Addressing the Ethical Challenges of Veterinary Practice in a Pari-Mutuel Environment

Veterinarians must own their role as the ultimate provider of healthcare of the horse in a pari-mutuel environment. The dynamics of the owner-trainer-veterinarian relationship confound this fundamental truth. Veterinarians cannot abdicate this responsibility. We must act on our professional obligation to put the horse first. We must be the advocate for the horse in all matters pertaining to racing. This is the fundamental standard for the equine practitioner. We can do no less.

1. Introduction

Medication is the number-1 topic of discussion in racing today. Medication is seen as the root of all of racing’s ills. As far as the public is concerned, “perception is reality.” Medication is perceived to be the cause of catastrophic injury, the cause of weakening the breed, and the means for cheaters to prosper. In fact, the use of medication in the current racetrack business model is driven by economic factors. In the succinct words of Jerome J. Aiken, President of Thoroughbred Racing Productions, “With purses being racing’s only revenue stream, owners have to win to stay in the game.” He properly emphasizes the reality that people race sore horses, not because they consciously want to place them at risk, but because they need the money to survive. “A sore horse is going to run on medication when the trainer is owed several thousand dollars and the trainer owes the groom and the feed man several thousand dollars.”

In terms of sheer numbers, “overnight” horses are the foundation of the racing industry in North America. Most of these races are claiming races, populated in large part by horses that have been found to be “at increased risk” to some degree for catastrophic injury.

Key Points

In 2010, the American Association of Equine Practitioners (AAEP) Racing Committee drafted “Clinical Guidelines for Veterinarians Practicing in a Pari-Mutuel Environment” (Appendix A). This document was not designed to be a generic standard of practice. Rather, it was written to provide guidelines for practitioners who practice on the backstretch and in training centers to recognize and promote practices that many veterinarians currently use to place the health, safety, and welfare of the horse uppermost in their daily work. The recommendations contained in that document represent a collection of practices that the AAEP believes places appropriate emphasis on the health, safety, and welfare of the racehorse.

To a very large extent, the use of medication in the current business model of racing is driven by entry date. The entry date is the date when a horse is entered into a race, and this date varies between racing jurisdictions. The AAEP believes that making healthcare decisions based on the entry date is not fundamentally in the best interest of the horse. All medical treatments of the racehorse should be based on a veterinary diagnosis, with appropriate time allowed after the treatment of an injury to ensure that the horse is recovered before racing. Although this medical philosophy seems like an obvious one for veterinarians, it represents an unqualified departure from the current practice model in a pari-mutuel racing environment in which horses are treated in preparation for a race. Trainers often do not want to medicate a horse unless they are sure that an upcoming race will fill. In this scenario, the horses are often given intra-articular injections within a few days of the race, eliminating any opportunity to evaluate the treatment effect before competition. The best practice is to treat a medical condition on the basis of a diagnostic work-up and demonstrate soundness before entry rather than treat after entry in preparation for a race.

All medical treatments and procedures performed on horses in a racetrack or training center setting should be documented. A medical records–based billing software that includes, at a minimum, the standards imposed by state veterinary practice acts for individual animals, should be used by veterinarians to create and maintain a timely, complete, and readily accessible medical record that can be presented to regulatory authorities as necessary to document treatments administered to all horses in training at racetracks and training facilities. Documentation of the use of all prescription drugs should conform to the requirements of the applicable state’s veterinary practice act.

The significant findings of diagnostic examinations performed on horses in a racetrack or training center environment should be documented in the horse’s medical record. Health certificates must be signed by the USDA:APHIS:VS accredited veterinarian who performed the examination to satisfy the animal health requirements inherent in such veterinary procedures.

For the most part, veterinarians working at the racetrack on a daily basis have a good understanding of the physical condition and musculoskeletal status of racehorses in their care. It is the responsibility of veterinarians to be an advocate for the safety of the horse. In circumstances in which a veterinarian determines that a horse may be at an increased risk of injury, he should inform the trainer of that circumstance and recommend that the horse not be entered to race. If the trainer enters a lame horse, it is the responsibility of the veterinarian to advise a regulatory veterinarian of that circumstance in order that the horse may be subjected to appropriate scrutiny before racing.

When the racing careers of these horses are finished, veterinarians play an important role in guiding their transition to an alternative career. One of the most critical roles a veterinarian can play in this process is to properly assess the potential for use as a riding horse. In consideration of the limitations of rescue and rehabilitation resources, it is critical that the racetrack practitioner realistically triage individual horses to provide the best opportunity for horses that are most suitable for riding, driving, or showing activities. Horses with fractures or chronic conditions that require extensive rehabilitation may be suitable for breeding, pasture turnout as an equine companion, or limited work in a correctional facility rehabilitation program, but these particular horses are generally unsuitable for riding and deplete the resources of rehabilitation/rescue agencies.

Veterinary fee structures should place emphasis on the value of professional services in addition to the administration and dispensing of medication. In addition, practitioners are encouraged to make themselves readily accessible to owners and trainers for consultation regarding diagnostic and therapeutic strategies or questions regarding the invoice. Invoices should accurately indicate all examinations, treatments, and procedures performed on individual horses. Both the invoice and the medical history should avoid colloquial terminology and be in common medical terminology. It is recommended that the invoice with payment history be delivered directly to the owner or owner’s agent with a copy to the trainer at least monthly. All communication with owners and trainers should be consistent with a transparent owner-trainer-veterinarian relationship.

Legal drug compounding requires a valid veterinarian-client-patient relationship. The veterinarian should limit the use of compounded drugs to unique needs in specific patients and limit the use of compounded drugs to those uses for which a physiological response to therapy or systemic drug concentrations can be monitored, or those for which no other method or route of drug delivery is practical.

Further, medication withdrawal times are calculated only for Food and Drug Administration–labeled medication. For this reason, the use of compounded medications in a racing environment is accompanied by an increased risk for a drug overage.

2. Conclusions

Veterinary medicine is not practiced in a vacuum. The business model of racing defines the practice of veterinary medicine in a pari-mutuel environment. In this intensely competitive environment, veterinary practice is conducted largely at the direction of trainers, who view veterinary services as a commodity. This economic context defines the fundamental ethical challenges of veterinarians who practice in the backstretch of racetracks or training centers.  [...]