"Basically, what the diagnosis comes down to is circumstantial evidence. If you know that somebody used cocaine, you might think that caused it, but they might have heart damage for another reason," Dr. Gottlieb said. "So it comes down to detective work, depending on age of person and what else you see, you would make that determination.
"I think we'll never know. It would be virtually impossible to prove it was cocaine that killed him."
The Journal reported that Dr. Isner, who assisted with the autopsy, said that a lawyer representing the Lewis family threatened to sue for damages if anything emerged from the autopsy about drugs. The lawyer denied the allegation.
With young people, experts say, scarring of the heart is more often associated with cocaine abuse.
In a single dose or over years, cocaine will damage the heart. A single dose can increase heart rate and blood pressure, narrow the arteries and cause a heart attack. That's because cocaine kicks into gear the sympathetic nervous system, which produces excess adrenalin. The extra adrenalin is like poison to the heart. If used consistently, cocaine can weaken the heart muscle, inflame it and ultimately kill the person taking it.
Mr. Lewis' doctors immediately began to question him about drug use after the fainting incident. He denied it.
He also refused to provide a urine or blood sample for drug tests, and that only heightened his doctors' suspicions.
Meanwhile, the Journal reported, the Celtics' chief operating officer at the time, David R. Gavitt, was telling doctors that NBA rules prevented them from forcing Mr. Lewis to submit to drug testing. However, the league permits testing when there is "reasonable cause" to suspect drug abuse.
That clause was never invoked in Mr. Lewis' case, despite the mounting medical evidence, the Journal said. Mr. Gavitt told Mr. Lewis' doctors that the ailing star "couldn't be forced into it." He also assured doctors, from his own experience with Mr. Lewis, that he was not a drug user.
Reviewing the case
Baptist Hospital, meanwhile, gathered a team of a dozen cardiologists from New England hospitals to review the case. They agreed that Mr. Lewis had a life-threatening condition called focal cardiomyopathy, caused by scarring of the heart muscle.
The Journal quoted New England Medical Center cardiologist Mark Estes as saying, "We were very unified in our view."
They also said Mr. Lewis might need to have a defibrillator implanted in his chest to shock his heart into a normal rhythm if it failed again. They also needed to know more about what really caused the damage in order to prescribe the right treatment.
Most importantly, patients whose heart problems were caused by cocaine need to be told to stay away from further drug abuse.
Doctors tried to get answers. "Reggie knew what we meant. We'd been pressing him about cocaine for days," Dr. Thomas Nessa, who was leading the medical team, told the Journal.
Before his doctors got any further with the case, however, Mr. Lewis packed up, left Baptist Hospital and checked into Brigham and Women's Hospital -- a respected affiliate of Harvard University.
There, Dr. Mudge performed further tests and concluded that Mr. Lewis had neurocardiogenic syncope, a benign confusion in the electrical signals running between the brain and the heart that was causing the heart to slow down at inappropriate moments.
Dr. Mudge told the Journal that he later had come to agree that Mr. Lewis' heart was damaged. He told the athlete privately that his career was over. He also told him that "cocaine is the only thing that would explain what we are seeing." If he was still using, Dr. Mudge warned, he had to stop immediately.
4( Two weeks later, Mr. Lewis was dead.
The newspaper's investigation found that the Celtics had plenty of reason for wanting to avoid any suggestion that Mr. Lewis was mixed up with drugs.
Pro basketball in the early 1980s was troubled by failing franchises, declining attendance and drug scandals, and the RTC Celtics were no exception.
A promising star from the University of Maryland -- Len Bias -- just had been drafted by the Celtics in 1986 when he collapsed in his dormitory and died from a cocaine overdose. Celtics center Robert Parish faced drug charges after federal investigators linked him to a shipment of marijuana.
The newspaper said the team had taken out $15 million in insurance on Mr. Lewis' contract and his life. But the money would not be paid if the star's disability or death were found to be drug-related.
After Mr. Lewis died, the insurer -- the Equitable Cos. -- launched an investigation but was blocked by Ms. Harris-Lewis from obtaining copies of his medical records from Baptist Hospital.
The Journal was told the insurance investigation since has been closed.
The newspaper also reported that the Celtics have emerged from their financial troubles. Net income more than quadrupled last year to $23.8 million, propelled by the sale of a TV station to Fox for $13.7 million. The team also received a $5.6 million settlement on Mr. Lewis' life insurance policy, beyond the more than $10 million set aside for the family.