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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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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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This Side Up: The Heart of the Matter

You would think the heart has enough on its plate. It literally never gets a break, not for one second, never mind a vacation. Never a morning's fishing, a bourbon after dinner. Yet somehow we have ended up charging this most vital of our organs with a second burden, figurative but scarcely less momentous, as the vessel of love.

So when the tireless engine of life finally fails, in one we cherish, we speak of our own hearts as being “broken.” And there were many such, in Lexington on Friday, when mourners bade farewell to the distinguished veterinarian Dr. Thomas Swerczek.

We reserve to their private grief the tribute that Dr. Swerczek was evidently no less exceptional in his dedication, as a family man, than in his professional accomplishments through decades of service at the local university. For those of us outside the reach of his own heart, however, the professor's name will always evoke the epic proportions of another.

For it was Dr. Swerczek who famously conducted the necropsy, in 1989, on perhaps the greatest Thoroughbred in the story of the breed. He estimated Secretariat's heart to be twice the average size, maybe over 20 pounds. This discovery conformed so obligingly with the horse's overall prowess, with his physical magnificence and almost supernatural running power, that it nourished some pretty excitable extrapolations.

Secretariat's heart is literally the stuff of legend. It places him in the same register as warrior heroes of Norse mythology, with their limbs like cedar trees. But legend is not even history, never mind science. And the perennial quest for an edge, in our business, has allowed a whole ancillary industry of theory and analysis to be energized by the freakish heart of a freak among racehorses.

On some level, no doubt, this can only have been encouraged by the very cultural duality we just noted in the human heart. In a racehorse, of course, the metaphorical dimension is not love, but courage. But it's obviously tempting, if only subliminally, to conflate the “heart” we celebrate in a horse that gives everything in a finish with the sheer physical proportions of the organ housed in its chest. We literally describe such animals as “big-hearted”.

After all, the same intangibility unites “heart,” in the sense of competitive ardor under the whip, and the physical organ that we can only ever see for ourselves at a post-mortem. Sure, nowadays we have technology that allows external estimation of cardiac capacity. But as is axiomatic in a less decorous context, there's a limit to the satisfactions available in size alone.

Another man of science recently mourned in Kentucky, Dr. David Richardson, once cautioned me that data available across the horse population does not permit pronouncement on the specimen in front of you. And cardiac physiology, being so complex, was his chosen example.

“They talk about heart size,” he said. “But the real question is: how does it squeeze? (What's called the ejection fraction.) How fast can it pump blood? How efficiently, in terms of oxygen use? So it's not just heart, but lungs. So people try to assess that, too, on a treadmill. But that's still not like running a race at distance. But even if you could get the cardiovascular bit right, then how about the legs? And the mind? You can gauge some of those things, sometimes–but it's very hard to say how the whole package will stand up to raceday pressures.”

As it happens, Dr. Swerczek also performed the necropsy on Bold Ruler. Though he would have been one of the greatest stallions in history even without Secretariat, apparently he did not have a large heart. But you know who did? The second largest one Dr. Swerczek ever saw, at 19 pounds, belonged to none other than Secretariat's hapless punchbag, Sham.

What an amazing coincidence. But what an obvious coincidence, too. Because Dr. Swerczek performed the same procedure thousands of times, including elite athletes from many different crops. And none of them, he said, ever came close to that pair.

So instead of this inadvertent legacy, in all the controversies and occult dogmas stimulated by Secretariat's heart, let's instead celebrate the many years of unsung contribution made by Dr. Swerczek to the welfare of the animal he loved. He made vital advances in several horrible diseases that afflict the Thoroughbred and was always in the frontline trenches in the trauma of Mare Reproductive Loss Syndrome.

He understood how many different factors, notably in environment and nutrition, can erode or assist the fulfilment of a racehorse. He knew that the system of flesh and blood maintained by those miraculous pumps is always too complex to permit glib answers.

Dostoyevsky identified two types of unhappy fool: the one with a heart and no sense, and the one with sense and no heart. By all means, go ahead and find out all you can about the heart. Maybe you can discern something instructive even in those of immature Thoroughbreds. But do keep your sense, all the same, along with their hearts.

Maybe ventricular capacity can indeed tell us something about stamina, caliber even, and heritability. To me, however, anything that remotely smacks of a “system,” any formula that claims to cut right through the mysteries of our vocation, deserves its place somewhere on the spectrum that starts, at one end, with snake-oil.

Science, with its scrupulous standards of evidence, will doubtless keep inching its way forwards through this whole maze. But in a business where the fast buck is never quite fast enough, some people will never want to hang around and wait.

Needless to say, we all know of highly professional horsemen exploring some of these potential edges. The responsible ones, invariably, will stress that the insights they seek can only address a single facet of what will always remain a very jagged diamond. And, actually, even the people who make it all sound very simple tend to be little more than credulous; fanatical, rather than fraudulent. But while it's a free country, and up to you how to spend your money in this very expensive game, I know what I'd suggest if anybody comes to you with a key to the single, secret lock on Thoroughbred potential. Give them your iciest smile, and wish them good day.

Apart from anything else, in claiming to be able to remove the guesswork, such people are inimical to precisely that element of inspiration which feels, to some of us anyway, most essential to the whole romance of what we do. Yes, some will be supported by wonderful gadgets; all, nowadays, by persuasive software. But give me the unadorned instinct of a seasoned horsemen, every time, and we'll see you out on that proving ground. First to the wooden stick.

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Medina Spirit’s Necropsy ‘Currently Underway’

Medina Spirit's necropsy is “currently underway” and a report on last week's sudden death of the GI Kentucky Derby winner is expected to be publicly released by mid-February, California Horse Racing Board (CHRB) equine medical director Dr. Jeff Blea said Wednesday.

“Completion of sudden death case file reports takes weeks and months to complete due to the in-depth level of analysis involved, and we fully expect a final report in this case in approximately two months,” Blea told commissioners at the Dec. 15 CHRB meeting.

“Tissue samples and specimens will be stored for further testing should the need arise,” Blea said.

Medina Spirit appeared sluggish then collapsed at Santa Anita Park after finishing a five-furlong workout Dec. 6.

The colt's admirable, overachieving career arc of going from a $1,000 yearling buy at a public auction to winning America's most important horse race only glowed for about a week before it was overshadowed by news that the Bob Baffert trainee had tested positive for an overage of betamethasone after winning the May 1 Derby.

No ruling has been issued for that 2021 Derby drug positive, although it has sparked a firestorm of controversy for occurring on the heels of four other Baffert horses testing positive for medication overages within the previous year, two of them in Grade I stakes.

“A sudden death in racing is defined as acute collapse and death in a closely observed and previously determined healthy Thoroughbred racehorse during or within one hour after exercise,” Blea said.

Like with all fatalities that occur on licensed CHRB premises necropsy, the regulatory agency is obligated to perform a necropsy and investigation.

Medina Spirit's necropsy is being carried out by pathologists at the California Animal Health and Food Safety Laboratory, which works in conjunction with the University of California (Davis) veterinary school.

That particular lab, Blea said, is “arguably one of the best in the country, if not the world.”

Blea explained that “Additional tissue specimens and samples will be shared with other departments at UC Davis, including toxicology, analytical chemistry, and genetics, as well as other university laboratories in the country to help determine the cause of death.”

But a definitive cause might never be known.

Blea called sudden death circumstances “frustrating,” and cited a published study that concluded only 53% of sudden equine deaths eventually turn up a definitive diagnosis. A presumptive cause of death is given 25% of the time, with the remaining 22% “unexplained,” he said.

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