Four years ago, Dagestani heavyweight boxer Magomed Abdusalamov (18-1, 18 KOs) fought Mike Perez on the HBO-televised undercard of Gennady Golovkin vs. Curtis Stevens in New York. The 10-round unanimous decision loss proved to be nearly fatal for Abdusalamov, who suffered permanent brain damage from the fight.

Having filed suit against multiple parties, including the New York State Athletic Commission (NYSAC), the Abdusalamov family was awarded $22 million, “in what is believed to be the largest personal injury settlement the state has made,” according to a report from ESPN.

After Abdusalamov’s fight on Nov. 2, 2013, his family filed suit alleging recklessness, gross negligence and medical malpractice by the New York State Athletic Commission, NYSAC staff and the doctors it retained to work that night. The complaint said improper care crucially delayed diagnosis and treatment of a developing blood clot in Abdusalamov’s brain. He underwent emergency surgery, suffered multiple strokes, was in a coma for weeks, and was hospitalized for more than 10 months, including in-patient rehabilitation.

Now 36, Abdusalamov remains paralyzed on his right side and unable to walk. His speech is mostly limited to mumbling. His wife, Bakanay Abdusalamova, said doctors told her he’d likely never talk again, but now he occasionally delivers fully formed words with clarity. She cares for him and their three daughters — ages 11, 8 and 4 — in a Connecticut house provided by a friend.

Abdusalamov was paid $40,000 for the fight and received the full $10,000 payout from a mandatory minimum insurance policy. A year-and-a-half later, the incapacitated ex-boxer and his family were more than $2 million in debt, according to a 2015 court filing.

A scathing report by the New York State inspector general later faulted the athletic commission for (among a host of other things) gross incompetence and improper procedure by the medical staff. Here’s an excerpt from those findings, which included Abdusalamov having to go to the hospital via taxi cab.

The investigation revealed that Abdusalamov left the arena after the bout on his own accord at approximately 11:50 p.m. Just outside the arena, however, Abdusalamov vomited. When Abdusalamov became ill, his manager found Abdusalamov’s promoter and together they informed Athletic Commission Chair Melvina Lathan that Abdusalamov needed to be taken to a hospital. Lathan directed them to Chief Medical Officer Barry Jordan. In sworn testimony before the Inspector General, Jordan stated that no one impressed upon him that it was an emergency, and he believed Abdusalamov was going to the hospital to have his facial injuries examined. Jordan testified that he advised them to take Abdusalamov to Roosevelt Hospital.

Although there were ambulances at Madison Square Garden available to transport Abdusalamov to the hospital at that time, the Inspector General found that the Athletic Commission lacked a formal tactical emergency plan. Consequently, Athletic Commission staff, the boxers, and their teams were unaware of what steps to take in the event of an emergency after a post-bout examination and in the absence of a physician.

As a result, Abdusalamov’s team lacked any knowledge of the availability of ambulances outside the arena. Instead, Abdusalamov travelled by taxi cab to Roosevelt Hospital. Abdusalamov arrived at the hospital within approximately 15 minutes of leaving Madison Square Garden.

The report also noted that NYSAC inspector Matthew Farrago had “failed to alert a physician, and instead directed Abdusalamov to find a taxi to take him to a hospital of the driver’s choosing.”

In the aftermath of the investigation, sweeping changes were made within the historically maligned commission. New policies were also put in place with regards to insurance requirements for combat sports events in the state.

As MMA Fighting’s Marc Raimondi notes, “New York now requires promoters to take out $1 million traumatic brain injury insurance policies out on every fighter on every card, which was part of the bill bringing MMA to the state.” While major boxing promoters and MMA organizations such as the UFC and Bellator MMA can afford this expense, that is not the case for smaller promoters, and it has effectively killed off the regional scene in New York.