Blea Suspension: Medical Necessity Or Political Theater

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Dr. Jeff Blea | AAEP photo

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Given Jeff Blea's high-profile position as equine medical director for the California Horse Racing Board (CHRB), news last week that the California Veterinary Medical Board had issued an interim suspension of his veterinary license set the latest alarm bells clanging across the industry.

Certainly, the accusations leveled against Blea appear a damning indictment of his veterinary bona-fides.

According to the veterinary board, Blea presents a “danger to public health, safety and welfare,” due to his oversight of the investigation into the death of the Bob Baffert-trained Medina Spirit (Protonico), the Kentucky Derby winner who collapsed and died after a scheduled workout on Dec. 6 at Santa Anita.

“There exists a clear conflict of interest with Respondent Blea's continued involvement in the drug testing program and investigations,” wrote the board. “The requested interim suspension order will prevent the appearance of impropriety and any possible undue influence by Respondent Blea.”

The broader reasons the board gives for justifying the action includes Blea allegedly administering “dangerous drugs” to racehorses without a prior examination, without forming a diagnosis and without medical necessity.

But it has also raised questions as to whether the veterinary board's decision is one underpinned purely by ethical and medical reasoning, or if political winds fomented by Medina Spirit's tragic death–a highly contentious affair due to the horse's unique achievements and the checkered regulatory history of his connections–are a key driver of the action?

The TDN spoke with eight veterinary medical experts who describe the accusations largely as matters that rarely, if ever, rise to the level of a suspended license. Some point to how Blea had already undergone a rigorous screening to sit on the Horseracing Integrity and Safety Act's Anti-Doping and Medication Control Committee.

“I have absolutely no doubt that Dr. Blea is capable of conducting an absolutely perfect investigation to the best of his ability into Medina Spirit's death,” says Scott Hay, the immediate past president of the American Association of Equine Practitioners (AAEP), and someone who has known Blea professionally and personally for years. “He doesn't play games.”

According to Julia Wilson, executive director of the Minnesota Veterinary Medical Board, the actions of their California equivalent sets a potentially “unusual precedent” in state law.

Says Wilson, “I'm hoping this ends well.”

Timeline of Events…

Racetrack practitioners in California have been in the direct cross-hairs of the veterinary board since at least September of 2017, when the board received a complaint from the CHRB against three veterinarians who practiced at Golden Gate Fields in Northern California, according to public veterinary board documents.

The CHRB complaint alleged that veterinarians Kim Kuhlmann, Steven Boyer and Kenneth Allison were guilty of several infractions, including prescribing and administering medications to equine patients “per the trainer's instructions, without an examination or medical necessity.”

According to George Wallace, an attorney representing the three veterinarians, the veterinary board's investigation resulted in monetary citations and abatement orders against his clients.

Subsequent informal conferences between representatives from the veterinary board and the three veterinarians themselves resulted in those citations being withdrawn, says Wallace.

“The board, at that point, is supposed to either affirm that it is going forward with the citations, modify the citations within the bounds of what it can do with the citations, or dismiss it,” says Wallace.

“What the board did here was, instead of dismissing, it issued a peculiar order saying, 'we're withdrawing the citations without prejudice,' which everybody interpreted on the face of it as a dismissal,” Wallace says.

However, on Feb. 10 last year, the veterinary board filed formal accusations against Kuhlmann, Allison and Boyer related to the original 2017 complaint but with additional alleged violations. Possible disciplinary actions include suspension or revocation of their licenses.

The veterinary board has yet to hold a formal hearing on these accusations, however a hearing is scheduled for this Thursday in Alameda County Superior Court as part of the defendants' attempts to have the accusations dismissed altogether.

The same month the revised accusations were submitted–February 2021–the veterinary medical board allegedly received an anonymous complaint concerning the “unsafe treatment of equine patients” by multiple Californian racetrack veterinarians. In its subsequent investigation, the board issued record request letters to at least 10 different veterinarians, says Wallace. No formal accusations were officially filed, however, until after Medina Spirit died of an apparent cardiac event on Dec. 6.

The nature of Medina Spirit's death conjured memories of a CHRB investigation into the sudden deaths between 2011 and 2013 of seven Baffert-trained horses during training or racing.

The CHRB's investigation report found Baffert-trained horses during that period were significantly more likely to die from sudden death than non-Baffert trained horses, calling the difference “dramatic.” The report noted how the horses had been administered thyroxine–a thyroid hormone typically used to treat hypothyroid conditions–and that use of thyroxine is “concerning in horses with suspected cardiac failure.”

Two days after Medina Spirit's death, the veterinary medical board issued formal accusations against veterinarian Sarah Graybill Jones for a variety of offenses, including negligence in the practice of veterinary medicine and dispensing drugs without medical necessity.

On Dec. 13, California Senator Dianne Feinstein issued a public letter to the CHRB urging the board to conduct a thorough and transparent investigation into Medina Spirit's death.

Four days after Feinstein's public missive, the veterinary board issued formal accusations against Blea and private veterinarian Vince Baker, one of Baffert's long-time veterinarians.

On Christmas Eve, an emergency hearing was held on the veterinary board's petition for an interim suspension of Blea's veterinary license.

Three days into 2022, the administrative law judge who heard the case formally sanctioned that interim suspension.

Nature of the Accusations…

The accusations levelled against Blea revolve around his treatment records for six unnamed horses in his care between January and March of last year.

Among the complaints listed in the petition for an interim suspension, Blea allegedly administered “dangerous drugs” to racehorses without a prior examination to form a diagnosis and determine medical necessity.

The “dangerous drugs” listed are acepromazine, Adequan, aspirin, dormosedan, glycopyrrolate, methocarbamol, phenylbutazone, thyro-L Thyroxine, torbugesic and trichlormethiazide/dexamethasone.

Several of these medications are in everyday use on the backstretch, especially acepromazine, otherwise known as “ace,” a tranquilizer routinely used to sedate excitable horses during training. The same applies to Lasix, the ubiquitous race-day anti-bleeder medication, and phenylbutazone, a painkiller referred usually as just “bute.”

These drugs are not necessarily dangerous definitionally, says Bryan Langlois, former president of the Pennsylvania Veterinary Medical Association and someone with no professional or personal relationship to Blea. Rather, the term is a regulatory classification, peculiar to California, meaning that they cannot be given without a prescription, he says.

“In theory, it's basically anything that needs to be given on the order of, or prescribed by, a veterinarian,” says Langlois, about the “dangerous drug” classification. “At the same time, there are tons of supplements out there that could be considered very dangerous, too, but which don't fall under that definition.”

According to Langlois, “when you look at some of the drugs they're talking about–aspirin or bute that are normally given–yes, you do have to have an understanding of what you're doing, but you're not talking about drugs that you have to be so, so careful of all the time. For some reason, they legally define it as that in the state practice act.”

In a similar fashion, Blea is accused of unprofessional conduct in using drugs that are not FDA approved for equine administration, like Thyro-L, Trichlormethiazide /Dexamethasone powder and aspirin powder.

However, just because these drugs don't have FDA approval for use in horses doesn't mean veterinarians are prohibited from prescribing them, says Langlois.

“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,” says Langlois.

“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 says.

The board accuses Blea of failing to establish “any” veterinary-client-patient relationship (VCPR), claiming that he had “administered, prescribed, dispensed and/or furnished drugs and treatments” to his six equine patients “without establishing the necessary VCPR.”

This particular accusation, says Langois, taps into an ongoing debate within the veterinary community–what is the correct vet-client-patient dynamic when that relationship isn't clearly defined?

A standard relationship is one between the veterinarian and the owner of the animal. In small animal practice, the owner is the one who typically brings a sick pet in for treatment, for example.

But within horse racing, the trainer often acts as a middle-person, making decisions about veterinary treatments on behalf of the owner.

“A lot of times an investigator will look at that and go, 'well, does the owner know you've been doing all of this?' And as you know on the backside, it's usually the trainer's calling the shots as an agent for the owner,” says Langlois.

Unsurprisingly given Medina Spirit and Baffert's history with sudden deaths, the veterinary board zeroes in on how Blea allegedly prescribed, dispensed and/or administered thyroxine to one of the horses in his care “without establishing a veterinarian-client-patient relationship, without performing an examination, without forming a diagnosis, and most importantly, without medical necessity.”

“I can tell you that Dr. Blea met all our criteria for that prescription,” says former CHRB equine medical director Rick Arthur, pointing to a 2014 CHRB advisory on thyroxine use that was in effect during the treatment period identified by the veterinary board.

Interestingly, in the November CHRB committee meeting some three months before the alleged anonymous source contacted the veterinary medical board, Arthur shared how from 256 prescriptions for thyroxine during the first nine months of 2020 in Southern California, over half were for two trainers and 80% prescribed by just three veterinarians.

Though Arthur declined to disclose who the three veterinarians were, he told the TDN that Blea was not one of them.

According to Langlois, the nature of the complaints leveled against Blea essentially amount to poor record keeping.

“There are some causes for concern,” says Langlois. “The one thing we don't know, and this probably won't come out until the actual hearing, is, so far they've only really identified the horses that were treated by their initials. We don't know if something detrimental happened to those horses after those treatments or not. It doesn't seem like it because the board did not say anything about that.”

However, “when it comes to rising to the level of needing an immediate suspension, in my opinion, I don't think it reaches that level,” says Langlois.

According to Wilson, “just about every” complaint the board follows up on results in findings of poor record keeping. In the small number of instances where the record keeping is especially lax, she says, the veterinarian must take a remedial record-keeping course and their records are monitored for a period of time.

And so, what are the sorts of offenses that typically warrant a suspended license? Someone who presents a “serious risk of imminent harm to the public,” says Wilson.

Last year, the California veterinary board revoked three licenses, and while record keeping issues were listed on two of them, they were attached to much more serious offenses like “negligence” and “incompetence” in one case, and “discharging patients in unstable condition” in another. The vast majority of record-keeping issues listed last year resulted in citations or fines.

Eric Peterson, former member the Kentucky Veterinary Medical Board, explained that had he been presented with the same set of accusations, he would have recommended issuing a fine of “at most” $100.

“I was on the Kentucky vet board for 10 years. This would be minimal,” says Peterson, who says has known Blea for some 25 years. “We might not even fine him for this.”

Nevertheless, state veterinary boards, says Peterson, are vulnerable to political coercion. To illustrate, he cited a case from a few years prior whereby several Kentucky-based veterinarians were charged with purposefully altering the radiograph dates on horses headed for auction.

“Politics got in the way and nobody was suspended,” says Peterson.

The veterinary board failed to respond to a request for comment before deadline.

The TDN also sent a series of questions to the California Department of Consumer Affairs, which works with the veterinary board.

In response, spokesperson Matt Woodcheke wrote that the veterinary board's highest priority is to “protect the public through the licensing and regulation of veterinary professionals,” and that the board is “performing its mandate under California law to protect consumers through administrative disciplinary action.”

Friction Between Vet Board and CHRB…

Indeed, Blea's continued licensure, argues the veterinary board, presents a danger to “public health, safety and welfare” through his oversight of the various programs conducted at UC Davis for the CHRB, including the university's necropsy program–a medical process that forms part of the CHRB's investigation into Medina Spirit's death.

“Because Respondent Blea is alleged to have administered dangerous and medically unnecessary drugs to numerous racehorses, it stands to reason that he approves of such practice by other veterinarians,” the board states.

While the role of the CHRB's equine medical director is not contingent upon having an active veterinary license, the CHRB responded to Blea's interim suspension by bringing in the executive associate dean of UC Davis's School of Veterinary Medicine to oversee the necropsy of Medina Spirit.

This, the CHRB stated, “satisfies the VMB's stated reason for filing the temporary suspension petition and therefore requires it to consider its withdrawal.” But will it?

According to Wallace, his office has been in “communications” with the California Department of Justice about the subject of “whether or not veterinary licensure is required to be equine medical director.” Wallace declined to elaborate upon further details of the communications.

More broadly, this episode appears to be the latest in an ongoing turf-war over regulatory jurisdiction of racetrack veterinarians between the CHRB and the veterinary board. Of the veterinary board's eight members, its three non-vet board members are active animal welfare advocates, reports the Blood-Horse.

“Equine veterinarians at the track are in a position of being regulated in their activities by at least two different agencies between the vet board and the racing board. Those two agencies, I think, don't see eye to eye on who should be doing what where,” says Wallace.

As such, the vet board is putting the “scope of its authority” to the test here, says Wallace. “It has strong opinions that it can do everything that it is trying to do. Not everyone agrees with those opinions. And that's what makes for lawsuits.”

Langlois says that from a purely public perception standpoint, “there probably is some merit” in the veterinary board's argument to remove Blea from overseeing the Medina Spirit investigation.

Otherwise, Langlois says, there appears no obvious conflicts of interest that might preclude him from the task. Blea wasn't Baffert's private veterinarian, for example. Nor did he treat Medina Spirit personally.

“I would think there would be more merit to their argument if he was the one physically doing the necropsy or physically running the drug tests, or physically collecting the samples from Medina Spirit after his death,” says Langlois. “But from what I understand, he isn't.”

The formal hearing for Blea's interim license suspension is scheduled for Jan. 21.

Wallace warns some of the other vets who have been issued record request letters should be braced for formal accusations against them.

Kathryn Papp is an East Coast-based veterinarian and vocal critic of the over-use of medication in horse racing, who nonetheless describes Blea's suspension as unjustified.

Papp says that if she were practicing in California, she would be “fearful” of having to second and triple guess “every diagnosis I made or procedure I performed.” She adds that if “our livelihoods and very right to work are going to be threatened and, or punished unfairly,” then “I could not understand why anyone would want to continue being an equine practitioner in California at all.”

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