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When athletes collapse, think heart first

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AT LEAST ONCE a month, Jewel Upshaw gets a notification on her phone and braces herself. She’s part of several online groups that share news about sudden cardiac arrest, and when someone tags her, she knows it has happened again.

Then she looks to see if the person lived or, like her son, Zeke, died.

The alert she received on Feb. 11 involved a professional hockey player, Jay Bouwmeester of the St. Louis Blues, who collapsed on the bench during a game. He was revived. When Jewel went to read about it, the article had a video, but she couldn’t watch. “That’s too hard to do,” she said.

The scene of a seemingly healthy athlete collapsing, the medical staff rushing to his side, teammates and opponents worried and dumbstruck, was just too much like what she saw when Zeke Upshaw fell to the court while playing for the Grand Rapids Drive of the NBA’s G-League two years ago this week.

In the case of Bouwmeester, 36, EMTs saw he was in cardiac arrest and immediately began CPR. Another mother was spared Jewel’s loss.

“It just takes me back,” Jewel said. “It’s bittersweet. I’m so happy they recognized it and saved him. [But] my heart immediately goes to sadness because it wasn’t that case with Zeke.”

ON MARCH 24, 2018, the Grand Rapids Drive played the Long Island Nets in the last regular-season game, and there was a playoff berth on the line. Zeke, a shooting guard from Chicago, had played at Illinois State University and then as a graduate transfer at Hofstra. His 3-point shooting entering the season finale was 40.9%, enough to make him a credible contender for the NBA’s summer league, where every team would be able to see him.

Even if he couldn’t get the call to the league, he might have received a chance to play at a higher level in Europe.

He had a solid game that night, scoring 11 points in 29 minutes. With less than a minute left, the Drive led 100-97. Long Island inbounded the ball with 47 seconds to go. Along the baseline, away from the ball, Upshaw dropped to the floor, face down, palms up.

No player on the court seemed to notice immediately. Then one opposing player reacted. Then another. Then the referee blew his whistle. About six seconds after Upshaw collapsed, a team doctor and trainers sprinted to the corner of the court where he was lying.

In video of the incident from two angles, we see what happens next: The Drive’s assistant team physician and trainers from both teams say something to Upshaw while huddled over him. They ask for someone to get a towel to place under his head. But no one can be seen checking Zeke’s pulse. No one turns him over. No one can be seen checking to see if he’s breathing.

Two minutes after the collapse, two EMTs, seemingly unhurried, walk their stretcher onto the court. Seven minutes after the collapse, the paramedics begin CPR in an ambulance, according to their report, but Zeke’s heart did not start again until he was at the hospital, about 40 minutes later.

About 1,600 miles away in Henderson, Nevada, Jewel had been watching the game on a Facebook stream. So was Zeke’s girlfriend, Julia Turner, whom everyone referred to as his fiancée because he was going to propose after the season. Jewel saw Zeke was down. Then Julia called her, screaming. They saw the messages scroll by on Facebook: Prayers for Zeke. Say a prayer for Zeke. Jewel was straining to see her son. All she could tell was he wasn’t moving.

Jewel and Julia got the first flight they could from the Las Vegas airport, a Delta flight that left at 12:30 a.m., connecting through Minneapolis. Six hours of holding each other and crying with little information. At the hospital after a sleepless night, Jewel saw Zeke and realized the situation was as bad as she feared.

You almost couldn’t see his face, there were so many tubes connected to him. His brain was swollen, she was told. Jewel convinced herself that if they wrapped his head it would somehow help the swelling. Mercifully, uselessly, someone wrapped Zeke’s head in gauze so Jewel would have something to hope for.

The head of cardiology came to speak to Jewel, a conversation she remembers only in pieces. But she remembers what the doctor said: “There’s no coming back from this.”

A day later, March 26, Jewel made the decision to disconnect her only child from the machines. The 26-year-old who thought he might have a shot at an NBA roster, who was planning to get married, was gone.

The funeral was on the South Side of Chicago, where Zeke grew up. He was a success story, raised by a single mother, the neighborhood kid who got into a top academic high school and earned a college basketball scholarship. There must have been a thousand people there. An alderman spoke. Arne Duncan, the U.S. Secretary of Education under President Barack Obama, was there, because he knew Zeke as a fellow alum of the University of Chicago Laboratory Schools.

Zeke’s coffin was placed in a crypt at the legendary Oak Woods Cemetery on the South Side. You can see Jesse Owens’ grave from the building where Zeke rests. Jewel is proud of that.

After the funeral, after she flew home to Nevada, Jewel forced herself to watch the video of what happened, from the time Zeke collapsed until the EMTs arrived and the cameras panned away.

The video pulled something out of her grief and confusion that was more direct. As she watched the apparently confused reaction of those around her motionless son, she felt rage.

“I’m screaming at the [screen], ‘Somebody, anybody, go to his aid!’ They were around him, but it’s like they were trying to figure out what’s going on. No one’s touching him. No one’s pumping his heart. Mouth to mouth. Do something.”

ESPN SPENT MONTHS going through Zeke Upshaw’s medical records. The picture that emerged was muddled. More than a dozen experts in cardiology and emergency medicine couldn’t agree on what led to his heart attack or even what underlying genetic heart disease afflicted him.

In its report, the Kent County Medical Examiner’s office in Grand Rapids identified a disease called arrhythmogenic right ventricular cardiomyopathy (ARVC). But several other top cardiologists said they were convinced Upshaw had a similar disease, hypertrophic cardiomyopathy (HCM). There was no evidence of drug use or any other mitigating factor.

Between November 2016 and March 2018, Upshaw went through three different heart screenings. Two were routine tests required by the NBA and one followed a fainting episode in 2017 — nine months before he died. An unexplained fainting episode, experts say, can be a harbinger of a larger cardiac problem.

Upshaw’s episode happened while he was working out at a Las Vegas gym the morning of June 21. By 6 a.m. that day, the temperature outside was already 106.

Karlton Grant, who runs the gym, said Upshaw was doing a drill with several other players: drive the ball toward Grant, make a move, then get past him. As Upshaw passed, Grant turned to look at the next player.

“We heard this noise. He just hit the floor super hard, like he knocked himself out, that’s how hard it was,” Grant said.

Grant turned to see Zeke unconscious, foaming at the mouth, convulsing. He estimated that Upshaw was unconscious for 10 to 15 seconds. As they talked about calling 911, Upshaw came to.

“He didn’t say anything. He was just more like in shock mode, like, ‘did I really black out?'” Grant said. “We were thinking it was because it was hot. … I wouldn’t think it was something to do with the heart.”

They gave him a sports drink and a granola bar, and Zeke called his girlfriend. “He said, ‘Baby, I fainted like 30 minutes ago. I’m fine. I just want to get checked out. So, please take me to the hospital.'” Julia Turner said. “I was like, ‘What happened?’ He said, ‘I think I was dehydrated.’ He looked fine. He was normal, like nothing happened.”

Upshaw stayed in the hospital overnight for observation. The hospital report has several references to possible dehydration, but a blood test showed something else: elevated troponin, a protein released into the bloodstream when the heart is damaged.

The next morning Zeke was discharged. Among the instructions on his discharge papers: “You may resume your normal activities when you are feeling back to normal.”

On June 23, Upshaw had an echocardiogram. The report identified his heart as having “left ventricular cardiomyopathy,” a thickening of the heart wall.

But even in hindsight, the indications were unclear. Some thickness in the left ventricle is not uncommon in athletes. The more you use the muscle, the thicker it can get, which can lead to a benign condition known as “athlete’s heart.”

Martin Maron, a cardiologist and the director of the Hypertrophic Cardiomyopathy Center at Tufts University Medical Center in Boston, reviewed all of Upshaw’s medical reports, including his three echocardiograms, at ESPN’s request. He also asked one of his partners to review them. Both agreed there was nothing in any of those screenings to indicate heart disease.

“It wasn’t even a close call,” Maron said.

According to hospital records, as well as Jewel Upshaw, Julia Turner and a hospital employee, Upshaw was told he could return to activity when he felt ready. Jewel Upshaw and Turner said they don’t believe Zeke knew he had a heart condition.

“If he knew he had a problem he wouldn’t have played. He would have told me,” Jewel said. “They said he was cleared to play in a couple of days. He told me everything. Julia, too.”

ESPN spoke to all but two of Zeke’s Drive teammates. All said he never mentioned the fainting episode or expressed concerns about his health.

“No one ever heard about it,” said teammate and close friend Kenneth “Speedy” Smith. “I’m sure no one knew anything of it.”


MARON ALSO REVIEWED two videos of Upshaw from the night of his collapse, one from the game broadcast and one shot by a fan. He was among 15 of 17 medical experts ESPN interviewed who said they could find no reasonable explanation why team medical personnel and the EMTs at no point in the video can be seen checking Zeke’s pulse. No one appears to check if he is breathing. No one turns him over. No one uses a defibrillator that can be seen on the stretcher.

“The first thing you have to be thinking in this situation is, could this person be in a cardiac-arrest situation? And the way you would know that is you would take a pulse,” Maron said.

Watching the way Upshaw suddenly went to his knees and then facedown on the court, Maron said it’s unlikely Upshaw felt anything. He lost consciousness immediately. Some people who go into sudden cardiac arrest and are revived don’t have any memory of it.

According to interviews with ESPN and in the medical examiner’s report, players said the medical staff told them they asked Zeke if he had hit his head — his lip was bleeding — and that he replied, “Yes.” If the medical staff thought they were dealing with a head injury, that could explain why no one checked for life signs.

Maron, again reflecting the majority of the experts ESPN interviewed, said he can’t say for sure whether Upshaw could have responded to questions the way the medical staff described.

“It’s difficult for me to imagine that he is having a conversation. I certainly don’t see evidence of that on the video, though it’s hard to say for sure,” he said. “Knowing the nature of the cardiac arrest that he’s experiencing and the fact that he’s so motionless here that makes it really to me seem unlikely.”

It’s possible, he said, that Upshaw was making noises that the staff mistook as responses. People in cardiac arrest often emit a gurgling sound as the lungs struggle for a while to get air. It’s known as “agonal breathing.”

One of the first responders was a veteran 55-year-old paramedic who was honored by the American Heart Association in 2015 for helping to save a heart attack victim. The other was 22. Based on the ambulance report and the autopsy, they had been told they were dealing with a concussed player.

Maron said it was difficult to explain why no one checked Upshaw’s pulse or why CPR was not started for seven minutes, according to the paramedics’ report.

“Obviously, I can’t speak for the first responders that were there,” Maron said. “They may have had a different assessment of things when they arrived on the scene. Based on the video that I saw, to me, it’s hard to understand how CPR wouldn’t have been started earlier.”

The senior paramedic did not return messages seeking comment. The younger one, reached by phone, declined. A spokesman for their employer, Life EMS, also declined comment.

There is no guarantee a defibrillator would have saved Zeke Upshaw. Maron said some patients with heart disease can be difficult to revive because the abnormal thickness of the muscle deflects the charge from the defibrillator. But, he says, it would have improved his chances.

JEWEL UPSHAW’S LAWSUIT against the NBA was settled last July for an undisclosed amount. She’s still in the process of suing the companies that own the Drive and their arena, and Life EMS, the company that provided the ambulance and the paramedics. Those parties have declined to comment.

Jewel and and Julia Turner remain close and live not far from each other outside of Las Vegas. Jewel created the Zeke Upshaw Foundation to educate schools and athletic organizations about sudden cardiac arrest. She is focused on spreading the message that if someone collapses, assume it’s a heart issue. Try CPR. If there is an automatic external defibrillator, use it. It won’t hurt someone who has a normal heartbeat.

But in quiet moments, she quickly finds herself overwhelmed.

“I’m trying to stay on course. Anytime I can talk about Zeke, I do,” she said. “Anytime I can talk about this silent killer, I do. I don’t always cry. I do try to educate.”

And her phone keeps buzzing with notifications, sometimes once a week, about someone like Bouwmeester.

“More recently I got something about a couple of high school students,” she said. “It’s at least once a month. And those are just the ones I hear about.”

ESPN’s William Weinbaum and Mike Farrell contributed to this report.

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Which superstars and teams will be in the NBA bubble? That debate is heating up

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The final, fleeting fight for 30 teams to resume the NBA’s season is raging through these last days of indecision. Hours of commissioner Adam Silver’s time are being spent engaging owners and high-level executives making the case for how the league should march into the summer’s playoffs, including those desiring the entire league to descend upon Orlando, Florida.

Some want a wide-open playoffs, a knockout round to give those teams among the worst a way to punch up into the play-in for the eighth seed. Some want every market — New York and Chicago included — invited into the fans’ consciousness. And some are fearful of delivering the competitive disadvantage of a nine-month hiatus prior to the start of the 2020-21 season to young, rebuilding franchises.

From all angles and agendas, there are appeals underway to Silver. Thirty teams returning for the resumption of the season in Orlando has lost momentum, but it still has a significant lobby.

The Atlanta Hawks have the second-worst record in the Eastern Conference and the third-youngest roster. As a franchise, they’re chasing the chance to grow a young roster besieged with injuries and suspension — and buoyed by a February deadline trade for center Clint Capela — by getting back onto the floor.

The NBA and National Basketball Players Association have discussed a model of 30 teams returning to reach a target goal of 72 regular-season games, sources said. The Hawks, who had 10 players participate in voluntary workouts on Memorial Day, are the league’s closest to that total with 67 games played this season.

“Our guys are excited about the opportunity to get back to it,” Travis Schlenk, the Hawks’ president of basketball operations and general manager, told ESPN. “It has importance for us. We’re a young team, and because of injuries and some other things this season, we didn’t get to see them all together.

“Clint says he’s feeling better, and there’s a possibility that we can get him back on the court. Practicing and playing five games would be valuable to us.”

Cleveland is eager to play too. Another young roster, another franchise that needs to show improvement of its younger players. Detroit wants to get back to training camp and play games. New Orleans. Portland. Charlotte. Washington. Outside the playoff picture, there’s enthusiasm to play.

As everyone expected, of course, there isn’t unanimity on these issues. When the NBA and NBPA canvass teams at the bottom of the standings, they also hear ambivalence. Not one owner or GM is explicitly telling anyone they don’t want to play this season. Even so, there are enough players on enough bad teams who’ve shared the idea that they don’t see the value in several weeks of camp and quarantines to play five to eight regular-season games with no playoff potential.

Some lottery teams have also made it clear via back channels to the league that if their players are decidedly so-so on returning, there will be no showdown. Translated: If you need to keep us out, we’ll gladly keep our favorable lottery position. See you next season.

Privately, Silver has been considering the idea that there are plenty of sensible reasons to pare down the roster of teams in Orlando. First, there’s safety. Fewer teams, fewer people to contract or spread the coronavirus — and less bad basketball. Even elite teams will be sloppy upon return, so what about the others?

There will be a lot more Damion Lee and Alen Smailagic than Stephen Curry and Draymond Green. In a normal year, no one would care about the Golden State Warriors playing out the final string of games in obscurity with young players. This time? It would represent the unveiling of the NBA’s return, and it would be precisely what the NBA doesn’t want: a bad television spectacle.

If anyone tells you the NBA knows exactly what it’s going to do, they’re probably ahead of themselves. This is still an open discussion, and there will be more debate on Thursday’s GM call with the league, and Friday’s board of governors call. It’s possible the league could bring a recommendation to the owners on Friday, but that’s still uncertain. The NBA believes it has time to deliberate and discuss the matter. In fact, there’s a possibility the first games played in Orlando could be in August, not July, sources said.

In the end, the NBA will come to the NBPA with a couple of detailed scenarios, recommending one. They’ll do so after hundreds of hours of talks with union officials and players, a full download of data about the union’s preferences.

The league’s GM survey included a pool play option featuring somewhere between the 16 current playoff teams and the full body of 30 NBA teams, sources said. Teams would be divided into a certain number of groups, and face each member of their group the same amount of times. (The total number of pool games has not yet been specified.) All of these would likely be branded as playoff games.

Based on the final standings within each group, eight teams would advance out of pool play into a bracket meant to mimic the league’s normal postseason structure, sources told ESPN’s Zach Lowe.

Several current postseason teams were not initially enthusiastic about that proposal, sources told Lowe. A slump in group play could result in what is currently a solid playoff team — even one slated for home-court advantage in the first round of a normal postseason — failing to advance into the eight-team tournament, while a present-day lottery team might get hot and make the final eight.

“It isn’t like guys can run off to Vegas or Europe on vacation if we don’t play. There’s a level of boredom that makes guys more willing to play right now too.”

Eastern Conference GM

No one wants a product that embarrasses the NBA. Appealing to players only on a sense of duty for the league’s greater good isn’t going to work. Free agency is already fraught with peril this year — and probably longer.

Some agents are hinting to GMs: Clients who’ve had good seasons on the way into free agency don’t want to risk undoing that success in a return. Those on contenders will have a hard time explaining why they’re not playing — and virtually every one of them is too competitive and committed to sit out.

On mediocre and bad teams? Well, you’d have some players ducking out of a return — especially if it’s just six to eight games. That has to be a significant part of the consideration for Silver.

There’s so much to examine, and so many factors that could leave teams feeling unfairly treated. The West’s No. 8 seed, Memphis, had its toughest stretch of games left this season. Portland, New Orleans and Sacramento are within 3.5 games in the standings. Portland — with Jusuf Nurkic and Zach Collins possibly returning — and New Orleans — with a well-conditioned Zion Williamson — could be dangerous challengers in a play-in scenario.

Another factor in the wishy-washy nature of how unconvinced players on non-playoff teams could react to getting called back for a resumption: “It isn’t like guys can run off to Vegas or Europe on vacation if we don’t play,” one Eastern Conference GM said. “There’s a level of boredom that makes guys more willing to play right now too.”

There are still a number of ideas under discussion, including this one: bringing back the four Western Conference teams on the playoff bubble for play-in purposes, but none in the Eastern Conference, sources said.

“Over the weekend, you’re getting a sense the league is starting to realize: Less is more,” one high-ranking Eastern Conference executive told ESPN.

When the NBA feared losing the season completely in March, it was easier for owners, executives and players to hear Silver preparing everyone for how frustrated and aggrieved they might be once these choices are made. As everything moves closer to a return, it’s clearer that’ll be the case.

“If we don’t show up, we lose more money,” one NBA starter on a non-playoff team told ESPN. “We are already in the hole. And what message does it send to the public, the teams, the players that we are OK with 10 to 14 teams not playing? We already have a competition problem in the league.

“My thing is, play 30 teams for as many games as possible for the money, or go straight to the playoffs.”

Adam Silver hears them all. And wherever he lands on the issue, whatever model he suggests to the owners and union that makes the most sense for all, the commissioner always did suspect how it would end: hard decisions leaving hurt feelings. This is a small part of the pandemic’s price to the NBA.

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Damian Lillard says he won’t play restarted season if Blazers don’t have ‘true opportunity’ for playoffs

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Trail Blazers star Damian Lillard says he won’t compete in a restarted NBA season if Portland does not have a legitimate shot to make the playoffs.

“If we come back and they’re just like, ‘We’re adding a few games to finish the regular season,’ and they’re throwing us out there for meaningless games and we don’t have a true opportunity to get into the playoffs, I’m going to be with my team because I’m a part of the team, “Lillard told Yahoo Sports on Tuesday. “But I’m not going to be participating. I’m telling you that right now.”

A joint task force between the NBA and the players’ union has been negotiating plans for a resumption of the NBA’s season, which has been suspended indefinitely since March 11 because of the coronavirus pandemic. Teams are expecting the league to issue guidelines for a resumption of play by June 1, sources have told ESPN.

When play was suspended, the Trail were in ninth place in the Western Conference with a 29-37 record that left them 3 1/2 games behind the Memphis Grizzlies (32-33) for the conference’s final playoff berth. It remains unclear whether the NBA will play the remainder of its regular season or proceed directly to the playoffs.

Lillard, a five-time All-Star, said he was hoping the league would opt for a play-in style tournament involving the No. 7 through 12 seeds. With center Jusuf Nurkic and power forward Zach Collins returning from injuries, Lillard said he likes the Blazers’ chances in that situation.

“We had fought ourselves back into position to get a spot,” Lillard said. “We had our starting center and starting power forward coming back, so we had a lot to look forward to and for a great reason. Now, they’re healthy and have extra time to train and rehab while everybody’s rusty. So now, they won’t be coming back as the only rusty players. And if everybody’s rusty, we can come in here and beat everybody.

“It’s going to be hard to get going with no fans, you’ve been off all this time and some people are just ready for summer like, ‘(Expletive) it, I haven’t played in a long time and the season is basically over to me. Do I really care like I cared before?’ It’s going to be a lot of those factors going on and that presents a lot of room for a team to sneak some (expletive). Like, really mess around and knock some teams off and then, ‘Oh, they’re in the Western Conference finals.’ It’s room for that with this situation. So the fact that it’s possible and we wouldn’t get an opportunity at that, that’s weak to me. I ain’t getting no younger.”

Lillard, 29, is the NBA’s fifth-leading scorer this season, averaging career highs of 28.9 points and 7.8 assists per game. The Blazers reopened their practice facility earlier this month for voluntary workouts.

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Michael Jordan to Rod Thorn — I won’t play if Isiah Thomas is on Dream Team

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Old audio of Michael Jordan has surfaced in which he says he told NBA executive Rod Thorn, who was part of the USA Basketball selection committee, that he wouldn’t play on the Dream Team in 1992 if Detroit Pistons star point guard Isiah Thomas was also selected to the team.

“Rod Thorn called me, and I said, ‘Rod, I won’t play if Isiah Thomas is on the team,'” Jordan is heard telling reporter Jack McCallum in a 2011 interview, which was aired on his podcast “The Dream Team Tapes.”

“[Thorn] assured me,” Jordan is heard saying in the old interview. “He said, ‘You know what? Chuck doesn’t want Isiah. So, Isiah is not going to be part of the team.'”

“The Last Dance,” ESPN’s documentary on Jordan and the 1990s Chicago Bulls, has renewed debate about Thomas’ absence from the Dream Team. After an episode highlighted Thomas’ Pistons leaving the court rather than shaking hands with the victorious Bulls after the 1991 Eastern Conference finals, Thomas lamented the possibility that the action cost him a spot on the 1992 U.S. Olympic team — the first to feature NBA players, producing the greatest collection of star talent basketball has ever seen.

In “The Last Dance,” Jordan said he didn’t have anything to do with Thomas not making the Dream Team.

“Before the ’92 Olympics, Rod Thorn calls me and says, ‘We would love for you to be on the Dream Team,’ Jordan said in the documentary. “I say, ‘Who’s all playing?’ He says, ‘What does that mean?’ I say, ‘Who’s all playing?’ He says, ‘Well, the guy you’re talking about or you’re thinking about, he’s not going to be playing.’

“I respect Isiah Thomas’ talent. To me, the best point guard of all time is Magic Johnson and right behind him is Isiah Thomas. No matter how much I hate him, I respect his game. Now, it was insinuated that I was asking about him, but I never threw his name in there.”

Thorn and fellow NBA executives Jack McCloskey and Russ Granik were part of the selection committee formed by USA Basketball that was headed by the late C.M. Newton, the then-Kentucky athletic director who also served as an assistant under Dream Team coach Chuck Daly. Mike Krzyzewski and P.J. Carlesimo also served on the committee and were Daly’s assistants on the team.

Thorn, who was the Bulls’ general manager when the team selected Jordan in the 1984 draft, recently told ESPN’s Golic & Wingo that Thomas’ name never came up in a phone call concerning the Dream Team.

“There was never anything in my conversation with [Jordan] that had to do with Isiah Thomas, period,” Thorn told Golic & Wingo. “He said, ‘I’ll do it.’ … Isiah’s name never came up during that conversation. He never backtracked and said he didn’t want to do it from that time on, to those of us in the NBA office.”

According to McCallum’s account of the selection process in his book “Dream Team,” Thomas had plenty of support from the USA Basketball committee. Ultimately, Jordan’s opposition to having Thomas on the team — as well as the unwillingness of any other member of the Dream Team to advocate for him — doomed Thomas’ chances, McCallum wrote in his book.

The decision might have been easier since a year had passed since the Pistons had won their second NBA championship, and Thomas had been limited to 48 games by a wrist injury and averaged a career-low 16.2 points per game during the 1990-91 season.

“I don’t know what went into that process,” Thomas said in the Jordan documentary. “I met the criteria to be selected, but I wasn’t.”

ESPN’s Kevin Pelton contributed to this report.

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