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Amended Accusations Set Ball Rolling Towards Blea Hearing

In an amended accusation, the California Veterinary Medical Board has revised its original set of complaints leveled against California Horse Racing Board (CHRB) equine medical director, Jeff Blea.

The additional information, however, mostly “fine-tunes” what was included in the original accusation against Blea and doesn't change the “big picture,” said George Wallace, Blea's attorney.

According to various leading veterinary medical experts, that big picture is one largely of lax record keeping.

What the amended accusation does, however, is set the ball rolling on a rough time-table leading to a full hearing, giving Blea 15 days with which to file a notice of defense.

Once Blea's notice of defense has been filed, the formal hearing is required to be scheduled within 30 days, said Wallace. But due to the complicated nature of the case, it will likely take longer, he said.

“We expect to oppose and refute most everything here when the appropriate time comes. It remains the case that the allegations of the Accusation are disputed, and will be either refuted altogether or shown to be consistent with the professional and legal obligations of equine veterinarians generally, and particularly of equine veterinarians at California race tracks,” Wallace wrote in an email, regarding the amended accusation.

Blea was put on administrative leave from his position as California horse racing's head veterinarian by UC Davis in January. As per an administrative law judge ruling from earlier this month, Blea's veterinary license is also temporarily suspended pending a formal hearing.

In the interim, Blea might still seek injunctive relief in the California Superior Court to lift the temporary block on his veterinary license due to the fact the suspension has “serious problems in terms of a lack of an evidentiary basis,” Wallace said. A decision on such a move could arrive by next week, he said.

After the administrative law judge's ruling earlier in February, CHRB executive director, Scott Chaney, explained that the agency was contemplating similar legal intervention in the Superior Court on behalf of Blea.

According to a CHRB spokesperson Wednesday, no decision had yet been made on the agency's legal approach in the case.

The veterinary board accuses Blea of a number of offenses, including allegedly administering drugs to racehorses without a prior examination to form a diagnosis and determine medical necessity, failing to establish “any” veterinary-client-patient relationship, and of issuing drugs that are not FDA approved for equine administration.

A subsequent TDN investigation found a broad consensus among veterinary medical experts that the infractions are largely matters of poor record keeping which typically result in punitive actions less severe than a suspended license.

Veterinary experts also suggested that the medical board's investigation into Blea potentially failed to account for the unusual nature of veterinary practice on the backstretch, where veterinarians with multiple barns under their care can build the sort of relationship with their animals that is absent from traditional small animal practice.

In its original argument for an interim suspension, the veterinary board claimed that Blea presents a “danger to public health, safety and welfare,” due to his oversight as equine medical director of the high-profile investigation into the death of the Bob Baffert-trained Medina Spirit (Protonico), the GI Kentucky Derby winner who collapsed and died after a scheduled workout Dec. 6 at Santa Anita.

The final results of that necropsy were issued to the public last week, with Medina Spirit's cause of death ultimately “undetermined.”

According to UC Davis, Blea remains on administrative leave, despite completion of the necropsy.

“The conclusion of the Medina Spirit necropsy does not affect the status of the equine medical director position. Dr. Blea's administrative leave continues. In the meantime, school personnel continue to fulfill the duties of the equine medical director for the California Horse Racing Board,” wrote a UC Davis spokesperson, in an email.

The amended accusation includes details that weren't included in the original complaint.

It states, for example, that Blea's veterinarian confidential reports revealed “clusters of equine patients were administered identical medications and treatments, at the same time, at the request of their trainers without medical necessity.”

Listed in explanation are the following substances that are commonly found along the racetrack backstretch: Adequan, Gastrogard, Aspirin powder, Acepromazine pills, Uniprim, Otomax, Legend (a hyaluronic acid), and Tucoprim powder.

The amended accusation also adds additional substances to those that Blea reportedly possessed or used that have not been approved by the FDA.

But as Bryan Langlois, former president of the Pennsylvania Veterinary Medical Association, had previously told the TDN, just because certain drugs don't have FDA approval for use in horses doesn't mean veterinarians are prohibited from prescribing them.

“A lot of drugs that are out there, they're FDA approved but only in certain species or only in humans. The companies never did the trials to test them in animals to get the FDA certification. So, a lot of times, we prescribe these drugs as off-label use,” Langlois had told the TDN.

“Usually, what that means is that there is no FDA approved equivalent out there for that species. The research has been done and the drug dosage has been worked out so that it can be used safely in animals, you just have to make the owner aware of the fact that you're using it off-label,” he had said.

Among the punitive outcomes the veterinary medical board is seeking against Blea is full revocation or suspension of his license.

The TDN asked Langlois to review the amended accusation. In a text, he explained that the nature of the allegations still don't rise to the level requiring immediate license suspension.

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KHRC Mum on Medina Spirit, Vows Future Transparency

Against the backdrop of the 2021 GI Kentucky Derby drug positive investigation dragging past the nine-month mark and the Kentucky Horse Racing Commission (KHRC) maintaining a conspicuous silence throughout the drawn-out process, KHRC chairman Jonathan Rabinowitz obliquely referred to the scandal for the first time at an open, public meeting Tuesday.

Although Rabinowitz did not specifically mention Medina Spirit's betamethasone overage or trainer Bob Baffert's long-delayed stewards' hearing that was finally conducted Feb. 14, that controversy was almost certainly the catalyst for the chairman stating that the KHRC is seeking to change administrative regulation 810 KAR 9:010, which deals with the KHRC's hearings, reviews and appeals process.

Rabinowitz said Feb. 15 that regulation “historically precludes the commission from making public statements prior to the issuance of stewards' rulings.”

After Tuesday's meeting, TDN confirmed with the KHRC's general counsel, Jennifer Wolsing, that Rabinowitz was referring to section 1 (4) of that regulation, which states: “Stewards' and judges' hearings shall be closed, and the stewards and judges shall make no public announcement concerning a matter under investigation until the conclusion of the hearing.” (Read the full regulation here).

Rabinowitz said, “This commission is committed to transparency, as well as the best interest of the horsemen, associations, and the racing industry as a whole. As a result, we've begun the process of making significant changes to 810 KAR 9:010 in order to ensure that this commission remains an industry leader in transparent government. It is of the utmost importance to this commission that we get this reg changed.”

Commissioner Bill Landes III was the only KHRC member to follow up on that statement with an opinion.

“Transparency and a more [public] process will allow us to become more effective commissioners in that we will be perceived [that] we care and know what the hell is going on–and that is not necessarily how we are perceived today. This is a breath of fresh air,” Landes said.

Those comments about possible future changes were preceded by a slate of actual KHRC regulation changes, all of which got voted in unanimously during Tuesday's meeting. Because they still need to go through a public notice and approval period at the state level, the following regulations are not expected to go into effect for another seven to nine months:

Allowing a horse to enter a race even when the horse is on the veterinarian's, stewards', or starter's list, provided the horse has a posted “off” date on or before the date of the

race.

Workout requirements for layoff horses: The current regulation states that a horse that has not started in the past 45 days shall not be permitted to start unless it has at least one published workout within 20 days of entry. The new regulation adds requirements for horses that have not started in the past 90 days (two published workouts during the past 90 days, one within 20 days of entry) and for 180 days (three published workouts during the 180 days, one within 20).

Mutuel Couplings: The current regulation states that horses entered in the same race and owned by the same owner shall be joined as a mutuel entry. The revision allows for some flexibility by stating that horses owned by the same owner “may” be joined as a mutuel entry.

Also, the current coupling regulation states that horses having common ties through ownership shall not start in a purse race to the exclusion of a single entity. The proposed revision expands that requirement to include horses with common ties through ownership or training.

Another current regulation states that the racing secretary may uncouple entries having common ties through training to make two separate betting interests. The revision expands that rule include horses with common ties through training or ownership. A trainer entering two horses in a race will have to indicate a preference for one of the horses.

If a coupled horse commits a foul during a race, current regulations may be interpreted to “require” the stewards to include any horses coupled with an offending horse in the penalization. The revision deletes the reference to the coupled horse. Additionally, the revision clearly states that if a horse deliberately interferes in the order of finish for the benefit of another horse with common ties through ownership or training, then both horses may be penalized.

Claiming Regulations: A licensed owner must have made a start within the last 30 days at a Kentucky track in order to be eligible to claim a horse. An authorized agent may act on behalf of an owner who meets the above criteria in order to claim a horse. A “claiming license” will be issued to someone who does not currently own a horse but wants to claim one horse only. After that one claim, the claiming license is rescinded, and the above ownership rules apply.

Also, an owner may only claim one horse from a single race. A trainer may claim as many as two horses from a single race, but only if the horses are claimed for different owners. A claimed horse shall not race outside of Kentucky for 30 days from the date of the end of the meet during which the horse was claimed. That represents a change from the current regulation, which states that a horse can race outside of Kentucky after the close of entries for closing day of the meet.

A claimed horse shall not be sold or transferred within 60 days after the day it was claimed (except via another claiming race). This is a change from the current 30-day regulation.

After the race has been run, a claimed horse shall be delivered to the test barn (or detention barn) for post-race inspection When the horse passes KHRC veterinary inspection, it will be delivered to the successful claimant. The funds for the horse will be available when the horse passes inspection and is delivered to the successful claimant.

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Baffert Legal Team Optimistic After KHRC Hearing

A full 289 days after the running of the 2021 GI Kentucky Derby, the Churchill Downs stewards finally got around Monday to holding a closed-door hearing regarding the positive post-race test for Medina Spirit (Protonico). And while a decision may not be imminent, Clark Brewster, the lawyer representing trainer Bob Baffert, emerged from the hearing hopeful that his side will prevail.

“Upon an honest and fair-minded review, Bob Baffert and Medina Spirit will be fully exonerated,” Brewster wrote in a text.

As has been the case with the Kentucky Horse Racing Commission (KHRC) since the running of last year's Derby, the hearing was shrouded in secrecy, which left many questions unanswered. Brewster said he did not know when a decision would be announced.

“How long is a string?” he texted, using a phrase that meant he did not know the answer and did not want to venture a guess.

Medina Spirit tested positive for the medication betamethasone.

Should the Churchill stewards decide to disqualify Medina Spirit, Brewster, Baffert and owner Amr Zedan would have the option of appealing the decision to an administrative law judge. It seems likely that's an option they would take in a legal battle that could drag on interminably.

At first Baffert denied that Medina Spirit had ever been treated with betamethasone, but then changed his story. He said the horse was treated with a skin ointment before the Derby to deal with a rash and the ointment contained betamethasone. The Baffert team subsequently had a split sample from the race tested and said it proved that the betamethasone came from the ointment, which meant that it was not injected into the horse, something that, possibly could have improved performance. The stewards may decide that it does not matter where the drug came from and that its presence in Medina Spirit warrants a suspension, no matter the circumstances.

“We are now left to trust that the stewards will apply the uncontroverted facts to the Kentucky Racing rules as they are written,” Brewster said in his text. “Medina Spirit was treated by veterinarian prescription with a topical salve for a skin infection. The Kentucky rules expressly permit use of topical salves and the treatment given to Medina did not violate any rule. The post-race specimen positive reporting 21 picograms of betamethasone was caused by the topical salve. The Kentucky Rules (and all other jurisdictions) restrict only Betamethasone Acetate or Sodium Phosphate (which appears in a horse's system when injected with betamethasone). These formulations are Injectable solutions into a horse's intra-articular joint. Medina Spirit was never injected with betamethasone and the evidence presented today proved that conclusively.”

Brewster wrote that Baffert has been treated unfairly.

“The false narrative regarding this case was sprung early and spread widely by uninformed or malevolent accusers and spread by careless reporting,” he said.

Even should the stewards decide to maintain Medina Spirit as the winner, Baffert could still be on the outside looking in when it comes to the 2022 and 2023 Derbies. He is under a two-year suspension issued by Churchill Downs and the track would be under no obligation to lift its ban if Baffert is cleared by the KHRC.

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Medina Spirit Necropsy: Cause of Death “Undetermined”

The cause of GI Kentucky Derby winner Medina Spirit's (Protonico) sudden death on Dec. 6 at Santa Anita remains undetermined, according to the findings of a necropsy on the horse.

In a news release issued in tandem with the necropsy report Friday, the California Horse Racing Board (CHRB) stated that a “definitive cause of death was not established despite extensive testing.”

As per the CHRB news release, while omeprazole—an anti-ulcer medication—and the ubiquitous diuretic Lasix were detected in blood and urine samples, these findings were consistent with the medication report filed with CHRB by the attending veterinarian.

“No other drugs, heavy metals (including cobalt), or toxicants were detected,” wrote the CHRB.

The necropsy report itself summarises the findings of the study, which experts say are indicative of sudden cardiac events in racehorses.

“The most remarkable gross and microscopic changes were pulmonary congestion and edema, with milder hemorrhage. There were also congestion and small hemorrhages in multiple organs. No significant evidence of prior episodes of pulmonary hemorrhage other than a single and mild focus of hemosiderosis was observed,” the necropsy report states.

According to the report, “detailed microscopic examination” of the heart revealed minimal changes in the myocardium, the muscular layer of the heart.

“Although the significance of this finding remains undetermined, it is likely incidental because of the limited extension and severity, and also because similar changes have been seen before in horses dying of non-cardiac related causes (e.g. euthanasia). In addition, mild remodeling (thickening of the adventitia) of the intra-pulmonary veins was observed. This is also likely an incidental finding,” the report states.

Extensive toxicologic testing using “multiple samples” obtained at necropsy proved “unrewarding,” the report states.

“Considered altogether, the results of the post-mortem examination, histopathology, and ancillary testing, are supportive of a sudden cardiorespiratory arrest as it may occur with acute cardiac failure. A defect in the cardiac conduction system should be considered as a possible cause of cardiac failure,” the report states.

Unrelated to the sudden death, the pathologists discovered degenerative joint disease in Medina Spirit's four fetlocks and both elbow joints. These sorts of issues are typical in racehorses.

The necropsy was performed at the California Animal Health and Food Safety (CAHFS) San Bernardino laboratory, by a team who form part of the diagnostic laboratory system of the University of California-Davis (UC Davis) School of Veterinary Medicine.

In its news release, the CHRB outlined the mechanics of the necropsy, which included the collection and examination of tissue samples from the heart, lungs, liver, spleen, kidney, stomach, intestines, muscle, brain, spinal cord, testicles, and other glands. Additionally:

– Liver tissue was tested for various substances including heavy metals like cobalt, anticoagulants, pesticides, environmental contaminants, and drugs.

– A blood sample was sent to Cornell University to be tested for thyroxine.

– Blood, urine, and aqueous humor samples were screened for “hundreds” of legal and illegal drugs and substances, including erythropoietin (EPO), clenbuterol, and betamethasone.

– Heart tissue samples were sent to the University of Minnesota and to the UC Davis Veterinary Genetics Laboratory as part of ongoing collaborative research program with the CHRB investigating possible genetic causes of sudden death in racehorses.

– The finalized report—including necropsy photographs and microscopic sections—were sent to experts at the University of Kentucky and the University of Guelph, Ontario, Canada, for independent review.

In his response in the necropsy report, Grant Maxie of the University of Guelph, explains how cases of sudden unexpected death in racehorses are “frustrating to deal with, and frequently remain unresolved, as in this case.”

Without the monitoring of cardiac rhythms, Maxie writes, “cardiac electrical activity remains unknown.”

Maxie adds that “minor lesions of myocarditis (“very rare mononuclear infiltrates” in this case) or fibrosis (as in the Swale syndrome) may be the source of electrical instability

and dysrhythmia, but such comments are speculative in postmortem cases.”

Marked acute pulmonary congestion and edema in this case is “consistent with acute heart failure,” he writes.

During a media Q&A Friday morning after the release of the report, representatives of UC Davis explained how the necropsy performed on Medina Spirit mirrored those performed on other racehorses who have died in California, except for one difference: US Davis sent the report for peer review.

The drug testing results, however, were not peer reviewed, said CAHFS director, Ashley Hill.

“We tried to find somebody to look at the drug test but we weren't able to,” said Hill, who explained that the university they approached raised liability concerns.

“We weren't able to get the contract turned around in a timely manner, and we thought it was more important to get the results out,” Hill said.

CHRB executive director Scott Chaney also explained that the samples the agency had taken—a separate process to the necropsy study—had yielded no drug positives.

The Bob Baffert-trained Medina Spirit collapsed and died after a scheduled workout on Dec. 6 at Santa Anita.

Medina Spirit's death triggered a wave of international headlines, not only because the horse faces possible disqualification from the Derby after a post-race sample tested positive for betamethasone, but also because seven Baffert trained horses infamously died suddenly during training or racing between 2011 and 2013.

A subsequent CHRB report found that those horses had been uniformly administered thyroxine-a thyroid hormone used to treat hypothyroid conditions-and that use of thyroxine is “concerning in horses with suspected cardiac failure.”

During the Q&A, UC Davis's Francisco Uzal explained that while the blood sample sent to Cornell University showed thyroxine levels below the limit of detection, he was unable to confirm if that result was “significant” as such blood samples are typically collected from live animals.

“If this was blood from a live horse, you could speculate that this horse was producing very little thyroid hormone. But because it came from a dead horse, we don't know how to interpret that,” Uzal said.

As highlighted in this TDN article from 2018, a host of unknowns typically surround instances of sudden death in racehorses—a term that comprises many different causes, not simply issues related to the heart.

Sudden death includes massive bleeding in the lungs or abdomen, fractures of the skull or neck, and hemorrhaging from a pelvic fracture-all these injuries can prove swiftly fatal in a manner that, outwardly, resembles a cardiac issue.

Even when post-mortems are performed, when it comes to sudden cardiac death, oftentimes there are no lesions, ruptured arteries or damaged heart tissue that pathologists can point to with authority and say this or that caused the heart to stop.

What's more, sudden deaths happen extremely rarely.

In a 10-year period between 2007 and 2017 in California, 8.2% of all training and racing related fatalities were sudden deaths. So, what are the possible causes of so-called equine heart attacks? Answers aren't always easy to come by.

This comprehensive 2011 international review study points out that pathologists were only able to make a definite diagnosis in 53% of cases, a presumptive diagnosis in 25% cases, with 22% of cases left unexplained.

Indeed, rupture of the aorta-the largest artery in the body-is “anecdotally thought to be a common cause of exercise-related sudden death in horses,” but that it occurs in only 1% of cases, the study found.

There are other possible causes. Unlike human heart attacks due to clogged arteries, the sheer size of the equine heart makes them susceptible to electrical irregularities, like arrhythmias—an irregular heartbeat—and heart murmurs, the presence of irregular heartbeat sounds.

Experts point to a possible connection between the use of substances like clenbuterol, calcium, magnesium and cobalt—those that can alter equine cardiac muscle—and sudden cardiac death. But that connection hasn't been made definitively.

What's more, there have been efforts to try to identify a possible connection between certain genes in horses and a higher susceptibility towards cardiac problems. But again, this is a sphere of research with a lot more leg-work needed.

The investigation into Medina Spirit's death isn't over, however.

A review of the necropsy report will now be performed by official veterinarian Alina Vale, a CHRB safety steward and a member of the Board of Stewards. The CHRB will eventually publish this separate report.

“Any potential rule violations uncovered in this process will be investigated by the CHRB and would result in a complaint and possible disciplinary action. This process takes place for every fatality occurring at a CHRB regulated facility,” according to the CHRB.

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