Last week and in front of family members, Carvalho’s death was viscerally described at a coronial inquest.
Carvalho took 41 blows to the head during the bout. Attempts to provide medical care to the stricken fighter were hindered by poor access.
When Carvalho’s stretcher did eventually reach the ambulance, he was placed unsecured on the floor. In the rush to an emergency centre that could treat the swelling on his brain, Carvalho was brought first to the Mater Hospital and then to Beaumont.
Even the opaque medical terms — the cause of death was acute subdural haemorrhage due to blunt force trauma to the head, with aspiration of gastric contents as a factor — do little to hide the egregious nature of the fatality.
The jury verdict of “death by misadventure” gave Carvalho’s family some answers to what exactly happened that April evening nearly two years ago. It has also prompted questions as to the current regulation and even legal status of MMA in Ireland.
The easiest way to regulate MMA would, of course, be to prohibit it.
That perspective on MMA is more one of ethics than law.
On the one hand, there is the view — epitomised by US Senator John McCain’s 1996 phrase “human cockfighting” — that such are the inherent, intentional dangers of MMA that it should be proscribed.
The view is that if part of your risk analysis for an MMA event is to have an ambulance on standby with a plan for the quickest route to the nearest neurological centre, then it’s questionable whether it should be categorised as a sport.
In contrast, fighters like Joao Carvalho and Charlie Ward, his immediate opponent, were fully aware of, consented to and trained for the risks involved.
Moreover, many sports — horse racing, motorsports and snow sports etc where fatalities have occurred — also have detailed medical emergency plans.
Calls for prohibition may be immediately populist but, as even John McCain realised, strict regulation may be more effective in the long term.
The jury in the Carvalho inquest suggested the establishment of a national governing body for MMA.
In May of last year, Sport Ireland set up a working group to discuss with the Irish MMA Association (IMMAA) how best to regulate the sport. I chaired it and the report has now been published online by Sport Ireland.
In the immediate aftermath of Joao Carvalho’s inquest, the Minister for Transport, Tourism and Sport alluded to the report but said that the lack of progress in implementing it was because of “foot dragging” by IMMAA.
In contrast, in compiling the report and meeting with IMMAA including its leading figure John Kavanagh, Conor McGregor’s coach, I found they were acutely aware of their responsibilities.
One of the problems for IMMAA is its developmental stage.
Most similar organisations have a basic club structure that feeds into a hierarchy of governance. MMA in Ireland does not have that. Put simply, it is based around certain gyms and key individual instructors.
This means that the key difficulty is not how to regulate the sport, with IMMAA as its governing body, but whether IMMAA has the critical mass to act as a regulator in the first place.
That process can take time and even when begun might mean that the sport in Ireland must accept modified rule changes; for example, not permitting so-called ground and pound-style strikes.
In compiling the report for Sport Ireland, it was clear to me that IMMAA could learn a lot from the experience of the Irish Martial Arts Commission (IMAC), which is the governing body for a range of different martial art disciplines.
IMAC is recognised by Sport Ireland. There is a slight misunderstanding of the role of Sport Ireland in the regulation of MMA.
Sport Ireland is primarily a body which provides funding for recognised sports. In order to be recognised, a sports body must meet certain criteria relating to its constitution, corporate structure and policies on participant safety, child protection, doping etc. But it is up to the sports body itself to draft and enforce such policies.
For better or worse, that’s the self-regulatory model we have in Irish sport.
The only person with the power to intervene is, ironically, the minister, who could initiate a process of statutory regulation. Some of the states in Australia, for example, have dedicated combat sports legislation.
UFC 221 was held last weekend in the Perth Arena. Up until recently, such events had been banned in Western Australia but extra powers given to the state’s Combat Sports Commission, including onerous safety checks, allowed it to regulate and host the event.
On UFC, IMMAA is likely to want to establish a pathway from youth involvement in the sport, to competitive amateur events to professional MMA events and, possibly, UFC. Developing a coherent regulatory system for the kid who steps into a gym in Dublin and who wants to become the next Conor McGregor will take time.
The amateur and professional wings of many combat sports, notably boxing, usually have separate organisations.
As it happens IMMAA has good relations with many of the promoters of professional MMA events in Ireland and can advise on safety and welfare standards. In this, IMMAA has benefited hugely from liaising with the Safe MMA programme established by Professor Dan Healy, a consultant neurologist at Beaumont Hospital.
In contrast, some promoters of professional MMA events in Ireland appear, in effect, to be sole traders. In the absence of any regulatory oversight of their activities, and given what we now know from the Carvalho inquest, a stay should be put on any similar future events on the grounds that they are not merely “misadventures”, but illegal.
Lack of care in the octagon or ring can result in tragic loss of life but also significant legal costs.
For example, last year heavyweight boxer Magomed Abdusalamov was awarded $22m (€17.7m) in a medical malpractice claim against the New York State Athletic Commission, for lack of adequate ringside medical care in the aftermath of a bout against Mike Perez in 2013.
Abdusalamov is paralysed and needs 24-hour medical care. Another boxer who still needs significant care in Michael Watson who suffered brain trauma in a world title bout against Chris Eubank in 1991.
Watson successfully sued the boxing authorities claiming that inadequate medical attention hindered a full recovery. The British Boxing Board of Control comprehensively reviewed its medical protocols after that bout.
Exactly two weeks before the Carvalho fight in 2016, the Watson-Eubank guidelines were seen to good effect and probably saved the life of British middleweight boxer Nick Blackwell. Stopped in the 10th round of a title fight, Blackwell was rushed to hospital and put in an induced coma. Within 24 hours he was talking to family and friends at his bedside.
Blackwell’s’ opponent that night was Chis Eubank Jr.
Effective health and safety protocols can protect generations of sports participants.