COLUMBIA — Depositions in the recently settled lawsuit filed by the family of fallen Missouri football player Aaron O'Neal show that school officials failed to follow written policies for medical emergencies when the player collapsed and later died during a 2005 summer workout.
The team of athletic trainers and strength coaches leading the voluntary workout in head coach Gary Pinkel's absence knew little about the warning signs of exercise-induced trauma brought on by sickle cell trait, despite NCAA, school and professional association requirements.
The school's strength and conditioning director, who supervised the workout, testified he lacked the necessary professional certification to be hired.
And the athletic department's sports medicine director rejected requests from concerned colleagues and players to examine the 19-year-old reserve linebacker even after he exhibited signs of medical distress, legal documents provided to The Associated Press show.
O'Neal's death has loomed large over a Missouri football program that under Pinkel vaulted into the national championship chase in recent seasons. The school kept his empty locker intact. Players and coaches chanted his name before and after games and cited his memory as inspiration.
But the July 12, 2005 death also raised questions about player safety and a school's responsibility to monitor its athletes' pre-existing medical conditions. The debate isn't limited to Missouri: in March 2008, Central Florida wide receiver Ereck Plancher — like O'Neal, a 19-year-old redshirt freshman with sickle cell trait — died in an offseason conditioning session. His parents have also sued the school.
Missouri agreed in March to pay $2 million to O'Neal's parents, settling a 3 1/2-year-old suit before trial. The settlement includes language that attributes no fault to Pinkel, athletic director Mike Alden, sports medicine director Rex Sharp, strength and conditioning director Pat Ivey and 10 other current or past university employees.
Sharp, Ivey and Alden did not reply to AP interview requests. Chad Moller, a university athletics spokesman, said the school is trying to move on nearly four years after O'Neal's death.
"People here feel that this book is closed," he said. "The most important issue for all of us was the tragic loss of Aaron."
The wrongful death lawsuit alleged that school employees failed to take necessary medical precautions triggered by the sickle cell genetic condition O'Neal carried. The hereditary trait found in an estimated 8 to 10 percent of blacks can limit blood flow during intense exercises, causing muscle breakdown that is sometimes fatal.
O'Neal, a 6-foot-3, 220-pound redshirt freshman, began to struggle about 45 minutes into the hourlong workout. Players wore shorts, T-shirts and cleats but no pads. He completed the first four of six agility drills without problem, but began to falter during the fifth drill, which he was told to repeat.
By the final drill, O'Neal complained of blurry vision. At one point, he sunk to his hands and knees. When a 300-pound offensive lineman completed the drill first, O'Neal was ordered to repeat it three more times.
"I'm trying," he said, when told to jog and not walk back into line. "I'm not weak. I just can't go on."
O'Neal eventually slumped to the ground and was helped off the field by a teammate to a nearby locker room.
In a deposition last August, Ivey testified that he expected Sharp to examine O'Neal at that point. But Sharp declined — and rebuked wide receiver Brad Ekwerekwu for "babying" O'Neal by squirting water on the player's head.
Sharp later testified in his own deposition that he did not assist O'Neal "because he thought he was a recovering athlete and I've seen that in my years of experience many times."
Ivey said he turned his attention to dealing with a small group of reporters who saw the workout. Testimony shows that Ivey and others supervising the session were worried that the performance by O'Neal and several other players would create negative publicity.
Once in the locker room, O'Neal's condition worsened. Two strength coaches left the area before strength coach Josh Stoner decided to flag down a campus landscaping truck, which then carried an unconscious O'Neal to the football team offices rather than a hospital one-quarter mile away.
The athletic department's Emergency Action Plan advises employees to call 911 "as soon as the situation is deemed an emergency ... or is life-threatening."
The emergency plan also requires immediate access to telephones should a problem arise, as well as maps to alert employees and ambulance crews to the nearest exits. Several conditioning coaches testified that the only location near Faurot Field with such equipment was inside a training room that was locked in the summer.
University employees also offered conflicting accounts about the frantic moments after O'Neal was taken from the football stadium but before he made it to the hospital.
Sharp said that once in his office he saw O'Neal in the truck. He testified that he hesitated to call 911 because Stoner came inside and said "I need help," but didn't mention O'Neal by name. Stoner testified that he immediately identified O'Neal as the player needing help.
And once Sharp went outside to the truck, he left his cell phone behind, further delaying the call for help. Another trainer inside the building then called 911. O'Neal died soon after he arrived at University Hospital, about 90 minutes after the workout ended.
O'Neal's official cause of death, according to the former Boone County medical examiner, was viral meningitis. But that was later discredited, and several outside experts cited sickle cell trait.
The depositions reviewed by the AP also describe O'Neal's teammates' doubts about that initial conclusion. During a team meeting days after his death to share the autopsy findings, senior captain Derrick Ming and team leaders Lorenzo Williams and Ekwerekwu walked out.
At least 13 college football players with the inherited blood disorder have died from exercise-induced trauma, according to the National Athletic Trainers Association. In 2007, the group issued a report urging colleges to screen for sickle cell trait. Missouri only tests its athletes at their request.
Missouri's sports medicine handbook stipulates that Sharp and his assistants be familiar with the medical literature concerning sickle cell trait. In his deposition, Sharp said he was not aware of the requirement.
Stoner also testified that he was unfamiliar with the effect of sickle cell trait on rhabdomyolysis, the stress-induced muscle breakdown that can damage cells and vital internal organs — even though handwritten notes from a 2003 Collegiate Strength and Conditioning Coaches association meeting showed he attended a symposium on the topic.
Ivey, who was hired in 2004 from Tulsa, said in his deposition that at the time of O'Neal's death he lacked certification by the National Strength and Conditioning Association, a qualification listed as a requirement on a university job description.
NCAA rules prohibit head coaches and their assistants from attending preseason summer workouts, which are billed as voluntary but in practice are anything but. Still, Pinkel — who was not at the practice — made his expectations of his players clear in letters sent to their homes before the 2005 season and included in court records.
"You must be dying to be a great player, and you must be accountable to your teammates!" Pinkel exhorted in one such letter.
Sharp, the school's head athletic trainer since 2006, was named assistant athletic director for sports medicine in 2008. Ivey, a former Missouri defensive end who played for three NFL teams, was appointed assistant athletic director for athletic performance in 2007.