According to our review of congressional testimonies and national studies on professional boxing dating from 1994 through 2002, 15 fundamental elements are considered important in helping address the sport’s major problems. Six elements could help to protect the health and safety of professional boxers, four could help to protect their economic interests, and five could help to correct problems affecting the integrity of the sport. The six elements that could help to protect the health and safety of boxers would provide medical examinations, including neurological testing; monitoring of training injuries; assessments of medical risks; health and life insurance; the presence of appropriate medical personnel and equipment; and enforcement of suspensions for injuries. According to the testimonies and studies, these elements are important because, although the overall rate of injury is lower in professional boxing than in many other sports, the risk of severe or permanent brain injury is greater. Neurological testing may be needed to detect such injury. Furthermore, because injuries may occur during training and sparring as well as during boxing events, monitoring during training was recommended, and health and life insurance may be needed before and after as well as during events. In some instances, the treatment a fighter receives in the initial minutes after an injury determines whether the fighter recovers or sustains permanent damage or death. Having an ambulance and qualified medical personnel on-site, rather than on call, can be critical. Enforcement of suspensions imposed by boxing commissions in other states is important to prevent injured boxers from trying to fight outside the states in which they are registered before their injuries have healed. The four elements that could help to protect boxers’ economic interests would require pension plans for boxers, require full disclosure of purses and payments, require minimum uniform contractual terms between boxers and prohibit conflicts of interest. Without a union to represent their economic interests, boxers have often been exploited, and although the sport has generated enormous wealth for others, many professional boxers have been left penniless. Comprehensive pension plans for boxers are almost nonexistent, and boxers have sometimes been left to pay trainers out of their share of the fight purse when the financial responsibilities of promoters and managers were not disclosed in advance. Conflicts of interest between promoters and managers and long-term contracts with promoters have also disadvantaged boxers. The 5 elements that could help to correct problems affecting the integrity of the sport would require registration and training for judges, referees, and others; prevent sanctioning organizations from exercising undue influence in the selection of judges; establish uniform boxing and scoring rules; require reviews of sanctioning organizations’ rankings of boxers; and require knowledge of the sport for commission officials. Reports of unqualified officials, last-minute changes in the procedures for selecting judges, nonstandard boxing and scoring rules, fraudulent rankings that have resulted in injury and even death for weaker boxers, and political appointments to boxing commissions have undermined the integrity of the sport. Table 1 sets forth the 15 elements we identified. For more detailed information on the problems discussed in the testimonies and studies and the recommendations made to address these problems, see appendix II. The act’s provisions fully or partially cover 10 of the elements that we identified as important to address the health and safety, economic, and integrity problems facing professional boxing. Our analysis shows that one of the act’s provisions fully covers the element that requires evaluations of medical information on boxers and assessments of the risks involved in allowing them to fight before each match. The act’s provisions partially cover 9 elements. For example, one provision partially covers the element requiring medical examinations, including neurological testing, before and after a fight. (The provision requires prefight, but not postfight, examinations and no neurological testing.) Another provision partially covers the element requiring the presence of medical personnel and equipment at fights and the filing of postfight medical reports. (It requires the presence of medical personnel and equipment, but not the filing of postfight medical reports.) Table 2 sets forth our analysis of the extent to which the act’s provisions cover the fundamental elements we identified. On March 13, 2003, the Senate Committee on Commerce, Science, and Transportation approved S. 275, a bill that would further amend the act. If enacted, the proposed legislation would expand the act’s coverage of four fundamental elements—those dealing with the evaluation of medical information, minimum contractual terms, the selection of judges, and reviews of rankings. In addition, the proposed legislation would establish the United States Boxing Administration (USBA) within the Department of Labor and empower it to consider other fundamental elements in addressing professional boxers’ health, safety, and other concerns. USBA would be responsible for providing oversight, administering the federal boxing laws, and issuing minimum standards to protect the health, safety, and general interests of professional boxers. Its responsibilities would also include licensing boxers, promoters, managers, and sanctioning organizations and maintaining a registry of medical records and medical suspension information on all boxers. USBA would also be authorized to conduct investigations and to suspend or revoke licenses for misconduct after providing notice and hearing. The 8 state and 2 tribal boxing commissions that we reviewed varied in the extent to which they had documentation indicating compliance with the 10 provisions of the act related to the fundamental elements we identified. The act does not require the commissions to document their compliance. However, because documentation constituted the only verifiable evidence of compliance, we reviewed all available documentation in the commissions’ event files, including pre- and post-fight medical examination check sheets, insurance coverage forms, copies of contracts between boxers and promoters, event sheets identifying boxers’ registration numbers, promoters’ revenue reports to commissions, and statements of independence signed by ring officials. All 10 commissions had documentation indicating compliance at least 75 percent of the time for three provisions—those that require prefight medical examinations, disclosure of amounts paid to promoters, and registration of boxers—but only 2 commissions had documentation at least 75 percent of the time for the provision prohibiting conflicts of interest. (See fig. 1.) Five of the commissions said they usually complied with this provision but did not document their compliance. The 10 commissions’ documentation for the remaining six provisions varied within this range. (See table 4 in app. 3 for the results of our analysis of the commissions’ documentation.) When asked why they did not always document their compliance with the provisions, the commissions often did not provide a reason, but when they did, they generally pointed to privacy or liability concerns, said they were unaware of the federal provisions, or said they thought documentation was not needed. For details on the reasons the commissions provided for not documenting compliance, see appendix III. The eight states and two tribes that we reviewed vary in the extent to which their provisions cover health and safety and economic elements in addition to those covered in the act. Each of these states and tribes has some provisions that cover additional fundamental elements or portions of fundamental elements. The number of such provisions enacted by an individual Commission ranges from 10 (California) to 4 (Missouri). All 10 states and tribes have provisions fully covering the additional element that requires uniform boxing and scoring rules, and eight states or tribes have provisions fully covering the additional element that requires the filing of postfight medical reports. California was the only state with provisions fully covering 3 other additional elements—for monitoring injuries sustained during training, enforcing suspensions for debilitating training injuries, and providing pension plans for boxers. Four states or tribes have provisions that go beyond the act in requiring postfight medical examinations, but none of these states or tribes requires neurological testing. Similarly, three states or tribes have provisions that go beyond the act in requiring that boxers be provided with health insurance before and after, as well as during, each match, but none of these states or tribes requires life insurance. Figure 2 summarizes the results of our analysis. The primary reason provided by the states and tribes for not having provisions covering additional elements was that the provisions would be too costly to implement. For more details, see appendix IV. Actions taken by the Department of Justice under the act have been limited. Justice officials said the department does not prosecute cases unless they are referred to it by federal law enforcement agencies. There were no records of cases brought by U.S. Attorneys under the federal boxing legislation during fiscal years 1996 through 2002, and there were no referrals from law enforcement agencies. Because the act provides for state and civil remedies in addition to federal criminal prosecution, Justice officials said that cases could be referred to state authorities rather than to U.S. Attorneys. Furthermore, the officials said, violations of the act are misdemeanors, and U.S. Attorneys generally pursue only felony cases, although they would prosecute a misdemeanor if circumstances warranted. In commenting on a draft of this report, the president of ABC said that ABC had made two referrals to U.S. Attorneys’ offices. The first, made in October 2002, concerned the World Boxing Association’s ratings of a boxer. According to the ABC president, the referral was dismissed because the World Boxing Association provided the U.S. Attorney with a copy of its rating criteria and the boxers were well known. The ABC president said that the other referral, made to the Arkansas U.S. Attorney in 2001, reported that professional boxing was occurring in bars without the supervision of the Arkansas boxing commission. The ABC president said that ABC had not received a response to the referral and the case had not been prosecuted. The Federal Trade Commission’s (FTC) responsibility under the act is limited to making available to the public the information it receives from sanctioning organizations. FTC has no responsibility for enforcing compliance or verifying the accuracy of the information. FTC officials said they periodically check the sanctioning organizations’ Web sites to assess whether the required information has been made available to the public and has found the Web sites to be adequate. Our review of the Web sites of 14 sanctioning organizations found that this information was posted on the Internet. FTC officials also said they had not received any consumer complaints related to the boxing industry. In February 2003, legislation was introduced in the Senate that would amend the act by, among other things, creating a new organization within the Department of Labor to provide oversight and enforcement of the federal boxing laws. The purpose of this new federal organization is to facilitate more uniform enforcement of federal requirements designed to enhance boxers’ health, safety, and economic interests as well as the integrity of the sport. This organization would have the authority to issue regulations, including requirements for documentation; to monitor and oversee the commissions’ compliance with the existing federal protections for professional boxers; and to establish additional protections, if necessary. Although our review was limited to eight state and two tribal boxing commissions, the uneven documentation of compliance we found with the act’s provisions to protect the health, safety, and economic well-being of professional boxers does not provide adequate assurance that professional boxers are receiving the minimum protections established in federal law. Without complete and accurate information on the extent to which the act is being enforced and without a federal agency to proactively ensure nationwide compliance, there is little assurance of compliance. While the Justice Department has the authority to prosecute violations of the act, it focuses its limited resources on prosecuting felonies, is not responsible for monitoring compliance, and would prosecute a case only if it received a referral from a federal law enforcement agency. Since 1996, it has received no referrals from federal law enforcement agencies and pursued no cases of violation of the act. If enacted, the legislation would create a new organization within the Department of Labor that could address this gap in the oversight and enforcement of the federal boxing laws. We requested comments on a draft of this report from the Department of Justice, the Federal Trade Commission, and the Association of Boxing Commissions (ABC). The Department of Justice’s GAO liaison and the Federal Trade Commission’s GAO liaison and Office of General Counsel provided only oral technical comments, which we incorporated as appropriate. The president of ABC provided written comments, which are reproduced in appendix VI. We also provided the boxing commissions of the eight states and two tribes that we reviewed with the opportunity to review and comment on the facts in the report that related to their operations. We received written comments from the Missouri, Miccosukee, Mohegan Sun, Pennsylvania and Texas boxing commissions; these comments appear in appendixes VII through XI. As of July 16, 2003, we had received no comments from the California, Florida, Indiana, Michigan, and Nevada boxing commissions. In his written comments, provided on June 30, 2003, the president of ABC said that while ABC has had some successes, much work needs to be done to achieve uniformity in the regulation of boxing. He said that feedback from ABC’s membership on federal involvement in regulating professional boxing is mixed: many members regard such involvement as intervention, while others welcome it. He also said that some members believe that making certain types of testing (e.g., neurological testing) mandatory would have a negative impact on their jurisdictions because of the cost. According to the president, ABC is frustrated with the lack of enforcement of the Professional Boxing Safety Act of 1996. He said that violations of the act occur frequently, yet no government agency has been willing to enforce the current laws. The president said that he hopes the members can use the act’s 10 provisions as a starting point for standardizing the regulation of boxing. The Administrator of the Missouri Office of Athletics, who is also the president of ABC, provided written comments on the portion of a draft of this report applicable to Missouri on June 30, 2003 (see app. VII). While noting that the Missouri Office of Athletics encourages the standardized regulation of boxing, he said he also recognizes that any actions taken will have an economic impact on the sport that will have to be considered. In addition, he questioned who would enforce any new federal boxing provisions and stated the current law is not being enforced. He said that both state and tribal boxing commissions, through ABC, should work to standardize the regulation of boxing in the areas discussed in our report. He also made some technical comments, which we incorporated in the body of the report. The Miccosukee, Mohegan Sun, Pennsylvania and Texas boxing commissions also provided written comments, which appear in appendixes VIII, IX, X, and XI, respectively. In their comments, they expressed appreciation of our work, indicating, for example, that our report helps to clarify issues related to the protection of boxers’ health, safety, and economic interests. In addition, the Miccosukee and Pennsylvania boxing commissions cited tribal or state regulations that cover portions of some of 15 the elements we identified in the report as fundamental to protecting boxers’ health, safety, and economic interest and to enhancing the integrity of the sport. In some instances, the Miccosukee and Pennsylvania boxing commissions noted that it would be difficult for them to implement certain elements because of personnel and budgetary constraints or because of their limited jurisdiction. For example, the Miccosukee commission said that it could not monitor training injuries because it would not be feasible for the Miccouskee commission or any other boxing commission to send representatives to gyms throughout the United States and other countries to monitor real time training injuries. The Miccosukee commission also indicated that in the future it could complete and file checklists in event files to document its compliance with certain provisions, such as the one requiring the presence of appropriate medical personnel and equipment during and after events. The commission said that the lack of documentation in its files does not adequately reflect its compliance with this provision. The Pennsylvania commission noted the diversity among various boxing commissions in implementing the federal law. Finally, the Texas commission said it lacked authority to implement several of the 15 fundamental elements identified in the report. We recognize that boxing commissions vary in their approach to regulating boxing because of differences in their laws or regulations, local situations, and available budgetary and personnel resources. Furthermore, we recognize in our report that a lack of documentation does not necessarily mean that a requirement was not met. However, we had no other practical means to assess the extent to which the federal requirements were being addressed. Additionally, we agree with the Miccosukee commission that appropriately completed checklists would help to document compliance. Finally, we believe that our findings, along with the comments we received on our draft report, should provide Congress with useful information as it considers S. 275. As agreed with your office, unless you publicly announce its contents earlier, we plan no further distribution of this report until 5 days after the date of this letter. At that time, we will provide copies of the report to the Ranking Minority Member, Senate Committee on Commerce, Science, and Transportation, and the Chairman and Ranking Minority Member, House Energy and Commerce. Copies of the report will also be sent to the Attorney General, the Chairman of the Federal Trade Commission, the Secretary of Labor, the Association of Boxing Commissions, the California State Athletic Commission, the Florida State Athletic Commission, the Indiana Boxing Commission, the Michigan Bureau of Commercial Services, the Missouri Office of Athletics, the Nevada Athletic Commission, the Pennsylvania Athletic Commission, the Texas Boxing and Wrestling Program, the Miccosukee Athletic Commission, and the Mohegan Tribal Gaming Commission Athletic Unit, and to others on request. In addition, the report will be available at no charge on the GAO Web site at http://www.gao.gov. Key contributors to this report are listed in appendix XI. If you or your staff have any questions, please contact me on (202) 512-2834 or ungarb@gao.gov. State or Indian tribal commission Miccosukee (FL) Mohegan Sun (CT) Mashantucket Pequot (CT) 1% (Continued From Previous Page) State or Indian tribal commission Washington, D.C. Saginaw Chippewa (MI) Pueblo de San Juan (NM) Oneida (NY) Yakahama Nation (WA) For each of the 15 fundamental elements that we identified, this appendix provides a summary of a major problem in professional boxing that the element is designed to address. The summaries are based on the congressional testimony and national studies—by the National Association of Attorneys General (NAAG) Task Force, the Department of Health and Human Services, and the Department of Labor—that we reviewed. The summaries also include recommendations made at the hearings and in the studies to address the problems. The problems are divided into three categories: health and safety, economic protection, and integrity of the sport. In June 1998, the U.S. Department of Health and Human Services reported the results of a study mandated by Congress on health, safety, and equipment standards for boxing. The study found that although the overall rate of injury is lower in professional boxing than in many other sports, the risk of sustaining a severe or permanent brain injury is greater in boxing because fighters are exposed to repeated blows to the head. Head injuries account for a significant portion of all boxing injuries. Factors such as poor boxing ability, reduced supervision, and small stature are thought to increase the likelihood of traumatic head injury. Similarly, the length of a boxer’s career and the total number of bouts in training, sparring, and competition combined have been linked to the severity of neurological damage. Because neurological damage is not always detected during routine medical examinations, neurological testing may be necessary to identify it. According to a professional boxing trainer with over 25 years of experience whom we interviewed, boxers are required to train and spar in the gym daily for months in preparation for a fight. He said that during the sparring sessions, many boxers sustain injuries that are not reported to the boxing commissions. As a result, some of the boxers participate in events with pre- existing injuries, exposing themselves to further injury or harm. In an effort to protect the health and safety of professional boxers, the NAAG task force recommended in 2000 that state inspectors inspect boxing gyms if adequate funding and staff are available. To help protect the health and safety of boxers, the NAAG task force recommended that all commissions implement a medical classification system that would establish risk levels for boxing injuries. For a fighter whose record included any element of a high-risk classification (e.g., repeated knockouts), the task force further recommended that commissions be required to impose a temporary suspension until the fighter received a medical clearance or required examination, such as a neurological examination conducted by a neurologist using magnetic resonance imaging and an electrocardiogram. In 2001, a representative of the Nevada Attorney General testified that although common sense dictates that an on-site ambulance is needed for all boxing matches and should be available to transport an injured boxer to a hospital, many promoters would prefer to call 911 if an ambulance is needed. The representative said that while this arrangement may be more cost-effective for the promoter, the treatment of a fighter in the initial minutes after an injury—whether waiting for an ambulance to arrive or receiving immediate and appropriate medial care—is critical in determining whether the fighter will recover or suffer permanent damage or death. Similarly, in 1983, the World Medical Association said that professional boxing events should be held in locations where adequate neurosurgical facilities are immediately available for emergency treatment of an injured boxer, a portable resuscitator with oxygen equipment and appropriate endotracheal tubes are available at ringside, and an ambulance is continuously on-site to transport any seriously injured boxer to a hospital immediately. The Professional Boxing Safety Act of 1996, as amended (the act), requires the continuous presence of a ringside physician and an ambulance or medical personnel with appropriate resuscitation equipment at each boxing event, unless equivalent protection is required by the boxing commission’s provisions. A Pennsylvania Athletic Commission official testified in May 2001 that boxing commissions should be required to develop criteria for licensing professional boxers, which should include reviews of boxers’ fight records (i.e., wins, losses, knockouts) and suspensions, and a centralized database of medical examination information on all licensed boxers. He said that the database should be accessible only to boxing commission officials and would provide boxing commissions with an additional screening mechanism to use in their license determination process. The president of the Association of Boxing Commissions (ABC) told us that current insurance provisions require promoters to provide health insurance coverage only during a boxing event. However, he said such coverage does not protect boxers in other instances when they may need medical treatment but do not have health insurance or the financial resources to pay for treatment. For example, boxers may sustain injuries during an event but not recognize until later that they have been injured and need treatment. Many boxers also sustain injuries during training or sparring. In 1996, a New Jersey Boxing Commission representative testified that boxers spend far more time sparring in gyms than competing in events; as a result, they are more likely to sustain injuries during this period. The representative said that to prevent injuries to the head and other parts of the body, the amount and intensity of sparring should be monitored. A trainer we interviewed said that boxers should have health and life insurance coverage throughout the training period, as well as before, after, and during an event, in order to address any medical conditions or injuries. However, he said many insurance companies do not offer boxers health and life insurance at affordable prices. In 2002, the president of ABC testified before the Senate Committee on Commerce, Science, and Transportation on the need for the uniform enforcement of all suspensions imposed by boxing commissions. Currently, such enforcement is applicable only to suspensions imposed on boxers for recent knockouts or for a series of consecutive losses and medical reasons. The president said that in some instances, commissions have suspended boxers for falsifying documents or other types of inappropriate behavior and that to avoid serving the imposed suspensions, some boxers have traveled to other states and obtained a license to continue boxing. Professional boxing offers no long-term financial protection for its participants, although purses for the big events are in the millions of dollars and televised worldwide, often on a pay-per-view basis. The New York State Attorney General testified in 1999 that the boxing industry has generated enormous wealth for virtually everyone except professional boxers. He added that over the decades, the interests of professional boxers have been ignored, leaving many penniless and medically at risk. In 1996, Congress mandated that the Secretary of Labor undertake a study on the feasibility of establishing a pension plan for professional boxers. According to the study, apart from programs run by the California commission and by the International Boxing Federation for its championship fights, comprehensive pensions for boxing are virtually nonexistent. The study concluded that a comprehensive program, if implemented for professional boxers, would consist of a charitable trust, a defined contribution plan, a defined benefit plan, and a disability income and survivor’s benefit program. In 1997, a reporter testified that in 1986 a boxer was guaranteed $300,000, with up to another $100,000 in training fees, for a fight. Out of a potential $400,000, the boxer was paid about $99,000. The manager did not pay the trainer and the boxer paid the trainer out of his share of the purse, leaving the boxer with $69,000. To address problems such as this, the NAAG task force study recommended that a model contract be developed to outline contractual disclosure requirements between the promoters, managers, and boxers. The model contract should specify the rights and responsibilities of all parties, such as the contest requirements, compensation (including a full accounting and disclosure of all deductions from a boxer’s purse), licenses, and remedies for lack of good faith, collusion, or breach of contract, including arbitration provisions. A Texas Boxing and Wrestling Program official cited reports of fights in which a manager managed both boxers and the manager and promoter were related. Such business arrangements limited the boxers’ chances of receiving fair payment. The official said that in theory, a manager is supposed to negotiate the most favorable economic terms for the fighter, while the promoter is supposed to make the largest possible profit on the event. There are frequent reports of boxers’ economic exploitation. For example, in January 2003, officials of the Mohegan Tribe Department of Athletic Regulations reported that a boxer had been fighting for more than a year and had never received payment for participating in events throughout the United States, although the manager was receiving the boxer’s fight purses. For this violation, the commission revoked the manager’s license for an indefinite period. In 2001, a Pennsylvania Athletic Commission official said that for years fighters have been contractually tied to promoters for a series of boxing events, limiting their ability and opportunities to pursue other promoters and to box in other events. The official said that the Muhammad Ali Boxing Reform Act, which limits the contracts between the boxer and promoter to 1 year, is a step in the right direction to correct this problem. A Nevada State Athletic Commission official testified in 1994 that boxing referees have to decide in a split second which fighter has won a bout. Accordingly, he said, judges should have the ability to closely observe the fighters and base their decisions on consistent scoring criteria. The NAAG task force made recommendations to help enhance the integrity of the sport, including the following: ABC should develop a standardized testing program to be administered to judges and referees. Judges and referees should be required to pass this examination before they receive their licenses. To be licensed as a referee, an individual should have prior experience officiating in amateur competition or in other states or jurisdictions. All referees should be required to receive training and attend a minimum of two medical training seminars each year. To be licensed as a judge, an applicant should be proficient in the rules and regulations of boxing and have prior experience officiating in amateur competition or in other ABC states or jurisdiction. To be licensed as a ringside physician, a physician should have a state medical license, be in good standing in the respective state, and have experience as a licensed physician for a minimum of 2 years. Ringside physicians should be required to receive training in ringside medicine. Promoters and managers should be licensed and regulated. The president of ABC testified in 2002 on the need for standards to prevent sanctioning organizations from interfering with boxing commissions’ selection of judges and referees. According to the president, that need was demonstrated during a nationally televised championship fight in 2001. He said that several weeks before the scheduled event, the sanctioning organization and the state boxing commission agreed that the sanctioning organization would designate the referee and one judge and the commission would designate the remaining two judges. However, less than 5 minutes before the event was to begin, a representative from the sanctioning organization threatened to withdraw the organization’s sanction—an action that would reduce the status of the fight to a nontitled event—if the commission did not agree to replace one of the judges selected by the commission with a judge designated by the sanctioning organization. The commission agreed to the sanctioning organization’s demands in order to retain the title status of the fight. Because the sanctioning organization was allowed to select two of the three judges, the president of ABC said the outcome of the event might have been compromised. In June 1996, a former Nevada Athletic Commission official testified that every boxing match in the United States should be conducted under the same boxing and scoring rules. While noting that ABC has established Unified Championship Rules for title bouts, he said that some commissions do not implement the same rules. The official said that standardizing boxing and scoring rules is important because fighters can have difficulty concentrating on protecting themselves in the ring when they are trying to remember whether a particular state uses a rule. Similarly, it is difficult for referees to focus on a bout if they are worrying about changes in the rules for different bouts. The NAAG task force study reported that sanctioning organizations’ rankings often are not based on objective assessments of talent or records of fighters’ wins and losses. Instead, according to the study, boxers associated with certain promoters may be highly ranked regardless of their skill and ability. The study reported that this creates fraud that can have deadly consequences. For example, a fight advertised as a major championship battle may turn out to be a mismatch, as was a bout held on November 13, 1982, between Ray “Boom-Boom” Mancini and Duk Koo Kim of South Korea. Mancini knocked out Kim, who never regained consciousness and died. The World Boxing Association had rated Kim as a top contender, even though he was not among Korea’s top 40 fighters. In 2002, an entertainment manager testified that state boxing commissions are generally underfunded and dominated by political appointees with limited knowledge of the sport. He said that many of these officials do not understand the boxing industry well enough to regulate it. This appendix presents the results of our analysis of the eight state and two tribal boxing commissions’ documentation of compliance with the act’s provisions and provides information on the reasons given by the commissions for not having documentation. Figure 3 summarizes the results of our analysis of the commissions’ documentation. The remainder of the appendix provides information on the extent to which the 10 boxing commissions had documentation indicating compliance with each of the act’s provisions related to a fundamental element. For the commissions that did not have or did not provide documentation for our review, the appendix also includes the reasons given by the commissions for not having or providing the documentation. When a reason is not specified, the commission did not provide a reason. Four of the 10 state and tribal boxing commissions (California, Indiana, Michigan, and Missouri) provided us with documentation of compliance less than 50 percent of the time with the act’s provision requiring the evaluation before each match of medical information and the assessment of risks involved in allowing a boxer to fight. The Missouri boxing commission said that it does not collect and maintain medical information because state law concerning confidentiality, disclosure, and civil liability issues prohibited them from doing so. The Michigan boxing commission said that they were advised by its legal counsel to limit the amount of medical information collected due to the commission’s limited authority to collect and protect such information. The Indiana Boxing Commission said it maintained medical information on professional boxers, but would not provide that information for review because of confidentiality and civil liability concerns. A Texas official said that the Texas Boxing and Wrestling Program used prelicense and prefight examinations, along with information obtained from Fight Fax, Incorporated, detailing a boxer’s record of wins and losses and medical suspensions, to assess the risks involved in allowing a boxer to fight before each match. This official added that when reported information indicated that a boxer’s physical condition was questionable, the commission might require the boxer to undergo additional medical tests to ensure that he or she was not participating in an event with a pre-existing injury. According to the official, the Texas Boxing and Wrestling Program does not disclose medical information it maintains on boxers to other commissions because of confidentiality and civil liability concerns. The California State Athletic Commission said it maintained medical information, such as the results of annual physicals and any neurological tests, on professional boxers registered in California, but it did not make this information available for review during our visit to the commission. Seven of the 10 state or tribal boxing commissions (Florida, Michigan, Nevada, Pennsylvania, Texas, Miccosukee, and Mohegan Sun) had documentation at least 75 percent of the time for the provision requiring minimum uniform contractual terms between boxers and promoters; the Indiana Commission had documentation 50 to 74 percent of the time; and the California and Missouri commissions had documentation less than 50 percent of the time. The Director of the Indiana Boxing Commission said that the commission’s representatives were responsible for obtaining copies of all contracts between promoters and boxers before an event and for ensuring that boxers were paid in accordance with the contractual terms. However, contracts between the promoters and boxers were missing from most of the commission’s event files. The director said that in some cases boxers forgot to forward their bout agreements to the commission after the matches. The Executive Officer of the California State Athletic Commission said that the contractual agreements between boxers and promoters were submitted to the commission before events and no events were held unless copies of the agreements were on file. However, many of the 2001 event files that we reviewed had no documentation of contractual agreements between boxers and promoters. No reason was given for the missing contracts. According to a Missouri Office of Athletics official, its legal counsel advised the commission against requiring boxing contracts because such agreements involved civil matters that were outside the jurisdiction of the Missouri Office of Athletics. Nine of the state and tribal boxing commissions (Florida, Indiana, Michigan, Missouri, Nevada, Pennsylvania, Texas, Miccosukee, and Mohegan Sun) that we reviewed had documentation at least 75 percent of the time for the provision requiring standards for rating boxers’, considering their records of wins and losses, weight differentials, caliber of opponents, and numbers of past fights, to protect against mismatches. The California State Athletic Commission was the only commission we reviewed that lacked documentation for this provision. According to the Executive Officer, the commission reviewed the reports of Fight Fax, Incorporated, and the commission’s chief inspector determined whether boxers were matched in accordance with their boxing skill levels, but the commission did not maintain any records on this process. All 10 of the state and tribal boxing commissions had documentation at least 75 percent of the time for the provision requiring medical examinations before fights. Six of the 10 state and tribal boxing commissions (California, Indiana, Missouri, Nevada, Pennsylvania, and Miccosukee) had documentation less than 50 percent of the time for the provision requiring the presence of appropriate medical personnel and equipment during and after each match. Officials from these 6 commissions said that no fight would proceed without emergency medical service and an ambulance on-site during events, but they did not document their compliance with this requirement. Furthermore, in commenting on a draft of this report, the Administrator of the Missouri Office of Athletics noted that the act does not require such documentation. The Florida, Michigan, Texas, and Mohegan Sun boxing commissions documented the presence of emergency medical personnel and equipment during the events at least 75 percent of the time. Three of the 10 state and tribal boxing commissions (Florida, Indiana, and Michigan) lacked documentation at least 75 percent of the time for the provision requiring health insurance for boxers during matches. The Florida State Athletic Commission said that it had not documented boxers’ health insurance because of a clerical mistake. The Director of the Indiana Boxing Commission said that many of the commission’s 2001 event files were missing documentation of health insurance coverage because in Indiana, a majority of the professional boxing events were organized by the same promoters, who usually secured an annual policy covering all of the events for the year. We asked the official for documentation of health insurance coverage for the events whose files were missing such documentation. However, this documentation was not made available during our review. Three of the 10 state and tribal boxing commissions (California, Michigan, and Nevada) had documentation less than 50 percent of the time indicating that they had enforced suspensions of boxers imposed by other commissions. Officials from these 3 commissions said that before approving fights, they reviewed the suspension information received from Fight Fax and the national suspension list to ensure that boxers were not participating in events while serving suspensions imposed by other commissions. The officials added that although this information was reviewed, they did not maintain a record of the information in the event files. All 10 of the state and tribal boxing commissions we reviewed had documentation at least 75 percent of the time for the provision requiring the disclosure of all purses and amounts paid to promoters. Two of the 10 commissions (Indiana and Missouri) had documentation less than 75 percent of the time for the provision requiring the disclosure of amounts paid to judges. The Director of the Indiana Boxing Commission said that the commission verified all forms of payment before events and ensured that all payments were made immediately after the events, but the commission did not make this information available during our review. The Missouri Office of Athletics said that the commission did not always document amounts paid to judges because Missouri law did not require the disclosure of such information. The official added that the promoters usually pay the judges by check through the Missouri Office of Athletics for tax purposes. The Miccosukee Athletic Commission was the only boxing commission with documentation at least 75 percent of the time for the provision that calls for ensuring that there are no conflicts of interest for boxers and promoters. Officials from the Michigan, Missouri, and Mohegan Sun boxing commissions said they were unaware that the provision had been enacted in federal law. The Director of the Indiana Boxing Commission said Indiana had not experienced any problems with boxers and promoters relating to conflicts of interest; therefore, the commission felt documentation for this provision was unnecessary. The Pennsylvania Athletic Commission was the only boxing commission with documentation at least 75 percent of the time for the provision that calls for ensuring that there are no conflicts of interest for boxers and commission representatives. Officials from the Michigan, Missouri, and Mohegan Sun commissions said they were unaware that the provision had been enacted in federal law, and officials from the California, Florida, Indiana, Nevada, and Texas commissions said they did not maintain documentation for this provision because they believed these issues were addressed through discussions. All 10 of the state and tribal boxing commissions we reviewed had documentation at least 75 percent of the time for the provision requiring boxers to be registered. Two of the 10 commissions (California and Indiana) had documentation less than 50 percent of the time for the provision requiring ring officials to be certified and approved. The Executive Officer of the California State Athletic Commission said the commission documented only current registrations and had purged the 2001 data from its files. During our review, the Director of the Indiana Boxing Commission said the commission was experiencing computer problems and could not provide us with the list of ring officials certified and approved in 2001. This appendix provides information on the extent to which the 10 states and tribes that we reviewed had provisions covering health, safety, economic, and integrity elements in addition to those covered by the act. The appendix also provides the states’ and tribes’ reasons for not having provisions covering certain elements. When reasons are not specified, the commissions did not provide them. None of the 10 state and tribal commissions we reviewed had provisions requiring postfight medical examinations, including neurological testing, for all boxers who participate in events outside their own jurisdictions. Three of the commissions said they did not have provisions requiring postfight medical examinations or neurological testing because they did not have the financial resources to administer such requirements and it would not be feasible to require small promoters or boxers to pay for them. However, the California, Indiana, Nevada, Texas, and Pennsylvania boxing commissions said they required postfight medical examinations when a commission requested that a previously injured boxer obtain a medical release before being allowed to fight. California was the only commission that required the monitoring of injuries sustained during training before events. Five of the state and tribal boxing commissions (Indiana, Missouri, Mohegan Sun, Pennsylvania, and Texas) agreed that from a safety perspective, monitoring boxers’ gym activities was a good concept, but they said they did not have the personnel or financial resources to monitor local gym activities. The Executive Director of the Pennsylvania Athletic Commission said that Pennsylvania did not require the monitoring of gym injuries before events, but he personally visited each local gym once or twice a year to monitor gym activities. Eight of the state and tribal commissions (California, Indiana, Michigan, Missouri, Nevada, Pennsylvania, Texas, and Mohegan Sun) required the filing of postfight medical reports. The Executive Director of the Florida State Athletic Commission said Florida did not require the filing of postfight medical reports because the commission and the small promoters and boxers did not have the financial resources to pay for physicians to conduct such examinations. The official added that in many cases the small promoters struggled to pay for the physicians needed to conduct the required prefight examinations. The Executive Director of the Miccosukee Athletic Commission said that the commission did not require the filing of postfight medical reports; however, he said a medical referral might be given to a boxer if the ringside physician suspected that the boxer had been injured and a follow-up examination or observation was needed. None of the state and tribal commissions require that boxers be provided with health and life insurance before and after each match. Generally, the commissions required the promoters to secure health insurance during a match, as the act requires. Some of the policies provided extended coverage for medical and accidental death and dismemberment for up to 1 year following the match. Four of the commissions (Michigan, Missouri, Pennsylvania, and Texas) said that providing coverage to boxers before or between matches—that is, during training—would be too costly. They stated that it is not the commissions’ responsibility to provide coverage, since boxers are independent contractors. California was the only state that required its commission to suspend boxers for training injuries. All of commissions agreed that suspending boxers for gym injuries was not feasible because many of the commissions were experiencing personnel and budgetary constraints and did not have the resources to monitor gym activities. California was the only state that required pension plans for professional boxers. Officials at the other nine commissions said that this was a positive initiative; however, six of the commissions (Indiana, Miccosukee, Michigan, Missouri, Pennsylvania, and Texas) questioned the contribution sources and basis for qualification. The Boxing Administrator of the Texas Boxing and Wrestling Program said that the problems associated with pension and retirement plans were similar to those attending the health insurance issue and that they were social rather than professional boxing issues. According to the Director of the Indiana Boxing Commission, pension plans would benefit boxers a great deal, particularly if boxers were older and nearing retirement, younger and intending to make a career of professional boxing, or injured and without an alternative source of income. The official said that problems would arise with funding, because promoters have little incentive to fund pension plans for boxers and might be unable to afford the additional expense. He said that deducting money from each boxer’s purse would also be difficult, because most boxers do not earn more than a few hundred dollars per bout. According to the Executive Director of the Pennsylvania Athletic Commission, the commission is pursuing funding for pension plans. The official added that in 1992, the commission attempted to use its budget surplus to start a trust for professional boxers; however, because of shortfalls elsewhere in the state’s budget, the funds were expended on other projects. The commission is initiating a charitable trust under ABC that has received some voluntary contributions thus far. The goal is to reach $500,000 in principal and operate the program using the account’s interest. The official said that because professional boxers are not unionized, a traditional pension fund would not be feasible. The Enforcement Division Director of the Michigan Bureau of Commercial Services said that the commission views operating a pension plan as outside the state’s role to protect the consumer. In addition, the official said, promoters operating in Michigan would not be willing to fund a pension plan. Officials from the Missouri Office of Athletics and the Miccosukee Athletic Commission supported the establishment of a pension plan; however, they questioned the feasibility of doing so, since boxers are independent contractors. Two of the state and tribal boxing commissions (Florida and Mohegan Sun) required full and open disclosure of all purses and costs of bouts, with the amounts paid to trainers and boxers broken out. According to the Executive Officer of the California State Athletic Commission, California has no provision requiring the disclosure of all purses and costs to trainers, but does require that the amounts paid and costs assessed to boxers be disclosed. The Enforcement Division Director of the Michigan Bureau of Commercial Services said that the commission did not have a provision requiring the disclosure of all purses and costs to trainers and boxers because the commission did not enforce any such agreements between these parties, as directed by their legal counsel. The Boxing Administrator of the Texas Boxing and Wrestling Program said that Texas only had provisions requiring the disclosure of all purses and costs to promoters and boxers. However, the Texas official said that the organization documented information on the fees that the trainers were paid from the boxer’s purse, although there was no requirement for such documentation. Eight state and tribal commissions (Florida, Indiana, Michigan, Nevada, Pennsylvania, Texas, Miccosukee, and Mohegan Sun) prohibited conflicts of interest for judges and referees. According to the Missouri Office of Athletics official, the commission has provisions for ensuring that there are no conflicts of interest for state boxing commission representatives. The official did not explain why the provisions do not address conflicts of interest for managers, judges, and referees. The Enforcement Division Director of the Michigan Bureau of Commercial Services said that a number of state officials resigned after the act established conflict of interest standards. Missouri was the only commission we reviewed with a provision requiring trainers, managers, promoters, and physicians to be registered and receive training. Officials from six of the commissions (California, Florida, Indiana, Miccosukee, Pennsylvania, and Texas) said that they had provisions requiring these occupations to be registered, but because of limited financial resources, the provisions governing training were applicable only to physicians and ring officials. Seven of the 10 state and tribal commissions (California, Florida, Missouri, Nevada, Pennsylvania, Texas, and Mohegan Sun) we reviewed had provisions for selecting judges and ensuring that sanctioning organizations do not influence the selection process. All 10 of the commissions we reviewed had provisions for selecting the boxing and scoring rules for events, such as ABC’s rules for championship events. Seven of the 10 commissions (California, Florida, Michigan, Nevada, Pennsylvania, Texas, and Miccosukee) had provisions that require officials who serve on boxing commissions to have knowledge of professional boxing. According to the Administrator of the Missouri Office of Athletics, the governor appoints the officials serving on the state’s boxing commission, and, as a result, some of these officials may not have a professional boxing background or knowledge. Similarly, representatives of the Mohegan Tribe appoint the officials serving on the Mohegan Tribal Gaming Commission Athletic Unit and therefore, according to the unit’s legal counsel, some of the officials may not have an extensive background in boxing. However, this has not been the commission’s experience, the counsel said. In analyzing the adequacy of efforts to protect the health, safety, and economic well-being of professional boxers and to enhance the integrity of the sport, our objectives were to (1) identify fundamental elements considered important to address the major health and safety, economic, and integrity problems facing professional boxing; (2) assess the extent to which the act’s provisions cover these elements and whether selected state and tribal boxing commissions have documentation indicating compliance with the act’s provisions; (3) assess the extent to which selected states and tribes have adopted provisions that cover fundamental elements in addition to those covered in the act; and (4) determine what actions the Department of Justice and the Federal Trade Commission (FTC) have taken under the act. To identify fundamental elements that are considered important to address the major health and safety, economic, and integrity problems facing professional boxing, we reviewed recent congressional testimony and studies conducted by a task force of the National Association of Attorneys General, the Department of Health and Human Services, and the Department of Labor. From these sources, which documented problems in the boxing industry and made recommendations to address them, we identified major problems facing the sport and consolidated the recommendations into 15 fundamental elements that, if implemented, could provide an adequate level of health, safety, and economic protection to boxers and help enhance the integrity of the sport. We discussed these elements with the Association of Boxing Commissions, which agreed that the elements could provide the desired protection and enhancement. To assess the extent to which the act’s provisions cover the fundamental elements we identified, we analyzed the act’s provisions and determined how many cover fundamental elements, either fully or partially. To assess the extent to which selected state and tribal boxing commissions have documented their compliance with the act’s provisions, we identified 8 of the 46 state boxing commissions and 2 of the 8 tribal boxing commissions for review. We looked at provisions in the act that were related to the 15 fundamental elements. The eight states are California, Florida, Indiana, Michigan, Missouri, Nevada, Pennsylvania, and Nevada; the two tribes are the Mohegan Sun (Connecticut) and the Miccosukee (Florida). We selected California, Florida, Missouri, Nevada, Pennsylvania, and Texas because they held the largest number of professional boxing events in calendar year 2001, the most recent year for which complete data were available. We selected Michigan and Indiana to represent states that held a smaller number of events in calendar year 2001 than the other states selected. We selected the Miccosukee and Mohegan Sun tribes because they were the Indian tribes that held the largest number of professional boxing events in calendar year 2001. The state and tribal commission we selected accounted for 49 percent of all professional boxing events held in the United States during calendar year 2001. At the Indiana, Michigan, Miccosukee, and Mohegan Sun commissions, we reviewed the cases files for all professional boxing events held in 2001, and at the remaining commissions, we reviewed the case files for a random selection of professional boxing events held in 2001. Because we randomly selected boxing events in these states for review, our sample for each of these states is just one of many samples we could have drawn. Since each sample could have produced a different estimate, we express our confidence in the precision of the estimates for our particular samples using 95 percent confidence intervals. These are ranges within which we are confident that 95 out of 100 samples drawn from these particular events would include the true value for all the events in the state. All the estimates based on sample data in table 3 have 95 percent confidence intervals not exceeding plus or minus 10 percentage points, unless otherwise indicated. To present the results of our case file reviews, we divided the actual or estimated percentages of cases with documentation into three compliance categories: 75 to 100 percent, 50 to 74 percent, and below 50 percent. We did not independently verify the documented compliance, and the results of our reviews at these 10 commissions cannot be generalized to all boxing events held nationwide during 2001. The documentation that we reviewed at the selected commissions varied. Because the act does not require documentation and the commissions have no uniform record-keeping standards, we considered all types of documentation maintained and provided to us by the commissions for our review. Such documentation included pre- and post-fight medical examination check sheets, insurance coverage forms, copies of contracts between boxers and promoters, event sheets identifying boxers’ registration numbers, promoters’ revenue reports to commissions, and statements of independence signed by ring officials. To assess the extent to which selected states and tribes have adopted provisions that cover fundamental elements in addition to those covered in the act, we reviewed the boxing provisions enacted by the eight states and two tribes and identified provisions that cover fundamental elements or portions of fundamental elements that the act does not cover. We confirmed with the boxing commissions of these states and tribes that they agreed with our analysis of their provisions, and we asked these officials why their state or tribe had not enacted provisions covering additional fundamental elements. Our findings for these selected states and tribes cannot be generalized to all 46 states and eight tribes. We did not assess the extent to which the states and tribes had implemented or enforced the provisions that cover additional fundamental elements. To determine what actions the Department of Justice and FTC have taken under the act, we determined the role that each is assigned under the act. We then met with Justice officials to identify whether any investigations or prosecutions had been conducted under the act in the jurisdictions of the eight state and two tribal commissions in 2001. In addition, we reviewed Justice’s central case management system for possible cases prosecuted during fiscal years 1996 through 2002. We also met with FTC officials to determine whether they had received consumer complaints related to the boxing industry. Furthermore, to determine that the sanctioning organizations were making the required information available to the public, we reviewed the Internet Web sites of 14 sanctioning organizations. We performed our work in accordance with generally accepted government auditing standards from September 2002 through July 2003 in Washington, D.C., and at the following state or tribal boxing commission locations: California State Athletic Commission, Sacramento, California; Florida State Athletic Commission, Tallahassee, Florida; Indiana Boxing Commission, Indianapolis, Indiana; Michigan Bureau of Commercial Services, Lansing, Michigan; Missouri Office of Athletics, Jefferson City, Missouri; Nevada Athletic Commission, Las Vegas, Nevada; Pennsylvania Athletic Commission, Harrisburg, Pennsylvania; Texas Boxing and Wrestling Program, Austin, Texas; Miccosukee Athletic Commission, Miami, Florida; and the Mohegan Tribal Gaming Commission Athletic Unit, Uncasville, Connecticut. 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Summary: The Professional Boxing Safety Act of 1996 established minimum health and safety standards for professional boxing and provided for limited federal oversight by the Department of Justice and the Federal Trade Commission. In 2000, the Muhammad Ali Boxing Reform Act amended the act to better protect boxers' economic well-being and enhance the integrity of the sport. However, reports of problems continue, including permanent and sometimes fatal injuries, economic exploitation, and corruption. GAO was asked to (1) identify fundamental elements considered important to protect professional boxers and enhance the integrity of the sport; (2) assess the extent to which provisions of the Professional Boxing Safety Act of 1996, as amended (the act), cover these elements and determine whether selected state and tribal boxing commissions have documentation indicating compliance with the act's provisions; (3) determine whether selected states and tribes have provisions that cover additional elements; and (4) identify federal actions taken under the act. Based on GAO's review of congressional testimonies and national studies dating from 1994 through 2002, GAO identified 15 fundamental elements that are considered important to protect boxers' health, safety, and economic well-being and to enhance the integrity of the sport. The act addresses 10 of the 15 fundamental elements that GAO identified. The 8 (of 46) state and 2 (of 8) tribal boxing commissions that GAO selected for review accounted for 49 percent of the fights in 2001 and varied in the extent to which they had documentation indicating compliance with the 10 provisions of the act related to the fundamental elements. For example, all 10 commissions had documentation indicating compliance at least 75 percent of the time for 3 provisions--requiring prefight medical exams, disclosure of purses and payments, and registration of boxers--but only 2 commissions had documentation indicating compliance at least 75 percent of the time for a provision prohibiting conflicts of interest. Commissions either gave no reason for the lack of documentation, cited privacy or liability concerns, or said they were unaware of the federal provision. The eight states and two tribes that GAO reviewed vary in the extent to which they adopted additional provisions that cover elements not covered by the act's provisions. The number of such provisions ranges from 10 (California) to 4 (Missouri). For example, the states have provisions requiring the filing of postfight medical reports, uniform boxing and scoring rules, and boxing commission officials' knowledge of the sport. Federal actions taken under the act have been limited. The Department of Justice said it has not exercised its authority to prosecute cases because none have been referred to it by federal law enforcement authorities. Furthermore it noted that violations under the act are misdemeanors, and it generally applies its resources to prosecuting felonies. The Federal Trade Commission periodically checks the Web sites of the organizations that sanction professional boxing events to see whether they have posted the information that they are required to make available to the public and has found them to be adequate. Legislation was recently introduced to significantly amend the act by, among other things, creating a new organization within the Department of Labor that would provide oversight and enforcement of boxing laws. This new federal organization is intended to facilitate more uniform enforcement of federal requirements aimed at enhancing boxers' health, safety, and general interests as well as the integrity of the sport. The Department of Justice and the Federal Trade Commission provided only technical comments on our report. The Association of Boxing Commissions and five state and tribal commissions had concerns about the lack of existing federal enforcement and the economic impact of any additional federal requirements.