Ok, so here's how it'll work. After any hand in which Prestige drops by 1 or more, every PC gets a "visit" from an enforcer. If that PC's Respect is above 1, the visit is non-life-threatening, it's just stressful. Increase Exhaustion by 1.
On the other hand, if a player's Respect is at 1, it's a "hit". Increase Exhaustion by 1 (The PC pushed himself and managed to escape), and then, if Exhaustion is at the max (undecided now) the PC dies (He's too tired to run anymore).
When a PC dies, split his money equally amongst all other PCs. Some PCs may wish to force down another PC's Exhaustion and Respect and then force a loss of Prestige, in order to get that player killed (and thus make more money). Cool, huh?