shaken Silver called Roberts the morning after Malone passed away. The players' association was working on a program that would fund cardiac screening and supplemental health insurance for its retired players. Silver wanted to know how close the union was to rolling out its initiative and how the league could help expedite the process.

While there still may be potentially acrimonious labor negotiations looming between Silver and Roberts over the current collective bargaining agreement, which includes an opt-out for both sides in 2017, the sudden death of two of the NBA's biggest brethren has linked Roberts and Silver in a joint effort to ease the health concerns of its retired players.

Roberts said action from the players' association on providing screening for their retired players is "imminent.''

"I wish I could give you an exact timetable, but we have to make sure all the components are in place," Roberts said. "I will tell you we hope to have something sooner than later.

"I think both Adam and I feel the urgency. We don't want to lose another player before [taking action]."

"It's an extremely high priority for us," Silver said.

"The cardiac issues our players have experienced are well known."

Silver said the NBA is prepared to kick in both financial support and a vast array of medical resources, including a prodigious network of cardiologists that have been affiliated with the NBA for years.

Roberts and her staff presented their vision of comprehensive screening for retirees to current players at their annual Las Vegas meeting in July. While union officers (among them president Chris Paul and vice president LeBron James) were keenly receptive, they pressed for more specifics and wanted assurances the program would be sustainable.

At that meeting, according to union sources, the players voted to set aside funds to implement screening, with the larger (and more costly) issue of supplementing health insurance to be readdressed at their February meetings, when a more comprehensive blueprint would be available.

The program could cost more than $17 million, according to league sources. The union's coffers will be replenished by a lucrative television deal with ESPN and TNT that kicks in for the 2016-17 season.

The good-faith actions of current players were welcome news to retired veterans who have been rattled by the spate of cardiac-related deaths. Although there is no concrete data linking basketball players who are large in stature to early death from cardiac distress, the prevailing opinion among many former NBA stars is there has to be a correlation.

"It's too close to home," former star center Bob Lanier said. "It's the topic nobody wants to address. How many people have we seen in our lifetime who are big and really tall and are 70-something years old? Not many. That's because people [my size] don't live that long.

"I know things are evolving. People are taking better care of themselves. They exercise, they watch their nutrition, they try to limit the stress in their lives. I do all of those things. But we're still losing guys younger than we should."

Dr. Alfred Bove, physician emeritus at Temple University School of Medicine and a former Philadelphia 76ers team doctor, dismissed the notion that NBA stars are at higher risk for cardiac-related deaths than the general population.

"You could use the model they have for dogs," Bove said. "If you are a big dog, you don't live as long as a little dog, but I'm not convinced that's how it works with humans.

"I feel badly these guys feel they are at risk for a shorter life span, but there are other factors that are leading to that."

Bove said athletes generally enjoy a better survival rate than the general population, but when they stop playing they become prone to weight gain. That can lead to hypertension and diabetes, which has proven to be prevalent among African-Americans. A proper diet, routine exercise, limiting alcohol, eliminating smoking and undergoing regular screening, Bove said, are steps that should alleviate the players' fears.

The players' association has put Joe Rogowski, its director of sports medicine, in charge of overseeing the screening program. Rogowski, who worked for the Houston Rockets in a similar capacity, said he understands the concerns of a population that has seen a slew of former and current players experience heart issues.

"We need to do some additional research on these guys," Rogowski said. "I'd like to be able to answer the question, 'What does a retired basketball player's heart look like?'"

Dr. James H. O'Keefe, a sports cardiologist at Mid America Heart Institute in Kansas City, has lectured on a study that measured marathoners who engaged in vigorous exercise over a prolonged period. While there was an obvious benefit to exercising, there was also data, according to O'Keefe, that showed some marathoners who engaged in "extreme" exercise over many years developed enlarged hearts and scarring from tearing of tiny heart muscles.

That study, O'Keefe said, is not applicable to basketball players.

O'Keefe acknowledged that larger, huskier people do experience "some added cardiac risk," but that can be combatted, he said, with a "healthy heart lifestyle" and regular screening.

"Being tall does increase the risk for atrial fibrillation, but that is not a fatal condition and can be treated with medication," O'Keefe said. "This is a new age in treating the heart. We have very effective treatments available to us."

In 2006, following the sudden death of 26-year-old Jason Collier of an enlarged heart, the NBA implemented a mandatory screening program for its players that includes three cardiac tests: an electrocardiogram, a resting echocardiogram and a stress echocardiogram. The program also includes a routine physical, blood work and a profile of the player's family history. Jeff Green, Ronny Turiaf and Channing Frye are among the players who were diagnosed with serious heart issues through routine screening.

A similar program for retired players, said Dr. Tim Byrne, who is part of the Phoenix Suns medical staff, would be more than sufficient.

"I understand why the players feel the way they do," Byrne said. "When we have this type of thing -- two former players dying back-to-back just weeks apart -- they see themselves as this select little group.

"There are plenty of risk factors that contribute: increased body mass index, hypertension, family history.

"But simply being an NBA player is not one of them."

Newly minted Hall of Famer Spencer Haywood said screening for retired players should not be limited to cardiac-related issues.

Haywood said his prostate cancer was detected as part of routine blood work done during his yearly physical exam. Because his condition was detected early, Haywood said, he's expected to enjoy a full recovery.

"I'm the lucky one," Haywood said. "I have health insurance through my wife's job. Most of our guys do not. We have black men from our league walking around with prostate cancer, and they don't even know it.''

Haywood said one of the most frustrating misnomers is the supposition that all ex-NBA stars are wealthy. He said a construction worker recently came to his home to remove some debris and asked him, "Is this your play house?"

"I said, 'C'mon now, I'm not on 'Ballers.' I never made that kind of money,'" Haywood said.

Haywood attended the union meetings in Vegas and informed Paul and James that elite players of his generation made no more than $50,000 or $75,000 at the height of their careers. He said he was impressed by the response of both stars.

"LeBron said to me, '$50,000? That's per diem money.' I think he understands what we're dealing with here,'' Haywood said.

Lanier said many retired players recognize the formula for healthy living, but the pounding of a long NBA career has left many of them hobbled and, in some cases, incapacitated, thus unable to exercise at all.

"I was trying to help one of my grandkids learn how to ride a bike," Lanier said, "but I couldn't keep up to balance her because my joints hurt so much."

There's a surprisingly large population of ex-players, Haywood said, who refuse to go to the doctor because "they're afraid of what they'll find out.''

Lanier believes those concerns can be rectified with the support of the current union leadership.

"If they go through with this, it will be the most wonderful thing they've ever done," Lanier said. "We haven't done enough for our past players, who have a rich history of promoting our game. I can't tell you why that is.

"I don't believe it's out of malice. I just think we haven't been in the forefront of peoples' minds.

"Maybe now we are."