An 18-year-old fighter who died following a boxing event in Quebec may have suffered from Second Impact syndrome, according to a coroner's report that includes several recommendations for the province's gaming authority and event promoters.
Jeanette Zacarias Zapata, a Mexican fighter, was knocked unconscious during a match on Aug. 28, 2021 against Quebec boxer Marie-Pier Houle and was taken away on a stretcher.
The event was held at Montreal's IGA Stadium and organized by Groupe Yvon Michel (GYM), an established promoter in the province.
Zapata died in hospital on Sept. 2 — five days after the fight.
In a report made public on Tuesday, Quebec coroner Jacques Ramsay said the 18-year-old died of brain trauma caused by repeated blows to the head.
The coroner describes the death as violent but accidental.
A lot to learn from boxer's death, coroner says
Second Impact syndrome (SIS), which the coroner brought up as a possible contributor to the boxer's death, refers to situations where people experience a second head injury before fully recovering from the first.
In his report, the coroner points out that it is a rare occurrence that has not been studied extensively.
Heading into her final fight, Zapata was coming off a knockout loss during a fight in Mexico.
During that fight, Zapata suffered several blows to the head, hung on to the ropes and and got on her knee before the referee stepped in to stop the fight. She ultimately fell to the floor.
After the fight, her father confirmed that her daughter had lost consciousness and attributed that to a lack of oxygen.
In Mexico, Zapata was prohibited from taking part in boxing-related activity for two months following her brutal loss, which is the norm in several boxing jurisdictions including Quebec, the coroner said.
More than three months went by between the fight in Mexico and the one in Montreal that led to her death, which is a much longer delay between head injuries than the ones usually included in studies about SIS, the coroner wrote.
The coroner said the brain swelling, or cerebral edema, that Zapata suffered after the fight was "major" and developed quickly.
"It was to the point that the intracranial pressure was already difficult to deal with during the first few hours in the hospital," the coroner wrote.
"The quickness with which it set in could be interpreted as a sign of Second Impact syndrome."
Studying Zapata's case could contribute knowledge on SIS, the coroner said.
Two physicians and a team of paramedics were assigned to the Montreal fight. A second team was called once it became clear that Zapata's condition was serious.
Prior to that bout, Zapata had filled out a questionnaire from the Régie des alcools, des courses et des jeux (RACJ), the gaming authority that licenses combat sporting events in the province.
"Ms. Zacarias Zapata answered 'no' to each question include the one asking if she's ever had a concussion, a head injury or experienced loss of consciousness," the coroner's report reads.
"That means she did not consider her K.O. in May to be a concussion."
Jeanette Zacarias Zapata,left, fought Marie-Pier Houle in a welterweight bout at IGA Stadium in Montreal in 2021, about 15 weeks after being knocked out in a Mexican fight. (The Canadian Press/Ho-Gym)
Tighter controls, more testing for fighters coming off K.Os
The coroner's report includes three recommendations.
He recommends the RACJ makes it mandatory for fighters coming off a knockout loss to submit a complete description of what happened, including submitting video of the fight if there is any, and a post-fight medical report.
The coroner describes this as a "shared responsibility" between the RACJ and the event promoter.
The coroner also says fighters coming off a knockout loss should undergo neuropsychological testing and those tests should be compared to previous ones.
The coroner also wants the RACJ to require combat athletes to submit neuropsychological tests when granted a licence to fight. Those tests could be used for comparison if those athletes were to ever be knocked out during competition.
In a meeting with reporters, Yvon Michel, the president of GYM, said he welcomed the coroner's recommendations.
He described Zapata's death as "one of the most difficult experiences of my career."
Houle, Zapata's final opponent, has appeared in six bouts since the incident, according to BoxRec, an online boxing database.
"Never, ever, is the intention of seriously injuring an opponent in my plans," Houle wrote in a social media message that was posted while Zapata was hospitalized.
After she died, Houle posted a separate message, saying that she felt devastated by what happened.