Kile’s Death Could Lead to Heart Scans

It would happen occasionally on trips, when he was alone in a hotel bed, still wired from the night’s game and distracted with thoughts of his family thousands of miles away.

Scott Spiezio’s heart would race a bit, and he would wonder ever so briefly, “What’s that twitch?”

Before, the Angel first baseman would quickly dismiss any worry. He is a healthy, strong, professional athlete.

Then came June 22, when St. Louis Cardinal pitcher Darryl Kile, 33 years old and in the prime of his career, was found dead in a Chicago hotel room. A final autopsy report released Tuesday revealed Kile’s coronary arteries were 90% blocked, and that coronary atherosclerosis (hardening of the arteries) caused his death.

Spiezio has suddenly reassessed those little twitches in his chest.

“What I’ve learned,” he said, “is that it might be something I’d never expect.”

The annual physical examinations major league players typically have during spring training do not routinely include the types of tests that might have indicated Kile was in danger.

Some players are hopeful that will change and say teams should make heart scans routine.

“I would think a lot of guys would be receptive to that,” Dodger catcher Paul Lo Duca said. “When you’re at this level, it’s easy to think you’re invincible.

“If a guy is shown to have high blood pressure or cholesterol or to have a family history, why wouldn’t you want to take [the scan] to follow up on it? ... It’d be a relief.”

Language in Major League Baseball’s collective bargaining agreement allows for heart scans to be used during physicals, but there is no immediate plan to make such tests mandatory.

“It’s so soon [after Kile’s death] that the idea of instituting a policy just can’t be answered right now,” said Vince Wladika, Major League Baseball’s public relations business director. “There is a tendency when something like this happens to have a knee-jerk overreaction. We don’t want to not react to this, but the way things like this usually get addressed are after we sit down and have a discussion about it with the union.”

The current collective bargaining agreement includes a passage that reads: “The player, when requested by the club, must submit to a complete physical examination at the expense of the club and, if necessary, to treatment by a regular physician or dentist in good standing.”

What is considered “complete” is open to interpretation, but no existing rule forbids treatment such as a heart scan.

St. Louis Cardinal trainer Barry Weinberg cited doctor-patient confidentiality when asked about what Cardinal doctors knew of Kile’s heart condition and his family history of heart problems. Kile’s father, David, died at age 44 after a heart attack in 1993. Jay Alves, a spokesman for the Colorado Rockies, refused to comment on any medical treatment Kile received during the 1998-99 seasons with that team.

“Our club obviously wants our players in the best shape possible and we want to check out whatever is a concern to them or an issue in their family’s history,” Alves said.

Said Rob Manfred, Major League Baseball’s executive vice president for labor relations and human resources: “The contents of the team physical are at the discretion of team doctors; they have the right to control the players’ care. Our view is that if the doctor believes [a heart scan] is an appropriate part of the physical, they are obligated to use it. I would not expect any kind of fight on this from the players. After all, who would want to be responsible for a guy not taking the test if something happened to him afterward?”

One players’ agent who didn’t want to be identified said some players might be reluctant to have a heart scan because it is “something new and out of the ordinary.”

But seven players interviewed during June’s Angels-Dodgers series at Edison Field said they would welcome a heart scan.

“I think it’s reasonable to say that Darryl Kile is proof that if more measures were taken, maybe it would have saved his life,” Dodger center fielder Dave Roberts said.

Said Angel shortstop David Eckstein: “There might be a fine line for things we shouldn’t agree to, but I don’t know where that line’s at, and I don’t think it’s this. Shoot, this could save your life and [the owners and MLB] are just making sure we’re OK.”

Barry Axelrod, Kile’s agent, said team-prescribed heart scans would be beneficial.

“But I don’t know if you need to legislate that,” Axelrod said. “If a player checks ‘Yes’ to other health conditions in his family history, do you mandate additional testing for all those, too? That might be overkill.”

There are two widely used heart scans. The Electron Beam Computed Tomography (EBCT) scan is designed to reveal calcium buildups in arteries. An EBCT is commonly used in full-body scans that can detect such problems as brain tumors, lung cancer and kidney stones. The procedure usually lasts about 15 minutes.

A Myocardial Perfusion Imaging test, which typically lasts one hour, requires the injection of a radioactive chemical compound and allows cardiologists and radiologists to view blood flow around the heart.

“If you see accumulation or reduced blood flow around the heart, there is likely some [heart] disease or blockage,” said Dr. Heinrich Shelbert, a cardiologist and radiologist who is a UCLA professor of molecular and medical pharmacology.

Because of the radiation exposure involved, the American Cancer Society and American College of Radiology don’t recommend scans for patients without risk factors, such as family history, high cholesterol, high blood pressure, diabetes or obesity.

In American Heart Assn. guidelines published Tuesday in its journal, an expert panel reported patients as young as 20 should be screened to prevent heart disease and strokes if they have two risk factors.

“The radiation is no more than that in an X-ray, and you know how many X-rays we’ve had in our careers?” Angel designated hitter Brad Fullmer said. “This is a good thing. We’re talking about a test that can rule out if you have signs of the leading cause of death.”

Shelbert said the ideal way to incorporate the Myocardial Perfusion Imaging test is as a follow-up examination for those identified with risk factors.

That would ease the workload for team doctors who opt to use the heart scan during the start of spring training, when all players in major league camp--typically about 65--undergo physicals.

“If you do have one of the risks, my stance is you can’t lose by using this,” Shelbert said. “If there’s something wrong, the test will show it.”

The EBCT scan costs about $400. The Myocardial Perfusion Imaging test is about $800. Shelbert said about six million Myocardial Perfusion Imaging tests will be performed on Americans this year, an increase of 400,000 from 2001.

The thoroughness of spring training player physicals is inexact. Although intense scrutiny in spring and postseason physicals is sometimes required of big-contract players by insurance companies, examinations vary among teams. Blood pressure and cholesterol level checks are routine, as are questions about family health history.

Yet two veteran Dodger players said they have never been asked to submit to an electrocardiogram test, much less a stress test in which an EKG reading is taken from a player running on a treadmill.

Dodger outfielder Marquis Grissom said a physical during his rookie year with the Montreal Expos confirmed the heart murmur he had since childhood. After further tests, Grissom was cleared to play.

“Anything health-wise, I’m going for, whether I like it or not,” Grissom said. “When something like [Kile’s death] happens, you really have to look at it. The guy was 33. With the great shape we have to be in to go out there, when something like that happens, we should do whatever we can to prevent it or keep it from happening to somebody else.”

Angel General Manager Bill Stoneman said he is in the process of arranging a discussion of heart scans among some players and team doctors Lewis Yocum and Craig Milhouse.

“This is a topic of internal discussion here: What place does this have?” Stoneman said. “Darryl Kile’s death was a tragic, sudden and unexpected event and we’ve been inundated with calls from companies who offer the scans. We want to do the right thing and we want our decision on this to be made intelligently.”

The timing for MLB officials to demand heart scans of all players amid ongoing labor negotiations is prickly and the deep divide on another health issue, testing for steroids. Baseball owners have submitted a steroid testing policy, but the union has balked at what it considers a privacy issue.

Said a source from the owner’s side: “Of course it’s to our benefit for our players to be healthy, but how far can we extend these health issues right now?”

Players can always take the initiative and arrange a heart scan through their personal physicians. But even that scenario has issues, said one agent who requested anonymity.

“A lot of players don’t even have personal physicians,” the agent said. “They have [orthopedic surgeons] they go to for things like knees and ankles, but do most of them have a general internist? No. They’re in such good health, they usually just take the physical in spring and they’re on their way. The only outside doctor they really have is a dentist.”

Lo Duca and Fullmer confirmed that to be the truth in their cases.

But Spiezio isn’t waiting around for a policy to be finalized. He asked Angel trainer Ned Bergert to arrange a heart scan.

“I’ve already signed up for one and I’m willing to pay for every member of my family and my wife’s family to take one too,” Spiezio said. “I have two small kids, and when I saw [Kile’s] three kids at his memorial, that crushed me.”

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Staff Writer Gary Klein contributed to this report.