Death by misadventure verdict returned at MMA fighter’s inquest

The Portuguese MMA fighter fatally injured in a Dublin contest was rushed to hospital on the floor of an ambulance, an inquest has heard.

Joao Carvalho (28) sustained 41 blows to the head in the Total Extreme Fighting contest at the National Boxing Stadium on April 9th, 2016.

The jury at his inquest, at Dublin Coroner’s Court, returned a verdict of misadventure on Thursday evening.

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Referee Mariusz Domosat at Dublin Coroner’s Court on Thursday. Photograph: Gareth Chaney/Collins

It had heard that medics carried the injured fighter through a crowded hallway to an ambulance waiting outside.

He was rushed to the nearest emergency department unsecured on the floor in the back of the ambulance amid chaotic scenes.

Mr Carvalho, a father of two, died in hospital two days after the fight. The cause of death was blunt force trauma to the head.

The inquest heard evidence from a neurosurgeon who said he was told there was a “limited budget” for the event when he raised concerns over the presence of suitably qualified medical personnel.

Mr Carvahlo’s brother José Alexandre Silvestre travelled from the UK for the inquest. “This was his dream. It was what he wanted. He loved this sport,” Mr Silvestre said.

He did not watch his brother’s fights, he said. “It was something he always wanted in this sport, to fight in a different country.”

Heavy punches

The referee stopped the fight in the third round of what he described as an “intense” contest.

“There was loads of heavy punches but it wasn’t anything unusual. Maybe the tempo was unusual, both were fighting really hard,” Mariusz Domosat said.

He ended the fight on a technical knockout because Mr Carvalho “looked exhausted”.

“They both showed huge heart in that fight,” Mr Domosat said.

Mr Carvalho’s opponent, Irish fighter Charlie Ward, said the bout was close. He said he went to take Carvalho down and they both fell.

“He staggered back to the other side of the cage, we both fell. I punched him a number of times and then the ref stopped it,” Mr Ward said.

The pair chatted in the medical room backstage after the event.

“Joao said he didn’t expect the fight to be so tough and I said the same. He asked for a photo of me and Conor McGregor. When I heard later that he’d died I was devastated,” Mr Ward said.

Around 10 minutes after the fight, Mr Carvalho began to lose consciousness.

Medical cover was provided by EventMed, a company that provides medical support for events around Dublin. There were three doctors present and one Red Cross ambulance.

Ambulance driver Lawrence Fitzpatrick said the medical room was small and crowded and the 3ft-wide corridor was “chocabloc”.

“The stretcher was there but they literally couldn’t get him out of the room, people were standing around looking,” he said.

The patient was carried down the corridor. Inside the ambulance, Mr Fitzpatrick was told the patient was on the floor.

“It meant I had to drive safer. He’s not secured,” he said, adding this had never happened before.

Safety concerns

EventMed owner and paramedic Kate Michlic told coroner Myra Cullinane it was her decision to keep the patient on the floor for the transfer.

“The main thing is time, to go straight to hospital,” she said. Asked how the patient got on the floor, she said “I did not ask why”. There was confusion over which hospital the patient would attend. He was brought first to the Mater and later to Beaumont.

The inquest heard from neurosurgeon and Safe MMA Ireland co-founder Prof Daniel Healy who said he contacted the promoter Cesar Silva with safety concerns before the fatal fight.

“Mr Silva indicated there was a limited budget for the event and the safety standards required were not possible,” Prof Healy said.

Mr Carvahlo died two days after the fight at Beaumont Hospital on April 11th, 2016.

The cause of death was acute subdural haemorrhage due to blunt force trauma to the head, with aspiration of gastric contents as a contributory factor.

The jury returned a verdict of misadventure and recommended the endorsement of a national governing body for MMA in Ireland.

It further recommended that all medical partners engage nationally qualified paramedics and in the short term MMA Ireland adopts boxing’s safety standards.