Toxicology tests and other evidence have revealed that former Steelers lineman Terry Long committed suicide by drinking antifreeze, but the Allegheny County medical examiner's office also found that head trauma suffered during Mr. Long's eight-year career in the National Football League contributed to his death.
Mr. Long's death June 7 had been ruled accidental. But after further tests revealed the presence of antifreeze in Mr. Long's system, the manner of death was changed to suicide.
Dr. Bennet Omalu, a neuropathologist at the office, took things a step further, arguing that Mr. Long's head injuries as a football player set the stage for depression severe enough to make him suicidal.
"People with chronic encephalopathy suffer from depression. The major depressive disorder may manifest as suicide attempts. Terry Long committed suicide due to the chronic traumatic encephalopathy due to his long-term play," Dr. Omalu said yesterday. He later added, "The NFL has been in denial."
At odds with Dr. Omalu's conclusion was Dr. Joseph Maroon, the Steelers' neurosurgeon for the past 24 years and an expert on concussions.
"I think it's fallacious reasoning, and I don't think it's plausible at all," Dr. Maroon said yesterday. "To go back and say that he was depressed from playing in the NFL and that led to his death 14 years later, I think is purely speculative."
Mr. Long, 45, died five hours after being found unconscious in his Franklin Park home. The cause of death was inflammation of the lining of the brain and brain swelling as a result of ingesting antifreeze, the death certificate said.
A contributing cause was chronic traumatic encephalopathy -- or "getting smacked in the head over and over again," said Joseph Dominick, chief of operations at the medical examiner's office. The condition is known as punch drunk.
"The trauma, according to the death certificate, was a result of his injuries during his tenure as a football player," Mr. Dominick said yesterday. "I think it is the same as what was on Mike Webster's death certificate."
Mr. Webster, a Hall-of-Fame Steelers center who died in 2002, suffered from a similar disorder.
Mr. Webster's family, alleging that he suffered football-related head injuries that led to his declining health, was awarded disability benefits last year after suing the NFL pension fund.
Dr. Omalu, who co-authored a paper on Mr. Webster's injuries last year in the scientific journal Neurosurgery, has submitted a second paper for peer review that compares the cases of Mr. Webster and Mr. Long.
In an interview, Dr. Omalu described a "cascade" of events that began with football-related injuries and ended in suicide.
People with Mr. Long's disease, Dr. Omalu said, are beset by depression, short-term memory problems and a "loss of executive function," which manifests itself in poor business decisions.
Three months before he died, Mr. Long was indicted by a federal grand jury on charges that he fraudulently obtained $1.2 million in state loans for his company, Value Added Food Groups, a chicken-processing plant on the North Side.
The two-story, 30-employee business was extensively burned in a fire that federal authorities say was arson and for which Mr. Long filed an insurance claim.
Mr. Long filed for protection under federal bankruptcy laws in March on the same day he was indicted on federal charges of arson and mail fraud. Authorities in Kansas City, Mo., also held a warrant for Mr. Long on a felony charge of writing bad checks.
Last year, Dr. Maroon publicly disagreed with former coroner Dr. Cyril H. Wecht, who linked Mr. Long's death with his football days. Dr. Wecht is a co-author on Dr. Omalu's papers.
Dr. Maroon, who is also vice chairman of the neurosurgery department at the University of Pittsburgh Medical Center, said it was impossible to tell whether Mr. Long suffered head injuries outside of two documented instances.
Mr. Long had a concussion in 1987 after colliding with an opposing player and another in 1990 from an auto accident. He played football from 1984-91.
"They really don't know of any head injuries that Terry Long may have experienced before, during or after his football playing that was unrelated to football, and I think that's a critical point," Dr. Maroon said.
"He could have had a head injury that wasn't reported before football. He could have had a fight, he could have had a head injury ... And that's why I'm saying it's so speculative," Dr. Maroon said.
The medical examiner's office last June issued an initial death certificate listing the cause and manner of death as pending. Three months later, a second certificate called his death accidental.
It was not until testing at an outside laboratory on Mr. Long's tissues and urine yielded positive results in October for ethylene glycol -- the active ingredient in antifreeze -- that a third and final death certificate was issued Oct. 19. The manner was suicide.
Jonathan D. Silver can be reached at firstname.lastname@example.org or 412-263-1962.