G-Leaguer Zeke Upshaw diagnosed with heart disease year before he died

Orion Sang , George Stoia | Detroit Free Press

Less than a year before Zeke Upshaw died, he fainted while playing basketball and was diagnosed with heart disease.

Now, his family is suing for damages on the premise that the Grand Rapids Drive basketball player’s demise could have been prevented.

Upshaw, 26, collapsed on the Drive’s home court at The DeltaPlex Arena near the end of a game on March 24. And though a second heart test in October 2017 yielded results that were interpreted as normal, he did not receive any basic life-saving treatment for more than four minutes after he fell face-down to the floor and his oxygen-deprived brain began to die, according to records obtained by the Free Press.

Upshaw was pronounced dead two days later.

His heart had failed him.

The response by the medical staff for the Drive, a Gatorade-League affiliate of the Detroit Pistons, forms the crux of the lawsuit filed Wednesday by Upshaw's mother in U.S. District Court for the Southern District of New York against the NBA, Pistons, DeltaPlex and Steve Jbara's SSJ Group, a Birmingham-based LLC that shares ownership of the Drive with the Pistons.

The lawsuit alleges negligence, and video of the incident published online shows life-saving treatments were not immediately administered as Upshaw lost precious seconds that could’ve been used to save his life.

The Kent County Medical Examiner's autopsy, obtained by the Free Press, states Upshaw was put through concussion protocol after suffering a sudden cardiac event, and medical experts say the delay in appropriate treatment could have played a role in his death.

“There is simply no good reason for the Defendants to have been unprepared for sudden cardiac death events such as Zeke’s, and for their failure to react quickly to save a life,” attorneys Robert Hilliard and Ben Crump wrote in the lawsuit. “Had properly trained medical professionals administered expeditious and proper treatment, Zeke would still be alive.”

The Free Press attempted to contact the defendants in the lawsuit.

Multiple attempts to contact Drive president Jbara went unanswered. DeltaPlex declined comment. The Pistons deferred comment to the NBA, which provided a statement from spokesman Mike Bass: “The NBA family continues to mourn the tragic passing of Zeke Upshaw. We received a copy of the complaint and are reviewing it.”

A timeline of 'a normal day'

The death interrupted what Drive assistant coach George Lynch described as “a normal day.”

“He was excited to play. Everybody was doing well,” said Lynch, who refused to discuss specifics of the incident. “It was a normal day — shoot around, practice, preparation for the game. He was playing well.”

Upshaw was defending Long Island Nets guard Shannon Scott as he fell to the floor directly across from his bench.

Scott thought Upshaw had run into somebody during the play, or had gotten injured during a scrum for an offensive rebound. The next thing Scott remembers is a trainer running onto the court as the game stopped.

“We didn’t know how severe it was," Scott said. "We thought he had just fell down or maybe he got hit on the rebound, but we then realized he wasn’t moving — his leg was moving a little bit, but that was all that we noticed.”

The care Upshaw received in the minutes that followed form the crux of the lawsuit, and the records obtained by the Free Press give a glimpse into how his sudden collapse was handled by medical personnel.

Some accounts vary between the lawsuit and autopsy.

Here's what the records show:

Approximately 9:05 p.m. — Upshaw collapses on the court, per the autopsy, and the team trainer and physician tend to him. Upshaw "apparently answered affirmatively" when asked if he had been hit by someone and is put through concussion protocol. The lawsuit says the Drive’s team doctor had “stepped out” before the end of the game and was not present when Upshaw collapsed. The lawsuit also says "for much longer than four full minutes, no cardio-pulmonary resuscitation was initiated, no chest compressions were started, no oxygen mask was placed on his nose and mouth, no airway was cleared and secured, and no defibrillator sensors and electric delivery patches were attached and secured to Zeke's chest." The autopsy says "resuscitative efforts were started" but does not say when.

9:08 p.m. — A stretcher is brought onto the court. Upshaw is then taken to an ambulance. According to DeltaPlex’s website, Life EMS Ambulance, an emergency services organization based in Grand Rapids, is responsible for medical transport from the arena.

9:21 p.m. — Upshaw reaches Spectrum Health Butterworth emergency department roughly 16 minutes after collapsing.

9:49 p.m. — The lawsuit claims Upshaw was oxygen-deprived for 44 minutes after his collapse, which includes time spent in the ambulance and part of the time he spent at the hospital. Only 20 percent of his brain was alive. The only evidence of injury, according to Upshaw's autopsy, was a ¼-inch cut near his upper lip.

The complexity with Upshaw’s death is that it came months after both his June 2017 diagnosis of hypertrophic cardiomyopathy (HCM), the leading cause of heart-related deaths of young athletes in America, and the relative clean bill of health he received by team doctors in October.

The June incident happened while Upshaw was playing basketball in Nevada. He fainted, causing him to hit his head on the ground.And though he didn't suffer a head injury, an echocardiogram showed concentric hypertrophy of the left ventricle. According to the autopsy, it was determined he had HCM.

Upshaw's heart muscle had thickened, obstructing some of the bloodflow through his left ventricle, and combined with the over-exertion that comes with playing a sport like basketball, which doctors say can cause a dangerous arrhythmia, it began a domino effect that eventually took his life.

HCM affects 550,000 people nationwide and is responsible for 36 percent of sudden cardiac deaths in young athletes, according to the American Heart Association. It's not new to the NBA. Reggie Lewis of the Boston Celtics died of HCM during off-season practice in 1993. Lewis was 27 years old, and he had collapsed once before. The path to his death seemed to mirror Upshaw's.

The lawsuit also noted the sudden cardiac deaths of former Loyola Marymount University star Hank Gathers (died in 1990) and Orlando Magic summer league player Conrad McRae, and it argues the NBA, which in 2006 became the first league to implement standardized cardiac screening, failed to "adequately prepare for and protect its league players from sudden cardiac death."

Yet despite the continued scrutiny surrounding heart health in athletes, Upshaw was cleared to play after receiving a stress echocardiogram in October at Metro Health: University of Michigan Hospital (Metro Health Sports Medicine is the exclusive health-care provider for the Drive). The results were "interpreted as normal," per the autopsy, and medical experts contacted by the Free Press say the discrepancy from the initial diagnosis may have been attributed to Upshaw's profession as a high-level athlete, who often have more developed and thicker heart muscles.

“People who are athletes (and) have enlargement of the chambers of the heart, they have thickening of the chambers of the heart, and there is some overlap between what they may look like in a trained athlete and something that’s pathologic like hypertrophic cardiomyopathy,” said David S. Bach, who specializes in cardiovascular disease and internal medicine at University of Michigan medical school.

“There are changes that can happen on an EKG in athletes’ even though they don’t have a problem with their heart, and if you have somebody who’s not really trained in the athletic heart reading those EKGs, they may disqualify a lot of healthy people, including kids.”

The Golden Five Minutes

It wasn't immediately clear which members of the Drive front office, coaching staff or medical staff knew about Upshaw's initial diagnosis, though the lawsuit cites a failure to “take a complete and thorough medical history” and “perform a complete and thorough physical examination.” It's also not clear whether the Pistons had any knowledge of it.

What is clear is how quickly team trainers and physicians needed to react after Upshaw hit the floor. The moments immediately after a sudden cardiac event begins are the sweet spot for performing life-saving care, doctors say.

This timeframe, per the lawsuit, is referred to as the "golden five minutes."

The Free Press spoke to three professors of cardiology at the University of Michigan medical school, including Bach, and all three agreed with the premise.

“The sooner somebody gets help, the better,” Bach said. “In the heart world, we say time is muscle. That the longer an oxygen-deprived interval goes on, the more muscle is at risk. And I’m sure that the same is true for the brain.”

Bach says there are "pretty good guidelines to follow" during a sudden cardiac event, such as checking whether the victim is breathing or has a pulse. If there’s no pulse, basic life-saving measures such as CPR can be performed. And if the victim doesn’t have a heart rhythm, or has a dangerous heart rhythm, then an automated external defibrillator, or AED, could be used to try to restore a normal rhythm.

But Upshaw didn’t receive basic life-support treatment within those five minutes, per the lawsuit. He didn’t receive CPR, and an AED was not used — though one is present on-site at the arena, according to DeltaPlex’s website.

Bach is also skeptical of the autopsy's findings that Upshaw would have been able to "affirmatively" tell the team trainer and physician that he had "been hit by someone" and "struck his head."

“As an outsider, it would be uncommon that somebody suffered cardiac arrest and was able to respond to a question,” Bach said. “The answer is, if they follow a concussion protocol, obviously they’re not doing the ABC’s of basic life support. … It would have delayed appropriate basic life support.

“If somebody doesn’t have a pulse, doesn’t have a blood pressure and they’re not breathing, and you’re doing a concussion protocol, then you’re probably not treating the right thing.”

The lawsuit did not mention Upshaw’s pre-existing heart condition nor the concussion protocol he was put through after his collapse. It did say Upshaw's "heart had stopped" as he fell to the floor, and he was "unconscious as a result."

Multiple attempts to contact attorneys Hilliard and Crump, who represent Zeke's mother, Jewel Upshaw, in the lawsuit, were unsuccessful.

Upshaw’s attorneys paint a picture of the team’s medical staff and personnel acting with “no sense of urgency,” and with “uncertainty, indecisiveness, and a complete and utter lack of appreciation of the severity of the moment.”

The suit argues that, based on video evidence and testimony from witnesses, this is when negligence occurred. Usage of the AED falls under “reasonable and ordinary care,” the suit argues, "along with failures to adequately respond to and treat Upshaw, perform CPR and select, screen, train and employ only qualified personnel."

“In fact, not a single life-saving measure was administered during the entire four minutes of the tragic event’s video recording,” the suit reads, later adding that, “according to witnesses, no one ever attempted to revive him.”

'We got a special guy here'

Joe Mihalich will never forget Nov. 19, 2013.

It was his fourth game as Hofstra's basketball coach, and he had taken the struggling program on the road to Richmond. Upshaw, a 6-foot-6 guard who had taken a graduate transfer from Illinois State, had the best game of his career: 37 points, nine rebounds, four 3-pointers.

“This was when we knew he was going to be a star that year,” Mihalich said. “I think we all looked at each other then and said ‘Wow. We got a special guy here.’ … I’ll never forget that game. He carried us. He was just so good.”

By all accounts, Upshaw’s career traced the same path as many Gatorade League players. He was hardworking and talented, but not quite elite.

“He was an everyday guy,” said Southern Methodist head coach Tim Jankovich, who recruited Upshaw to Illinois State and coached him from 2010-12. “... He’s a guy of character. He was a very good teammate, he had very good energy and he was just a very easy, fun guy to coach.

“He was an amazing young man. As good as he was at the time, we believed that he had a heck of a future ahead of him. We thought for sure his best days were ahead.”

Upshaw, born in Chicago, didn't play much at Illinois State, but he seemed to embrace his star status at Hofstra. He led the Colonial Athletic Association in scoring at 19.8 points per game.

“He was the total package: good player, good person, good student,” Mihalich said. “He made Hofstra a better place. I will always remember him as one of the guys that helped turn this program around … It’s someone you admire and someone you feel indebted to because of how much he helped our program. It was just a horrible thing.”

Upshaw went undrafted in 2014 but continued his pursuit of the NBA by playing two years overseas for the Helios Suns in Slovenia and Basket Esch in Luxembourg. In 2016, he returned to America and was taken in the fourth round of the NBA G League Draft by Grand Rapids.

After his first season with the Drive, when he averaged 6.5 points per game, Upshaw spent the summer training in Las Vegas with Karlton Grant, a personal basketball trainer Upshaw met through a friend. He spent most of his days trying to improve his game, and earned the label of “gym rat” from his coaches, trainers and teammates.

“When we did extra shooting he was always there,” Lynch said. “He stayed after practice and worked on his game and was one of the first guys on the floor before practice. He wanted to play in the NBA one day and he worked everyday to accomplish that.”

Upshaw averaged 8.5 points per game this past season, becoming a key contributor off the bench. His career seemed to be progressing, and the Pistons were aware of his growth with the Drive.

According to the lawsuit, ex-Pistons general manager Jeff Bower told B.J. Bass, Upshaw’s agent, that he “had been really happy for Zeke and the improvement he has shown ... This has been a good experience and the results speak to the effort that has been invested (by Zeke)... (We) will be discussing these things later in the spring.”

It's unclear whether Bower knew about Upshaw's heart history; he was fired as Pistons GM on Thursday. The conversation took place "in the months leading up to" Upshaw's death.

“To be in the gym with him, and he was always grinding with me, throughout the summer — to see this happen to him while playing the game he loves, it was tough,” Grant said.. “It was scary, it’s something I’ll never forget. It’s something I will have in my mind while I’m training players and their safety.”

Effectively 'brain dead' upon arrival

After Upshaw was removed from the court by stretcher at 9:08 p.m., he was transported by ambulance and arrived at the Spectrum Health Butterworth emergency room at 9:21 p.m.

“He had no spontaneous respirations, pulse, or obtainable blood pressure from the time he was placed into the ambulance until he arrived at Spectrum Health,” the autopsy states. “He was admitted to the intensive care unit and placed on ECMO (an oxygen machine).”

The lawsuit claims Upshaw at this point had “approximately 20-percent brain functionality left.”

“In other words, he was effectively 'brain dead' upon arrival,” the suit reads.

It is unknown what type of treatment Upshaw received between the hospital and Spectrum Health. Life EMS Ambulance did not return a call from the Free Press. Both records show Upshaw was given a prognosis of a clear medical “downhill course” as he remained in an unresponsive state.

Daniel Menees, an assistant professor at the University of Michigan’s medical school , said going a significant amount of time without oxygen — like what Upshaw endured — can result in a “multifactorial” downward spiral.

In that scenario, according to Menees, the best course of action would have involved getting oxygen to Upshaw’s body, perhaps with a breathing tube. The second goal would have been to get Upshaw’s heart to function in some capacity.

And if Upshaw’s circulation and heart rhythm had, in fact, been re-established, Menees says there would’ve been another possible treatment: cooling the body down in an attempt to limit the damage.

But it’s unlikely Upshaw progressed far enough to receive the cool-down treatment.

Two days after his collapse, Upshaw’s family instructed that he be placed on “comfort care,” records show.

Menees said the most common reason for people to withdraw care is brain death. If the suit's claim about Upshaw's 20-percent brain functionality is true, then there wasn't much Spectrum Health could’ve done upon his arrival.

Menees was hesitant to assign blame or negligence. But he did express his concerns with Upshaw’s condition entering hospital care, if in fact there was a lack of life-saving treatment following Upshaw’s sudden cardiac event. Menees also said the situation could have potentially benefited from the use of a defibrillator “early on” to help re-establish a normal heart rhythm.

“I would definitely say I would have serious concerns,” Menees said. “Four minutes is a long time to go. Kind of the basics of an emergency response team would be to check for a pulse, check for breathing. If those things are not there, CPR should be administered immediately.

“So that’s probably the first thing that should’ve been checked for, should’ve been looked for, so yes, I would be very, very concerned if there was a significant delay in those life-saving treatments.”

'I don't remember him having any problems'

The Free Press contacted several people connected to Upshaw’s basketball career. Grant, Upshaw’s personal trainer, declined comment when asked if he noticed any problems with Upshaw during their training. He also wouldn't comment on Upshaw's 2017 diagnosis.

Jankovich, Upshaw’s head coach at Illinois State from 2010-12, didn't remember whether Upshaw had ever showed signs of having a heart problem. Jankovich said he had “no recollection whatsoever of anything medical 10 years ago.”

Mihalich, Upshaw’s coach at Hofstra, also said he didn’t notice any health issues during their time together.

“He played every minute of every game, every minute of every practice,” Mihalich said. “I don’t remember him having any problems at all. Nothing. None of that stuff.

For more than a decade, the NBA has increased requirements regarding heart-health testing. The New York Times attributed the league's 2006 implementation of standardized cardiac screening to the death of Atlanta Hawks center Jason Collier, who reportedly died of a sudden arrhythmia caused by an enlarged heart. Just two summers ago, the National Basketball Players Association (NBPA) began offering free heart screenings for former players.

But that's not enough, the lawsuit argues. Citing a 2017 study from the Journal of the American Medical Association that revealed abnormal results in 81 of 519 players, the suit claims the echocardiogram testing that is currently part of league protocol “needs to be individualized for the sport” and that there “needs to be research into other kinds of diagnostic criteria.”

“Defendant NBA failed to either implement effective policy and procedures or failed to ensure policies and procedures were being consistently followed and complied with as those policies and procedures relate to responding to a sudden cardiac event during an NBA game,” the suit reads.

Shereef Akeel, a prominent civil liberties lawyer based in Michigan, said the chances the case reaches a settlement before heading to court depends on the strength of the case.

“You can negotiate from a position of strength,” Akeel said. “If you have a strong case, then it is more likely they settle this. If the case is weak, then you'll have less leverage.”

According to Akeel, in order to prove culpability, it must be established that there was a responsibility to provide proper care and treatment for injuries.

“Again, the history with negligence is they have to identify that there was a duty owned by the Detroit Pistons, the Grand Rapid Drive, the arena to provide care,” Akeel said. “That is the No. 1 hurdle they have to overcome.”

It's a question both sides will face as the lawsuit presumably moves forward.

But one thing is clear: Upshaw's death still stings.

“Would rather not comment beyond the fact I loved him and miss him dearly,” Bass, Upshaw's agent, wrote in a statement to the Free Press. “Terrible loss.”