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In June, 2014, Koko, the 43 year old female gorilla, experienced an episode described in her medical record as: "has not been doing well for the past week- has not been moving much, cannot seem to use legs well, poor appetite, lethargic." The owner and the attending veterinarian, who is out-of-state, speculated over the phone/text/email on various causes for her ailments, including stress/psychological and/or arthritis. The vet notes that the owner declines an immobilization for a full work-up. A pharmaceutical regimen is prescribed, and within the next few weeks, after adjusting the drug regimen by phone/text/email, Koko improves. During this episode, where Koko was described as being unwilling to use her legs, and also, according to on-site records, experiencing reduced function of her left arm, Koko was not examined by a veterinarian. There could have been many possible, and very serious causes for her sudden decline. Failure to conduct a physical exam put the animal's well-being at risk. The exhibitor is expected to establish and maintain a program of adequate veterinary care that includes the use of appropriate methods to diagnose and treat diseases and injuries, and the availability of emergency care. Serious clinical signs, such as those exhibited by Koko during this time period, should be promptly evaluated by a veterinarian via examination of the animal on site. If the attending veterinarian is not available, then a local emergency veterinarian should be consulted, as per the written program of veterinary care. A Veterinary Care issue was previously cited in 2012.