Horse Racing Doesn’t Have a Standard Concussion Protocol For Jockeys. Now, California Wants To Create One.

After riding horses for 37 years — much of it as a professional jockey — Frank Alvarado has seen his share of head injuries.

“A few times I don’t remember anything,” he said with a heavy Panamanian accent. “The only thing I remember is when I wake up in the hospital and — what am I doing here? And they say, ‘You fell.’”

He sat in the jockey’s lounge at Golden Gate Fields in Berkeley before the day’s races, a turquoise towel cinched around his waist. His chest and shoulders are taut ropes of sinew and muscle — not an ounce of fat to spare on this 120-pound jockey. 

“But thank God, I’m still alive,” Alvarado said.

He’s not exaggerating. Studies show horse racing has one of the highest fatality rates of any occupation — including other high-risk sports. Jockey deaths are often the result of head injuries. 

Case in point: A 33-year-old jockey died at a Pleasanton race track in 2012 when a horse stepped on his head after an accident. California horse racing made national headlines this year when dozens of horses died during races and training at Santa Anita Park, but these incidents also risk injury or death to riders. 

Unlike other pro sports where concussions are common — such as football and basketball — horse racing doesn’t have a standardized concussion protocol to determine when an athlete can return to competition. Concussion management varies from track-to-track and state-to-state, meaning jockeys often come back when symptoms are still present. That leaves them susceptible to further head trauma if an accident occurs.

Now, California wants to become one of the first states with a concussion protocol. Maryland is the only other state with a system in place, but California is a much larger market. It would require jockeys to complete an annual baseline assessment and get clearance from a certified physician to return after unintentionally dismounting from a horse. 

Jockeys, trainers and horse owners have opposed similar proposals in the past, since it would pull riders off the track. But as the long-term consequences of concussions become clear, the protocol has gained support.

“We’ve been working for the last 10 years to try to get a concussion protocol in place in our industry,” said Terence J. Meyocks, president of the national Jockeys’ Guild. “It should be in everybody’s best interest to work together … but it’s been very difficult.”

An ally in the fight has been Dr. David Seftel. He’s the physician at Golden Gate Fields and has seen numerous concussions in his examination room during his 20 years at the track.

“This is one of the most dangerous of all professional sports — if not the most dangerous,” Seftel said. “We have been working for quite a long time to bring into effect [a] concussion protocol that will help to protect our jockey community [and] preserve their capacity to work.”

Born in South Africa, Seftel moved to the United States in the late 1980s for a clinical residency at Harvard. He later worked in the emergency department at San Mateo County Medical Center. Needing a break from the emergency room grind, he took what was supposed to be a temporary position at the former Bay Meadows race track in the Bay Area. In 2000, he became Golden Gate Fields’ physician and has committed himself to the sport ever since.   

Seftel says a simple breakdown of the numbers illuminates the dangers of horse racing. Thoroughbreds weigh more than 1,000 pounds and reach speeds of more than 40 miles per hour. An accident can turn a 115-pound jockey into a human missile, hurtling headfirst toward the track or other riders.

These numbers haven’t changed much over the years, and neither have the risks. That’s why Rick Baedeker, executive director of the California Horse Racing Board, says he made the protocol a priority.

“It is overdue,” he said. “It’s been a long time coming.”

The board is the regulatory body developing the protocol in California. Once finalized, it needs to go through a months-long approval process.

At a hearing before the board earlier this year, veteran jockey Cody Jensen pointed to his own experience to show the urgent need for the protocol.

“I’ve suffered nine documented concussions — and who knows how many when I got back up there [on a horse] when I shouldn’t have,” he said.  

He and other riders say a system for monitoring head injuries, and requiring return-to-ride authorizations, could spare a new generation of jockeys from the long-term health complications tied to serial concussions.

Jockey Flavien Prat, who won the Kentucky Derby in May, standing near the winner's circle at Golden Gate Fields.Scott Rodd / Capital Public Radio

Flavien Prat is one of the sport’s top young jockeys.  The 27-year-old rider from France catapulted into the spotlight after his long-shot Kentucky Derby victory in May.

After a recent race at Golden Gate Fields, he told CapRadio that jockeys understand the long-term risks of head injuries. But their drive to compete often affects their decision-making, causing them to return too soon.

“Everybody tries to ride as much as [they] can,” Prat said. “But I think we need people around us who can say, ‘Yes he can or no he cannot.”

Top jockeys like Prat often feel pressure to return from horse owners and trainers. Missing a few days or weeks can mean losing an important mount on a favored horse. Pulling a top rider for six months, according to Seftel, can be career-ending. 

Thoroughbred Owners of California, an association of racehorse owners, did not respond to a request for comment.

The pressure to return is even greater for those in the middle of the pack. A survey from the Jockeys’ Guild found professional riders earn on average $29,000 per year. Unlike other pro athletes, who have salaried contracts and collect a paycheck on the sidelines, most jockeys earn nearly all of their income from winning races.

For middling jockeys, that means missing a few mounts could leave them unable to put food on the table or pay their bills.

“If a jockey doesn’t play, they don’t get paid,” Seftel said. “The result is, there’s an intense pressure for jockeys to get back to work, whether or not this is necessarily in their best medical interest.”

He believes the concussion protocol would be a good start, but fears the pressure on jockeys will encourage them to find ways around the new system.

Here’s one potential loophole: The protocol would also allow riders to get clearance from any physician trained in concussion management. Seftel says that opens the possibility of doctor-shopping if a jockey wants to return sooner.

He adds that the protocol could be strengthened by giving track physicians the final say over when a jockey can return.

Baedeker with the California Horse Racing Board acknowledges the protocol isn’t ironclad, and that jockeys may find ways around it.

“This is the easy part, when you’re talking about the concept and you’re working with language,” he said. “The difficult part is when it’s actually enforced.”

But he argues the current proposal is as far as the board can go without overstepping its regulatory boundaries.