Anyvbody know the most recent update on this?
updates??
PRP player who died wasn't dehydrated, experts say
Medical records show PRP player wasn't dehydrated, two say
By Andrew Wolfson
awolfson@courier-journal.com
Hospital records indicate that Pleasure Ridge Park High School sophomore Max Gilpin did not die because coaches denied him water during a football practice, according to a medical expert for Max's coaches.
Instead, a prescription drug Max was taking for attention-deficit hyperactivity disorder most likely triggered the heat stroke that led to his death in August, because it contained amphetamine, which can cause overheating, said Dr. George Nichols, Kentucky's former chief medical examiner.
Nichols has been hired as a consultant by lawyers representing former PRP coach Jason Stinson and his assistant coaches, who have been sued by Max's parents, Michele Crockett and Jeff Gilpin. Stinson also faces a criminal charge of reckless homicide in Max's death.
Because records show that Max was hydrated when he was brought to Kosair Children's Hospital -- and a drug screen there found amphetamine in his system -- Nichols said he concluded that the prescription drug Adderall probably caused the heat stroke.
Dr. William Smock, a professor of emergency medicine at the University of Louisville, who has no connection to the case and reviewed Max's medical records at The Courier-Journal's request, agreed with Nichols that Max's heat stroke was not caused by lack of water.
Smock, who is also director of the clinical forensic medicine program at University Hospital, also said he believes Adderall prompted Max's heat stroke and death.
"There is no indication this kid was dehydrated," Smock said.
An expert retained by Max's parents, however, said yesterday that the evidence shows Max's death was caused by excessive strenuous exercise in hot weather.
Dr. George Rodgers, a professor in U of L's department of pediatrics and its department of pharmacology and toxicology, said Max's initially low urine output when he was brought to the hospital is one of several factors that suggest he might have been dehydrated.
And he said the link to Adderall is "tenuous." While there have been reports of heat-stroke deaths caused by amphetamines, he said, they occurred in people taking excessive amounts, for weight control or other reasons.
Max was on a low dose of Adderall, he said, and he predicted the issue will be "played out in the courtroom."
Coach faces charge
The conclusions of Nichols and Smock are significant because Jefferson County prosecutors said in court papers released last week that Stinson faces a criminal charge in part because he repeatedly denied players water at the Aug. 20 practice where Max and another player collapsed. Max died three days later.
"The bottom line is that this tragic incident wasn't caused by lack of water," said attorney Bill Hoback, who is defending Stinson, six assistant coaches and PRP's principal and athletic director in the lawsuit.
Commonwealth's Attorney Dave Stengel, whose office is prosecuting Stinson, said he could not comment on the evidence or its potential impact.
Rogers and lawyers for Max's mother contend that Nichols' analysis is flawed because it fails to account for fluids Max received en route to the hospital and when he arrived in the emergency room.
But Smock said it would have been impossible for Max to have been rehydrated so quickly.
Even if Max's heat stroke wasn't caused by lack of water, however, Todd Thompson, co-counsel for Max's mother, said yesterday that Stinson and the other coaches were still negligent, first by requiring players to run until one of them quit the team, and then by waiting 15 to 25 minutes to call an ambulance.
Thompson also said the coaches failed to have ice towels on hand to cool players, as required under state rules.
Stinson, who has denied any wrongdoing, has estimated that EMS was called in about seven minutes.
Blame put on drug
Nichols said tests conducted after Max was admitted to Kosair Children's Hospital Aug. 20 show that the 15-year-old was not suffering from dehydration after he collapsed from heat stroke.
Smock, who reviewed a copy of Max's hospital records obtained by The Courier-Journal, agreed that the numbers in Max's urinalysis test, as well as the results of another set of exams, show that Max had plenty of water in his body when he arrived at Kosair.
Nichols and Smock also agreed that the most likely cause of the heat stroke was the prescription drug Adderall, which is taken by millions of children and adults.
Max was taking a daily dose of 20 milligrams of Adderall XR, an extended-release version of the drug, according to the medical records.
However, those records do not cite Adderall as a cause or contributing factor in his death, whose cause was listed as septic shock resulting from multiple organ failure brought on by heat stroke.
Prosecutors say Stinson repeatedly denied players water on that Aug. 20 afternoon when the heat index reached 94, despite receiving extensive training in the dangers of heat-related illnesses, and he forced them to run extra wind sprints as punishment for not practicing hard enough.
They allege that Stinson "conducted a contact football practice in a reckless manner that resulted in players becoming ill and one player, Max Gilpin, ultimately dying from heat stroke," according to records filed in Jefferson Circuit Court.
Prosecutors contend that their evidence shows that Stinson was aware that players were fatigued at the practice, but still ordered them to run extra wind sprints as punishment, insulting them and yelling at them that they "would keep running until someone quit."
During and after those sprints, Stinson "repeatedly denied the players water breaks," calling some cowards for attempting to get water, prosecutors allege.
When several players tried to help Max after he collapsed, Stinson yelled at them, "ordering them to stay away from Max because they were not his mother or his nurse," they alleged.
Brian Butler, one of Stinson's criminal defense lawyers, wouldn't comment on the impact of Nichols' and Smock's analysis on the criminal case against his client.
Scott C. Cox, a criminal defense attorney who is not involved in the case, said he expects the evidence will be subject to "a battle of the experts."
If it is proved that water wasn't an issue, Cox said, it would "weaken the commonwealth's case, but wouldn't deep-six it. The question would still remain whether the coaches acted recklessly" by making the players run extra laps on such a hot day.
Cox also said Stinson knew or should have known that Max was taking Adderall, since it was disclosed during a physical exam.
Max's physical-examination form on file with the district, dated May 13, 2008, indicates that he was taking Adderall and had been cleared to participate in athletics.
No dehydration seen
A urinalysis test performed shortly after Max was admitted to the hospital shows his urine was almost completely water, Nichols said.
According to Max's medical records, the test showed a particle level of 1.006 on a scale that ranges from 1.000 (totally water) to 1.030.
Smock and Nichols said that if Max had been dehydrated, his result would have been closer to the high end.
Smock also said that Max had a low level of ketones in his urine, while patients who are dehydrated have elevated levels. Ketones are a byproduct of the breakdown of sugar, he said.
Other tests also showed that Max was well hydrated, according to Nichols' examination of Max's medical records.
Nichols said he concluded Max's heat stroke was caused by Adderall in part because he was the only one who collapsed and died "out of thousands of students who practiced that day on both sides of the river."
Another player, senior Antonio Calloway, collapsed at the same practice and was hospitalized, but his records have not been made public.
Questions about drug
Nichols said there is no dispute that Max's death was caused by heat stroke, but he said it is a popular misconception that heat stroke is always caused by dehydration.
While heat stroke is not listed as a side effect of Adderall, the drug contains amphetamines that can interfere with the operation of the hypothalamus, causing core body temperatures to rise, Nichols said.
Matt Cabrey, a spokesman for Shire, a global drug company that makes the drug, said in an e-mail that "there is no data to support that Adderall XR, when used according to approved labeling, causes or contributes to heat stroke."
The Canadian government briefly withdrew Adderall XR from the market in 2005, citing the sudden, unexplained deaths of 12 children from 1993 to 2003 in the United States. The government put the drug back on the market after an independent panel found it impossible to determine whether it increases the risk of cardiac death.
The U.S. Food and Drug Administration has taken no action, saying that 30 million prescriptions were issued over those years for Adderall, and the number of sudden deaths among users was no greater than would be expected among a similar number of children not taking the drug.
Thompson, the co-counsel for Max's mother, said that Adderall is widely used by student athletes, and he noted that Jefferson County Public Schools has not required students using the drug to stay off the field in hot weather.
Lauren Roberts, a spokeswoman for the school system, said yesterday that the district would have no comment on Nichols' analysis or whether the district will review its policy on athletes using Adderall until officials have more time to look over the medical records.
Nichols acknowledged that Max's death was an "extremely rare event," and he and Hoback said it is up to school officials to decide what, if anything, to do in response. Hoback added that Max's parents had no way to know that their son was at risk in taking the drug.
"Michele Crockett said she filed her lawsuit because she was looking for answers," Hoback said. "This is the answer."
Reporter Andrew Wolfson can be reached at (502) 582-7189.
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