Fatal Four-Way: New York, Florida, Texas, Alabama, and the Test Three of Them Don’t Require

By Larry Goldberg

We said Florida was first. Here it is, next to the state that does the most, the state with the second-most fights in America, and the state whose code does the least. Four commissions, four answers to the same question: what has to be true about a man before you let him get hit in the head for money. All of this comes from each state’s own published rules.

BRAIN IMAGING

New York requires a brain MRI, dated within three years, on a minimum 1.5 Tesla magnet with six specified sequences, submitted at least three days before the bout so the Commission can actually review it. Evidence of prior traumatic brain injury on that scan is grounds for denial of a license.

Florida requires a normal MRI of the brain for applicants 40 years and older. Under 40, no imaging is required at all.

Texas requires no brain imaging at any age.

Alabama’s administrative code requires no brain imaging at any age. The commission’s own site separately hosts a medical advisory packet for fighters 41 and older that calls for an initial MRA and an MRI every three years. That packet is advisory. It is not in the rule.

Read the New York line again, because it is the one that matters. New York denies licenses based on what the scan shows. The other three all reserve the power to order imaging when someone has a reason to ask for it, and none of them has a duty to look. A commission that does not have to look usually will not, and a fighter who would fail a New York MRI never generates a file anywhere.

THE HEART

New York requires a 12-lead EKG dated within one year, for every licensed fighter.

Florida requires a normal EKG dated within twelve months, for applicants 40 and older only.

Texas requires an EKG at 36 and older. Under 36, none.

Alabama’s code requires no routine EKG.

THE TEXAS EEG

This one deserves its own line, because it is the most revealing rule in the four states.

At 36 and older, Texas requires a report of favorable physical testing including an EEG and an EKG. An electroencephalogram measures the electrical activity of the brain. It does not produce a picture of one. A bleed does not show up on an EEG. Neither does a lesion, an old hemorrhage, or a vascular malformation.

So for its oldest fighters, the second-busiest combat sports state in America checks the brain’s wiring and the heart’s rhythm, and never once looks at the structure of the organ taking the punches.

THE EYES

New York requires a dilated exam by a licensed ophthalmologist, annually. Uncorrected 20/200 or better in each eye, and corrected 20/40 or better in each eye.

Florida requires a dilated ophthalmological exam by an ophthalmologist or a certified optometrist within twelve months. Its disqualifier is blindness, defined as central visual acuity of 20/200 or less in the best eye with best possible correction. A solitary eye is disqualifying.

Texas requires an ophthalmologic exam by an ophthalmologist or an optometrist as part of licensure.

Alabama requires a dilated ophthalmological exam only for fighters who have competed in more than two hundred professional rounds. Its standard is a minimum uncorrected 20/200 in both eyes, produced upon request of the commission.

Those are not the same exam with different cutoffs. New York measures both eyes, corrected and uncorrected, and needs a real number in each. Florida measures the better eye. Alabama measures it for a fighter who has already taken two hundred rounds of punishment, if it asks at all.

THE NEUROLOGICAL EXAM

New York does not require an annual neurological exam as a licensing document, and it does not need one, because commission physicians have eyes on the fighter twice on fight weekend. Every fighter is examined at the weigh-in on Friday and examined again on Saturday night after the bout, both times by qualified doctors doing an extensive once-over rather than signing a form. Much of what a neurological exam looks for is built into both of those. New York also requires neurological clearance and sometimes an MRI after a knockout before a fighter competes again.

Florida has no routine requirement. Its rule states that if the executive director has cause to believe a participant may have suffered neurological injury, he may direct an EEG, a neurological exam, an EKG, an MRI, or a CT scan. Cause to believe, after the fact.

Texas has no routine neurological exam requirement beyond the EEG at 36.

Alabama requires a detailed neurological exam by a board certified neurologist, but only for fighters who have already competed in more than two hundred professional rounds, and then again after each successive fifty rounds.

And here is the line worth reading twice. Under Alabama’s rules, a boxer who has not submitted those results “may be allowed to compete provided however that such boxer’s license will, at the conclusion of the match, be medically suspended until such time as his neurological examination requirement is fulfilled.”

He fights first. The exam comes after. That is in the administrative code.

FREQUENCY IS NOT THE SAME AS QUALITY

Texas runs its medical exam and eye exam on a six-month clock, twice as often as the federal table will require. That sounds like a stricter state until you think about what those tests find. A dilated eye exam in January and another one in July will produce the same result in almost every case, and the physical rarely changes either. What it produces reliably is a second bill.

Meanwhile the test that would actually show something, the one that finds a bleed or a lesion or a malformation, is not required of anyone in Texas at any age.

That is the distinction that matters across all four states. Asking more often is not the same as asking the right question. A commission can run a fighter through the same exam every six months for a decade and never once look at the organ this sport is aimed at.

Credit where it belongs, though: Texas regulates boxing, kickboxing, MMA, and Muay Thai through a single program, which is the New Jersey structure. One office, every combat sport, no arguing about what to call the event. They built the right machine and then set a thin standard to run through it.

WHERE THE FEDERAL FLOOR LANDS

The Muhammad Ali American Boxing Revival Act cleared the Senate Commerce Committee last week with a medical table that applies to every professional boxer in every state. For New York it changes nothing. Florida picks up an EKG and a brain health requirement for fighters under 40. Texas picks up both under 36. Alabama gets a rewrite. But the brain health line reads, for a fighter under 40, an MRI of the brain or a neurologic examination conducted by a neurologist, and in a state whose current answer is nothing, the cheaper option is the one that gets used. The table sets no magnet strength, no sequences, and no acuity threshold. And there is no national registry, so a fighter denied in New York for a finding on his scan is an applicant with a clean file everywhere else.

None of that requires an act of Congress. Every one of those gaps is a state rule, and a rule is something a commission can change. New York wrote its standard itself. So did New Jersey, California, and Nevada. Florida, Texas, and Alabama have exactly the same authority and have made different choices with it.

Larry Goldberg is the publisher of BoxingInsider.com and a licensed boxing promoter in New Jersey and New York.