By Malinda Larkin
Divisions between two veterinary regulatory bodies in California appear to be closer to a resolution after more than a year of dispute.
For now, though, equine practitioners remain caught between how the California Horse Racing Board and California Veterinary Medical Board interpret and enforce the California Veterinary Medicine Practice Act. The differences largely center around preventive medicine, the veterinarian-client-patient relationship, record-keeping requirements, and compounding.
Scott Chaney, executive director of the California Horse Racing Board, said, “It’s basically a philosophical issue that has pointed out the limitations of the California veterinary practice act as it relates to practicing on large animals, particularly racehorses.”
Caught in the middle
The differing interpretations came to prominence last September after the CHRB’s equine medical director, Dr. Jeff Blea, was accused by the CVMB of violating the state practice act. Chaney said six other racetrack practitioners have also received complaints of alleged violations, and 14 others have gotten records requests from the CVMB, which is out of about 50 racetrack veterinarians that the CHRB licenses.
The California Veterinary Medical Board declined an AVMA News request for an interview. Matt Woodcheke, a public information officer with the CVMB, noted that the board does not confirm, discuss, or comment on complaints or investigations per state law.
He added that the CVMB “receives complaints from a variety of sources, including consumers and veterinary professionals, and conducts investigations that may result in the filing of an accusation. In addition, the Board performs veterinary premises inspections, which also may result in the filing of an accusation.”
On Dec. 17, 2021, the veterinary board formally accused Dr. Blea of several violations, including allegedly prescribing, dispensing, and administering medications to racehorses without establishing a veterinarian-client-patient relationship, performing an examination, or forming a diagnosis, all sometime between February 2020 and March 2021. Other allegations involved improper record keeping.
Dr. Blea has not practiced medicine on the racetrack since he took the role of equine medical director for the California Horse Racing Board in July 2021.
The veterinary board temporarily suspended Dr. Blea’s license to practice veterinary medicine, which was later upheld in court. The suspension resulted in the University of California-Davis, from which the CHRB contracts his services, putting him on paid administrative leave until recently.
The more serious allegations against the renowned former racetrack practitioner were dismissed, except for a minor record-keeping violation. He will be on probation for three years, complete three hours of continuing education on record keeping, and pay $131,464 to the veterinary medical board over a 30-month period as reimbursement for the cost of the investigation.
Chaney said the CHRB supported Dr. Blea from the beginning.
“We didn’t agree with accusations being filed, which fell short from an evidentiary standpoint. That was borne out in the settlement,” Chaney said. “We’re pleased he’s back to work. He settled for probation and CE classes, but he’s not the only racing vet that has complaints filed against him.”
Foley said the cases appear to be targeted at racetrack veterinarians.
“The concern, of course, is if this continues, nobody will want to practice in California,” Foley said, adding that these cases could spill over into horse show veterinarians or even other large animal veterinarians as well.
Differing interpretations
Since January, equine practitioners, the California VMA, the CHRB, and others have shared their concerns with the CVMB about how the state veterinary practice act is being applied to racetrack veterinarians and the equine veterinary community.
The AVMA testified before the California Veterinary Medical Board expressing concern as well. The AVMA and California VMA also expressed worry over a lack of transparency by the veterinary board.
Specific concerns laid out by the CVMA and CHRB are as follows:
- Veterinarian-client-patient relationship: The state practice act doesn’t account for VCPR creation through a trainer or client rather than through the horse owner. There can be multiple owners, and equine veterinarians might never have any contact with the owner or owners. The state practice act also requires a general or preliminary diagnosis to create a VCPR with no mention of when a veterinarian is only providing preventive treatment.
- Record keeping: Record keeping to document the VCPR in the herd model is difficult when there is a long-standing relationship with the client, rather than with the individual animal patient. The state practice act, for example, requires “progress” to be documented, but the term is unclear, and the CVMA said it seems to apply to daily progress when an animal is at a veterinary facility, rather than returning to or staying at the location where the animal resides.
- Compounding: The CHRB has concerns with a portion of the state practice act that prohibits “possession and/or use on the premises of a facility under the jurisdiction of the Board of any drug, substance or medication that has not been approved by the United States Food and Drug Administration (FDA) for use in the United States.” While the CVMB interprets the regulation as written, the CHRB contends that the regulation “permits such use where non–FDA-approved medications exist—a circumstance commonly present in equine practice” and would like to have the practice act changed to reflect that exception. In the meantime, the CHRB asked the CVMB to stop enforcing the regulation as written.
Dr. Blea’s personal lawyer, Michael P. Casey of Casey Bailey & Maines PLLC in Lexington, Kentucky, said a majority of the allegations against Dr. Blea were based on an incorrect interpretation of CVMB rules that would prevent the use of any compounded medications, even those authorized by the FDA. Casey cited the veterinary board’s allegation that no veterinarian could administer Thyro-L because it was “misbranded.” However, the CHRB allows the use of the drug under specific regulations, which Dr. Blea complied with.
Moving forward
But it appears there has been progress between the regulatory bodies in California. The CVMB formed an Equine Practice Subcommittee to its Multidisciplinary Advisory Committee in July.
The subcommittee has reviewed numerous documents surrounding the issues raised, including letters of concerns from the CVMA and CHRB, the pending accusations against racetrack practitioners, and the AAEP Clinical Guidelines for Veterinarians Practicing in a Pari-Mutuel Environment, according to the subcommittee minute’s background (PDF).
Next steps outlined by the subcommittee include meeting with the University of California-Davis and the American Association of Veterinary State Boards as well as researching the impacts of HISA on the California veterinary practice act and record-keeping requirements by other veterinary state boards.
Chaney said California racetrack veterinarians want to comply with regulations, but “they’re just confused about what they are and how to do it.”
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