'Checklist' Mindset - by Eric Mitchell

The annual Welfare and Safety of the Racehorse Summit continues to be a shining example of what cooperation, thorough data collection, and thoughtful analysis can accomplish in a sport as complex as Thoroughbred racing.

Particularly valuable is a continuing refinement of the risk factors that lead to catastrophic breakdowns. The more the industry learns, the more the myths surrounding breakdowns are exposed, such as the notion that a “bad step” causes many breakdowns or we simply need to live with the percentage of breakdowns seen today.

“We need to dispel the myth of inevitability,” said Dr. Mary Scollay-Ward, equine medical director for the Kentucky Horse Racing Commission, about catastrophic breakdowns on the summit’s first day. “When we have acceptance without objective analysis, we have complacency.”

Fortunately, an increase in objective analysis is shedding a brighter light on the circumstances leading to breakdowns. Dr. Lisa Hanelt, an examining veterinarian at Finger Lakes Gaming & Racetrack in New York, gave an insightful presentation on her efforts during the past two years to develop a model for identifying at-risk horses.

Hanelt, a self-professed lover of spreadsheets, began her risk-factor analysis of the Finger Lakes racing population by assessing how many starters in a race with a catastrophic breakdown fit one or more of nine risk factors identified in 2011 by Dr. Tim Parkin. Parkin is a veterinarian and epidemiologist from the University of Glasgow, who serves as consultant on the Equine Injury Database and performs analysis for The Jockey Club.

She found that many of the nine TJC risk factors described most of the horses racing at Finger Lakes, where 98% of the horses are more than 3 years old and 77% of starts are in claiming races.

“These risk factors identified horses at-risk but not necessarily the ones at the highest risk,” Hanelt said. “Our next question was then who were our fatally injured horses and are they typical or atypical of our general population?”

Hanelt did a detailed study of 19 horses that had orthopedic-related fatalities during 2013—looking at their racing, ownership, and training histories; historical pre-race exam findings; and documenting every incident behind one being put on a vet’s list.

“The Jockey Club risk factors are important, but every racetrack and every population of horses are slightly different,” she said. Her analysis showed that the fatally injured horses were not typical of the Finger Lakes population. Granted, Hanelt noted, 19 horses are a small sample, but she found several traits in common among the fatalities that allowed her to zero in on the highest risk factors at Finger Lakes.

They were:
• three or fewer starts at Finger Lakes;
• a recent trainer or owner change;
• a significant drop in class;
• a history in the previous six months of being on a vet’s list or having been scratched in the morning from a race; and,
• treatment with inter-articular steroids.

Hanelt then did risk factor scores using her new list. In the results of three races she showed at the summit, the horses that broke down fit into five of her five highest-risk categories. She found several horses that scored four out of five. One of the horses that scored a '4' belonged to a trainer, who ended up retiring the horse because he had recognized that continuing to race her became unacceptably high-risk.

Regular communication between the examining vets and the trainers goes a long way toward making the best decisions for the horses. Hanelt said examining veterinarians may not know as much about a horse's health history as a trainer or private vet, but will share information discovered during a morning exam or pass along a post-race observation. This is important information-sharing that could help avoid catastrophe later.

Hanelt concluded her presentation discussing the value of checklists, citing the best-selling book The Checklist Manifesto by surgeon Atul Gawande. The author argues that despite the tremendous knowledge we have, avoidable failures still plague us in health care, government, law, the financial industry—everywhere.

Gawande’s book focuses on making better decisions in complex and emotional situations by using a simple checklist.

Having a standard checklist to monitor the health of a racehorse regularly and determine whether it should be entered in a race, or even should still be running, would benefit everyone, according to Hanelt.

“Trainers have the power to make a horse a higher risk or lower risk, depending on his knowledge or skill,” she said. “And these are emotional decisions, whether it involves a high-stakes stakes race or it is a trainer with only two horses who has been working for months to get them ready. If the horse isn’t right, he loses his investment. A good risk model is objective.”

The same knowledge can help owners, too, assess whether their horses are being managed properly. We have the tools, and the information is getting better all the time. Now we just need to use them.

Editor's Note: A previous version of this column stated the risk analysis scores had been shared with trainers. These scores had not been shared.

12 Comments

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Lisa M. Hanelt

Thanks for the kind words.  One clarification:  the trainer with the high risk horse made the decision to retire him on his own.  I had no idea of this horse's risk score until I began testing the predictive strength of the risk model, which I did by calculating risk scores for all horses that ran in races in which a horse was fatally injured.

16 Jul 2014 12:48 PM
sceptre

Almost all catastrophic breakdowns are due to pre-existing pathologies-that's what was reiterated once again, and that's what should have been emphasized in this piece. Yes, the notion that they occur because of a "bad step" is a myth...The risk factor spread sheets are fine, but from the excerpts I read I failed to find any recommendations re- diagnostics or observational techniques which could aid in averting these breakdowns.    

16 Jul 2014 1:36 PM
EJMitchellKy

Thanks for the clarification, Lisa. Down the road would Finger Lakes then consider sharing these analytic scores with trainers?

16 Jul 2014 2:23 PM
Lisa M. Hanelt

The significance of the score is much more important than the actual score.  Risk models are for research.

Most of our high-risk horses were unfamiliar to the trainer, either because the horse was either new (recent claim or purchase, or transfer from another trainer) or just beginning its racing career.  Ownership and trainer of record is public information, easy to see on the racing program or in Equibase.  Many examining veterinarians, not just me, ask trainers, "How is this new horse training?  Does your rider like him?  Do you like him?  Did he come back well from his last race?"  It's an exchange of information, not meant to be threatening.  Often, it's pleasant and interesting.

Other risk factors are directly related to a trainer's knowledge about a horse's lameness issues.  Accurate diagnosis and appropriate management of a problem almost certainly decrease a horse's risk of suffering a future catastrophic breakdown.  Early diagnosis lowers risk as well.  It is dangerous for a trainer to ignore the warning signs of an injury.

Examining veterinarians don't know as much about a horse's health history as that horse's trainer or private veterinarian, but we update trainers when we discover something new during a morning exam, and we communicate significant post-race observations.  What examining veterinarians do know is if a horse has a history of being on a Vet's List.  This is often public, and it is not unreasonable to ask a trainer, "what happened when that horse was eased?  why was he pulled up?  did you know he has been vanned?"  To be clear, we don't allow horses currently on a Vet's List at another racetrack to race at Finger Lakes, but trainers sometimes acquire horses who worked off a Vet's List elsewhere.  We watch those horses carefully.

Sceptre:  In general, the more familiar a trainer is with his horse and his horse's problems, the lower that horse's risk.  It's an ongoing conversation, not a simple solution.  A checklist tells you what key questions to ask while you're looking at the horse.

As I said in my presentation, it is still necessary to examine the horse.

16 Jul 2014 4:33 PM
sceptre

I gratefully applaud the Welfare and Safety of the Racehorse Summit. It offered important insights on issues most crucial to the racehorse...I would imagine that the "at risk factors" differ somewhat from track to track. For example, all else equal the higher the racing "quality" of the horse, the faster it runs, and the greater is its risk for catastrophic injury-and less wear and tear to cause a breakdown. On the other hand, the "lesser" tracks tend to be populated with more "wear and tear" types, and many lesser tracks tend to offer a higher % of sprint races. Such variables as these, and more, make it difficult to form broad generalizations re-at risk factors. The focus should be on individual across the board monitoring-how practically best to accomplish this.

16 Jul 2014 5:18 PM
sceptre

What shouldn't the following be implemented?:

1. Hire competent, diligent racetrack association vets, and pay them accordingly.

2. Vets should be over cautious in not missing any potential "vet list" candidate.

3. Once on vet list this same vet must devise a proper diagnostic plan for horse in question, mandate that it is performed, and then review diagnostic findings. Depending on results, vet will either mandate that horse is retired, or devise a treatment plan. Vet to follow-up post treatment to determine whether horse should be removed from vet list, recommend additional diagnostics, or retired.

In this way--this first step--association vet serves as an independent overseer of the horses' well-being.

17 Jul 2014 11:27 AM
sceptre

Dr. Hanelt:

Your added remarks are appreciated.

It's my perception that the vast majority of catastrophic breakdowns occur in horses quite familiar to their trainers. Most trainers are simply incapable of adequately monitoring their trainees physical well being; their "education" and, in many cases, moral responsibility, is simply not there. The owners cannot carry the ball. These checklists will do little to combat the problem. We need better oversight from vets such as yourself. Push for more funding and more competent manpower.  

17 Jul 2014 1:36 PM
fb0252

Good for identifying risk factors, although I fear that u left out the most obvious, ubiquitous, and well known risk factor--training negligence.  Every horse is at risk, regardless every other risk factor unless appropriately trained for fracture resistance and injury prevention, phrases that still have yet to get into our veterinary vocabulary.

The Qs become--what is appropriate training for fracture resistance.  There is substantial info on this with a lot more to get.  Grayson jock club spends their time studying worms.  How about a few studies on what constitutes appropriate training for fracture resistance, and then implementation of rules that prevent entry unless these standards are met?

In the mean time, two rules would stop 75% of the injury nonsense including catastrophic breakdowns:

1.  any horse death, morning or aft., trainer on immediate probation pending investigation, and suspension if negligence is found in either training or pre-race diagnostics.

2. where is rule requiring scientific diagnostics for TV races, and when r we going to figure out that a state vet feeling a horse's legs for heat pre-race is inadequate to identify the injured horse?

17 Jul 2014 7:13 PM
Lisa M. Hanelt

sceptre:  You are absolutely correct that risk factors differ racetrack to racetrack, which I emphasized in my talk.  For example, a majority of Finger Lakes horses enjoy a winter vacation while the racetrack is closed (early December until mid-April), which probably reduces their risk.  I've heard other veterinarians mention a similar phenomenon with turf horses.  The annual winter vacation is probably why so many Finger Lakes horses enjoy long, sound racing careers then second careers.

Speaking only for Finger Lakes, three-quarters of our 2013 racing fatalities had experienced a change of owner or trainer in the six months prior to the catastrophic injury.  It isn't unreasonable to encourage trainers to watch their new horses closely, and ask questions when necessary.  Trainers see their horses every day.  Examining veterinarians see them for only a few minutes, on race day.

18 Jul 2014 11:59 AM
EJMitchellKy

Lisa, I really appreciate all your comments. I have a question about horses moving to a new track. Have you seen any research or heard anything anecdotally from trainers or vets about how long it takes for a horse to adapt to a track or surface change. Or, the best way to manage this transition?

18 Jul 2014 12:42 PM
Lisa M. Hanelt

Eric:  Re:  surface change -   As one of the other speakers said during the Welfare Summit, horses are wonderfully adaptable if they are sound and comfortable.  Elite horses ship often and race over multiple surfaces during a season.  That said, surface change probably represents risk to any horse with a pre-existing injury.  I'm sure someone is researching this, though I'm not aware of any specific projects.

fb0252:  The only practical, accurate race-day diagnostic procedure available at this time is a pre-race examination performed by a veterinarian.  An experienced examining veterinarian can pick up much more than heat. Diagnostic modalities commonly used in equine medicine include radiographs aka x-rays, ultrasound, MRI, CT scan and nuclear scan.  None of these are practical for the purposes of race day examinations.

There is current research re:  training methods that minimize the likelihood of injury, especially over the course of a horse's career.  It's a complicated topic, and there probably isn't just one correct method.

Good trainers are attentive to their horses and treat them as individuals.  They address minor problems before they become chronic injuries requiring extensive management.  Above all, the best trainers are patient.

19 Jul 2014 12:19 AM
fb0252

one more comment to Ms. Hanelt, and, a vet interested in injury prevention--who'd have thought.

1.  Agreed that scientific diagnostics impractical for most races.  The Q is: can the sport continue to ignore available technology for TV races--Pine Island comes to mind, and Go for Wand.

2.  Training minimums for fracture resistance have been established, though yet to be extensively tested.  Unless a horse breezes at least 4 times a month for minimum distance of 4f at minimum 12.5 speed the horse is at risk. Trainers who do less run horses at risk regardless of how caring, good,or otherwise attentive to animal husbandry they are.  It is interesting that Todd Plecher's barn e.g. since Mr. Plecher ratched up the intensity and frequency of his breeze work is a e.g. The # of Plecher's breakdowns and injuries have decreased.

3.  Insufficient inappropriate warm up for both breezing and racing should also receive major attention.

20 Jul 2014 3:00 PM

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