Racing’s Red Tape Keeps Equine Therapists From Their Work In New York by Natalie Voss|06.05.201912.07.2020|3:22pm4:57pm A therapist applies PEMF therapy to a racehorse In a stall at Todd Pletcher's Keeneland barn in mid-April, a normally-fractious colt could be found relaxing, one leg cocked, lower lip drooping and eyes half-closed. Veronica Caravella was busy moving a flexible hose deliberately around various muscle groups as she applied pulsed electromagnetic field (PEMF) therapy to relax tense or tired muscles. Caravella watched him with an air of frustration, knowing that once he shipped back home to New York, she wouldn't be able to provide him this kind of peace anymore. For months now, licensed equine therapists have struggled to get clarification on when and how they'd be allowed to administer PEMF to horses in the state again – or indeed, whether they'll be able to work on the backstretch in New York at all. The reason? Just your typical horse racing industry communication breakdown. “To me, there's just no logic, no reason being applied here and the horsemen are suffering as a result,” said Alan Foreman, counsel for the New York Thoroughbred Horsemen's Association (NYTHA). “Actually, the horses are suffering – this is good for the horse. There's nothing negative, this doesn't get into the argument of medication or anything like that. This is really in the best interests of the horse and nobody can dispute that.” And no one is disputing whether the therapy is in the best interests of the horse. PEMF directs a magnetic wave at the targeted area, producing an effect not unlike the electrostimulation therapy many people receive at their chiropractor's office. It does not operate on nerve endings or artificially reduce pain, but rather helps relax muscles and increase circulation. PEMF machines are not considered medical devices by the Food and Drug Administration, and there is no federal requirement that the operator be licensed as a physician or veterinarian. According to longtime equine therapist Dianne Volz, there are no long-term side effects from repeated use of the PEMF machine – which is good, since she and other therapists have their hands on the machine all day, every day. Some trainers have their own PEMF devices, but many major operations, including Todd Pletcher, Kiaran McLaughlin, and Shug McGaughey prefer to use independent therapists like Volz and Caravella because of the added man hours it would take to use their own machines. One PEMF session takes about 45 minutes, during which the user must be standing with the horse, moving the hose over the appropriate muscle groups, and one machine costs $22,000. It's easier (and cheaper) to outsource the task. Volz and Caravella offer other types of therapy, too – electrostimulation, ultrasound, laser therapy. Until the recent upheaval, Caravella and Volz had to have two licenses to use those machines on New York racetracks: one through the New York State Gaming Commission and one from the New York Racing Association. It took some time for Volz to get both groups to create a license specific to equine therapists, who aren't recognized by any state boards the way pharmacists or veterinarians are. After five years of having the designation, Volz and others were told the commission was planning to phase out equine therapist licenses but that existing license-holders were grandfathered in. Then, at the start of this year, Caravella was told equine therapists had been “ungrandfathered in” – apparently suggesting that once existing licenses expired, they would not be reissued. “I was like, is that even a thing? Isn't that the point of grandfathering in?” said Caravella. “I have trainers calling me asking, 'Are you ever coming back to New York?' There are horses there that need our services and we just have to turn them down.” Since then, equine therapists say they're not clear on what their license status is, if they'll be able to use PEMF again, and what regulators' issue is with the machines, which have been commercially available for more than a decade. Bellafina received PEMF therapy before the Kentucky Oaks “Nobody will stand up and say, 'It's me. I'm the one who has a problem,'” said Volz. “So we don't know what they're worried about, except that they're stopping horses from being helped.” Alan Foreman said the issue traces back to an afternoon at Saratoga last year. According to correspondence from the Gaming Commission, trainer Chad Summers wanted star runner Mind Your Biscuits to get a PEMF treatment. Fellow trainer John Terranova had a PEMF machine and his wife Tanya agreed to give the horse the treatment. Tanya Terranova was licensed as an assistant trainer rather than as an equine therapist at the time, and someone reported the discrepancy to the commission. The report brought the use of the machines to the attention of New York State Gaming Commission equine medical director Dr. Scott Palmer. Initially, Foreman said, Palmer did a quick examination of the state's rules and determined the use of PEMF by non-veterinarians may not be legal. Most states' veterinary boards do not allow non-veterinarians to perform diagnosis or treatment of a disease or injury (though how these words are legally defined seems to vary somewhat by state). There is a particular exception in New York's law for equine dentistry, but not for equine therapists. So, Palmer's conclusion was that if it were legal for equine therapists to work on horses, they should have an exception in the law. In absence of one, Palmer told the New York Racing Association equine therapists weren't to use PEMF machines because he thought their purpose seemed to be treating injury. New York trainers and veterinarians alike have since been in an uproar because both rely on therapists' ability to use the machines. Volz said most of them use the therapy for relaxation rather than treatment, and if a horse does have an issue, she receives instructions from the treating veterinarian and trainer on what they want done. Acting on behalf of NYTHA, Foreman said he reached out to Palmer, clarifying the machines' purpose and use. Afterwards, Foreman said Palmer told NYRA he had no problem with the machines' use by licensed equine therapists. But NYRA, having been alerted to a potential legal issue, wasn't willing to change the policy it had put out. NYRA declined to provide the Paulick Report with a statement about its stance on PEMF. The commission issued the following statement when asked for clarification on confusion about the machines' use: “Pulsed Electromagnetic Field (PEMF) therapy is regulated by the N.Y.S. Office of the Professions Board of Veterinary Medicine, who opined that such treatment is a veterinary medical procedure that may only be performed by a state-licensed veterinarian or a state-licensed veterinary technician working under the direct supervision of a State-licensed veterinarian. The commission allows such treatment, if consistent with the Professions Board requirements. Veterinarians and veterinary technicians are occupations that can be commission licensed.” For horsemen and therapists, the double-talk (or silence) is mind-boggling. PEMF in action “This is like rope-a-dope with Muhammad Ali — we're getting bounced back and forth (between the two agencies),” Foreman said. “The gaming commission doesn't have a problem, NYRA doesn't want to do it because they want someone to tell them it's legal. No one wants to tell NYRA it's legal.” NYRA told Caravella she had to either acquire a veterinary degree or a veterinary technician's degree to continue working in the state. The latter, she pointed out, is a two-year program which is available online and non-species specific. “We took a certification course on this machine from the company that makes it. We put in hours. I sent [NYRA] all our certifications and they said, 'No, it doesn't matter,'” she said. “You can go the whole [vet tech degree program] without putting your hands on the horse. They're telling someone who has that degree, who may not have ever put their hand on a horse, can come into a barn and use this, but we're not qualified.” Even students graduating with four-year degrees in equine therapy will not be permitted to operate the machines, Caravella was told. Foreman said NYRA and the commission consulted with New York's State Education Department, which manages the Office of the Professions and licensure for a variety of careers, including veterinarians. The Office, which did not respond to questions from the Paulick Report, confirmed NYRA's concerns, despite a letter dated earlier this year from Palmer supporting use of the machines. The Education Department made it clear: per existing laws, PEMF machines can only be operated by veterinarians and veterinary technicians. Volz and Caravella are now hoping the New York state legislature will clear things up. New York State Assembly Bill A7899 seeks to exempt the use of devices not considered by the FDA to be “medical devices” from the practice of veterinary medicine. Sponsored by J. Gary Pretlow of the 89th District and Carrie Woerner of the 113th District (both members of the Assembly Committee on Racing and Wagering), the bill, which has a twin in the state Senate in hopes of speeding its passage, has been referred to the legislature's Higher Education Committee. The current legislative session will end June 19. So far, indications are positive that the state legislature will be able to do what the racing industry in New York hasn't: give horses back their therapists.