Have rule changes led to real changes in NY corticosteroid practices?

Aqueduct Racetrack. Photo: NYRA/Adam Coglianese.

Two years after a report on racehorse health and safety in New York State suggested critical changes in various policies and procedures, an important recommendation regarding corticosteroid treatments has been formally updated, but remains under-enforced. Teresa Genaro traces the evolution of a rule meant to protect horses and riders that may be lacking in both foresight and oversight.

A grim winter at Aqueduct

In late 2011 and early 2012, horses racing at Aqueduct Racetrack in Queens, New York died in alarming numbers: 21 of them between Nov. 30, 2011 and March 18, 2012, nearly double the number that suffered catastrophic injuries in the same period the previous year.

It was a time of transition in New York racing: just months before, Resorts World Casino at Aqueduct had opened, and slots money began flowing to purses at the New York City track, resulting in inflated prize money at every level of racing, including the lowest claiming ranks, where purses in some cases jumped by more than 200 percent. 

It was supposed to be a time to celebrate stability in the sport; after a decade of legal and financial troubles, the New York Racing Association (NYRA) was supposed to be breathing easy. Instead, it was under scrutiny for the worst of reasons.

Spurred by relentless coverage of the equine deaths by local beat writers, New York Gov. Andrew Cuomo called for an investigation in March of 2012, and NYRA—which oversees Aqueduct, Belmont Park, and Saratoga—created a four-person task force on racehorse health and safety that would be chaired by respected veterinarian Dr. Scott Palmer. 

Issued in Sept. 2012 following a five-month study, the Task Force’s report found, as expected, that no single factor could be identified as the cause of the breakdowns. It did, however, point to the use of corticosteroids as a factor in approximately 30 percent of the equine deaths and recommended sweeping changes to New York’s corticosteroid policies, changes that were enacted by both the New York State Racing and Wagering Board and NYRA with a celerity unusual in both horse racing and New York State government. 

Two years later, NYRA has seen the number of fatal breakdowns during racing decrease. Of particular note, given that 17 of the 21 horses died in claiming races, deaths in claiming races dropped from 56 percent of all racing fatalities in 2013 (14 of 25) to 28 percent in 2014 (7 of 25) to date, according to the New York State Gaming Commission’s Equine Breakdown, Death, Injury and Incident Database

That’s the good news. The bad news is that despite the drop in fatalities, some regulations implemented to increase the health and safety of horses and riders are largely unmonitored, some practices largely unchanged since that terrible period in 2011 and 2012.   

The role of corticosteroids 

Synthetic corticosteroid injections are widely used in human and veterinary medicine to treat inflammation and pain associated with joint disease and arthritis, but while the Racing Medication and Testing Consortium recognizes their important therapeutic uses, it also warns of their ability to mask clinical signs of injury.  A 2013 position paper also calls attention to potential issues related to the prolonged use of corticosteroids: 

“Use of corticosteroids close to time of the event in sufficient doses to hide…predisposing disruptions of bone and cartilage puts horses and people at increased risk of serious injury. It is this concern that drives the need to move treatment time and medication doses far enough away from the event to assure the horse is performing without joint concentrations of corticosteroids high enough to hide impending structural failure and its potentially catastrophic consequences for the horses and people involved.” 

Those “catastrophic consequences” were a reality in New York, and in their aftermath, backstretch culture and state government met uneasily, leading to uneven, at times non-existent, compliance with and oversight of the very regulations put in place to address them.

Two years on, are New York’s horses any better protected than they were in the winter of 2012, when so many of them broke down? 

Reforming practices

Corticosteroid reform took three forms in the wake of the Task Force report. The New York State Gaming Commission (which supplanted the Racing and Wagering Board effective Feb. 1, 2013) first established a database – the Equine Steroid Administration Log, or ESAL – into which trainers or veterinarians are required to log all administrations of corticosteroids. The Commission also enacted an emergency rule requiring the transfer of the last 30 days of a horse’s corticosteroid history from one trainer to another in the event of a claim, and the timeframe for administering corticosteroids to horses before raceday was also lengthened: intra-articular (injected) corticosteroids can’t be administered within seven days of a race, and systemic treatments are prohibited within five days.   

The Task Force’s recommendations stemmed from the finding that seven of the 21 dead horses had been treated with intra-articular corticosteroids in periods ranging from four to 30 days before the date of the race in which they broke down. Four horses received injections within a week of the race. 

The Task Force concluded that corticosteroid treatment may have “confounded” pre-race examinations for soundness in some of the horses that broke down, stating that in some cases, “an opportunity may have been missed to prevent...[fatal] injury” because the treatment may have masked unsoundness that might otherwise have been detected before the race. 

And though at the time trainers were required by the Racing and Wagering Board to report intra-articular corticosteroid treatments, none of the treatments administered to the horses that had broken down had been reported. The Racing and Wagering Board itself took sharp criticism when the Task Force noted the “failure” of the Board to monitor compliance and enforce the regulation, thus making it impossible for veterinarians to identify a pattern of injections that might have been a tip-off to a horse’s compromised physical condition. 

The claiming system further implicates the role that corticosteroids can play in assessing equine soundness, as a new trainer or veterinarian would have little or no knowledge of any previous corticosteroid treatments the horses had received. 

Logging treatments

In order to ensure that injection records could be transferred, the Gaming Commission first had to create a mechanism by which they were kept. ESAL, which is accessible via the Gaming Commission website, requires that trainers or veterinarians enter the name of the corticosteroid administered, when and how it was administered, and what part of the horse’s body was treated.

While anecdotal information suggests that trainers and veterinarians are complying with this requirement, nearly two years after the process was implemented, there is still no reliable way to verify that all treatments are being reported, despite a recent audit by the Gaming Commission of the 2013 data. 

Conversations with a handful of trainers on NYRA backstretches indicate that they applaud and are familiar with the ESAL system, even as they are skeptical that trainers are 100 percent compliant.

On an autumn morning in Belmont Park office, trainer Gary Contessa, active in New York’s claiming game, pulled up an e-mail on his computer to display a notification that he receives when his veterinarian submits information about a corticosteroid injection.

“I don’t ask my vets to do this,” he said. “I insist on it. But are there trainers [injecting] five days out and not reporting it? I’m sure there are. It’s not a perfect system.”

Trainer Rick Schosberg doesn’t leave the data entry to his veterinarians; he does it himself. 

“If you have a breakdown and your vet records show you did the injection and [ESAL] doesn’t, then you’re in violation, and you should be fined. If you want to do it do it right, throw the book at these guys.” 

The problem is that there’s no way to figure out whom to throw the book at. 

In January of this year, Dr. Scott Palmer was named New York State’s equine medical director, 16 months after such a position was recommended by the Task Force that he chaired; he is responsible, according to the Gaming Commission, “for all aspects of equine healthy, safety, and welfare at New York racetracks” and to “ensure compliance with regulatory veterinary protocols.” 

It fell to him to try to determine the extent of backstretch compliance with ESAL requirements.

“We sent out a letter to veterinarians who treat horses here at New York racetracks and asked them to give us a list of intra-articular injections that they administered in 2013,” Palmer said in August at Saratoga. “Our intent is to compare that list with the ESAL list and see if there are areas where there may be a lack of compliance or lack of understanding. The fact that the treatment doesn’t show up in the ESAL list could be for many reasons, and our immediate goal is to figure out what the reasons might be and address them so we get increased compliance.” 

In order to ensure that injection records could be transferred, the Gaming Commission created the online resource ESAL. Photo: hitthatswitch/Flickr.

According to Gaming Commission spokesperson Lee Park, the audit indicated that about 6,000 corticosteroid treatments had been logged in 2013; Park did not disclose how the audit compared to the actual treatments input and denied a request to examine the ESAL records. 

In a conversation in August, Palmer admitted that it’s difficult to assess the level of compliance in submitting corticosteroid injection information. Whether veterinarians were willing to admit in the audit that they didn’t initially follow the rules is unknown, and as the audit is limited to 2013 records, the level of compliance in 2014 is also in question.

Palmer emphasized that the purpose of the audit is not to “hang anybody” or “make their life difficult;” instead, he said, the purpose is to educate those not in compliance, particularly trainers and veterinarians making what he characterized as a “good effort” to comply. He did not rule out penalties for what he called people “thumbing their nose” at the program.

“It’s a very important program, and it’s unacceptable for people not to be reporting those things,” he said.

Transfer of records

While the implementation of the ESAL system could be considered a qualified success, not even such faint praise can be conferred on the requirement to transfer corticosteroid treatment records. Enacted initially on an emergency basis without specifying who was responsible for transferring the records of claimed horses, that rule was permitted by the Gaming Commission to lapse in March 2013. 

Nearly a year later, in a letter from February 2014, the Commission’s general counsel formally requested amending the rule; a key change in the adopted, permanent rule was the explicit requirement that the previous trainer of a claimed horse provide to its new owner an accurate record of all corticosteroid injections administered to the horse within 30 days prior to the race in which it was claimed. The rule stipulates that the records must be transferred within 48 hours of the claim being made official.

A necessary and sensible change, it was not, apparently, ever communicated by the Gaming Commission directly to the people charged with carrying it out, according to a number of trainers interviewed for this story, though the fall 2012 newsletter of the New York Thoroughbred Horsemen’s Association included the text of the emergency rules. NYRA’s condition book, the bible of the backstretch, includes to this day the vague, original language of the emergency rule, which does not reflect the current stipulation that the former trainer of a claimed horse is responsible for transferring treatment records to the new owner.

Asked how trainers were informed of this new obligation, Gaming Commission spokesperson Park wrote, “Through the state administrative procedures act (SAPA), which is the regulatory process that affords ample opportunity for public review and comment.”

Through SAPA, proposed rules are posted on a government website, usually without significant public notice. Not shockingly, news of the posting and of the new rule came as a surprise to the trainers interviewed for this story. While they seemed well aware of the need to record corticosteroid treatments in ESAL, not a single one of the half dozen trainers interviewed was aware of an obligation to transfer corticosteroid treatment records to new owners. Two owners of claimed horses also had no idea that they should be receiving those records.

While several trainers acknowledged that they heard records could be transferred between trainers electronically, none was sure how it could be done, and during the course of interviews for this story, a trainer and an owner attempted to request through ESAL access to the records of recently claimed horses; neither was successful. 

At Saratoga in July, Schosberg claimed Violet Hour from trainer Todd Pletcher. For him to get access to records of any corticosteroid treatments administered prior to the claim, he said, he would have to approach Pletcher directly. 

“The only way you can find out is to go to Todd directly and say, ‘I’m requesting your vet records on this filly, you have 48 hours to give them to me,’” he said. 

While Schosberg had no doubt Pletcher would cooperate with such a request, the idea of demanding records from a fellow trainer and potentially reporting that person to the stewards for noncompliance runs counter to backstretch culture.

Trainer Leah Gyarmati added that trainers have little incentive to share information.

“A couple of people said that they tried to get [veterinary records on horses they’d claimed] and they were told [by the state steward] to ask the trainer for it,” she reported.

“Ask the trainer?” she said incredulously. “You just claimed off the guy. He’s not going to help you do anything. I’m not going to go to the trainer who I just claimed from, who’s probably pissed at me, and ask him for anything. It’s not his job to help me. If I do well with his horse, it makes him look bad.”

Both Tom Morley and Jeremiah Englehart, active claiming trainers, said that no trainer had ever asked them for records on horses claimed away from them; both also said that they had no idea of the process for requesting records on horses they’d claimed.

Gaming Commission steward Stephen Lewandowski confirmed that early in the process, he encouraged trainers to talk to each other about a horse’s history; now, he said, he accesses the information through the ESAL database and provides it to trainers who ask. He estimated that since the beginning of 2013, approximately 10 trainers have requested the information.

The Gaming Commission’s Park said that approximately 600 horses were claimed in New York last year and that he didn’t receive “a single request” for corticosteroid records by the trainers or owners who claimed the horses.

Gyarmati thinks that the responsibility for disseminating the information ought to rest with the state, not with individual trainers, an opinion echoed by trainer Morley.

“I find it odd that the onus is on trainer who was claimed from,” Morley said. “It should be up to the new trainer to make the request, or the Gaming Commission should do it automatically.”

That opinion would seem to be shared by The New York Racing Association.

According to the February 2014 letter from the Gaming Commission’s counsel, in which adoption of the records transfer rule was recommended, NYRA supported the rule but suggested “that the notice process would be improved if the former owner or trainer of the claimed horse were required to submit to the Commission, within 48 hours…after the race, the relevant records, then have the Commission make such records available to the new owner or trainer of the claimed horse.”

The Gaming Commission saw it differently.

“Staff believes that NYRA’s suggestion would add an unnecessary layer of reporting to the rule.”

Making it work

While additional layers of reporting might indeed prove cumbersome, there seems to be little doubt that they are in fact necessary. Debating about who is responsible for what to whom loses sight of the goals of the reform, which are to keep horses and jockeys safe.

While trainers may be neither aware of their responsibilities to transfer records nor proactive about seeking those records, they agree that the rule is an essential element in improving horse safety.

“If I claim a horse on August 30 and I know that an ankle was injected on August 15, I’m not going to inject that ankle on September 1 because I know I have just put a nail in that horse’s coffin,” declared trainer Gary Contessa. “But if we don’t know, we’re going to do what we – vets and trainers alike – deem necessary to get that horse as perfectly as possible to his next start. 

[pullquote] "In theory,” he went on, “we think we’re helping the horse by putting hyaluronic acid, which is a good substance, into the joint of a horse, or maybe with a corticosteroid at the same time, but if that ankle just had the same exact procedure done 13 days before, that puts up a flag to us and tells us, ‘Wait a minute, we got a major problem here, maybe we need to give this horse 30 days and figure out a better way to heal that thing.’ 

“Knowing what happened to that horse and how it often it’s happened in the time leading up to you claiming that horse would have a profound effect on the health of that horse going forward.” 

Englehart concurred. 

“The game is changing,” he said. “Everyone is trying to do the right thing by the animal.” 

Perhaps aware of the lack of information that has been disseminated on the backstretch, the Gaming Commission’s Park wrote in an e-mail in September, “A revised protocol and software upgrade has been developed to transfer this information immediately following confirmation of a successful claim from the original trainer’s ESAL account to the successful claimant’s ESAL account without initiation by the new claimant. The software is currently undergoing a technical revision.” Further updates on the upgrade were unavailable.

Promised improvements

Consensus in horse racing is about as rare as a 100-to-1 winner, so it is noteworthy that the regulations borne of consternation about the death of horses at Aqueduct were adopted largely without disagreement. The partnership between NYRA, state regulators, and horsemen offers a glimpse into the progress that can be made when industry entities come together to improve the safety and welfare of its human and equine athletes. 

That laudable partnership two years ago is now, regrettably, nearly non-existent. Regulations without compliance or oversight do little to advance the progress that should have been steady since their enactment, and praiseworthy as those regulations are, they should also be regularly reviewed and improved. Attempts to ensure compliance about ESAL entries should not come more than a year after the system was implemented, and while trainers are required to report their corticosteroid treatments, there’s no limit on how often horses can be injected, despite the documented hazards posed by their prolonged use.

And as 2014 comes to a close, it’s indisputable that corticosteroid treatment records are not being passed on with a claim any more frequently than they were two years ago, raising disturbing questions about a system that could, and should, be a model for other racing jurisdictions. 

“It’s going to get better,” Palmer said of the current system. “I wish I could tell you that it’s perfect. But I can tell you that it’s a doggone sight better than anything we had before.” 

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