Why it won’t just be up to the James family whether Bronny plays for USC — or any other school

Nine years ago, Chai Baker awoke to a bewildering scene.

The Oregon State basketball player had no idea why he was in a hospital bed, a tube down his throat, a monitor tracking his vital signs and loved ones by his side.

“It was terrifying,” Baker said. “I didn’t know what happened. I didn’t even know where I was or how long I’d been there.”

Baker soon learned that he’d collapsed two days earlier during a workout at Oregon State’s practice facility. At first, teammates noticed him gasping for air in the layup line. Moments later, athletic trainer Tom Fregoso was scrambling to administer CPR and shock Baker’s heart back into rhythm after the 19-year-old crumpled to the court and began convulsing.

The cause of Baker’s cardiac arrest turned out to be hypertrophic cardiomyopathy, a hereditary heart condition that Baker had never heard of before. He initially didn’t grasp the severity when his physician told him that it causes the heart muscle to thicken and stiffen abnormally, impeding blood flow and increasing the risk of arrhythmias.

By the time Baker returned to campus after a week in the hospital, he had made up his mind not to let his diagnosis stand in the way of his dreams. He felt fit and strong again. He had no chest pain or other symptoms. He was eager to implant a defibrillator in his chest so that he could return to playing basketball as quickly as possible.

Baker says he would’ve risked playing for Oregon State had the university not intervened and taken the decision away from him. Oregon State director of sports medicine Douglas Aukerman informed Baker in early November 2014 that the threat of another cardiac incident was too severe, that Baker could remain on scholarship but he couldn’t play again for the Beavers.

“When they didn’t clear me to play, it kind of crushed me,” Baker said. “It was very, very hard. I still felt physically like I could play. I didn’t understand the severity of my situation and I didn’t take it well.”

Baker’s story hints at what may be ahead for Bronny James as he undergoes testing to determine the cause of his cardiac arrest on July 24 and evaluates whether to keep pursuing basketball. It isn’t only up to LeBron James' eldest son and his family how much risk of a cardiac arrest recurrence they can tolerate. USC will also have to assess if the threat is too much to clear the highly touted incoming freshman to play for the Trojans.

A USC spokesperson declined comment when Yahoo Sports asked for an explanation of how the university decides whether to clear an athlete with a newly diagnosed heart condition. Cardiologists who have been involved in these decisions say that universities typically evaluate anything from the athlete’s risk of cardiac arrest, to the threat of a lawsuit or barrage of negative publicity if something went wrong.

“With college sports, there are lots of stakeholders that have an interest in the athlete playing but also not wanting to take on additional liability,” said Lili A. Barouch, director of sports cardiology at Johns Hopkins University School of Medicine. “It’s tough. It’s not always a straightforward decision.”

The Hank Gathers impact

It’s easy to pinpoint when schools started becoming more cautious about the risk of allowing athletes to play through a heart condition. It was the day that a supremely talented prospect with so much life in front of him stumbled, collapsed and never got up again.

Hank Gathers often declared himself to be the strongest man alive, but the Loyola Marymount forward wasn’t as invincible as his muscular physique and charismatic personality suggested. He had a heart condition that caused him to faint during a December 1989 game against UC Santa Barbara and to suffer fatal cardiac arrest three months later after a soaring alley-oop dunk against Portland.

The aftermath of the tragedy devolved into a deluge of malpractice and negligence allegations against the school, the doctors who treated Gathers and even his coach. Beverly Hills attorney Bruce Fagel filed a $32.5 million lawsuit on behalf of the Gathers family that ultimately netted a $545,000 settlement.

Gathers’ death lingered in the national headlines long after the LMU men’s basketball team finished honoring its fallen star with an emotional Elite Eight run. Decades later, his story still casts a shadow over a struggling basketball program that has not won a conference title since 1990 nor returned to the NCAA tournament.

That high-profile incident and another involving Boston Celtics star Reggie Lewis inspired research into whether these deaths were anomalies. As a result, we now know that sudden cardiac arrest is the No. 1 killer of young athletes. And that, as University of Washington sports cardiologist Jonathan Drezner puts it, late-adolescent male basketball players are “the single highest-risk demographic that we know of.”

Armed with that knowledge, college athletic departments have worked to detect warning signs of sudden cardiac arrest before disaster strikes and to prepare so that it’s not a virtual death sentence when it does occur. They’ve rehearsed emergency response plans. They’ve made AEDs more accessible. They’ve offered annual cardiac screenings for athletes. And they’ve become more risk-adverse when an athlete is diagnosed with a heart condition.

Will Stute, a sports attorney who has represented the NCAA in several high-stakes wrongful death lawsuits, says that his advice to athletic directors “would be to be very cautious in these situations.” Stute wouldn’t recommend clearing an athlete with a heart condition unless there is buy-in from the athlete, his or her family and “a highly qualified medical professional who understands this particular issue.”

“I think you need all that in today’s world,” Stute said, “to reduce the risk to a level that would be acceptable.”

None of the half-dozen universities that Yahoo Sports contacted agreed to make a physician or administrator available to explain how they decide whether to clear an athlete to play in these situations. Anecdotal evidence suggests the risk of potentially life-threatening cardiac arrest is the key factor.

The eldest son of Shaquille O’Neal discovered weeks before the start of his freshman season at UCLA that he was born with an anomalous coronary artery, a condition that only increases the risk of sudden cardiac arrest if it goes unfixed. UCLA cleared Shareef O’Neal to play again in 2019 after the 18-year-old underwent open-heart surgery to repair the abnormality.

Conversely, Wichita State denied point guard D.J. Bowles medical clearance to return to basketball after he suffered sudden cardiac arrest during a September 2013 practice and doctors couldn’t figure out the cause. Athletic director Eric Sexton explained afterward, “Our main concern is the health and well-being of D.J. for the rest of his life.”

New York sports attorney Dan Lust said “there’s an added level of risk for schools when they’re aware of a very public incident in a player’s past.”

“Everyone is always fearful of a lawsuit,” Lust said, “but you also don’t want anything to tarnish the reputation of your team or your medical staff. You don’t want the reputation that you care more about wins and losses than player safety.”

In years past, college basketball players have not always agreed with cautious decisions their universities have made. Many have gone shopping for a second opinion and for another school willing to grant them the opportunity to play.

Searching for a place to play

Tennessee forward Emmanuel Negedu had just finished a grueling workout 14 years ago when a teammate challenged him to a race. They would start at one end of Tennessee's indoor football facility and sprint to the other.

"He started making noises like I was scared and you know athletes," Negedu said with a chuckle. "If someone does that, then it's like, 'OK, let’s do it.'"

Negedu recalls hauling his 6-foot-7, 218-pound body across the finish line first and then turning around to talk smack to his teammate. His next memory after that is waking up in a UT Medical Center hospital bed surrounded by concerned friends and family members.

When Tennessee doctors examined Negedu, they could not explain why he lost consciousness and went into cardiac arrest, nor could they rule out the possibility of it happening again. As a result, the university told Negedu he could not play again for the Vols. He could either remain on scholarship or seek his release.

Negedu had immigrated from Nigeria as a teenager to pursue basketball and had blossomed into a top-100 prospect. To come that far just to quit at age 20 was an outcome that he couldn't stomach.

He asked for his release and took a visit to Indiana. The coaches liked him but the school wouldn't medically clear him.

Then he visited New Mexico. The university granted him permission to play if he got an internal defibrillator, agreed to daily heart rate monitoring and signed a liability waiver assuming all legal risk.

"I loved basketball,” Negedu said. "At that point, I was willing to give my life for what I loved. I didn't want to live with any regrets."

Ten games into his comeback, New Mexico administrators pulled Negedu aside and told him they couldn't risk allowing him to play for the Lobos anymore. The university said that Negedu's internal defibrillator produced a reading that caused doctors to sideline him, but Negedu swears, "Nothing happened to me."

Years later, it still gnaws at Negedu that he was forced to stop playing against his will and that he'll never know how far basketball could have taken him.

"Everyday I think about, 'What could I have been? What would I have done?'" Negedu said. "I signed papers. I got doctors’ opinions. I did stress tests. I did everything. I was more checked than any athlete we had. And still they took that choice away from me."

At about the same time that Negedu's basketball career sputtered to a halt, another cardiac arrest survivor refused to accept mounting evidence that he needed to retire. Allan Chaney wanted to keep playing even after collapsing at the end of a 2010 workout at Virginia Tech and then crumpling to the floor a second time during a pickup game a few months later.

Chaney struggled to find a transfer destination even after a Pennsylvania cardiologist cleared him to return to the court if he implanted a defibrillator in his chest. Only lower-tier High Point was willing to risk allowing him to play.

In his first season at High Point, Chaney started 27 games without incident and showed flashes of his old self. He was off to an even better start five games into the following season when he received “a life-saving shock” from his defibrillator while at the free-throw line against Wofford.

“At that point, I knew it was it,” Chaney said. “I knew it was time for me to hang it up. I loved basketball, but it wasn’t worth my life.”

More recently, other players with heart conditions have found success as transfers after being denied medical clearance at their original school. Former Alabama signee Jared Butler became a first-team All-American and a national champion at Baylor in 2021. Ex-Florida star Keyontae Johnson earned third-team All-American honors at Kansas State last season and helped lead the Wildcats to the Elite Eight. Both are now on NBA rosters.

Even so, Stute warns, "There are probably more significant legal concerns for the school that decides it's willing to tolerate risks that another school was not for a student-athlete to play for its team."

"In that scenario, I'd advise an athletic director to look a little more carefully at the medical advice and pressure test it a little more," Stute said. "You’d want to make sure the person giving you that opinion has a deep understanding of that particular cardiac issue."

A gamble for both parties

Little is publicly known about the underlying cause of Bronny James' sudden cardiac arrest or his chances of continuing his quest to join his legendary father in the NBA. LeBron wrote on July 27 that the family “will have more to say when we’re ready.” USC has consistently declined comment, citing “respect for student privacy.”

Bronny, 18, and LeBron were spotted earlier this week in and around the Mayo Clinic in Rochester, Minnesota, TMZ reported Tuesday. A James family spokesperson declined comment when Yahoo Sports asked if the father and son were there to meet with Dr. Michael Ackerman, a Mayo Clinic genetic cardiologist whose second opinion has previously helped some high-profile basketball players return to the court.

In 2018, University of Alabama doctors would not clear Butler after a cardiac screening revealed the incoming freshman had a milder version of the same heart condition that tragically killed Gathers. Butler sought a second opinion from Ackerman, who worked closely with the Baylor coaching staff to help devise a monitoring system so that the future NBA second-round draft pick could continue to play basketball safely.

Ackerman did the same for Johnson when the Florida star sought to resurrect his career more than a year after his heart stopped and he collapsed face-first during a game against Florida State. Doctors at Florida deemed the risk of a repeat cardiac arrest too high, but Ackerman's blessing carried considerable weight at Kansas State, where longtime Baylor assistant Jerome Tang had just been hired as head coach.

In March, Ackerman explained to The Wall Street Journal that whenever possible he tries to help an athlete figure out how to keep doing what they love. The goal, Ackerman added, is "helping our patients live and thrive despite their diagnosis rather than being shut down because of their diagnosis.”

Of course, it won't be Bronny's decision alone whether to play college basketball next season. He needs USC or another university to medically clear him, an especially high-stakes decision given the stature and fame of the family involved.

If Chai Baker could give Bronny one piece of advice, the former Oregon State guard says it would be to take the time to fully understand his diagnosis. Oregon State's reluctance to medically clear Baker made a lot more sense to him once he began researching hypertrophic cardiomyopathy on the internet and reaching out to other athletes who had it.

"As I gained knowledge of cardiac arrest and hypertrophic cardiomyopathy, that helped me come to the conclusion that maybe it wasn’t the right thing for me to play again," Baker said. "I was like, 'I love and miss the game, but I want to be here on this earth.' "

Nine years ago, Baker didn't like being stripped of the choice whether to medically retire or risk playing basketball. Now he says if he were running an athletic department, he too would want some control.

"They might love who you are and want you to play, but are they willing to take the risk of you losing your life?" Baker said. "It’s a gamble for both parties. So I feel that both parties should have input."