Substitution Errørs

Surveys Describe Harm from Differences between Prescriptions and Drugs Dispensed

By Greg Cima

Ten percent of veterinarians responding to recent polls said they have had patients harmed when outside pharmacies made substitutions in filling prescriptions.

Surveys conducted by five veterinary medical associations together indicate about one-third of respondents knew of occasions when pharmacies dispensed drugs to clients that were different from those that were prescribed or were different in dosage, and they did so without consulting the prescribing veterinarian. Most of those changes occurred without any known harm.

The Oregon, Idaho, Iowa, and Washington veterinary medical associations conducted their surveys in 2012, and the Southern California VMA conducted its survey in 2013. They received responses from 707 veterinarians.

Those veterinarians provided examples—included in reports from the VMAs—such as replacement of a prescribed insulin product with one less effective in dogs, a recommendation that a client administer aspirin to a cat rather than pay for a prescription nonsteroidal anti-inflammatory drug, and reduction of a dog's thyroid medication dosage that seemed high to the pharmacist in comparison with the dosage for humans.

Glenn Kolb, executive director of the Oregon VMA, which conducted the first survey, said veterinarians had been asking the association how to respond when they find out about substitutions. While he acknowledged that pharmacists need to counsel clients, it seems to him that some have altered prescriptions for animals on the basis of uses in human medicine.

Jennifer Davis, PharmD, president of the Oregon State Pharmacy Association, noted that a pharmacist can work with hundreds of patients in a typical week. While the Oregon VMA asked veterinarians whether they had encountered a change in a prescription at some point, she noted that the survey did not ask how many times such problems occurred.

“The error rate based on those thousands of interactions is exceptionally low,” she wrote in a message. “None-the-less, we accept that every error is significant and continually work on processes and knowledge that can minimize the likelihood of an error.”

Study and response in Oregon

Dr. Laird M. Goodman, owner of Murrayhill Veterinary Hospital in Beaverton, Ore., said a client told him she cut an epileptic dog's phenobarbital dosage in half on advice from a pharmacist who thought the dosage was high. The dog's seizures returned and could not be controlled, leading to a decision to administer euthanasia.

He also has seen alterations to patients’ thyroid medication prescriptions.

“In the good old days, they would at least call us and say, ‘Hey, are you sure you want to give this high of a dose?”’ Dr. Goodman said. “And we would advise the pharmacist that dogs take a higher dose than people.”

Gary Miner, RPh, compliance director for the Oregon Board of Pharmacy, expects that changes without consultation occur no more often in veterinary medicine than in human medicine, where they are rare. Over the past few years as the board has raised awareness among pharmacists about the need for consultation on veterinary prescriptions, he said, “They're probably more cautious about filling veterinary prescriptions than they are the human prescriptions,” although he hopes pharmacists provide the same due diligence for both.

Prior to the surveys, the Oregon Board of Pharmacy and the state's two pharmacy schools had been in talks about increasing pharmacy students’ education on veterinary pharmacy. Fiona Karbowicz, RPh, a consultant to the Oregon pharmacy board, said veterinary pharmacy has not been a substantial part of pharmacists’ education, yet pharmacists are filling increasing numbers of veterinary prescriptions.

“We saw the need to get more education out there in a variety of different ways,” she said.

Oregon's pharmacy board has advocated that pharmacists and pharmacy technicians be mindful when filling veterinary prescriptions, and the board has given pharmacy students and pharmacist associations presentations that included information on veterinary prescriptions, Karbowicz said. The board also requires that pharmacies dispensing veterinary drugs have references such as Plumb's Veterinary Drug Handbook or the Merck Veterinary Manual.

The Oregon State Pharmacy Association also has worked to improve the “critical link in patient care” between veterinarians and pharmacists by providing continuing education on veterinary pharmacy, Dr. Davis said. And she noted that an increasing number of U.S. pharmacists are completing residency training in veterinary pharmacies.

“We do need to work on opening stronger communications between pharmacists and veterinarians,” Dr. Davis said. “Pharmacists take their responsibility as the last check in drug review and distribution seriously but need to follow up with veterinarians if they have questions.

“We hope that veterinarians will be equally open to working with pharmacists as they fulfill their professional responsibilities.”

Kolb said representatives from the Oregon VMA and state pharmacy board have talked about the issue over the past two years, and the OVMA has developed information sheets for veterinarians to give to clients when writing prescriptions to be filled by outside pharmacies. He thinks changes in the absence of consultation are less common than before the OVMA conducted its survey.

Accidents, intent, and generics

Miner suspects that some of the Oregon VMA survey respondents who reported knowing of unauthorized changes were referring to instances when clients received generic rather than name-brand drugs.

If a veterinarian writes “no substitution” or “dispense as written,” a pharmacist cannot provide an equivalent without the veterinarian's authorization. But, Miner said, pet owners can request generic alternatives and, in doing so, override even a veterinarian's orders against substitutions.

He also said the Oregon VMA did not give details that would have let the board investigate incidents reported in the survey.

The board has been receiving more reports of errors since the survey, Miner said, although most are related to accidental changes rather than deliberate substitutions. Such mistakes are unfortunate but normal occurrences in pharmacies, he said.

Karbowicz said a 2013 investigation found, for example, that an Oregon pharmacy made a decimal point–related error rather than an intentional substitution in filling a prescription for a pet's thyroid medication at 0.05 mg rather than the prescribed dose of 0.5 mg, although the former would be a more typical dose for humans. The board imposed a $1,000 fine.

“We are initiating an investigation for each and every call that we get,” she said.

But Karbowicz, who previously worked in retail pharmacy, expects almost no pharmacist would intentionally dispense medication differing from a prescription without consulting the prescriber.

“I'm very appreciative of the surveys because they have brought the conversation forward,” she said. “And the conversation clearly showed that education and more awareness was needed around the whole topic, especially as it's just grown over the past, maybe 10 years, or so.”

But she said the survey results need to be substantiated, and the limited data available are not alarming.

Concern among VMAs

Candace Joy, executive vice president of the Washington State VMA, said her association's survey, patterned after the Oregon VMA's, indicated it is commonplace, in her words, “to have pharmacists switching drugs, altering dosages, changing quantities without any authorization from the prescribing veterinarian.” Her organization presented their survey findings to the Washington State Pharmacy Quality Assurance Commission.

The results, described in a January 2013 report, showed that most pharmacists call the prescribing veterinarian when they have questions or concerns. But they also show “an alarming trend in recurring problems by pharmacists unfamiliar with veterinary pharmacology and physiology” as well as problems related to an inadequate supply of veterinary drugs.

“Pharmacists are not specifically trained in veterinary pharmacology and physiology and are making the assumption that animals respond to drugs similarly to humans,” the report states. “Cats and dogs are not small humans and species variability in the metabolism of drugs is significant.”

Given the survey results from Oregon and Washington, Joy said such changes in veterinary prescriptions are a national issue.

“If it's happening this much in our two states, I know that it's happening everywhere,” she said.

Dr. Peter Weinstein, executive director of the Southern California VMA, which also based its survey on Oregon's, wants veterinarians to follow up on filled prescriptions and ensure that clients are receiving the intended products. He also advocates that veterinarians have working relationships with pharmacies.

He said that, as more clients receive prescriptions from pharmacists, organized veterinary medicine should find a way to benefit pets, pet owners, and veterinarians.

“I think that there has to be a way that we can all benefit from this and not end up in a contentious battle,” he said. “It's just going to change the way we think about conducting our businesses.”

For Cohn, relevance of AVMA and profession is front-and-center

Incoming president shares his concerns and hopes

Story and photo by R. Scott Nolen

Incoming AVMA President Ted Cohn is worried.

Worried about the rising costs of veterinary education. Worried by low veterinary salaries and depressed demand for veterinary services. Worried the AVMA isn't adequately meeting member needs. Worried about the lack of diversity within the AVMA leadership and profession. Worried whether veterinary services could be better promoted to the public. Worried too little is being done to support the one-health concept.

The companion animal practitioner from Lone Tree, Colorado, shared his litany of concerns at the Candidates’ Introductory Breakfast held July 25 in conjunction with the AVMA House of Delegates regular annual session in Denver. The 2014–2015 AVMA president referenced the Bob Dylan song “Things Have Changed” in which Dylan sings “I'm a worried man, got a worried mind.”

“On the cusp of assuming the presidency of this organization, that phrase pretty well sums up my own frame of mind,” Dr. Cohn admitted. “Let me tell you, I am worried. I am worried about any number of issues affecting our profession.”

Although the AVMA is working to address some of these issues, including by creating the Veterinary Economics Division and spearheading the Partners for Healthy Pets campaign, Dr. Cohn said forces outside the Association heavily impact the future of veterinary medicine.

“Our professional destinies are primarily determined, as they have always been, by the wishes and desires of the global society, which we serve,” he told delegates. “At best, (the AVMA) can only hope to exert a strong positive influence for what we believe is in the best interest of our members.”

Experimentation and “evolutionary changes” in veterinary education are necessary for the profession to meet society's ever-changing demands, Dr. Cohn said. He called on veterinary organizations and colleges to have the “vision, courage, honesty, and determination” to recognize what is currently occurring within the veterinary profession.

“While we may not have comprehensive control over the shape of our future,” Dr. Cohn said, “we do have a shared responsibility to try to alter what we can, to aid our members and our profession.”

Dr. Cohn reminded delegates how the AVMA undertook an initiative several months ago to enhance the Association's value to its members. Guided by member input, this Strategy Management Process is meant to better identify areas in which the AVMA can dedicate its resources and energies to bring members the services, products, and outcomes they want.

“If we really listen to our members and do this well—and it will definitely take courage, judgment, integrity, and dedication on the part of all of us in leadership—we will ultimately remodel the AVMA into an association of which we can all feel a proud ownership,” he said, calling the initiative one of the most important projects he's seen in nearly two decades of AVMA involvement.

Diversity and inclusion are essential to the sustainability and continued success of the AVMA and the veterinary profession, Dr. Cohn, a Tuskegee University graduate, said. Diversity is not about quotas or lowering standards, he explained, but about providing opportunities.

“For AVMA, that means actively supporting programs such as the Women's Veterinary Leadership Development Initiative,” he said. “And it also means educating members of underrepresented groups about the many positive aspects of a veterinary medical career.

“Through achieving a profession-wide demographic more similar to that of society, we increase our trust and widen our appeal to many consumers who today either underutilize or just do not avail themselves of veterinary services. We must embrace diversity and inclusiveness not only because it is good for business but because it is right.”

Dr. Cohn noted that the Partners for Healthy Pets campaign is supported by a large and growing coalition advocating for pets to receive preventive health care through regular veterinary visits. Just as the dental profession switched from a “drill and fill” model to one of preventing oral disease through regular checkups, Dr. Cohn said veterinarians must focus on preventing disease in their animal patients.

He called on those in private practice and clinical education to join the Partnership, use the tools provided, and enthusiastically promote the concept of annual checkups for patients.

Dr. Cohn doesn't believe promoting the veterinary profession should be limited to the delivery of pet care, however. “While it is certainly beyond the scope of the Partnership, I firmly believe we need to broaden the scope of our marketing efforts to encompass the breadth of our profession, beyond just companion animals,” he said.

“We especially need to embrace production agriculture. I would love to see AVMA lead a campaign emphasizing an appreciation of the veterinarian's role in the production of an abundant, wholesome, and above all, safe supply of animal protein,” Dr. Cohn explained.

One way veterinarians can demonstrate their relevance is by emphasizing the health link among animals, humans, and the environment, and the ways veterinarians promote the well-being of each, according to Dr. Cohn.

“By increasing our support of one health and working more closely with groups such as the One Health Initiative team and the One Health Commission, we can potentially provide new career paths for veterinarians,” he told AVMA delegates.

Dr. Cohn concluded his remarks by encouraging veterinarians to recognize change is upon them and to evolve. “While I don't expect you to always agree with the AVMA, nor with me personally,” he said, “I do expect as professionals we can and will address our differences with civility and respect, and work together to assist this great profession.

“AVMA works for us all but will only be there for us if we are there for AVMA. I am positive that divided, there is little we will accomplish. United, there is little we cannot do.”

Kinnarney, Stinson carry the day in the HOD


Dr. Joseph H. Kinnarney

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462


Dr. Rebecca E. Stinson

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462

It was a fine day for the two candidates from the Tar Heel State.

Drs. Joseph H. Kinnarney and Rebecca E. Stinson, North Carolinians both, prevailed over their opponents and were elected as 2014–2015 AVMA president-elect and 2014–2016 AVMA vice president, respectively, July 25 during the AVMA House of Delegates regular annual session in Denver.

Dr. Kinnarney is a mixed animal practitioner from Reidsville and president of four small animal hospitals and an equine hospital. A 1980 graduate of Cornell University's College of Veterinary Medicine, he has served as Student AVMA president, AVMA vice president, District III representative to the Board of Directors, and a member of the HOD.

“A year ago, I stood before you at the Candidates’ Breakfast, and I talked about economics. I talked about communication. I talked about us doing more public marketing. In the year of campaigning … I talked to members who had nothing to do with the House of Delegates, and I can tell you, they are looking for action on these issues,” Dr. Kinnarney said.

“We must address communication to our members,” he continued. “We must enhance and look at the economics of our profession. And we must market ourselves and speak to the public. Going forward, I will try my best to keep this on the front burner.”

As vice president, Dr. Stinson will spend the two years as the AVMA liaison to the Student AVMA and student chapters. The position also entails a seat on the AVMA Board of Directors as a voting member.

Dr. Stinson, who received her DVM degree in 2002 from the University of Georgia, is an equine practitioner and is also from Reidsville. In addition to being an AVMA Future Leaders Program participant, she was a member of the former AVMA Member Services Committee, the Council on Veterinary Service, and the Model Practice Act Task Force. Dr. Stinson is a former SAVMA president and was chair of the American Association of Equine Practitioners’ Student Relations Committee.

“Thank you so much,” Dr. Stinson said to the HOD. “I promise I will do the best job I can for you, and I think we're going to have a great couple of years together.”

Board has new name, shorter member term

The House of Delegates approved two amendments to the AVMA Bylaws July 25 during its regular annual session in Denver.

The HOD approved a bylaws amendment changing the name of the AVMA's board from Executive Board to Board of Directors to be consistent with the terminology used in laws covering not-for-profit organizations in Illinois, where the AVMA is incorporated.

The same amendment reduced the term of board members from six years to four, with the proviso that the change would not affect any board member elected prior to the close of the 2014 regular annual session of the HOD. The board's Governance Bylaws Working Group crafted the proposal. The working group believes that a shorter term will result in more opportunities for AVMA members to serve on the board. The bylaws already stipulated that board members may not serve consecutive terms.

In addition, the HOD approved a bylaws amendment adding a veterinary student, appointed annually by the Student AVMA, as a nonvoting member of the AVMA Council on Research.

Meyer looks to navigate the future in new role


Dr. Thomas F. Meyer

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462

Outgoing AVMA Executive Board Chair Thomas F. Meyer is running for president.

The mixed animal veterinarian and practice owner from Vancouver, Washington, launched his campaign for 2015–2016 AVMA president-elect July 25 at the Candidates’ Introductory Breakfast in conjunction with the AVMA House of Delegates regular annual session in Denver.

Dr. Meyer is currently the only candidate for the office. He is endorsed by the Washington State VMA.

Throughout his career Dr. Meyer has held leadership positions at the local, state, and national levels of organized veterinary medicine, including as president of the Washington State VMA. In 2008, the AVMA members of District XI elected him as their representative to the Board of Directors, and for the past year, Dr. Meyer has served as board chair. He is a 1978 graduate of Washington State University.

In his remarks, Dr. Meyer likened the AVMA to a linchpin, describing it as “an absolutely essential” mechanism that holds together a diverse and complex profession involved in many aspects of society.

“With that diversity and complexity comes the necessity to have the organizational structure and direction in which to keep our association—the AVMA—on a course that maintains value and relevancy for our members and the profession,” he said.

The AVMA has been “blessed” with visionary leadership during its more than 150-year history, Dr. Meyer said, noting the Association had recently embarked on a Strategy Management Process.

“This effort,” Dr. Meyer said, “was launched with full appreciation that our members’ needs and our profession are continually evolving. This comprehensive evaluation and planning effort will result in a stronger, more focused, and more well-oiled AVMA for our members.

“With all this directional input for the AVMA, my campaign focus is on navigating the future and why it's important to do so with purpose and certainty so that AVMA will continue to be that linchpin.”

Price, de Jong win top seats on AVMA board


Dr. V. Hugh “Chip” Price

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462


Dr. John H. de Jong

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462

Meeting in Denver July 29, the final day of the AVMA Annual Convention, the Association's Board of Directors elected and installed Dr. V. Hugh “Chip” Price of Shreveport, Louisiana, as chair and Dr. John H. de Jong of Weston, Massachusetts, as vice chair for the 2014–2015 Association year.

Dr. Price has been a board member since 2009, when AVMA members in Arkansas, Louisiana, and Texas elected him District VIII representative. He previously served in the AVMA House of Delegates and on the House Advisory Committee. Dr. Price is also a former president of the Louisiana VMA and the American Association for Laboratory Animal Science.

Currently, Dr. Price is director of animal resources at the Louisiana State University Health Sciences Center, where he is also professor of molecular and cellular physiology and professor of emergency medicine. He received his DVM degree in 1980 from Louisiana State University.

Dr. de Jong was elected to the AVMA Board of Directors in 2010 to represent Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont. The companion animal veterinarian and multiple-practice owner served in the HOD and has chaired the HAC, the Governance Performance Review Committee, and the Political Action Committee Policy Board. Dr. de Jong received his DVM degree in 1985 from Tufts University.

Helping to prepare for the worst

By Greg Cima


Destruction from the May 2013 tornado in Moore, Oklahoma (Courtesy of FEMA)

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462

Dr. Brigid Elchos, deputy state veterinarian in Mississippi, said state teams that respond to animal emergencies are better prepared because of an AVMA program.

She noted that team members in Mississippi used training from that program to assess animal needs and available veterinary infrastructure following a tornado this April in east-central Mississippi.

Dr. Leslie E. Cole, who is the emergency coordinator in Arkansas and Oklahoma for the Veterinary Services division of the U.S. Department of Agriculture's Animal and Plant Health Inspection Service, said the training delivered by AVMA Veterinary Medical Assistance Team members to state and county animal response teams in Oklahoma “has been tremendously helpful and essential.” The Veterinary Services incident management teams have not taken the training, but they have benefited, as local animal response teams have been better able to collaborate with Veterinary Services during emergencies.

“I just hope that the VMATs continue to have training and local capacity building as one of their mandates,” Dr. Cole said. “I've witnessed the value of that personally here in the state of Oklahoma, and it has borne very wonderful fruit.”

The American Veterinary Medical Foundation funds VMAT activities through the Foundation's Saving the Whole Family program.

AVMA Veterinary Medical Assistance Teams were founded partly as a response to Hurricane Andrew in 1992. Since 2009, the program's focus has shifted from disaster response toward helping state governments, primarily by training state and local teams in responding to emergencies and providing assessments of preparation and veterinary infrastructure. And the teams still can aid state governments during emergencies when requested.

The National Veterinary Response Team, which is under the Department of Health and Human Services, is the primary federal resource used to treat animals harmed by disasters.

Dr. Gerhardt G. Goemann, a VMAT commander and chair of the AVMA Committee on Disaster and Emergency Issues, said emergency animal issues are also “people issues.”

“When we respond to a disaster, we're really caring for people as much as we're caring for the animals because of the emotional bond,” he said.

Dr. Elchos said Mississippi veterinary team members applied VMAT training, provided by Dr. Goemann, following the April 28 tornadoes, one of which killed 10 people and damaged and destroyed homes, farms, and industrial buildings along its path through Louisville, Mississippi. Reports from the National Oceanic and Atmospheric Administration state that the tornado was on the ground for more than 34 miles and that it was part of a storm system that produced 21 confirmed tornadoes.

Because of the training, the state team members were better able to assess what veterinary care and animal sheltering capabilities were available, whether animals could be moved, whether animals were entering the affected area, and how state and local veterinary teams could help.

“Being able to do good assessments is extremely important to the success of the response,” Dr. Elchos said.

Dr. Goemann said he hopes the training he provides veterinarians helps them prepare for emergencies and understand how to aid during a disaster without increasing risk to themselves and fellow responders. And, when a hurricane or other disaster is looming, he hopes those veterinarians can help people evacuate animals so their owners do not stay behind.

Oklahoma residents also have shown more interest in preparing for animal-based needs when emergencies occur and in forming veterinary response teams since May 2013, when a tornado struck Moore, Oklahoma, Dr. Cole said. That tornado killed 24 people as well as killed animals and destroyed neighborhoods.

She thinks animal aspects of disasters are gaining recognition, and those who want to help are eager to find partners such as VMAT members.

“As training dollars from federal and state governments wane, the VMAT has a very important job in this local capacity building,” Dr. Cole said.

Dr. Christen L. Skaer, founder and president of the Sedgwick County Animal Response Team and past president of the Kansas State Animal Response Team, said VMAT members delivered the initial training and guidance that helped in forming both teams. VMAT members since have provided training that the organizations otherwise could not afford and helped the team members understand how to become involved during emergencies and fit into response plans.

“Learning how to behave with the other disaster responders and be taken seriously is a big deal,” Dr. Skaer said.

Dr. Elchos noted that few organizations offer training in veterinary medical response.

“Many times, agencies such as ours are not given resources, really, to do the kind of responses that a lot of these disasters require,” Dr. Elchos said. “And having an ability to be supported on that level by this profession and having that education, expertise available, and having people willing to come and assist is incredible.

“And we've always felt that VMAT has been a tremendous resource in whichever capacity it has been made available.”

The Department of Homeland Security is promoting disaster preparation during September, which the department designated as National Preparedness Month through a project started in 2003.

A new perspective from APHIS’ Clifford

Interview By Susan C. Kahler

In July, JAVMA News talked with Dr. John R. Clifford, the deputy administrator of Veterinary Services in the Department of Agriculture's Animal and Plant Health Inspection Service, about the agency's new strategic outlook and current issues.

Prior to becoming deputy administrator in 2004, Dr. Clifford served as acting deputy administrator. Earlier, he was the associate deputy administrator of the National Animal Health and Policy program, and from 1997–2002, he served as assistant deputy administrator. Dr. Clifford also has extensive field experience. He joined the APHIS staff in 1985 after working in a private mixed animal practice. The University of Missouri-Columbia awarded him his DVM degree in 1983.

To what degree do you anticipate that porcine epidemic diarrhea virus vaccines for use in sows will prevent transmission of this virus, which has been reinfecting U.S. herds?

The swine practitioners and researchers will continue to look at field trials and how effective those particular vaccines will be in providing immunity in the sows. The primary target here is the sows, and it's got to be immunity that's passed through their milk to the baby pigs to protect them from this coronavirus. I also think that practitioners and researchers will continue to utilize some of their other methods to improve immunity in those sows. It's still too early to tell how effective these vaccines are going to be.

Please elaborate on your comment at the World Pork Expo in June that you want to build a model with veterinarians and producers to handle the next organism that comes into the country differently than PEDv was.

Over the last several years, APHIS Veterinary Services has been positioning ourselves through a new strategic outlook for the future as well as going through some reorganization. There are many components to this. Basically, we're aligning ourselves to be more of an organization of animal health and not an organization that specifically addresses just a few diseases. The model I was referring to that we're in the process of developing—and actually putting out a white paper on for comment—is around the issue of emerging diseases. It's got a number of components to it such as it's important for us to have national reporting of certain diseases and emerging diseases so that we can effectively address these issues.

It's important to note that reporting does not mean that you're going to take action. First you've got to have the knowledge and information on what's happening. We need diagnostics and surveillance to be able to identify an emerging disease or a disease that's not present in the U.S.

The other component is what actions you would take. Very early on in that process, you may need to put a stop movement on the primary premises involved to get a handle on what you're dealing with and how best to address it. So basically, you would do your initial epidemiology to look at the pathway through which it entered, whether it was an emerging disease from within the U.S., a disease that changed in its clinical picture, or a disease like PED that entered from another country.

As we gather information through better epidemiology, it will help better inform us about what actions to take. The actions could be a whole host of things, from an eradication effort—and that can take on many approaches, it doesn't have to be depopulation—to the use of vaccine technology to education and research to deciding that it's best not to do anything. From the industry standpoint, it's going to be important for them to know that if we're going to take such action as a stop order, we're not going to do that in a way that's going to put producers out of business and inhibit commerce broadly.

What is the white paper time line?

I don't have an exact time line but hopefully not too long.

What more can you say about Veterinary Services’ “A New Perspective” document?

I have elevated our senior executives to be more strategic in helping the overall structure of VS to look at the vision for the future and help implement the reorganization to better align us for our future. Our “A New Perspective” document lays out the specifics about what we're trying to accomplish. Part of that is a one-health strategy. We've implemented a one-health office. We're very much involved with one-health issues—right now, for example, with issues from antimicrobial resistance to food safety to assisting our National Veterinary Services Laboratories with Salmonella diagnostics in bearded dragons. The Centers for Disease Control and Prevention requested our assistance in that. Obviously, bearded dragons are not farmed animals, but they're a lizard-type pet that passes Salmonella on to people. We provide assistance to many of our partners, from the CDC to the Food and Drug Administration to the USDA Food Safety and Inspection Service. We're not doing those from a regulatory standpoint; we're not to be an extension of them, but to provide additional services and help producers in the farming industry find better alternatives and answers to animal health issues.


Dr. John R. Clifford (Courtesy of USDA)

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462

What are the next steps APHIS plans to take to implement its recently proposed simplified biologics efficacy labeling and its 2011 proposed rule to replace the four levels of effectiveness with a uniform label format? Will the label changes be implemented concurrently?

We're currently evaluating the comments on the proposed rule. In the preamble, we recommended a four-year implementation period to allow for the transition from current labels to new labels. We will review those comments and then basically, within that implementation period, we're proposing that licensees would request an extension under certain conditions, maybe even for two years, to make these changes. We would then take action to implement the rule over time. We'll be working very closely with the industry to address them.

Are veterinarians becoming accustomed to the revised National Veterinary Accreditation Program, and is the renewal rate high enough to continue serving national needs?

Yes, the renewal rate is about 85 percent, and in addition, we've been getting about 2,600 new veterinarians per year over the last three years. With that renewal rate and new veterinarians, there should be more than an adequate supply of accredited veterinarians.

A year ago, the World Organisation for Animal Health (OIE) upgraded the U.S. classification to “negligible risk” of bovine spongiform encephalopathy. Since then, have any cases been detected, and have any new mitigation strategies been put in place to prevent BSE introduction and spread?

No, there are no new mitigation strategies. The last case that was detected in the U.S. was in California in April of 2012. It was an atypical BSE case. We've seen atypical cases in older animals, and they are not related in any way to contaminated beef, and, in fact, they may arise from spontaneous occurrence in older cattle. The current surveillance and actions by FDA and APHIS far exceeds the requirements of OIE, and FDA's feed ban remains a very effective strategy in addressing transmission of BSE.

Do foot-and-mouth disease preparedness efforts focus on education and on trade decisions based on the world map showing distribution of FMD by country?

FMD still exists in a lot of countries around the world. With regard to the actions that we take for our preparedness and prevention of FMD, it's a continual effort. Even though we've been free of the disease since 1929, we still take this disease very seriously and will continue to do so in protection of the U.S. livestock industry. Part of that preparedness has to do with the development and analysis of the importation of animals and products from countries that are either free or free with vaccination. The mitigations we have in place for those countries are, we believe, scientifically sound in reducing the risk of FMD introduction into the U.S. to a very, very low risk.

The most likely way FMD would come into the country would be illegal movement of a product into the U.S. The other component is our own preparedness here. We continue to work with the different sectors of the industry in developing strategies for vaccine use as well as for continuity of operations. Working together will enable us to address a major disease issue together to minimize the impact.

Does illegal movement fall under Customs?

It's both through Customs and Border Patrol, but we also have teams within APHIS Plant Protection and Quarantine that do our own looking for illegal products within the U.S. and do some of our own investigative work after products have come over the border. In addition, our land border ports from Mexico and Canada are there to protect the U.S. and hopefully prevent movement of illegal products into the U.S. They are handled and overseen by the Customs and Border Patrol. We provide the policy and regulatory oversight they use.

In May, APHIS made four changes to the program standards for chronic wasting disease to bring them into alignment with the rule that established the herd certification program. What is the importance of this action?

It was to make sure there was no confusion between the standards and the rule. With regard to the standards document, I know there are concerns about the program from both sides, from the farm-raised cervid industry itself to the Department of Natural Resources, the wildlife side of this issue. I think we've done the best we can to strike the proper balance, and we'll see how things go with the program.

You've been in your current position since 2004. Is it still a challenge? Do you miss private practice?

I was in a mixed practice, predominantly dairy cattle. I enjoyed that work, but I really don't miss it. I love serving American agriculture and the farm animal industry in this country, and I love being a representative and an advocate for them. I want to make sure that they're able to have healthy livestock. I enjoy working for the USDA and representing this country internationally as well as domestically. Sometimes, it can be stressful, but I think the enjoyment far outweighs any of the downsides.

Surveillance, diagnostics unaffected by lab closures

The federal laboratory closures, which followed mistakes involving biological materials, will not affect surveillance or diagnostic reference testing.

A report and a related announcement published July 11 by the Centers for Disease Control and Prevention indicate no employees were known to have been infected following incidents this summer involving Bacillus anthracis and highly pathogenic H5N1 influenza virus. But the agency temporarily closed an influenza laboratory and implemented a moratorium on transfer of pathogens, specimens, and other biological materials from its most secure laboratories.

The agency's response included halting work at its Bioterrorism Rapid Response and Technology Laboratory pending changes that could prevent “similar future incidents,” a CDC announcement states. Benjamin N. Haynes, a spokesman for the CDC Infectious Disease Team, said the action halted distribution of testing materials to state laboratories in the Laboratory Response Network that could be used to respond to emergencies involving biological or chemical agents.

Haynes said the agency was endeavoring to resume work in the affected laboratories and increase safety in all laboratories.

The July report indicates that, in June, researchers failed to ensure B anthracis specimens were inactivated before transferring them to a less secure laboratory. In July, CDC administrators learned that an H9N2 avian influenza culture that had been shipped in March to Department of Agriculture poultry researchers was contaminated with the highly pathogenic H5N1 influenza virus.

The CDC document “Report on the potential exposure to anthrax,” which includes an appendix on the inadvertent shipment of H5N1 virus, is available at www.cdc.gov/od/science/integrity/.

FDA issues guidance on regulation of cell-based products in animals

The Food and Drug Administration has issued draft guidance on the agency's current thinking about how existing regulations apply to the use of cell-based products, including animal stem cell–based products, in animals. The guidance is directed at facilities and individuals manufacturing and marketing such products.

The guidance clarifies the FDA's position that the agency has jurisdiction over cell-based products meeting the definition of a new animal drug. Such products generally meet the definition of a new animal drug if they are intended to diagnose, cure, mitigate, treat, or prevent disease in an animal or affect the structure or function of an animal. At this time, the FDA thinks an approved new animal drug application will be the appropriate regulatory pathway for most such products.

According to the document, the agency recognizes that autologous animal stem cell-based products that meet certain criteria pose a lower risk to human and animal safety than other animal stem cell-based products and therefore are a lower enforcement priority. These criteria are that the product is minimally manipulated, for homologous use, and for use in non-food-producing animals; that the manufacture of the product does not involve the combination of the cells with another article, with certain exceptions; and that the finished product is not combined with or modified by the addition of any component that is a drug or device.

Comments on the draft guidance should be submitted by Sept. 30. Parties may submit comments by visiting www.regulations.gov and searching for docket number FDA-2014-D-0634.

Growing a Green Practice

Ecofriendly Clinics Require Commitment, Planning

By Malinda Larkin

Veterinarians’ role in one health—treating the health of animals, humans, and the environment as interconnected—is understandably most focused on the animal side of things, but some veterinarians are advocating for practitioners to become more environmentally conscious as well.

“Going green” can involve something as major as building or remodeling a clinic in an environmentally sustainable manner. Or it can be as simple as switching to recycled paper or using fleece instead of cotton towels for bedding, says Dr. Matthew B. Rooney, owner of Aspen Meadow Veterinary Specialists in Longmont, Colorado.

“(Fleece towels are) nonabsorbent, and for bottoms of cages, they have a nice cushion. When dirty, we put them in the washer, and the fleece comes out almost dry. You save a ton of money and water,” he said. (See sidebar for more tips.)

Dr. Rooney and other ecofriendly enthusiasts say going green does require a commitment to the endeavor to really make a difference but that the hidden benefits and cost savings make it well worth the effort. It's all about starting somewhere.

Green by design

When Dr. Rooney decided to build a green practice in 2008, he opted for a renovation project rather than a new structure to keep the project more environmentally friendly.

“New builds are much easier to do, but they use a ton of resources,” he said. So instead, Dr. Rooney bought and had an old auto dealership gutted, reusing or giving away about 70 percent of the materials. Doing so helped his clinic attain LEED certification from the U.S. Green Building Council, which means the clinic meets a certain Leadership in Energy and Environmental Design standard for being environmentally responsible and using resources efficiently.

For the design portion, Dr. Rooney decided on a multiuse concept. For example, the laundry room is also the kitchen and blood bank. But the arrangement isn't permanent. “Right now, we have a doctor's office, but when we're ready to do a remodel, there are floor drains, and the size of room and design is already set up to turn it into dog runs. We can literally shut the doctor's office door, and five days later, it's all dog runs when we remodel, so there's no demolition of walls or having to add waste to a landfill,” Dr. Rooney said.

Veterinary clinics do have particular requirements, but they can be accommodated while going green, Dr. Rooney says. For example, practices need heating, ventilating, and air-conditioning systems with a high air-circulation rate. The upfront cost for purchasing a more efficient HVAC system may be higher, but according to the Environmental Protection Agency, replacing components of a less efficient HVAC system typically cuts energy costs by about 20 percent.

Dr. Rooney chose an efficient HVAC system with some solar energy components and insulated ducts. In addition, he invested in a thermostat system that—using the clinic's floor plan—can tell what the temperature is in each room and graph that information over time. The system has sensors for carbon dioxide concentrations that can also calculate how many people are in a room and adjust the temperature and flow rates accordingly.

Plus, Dr. Rooney said, “In the winter, there's hot air going out the door and new cold air coming in. Our HVAC system has these energy recuperation units that heat or cool the new incoming air with the old outgoing air, which recovers 70 percent of the energy that could have been lost.”


Aspen Meadow Veterinary Specialists in Longmont, Colorado, was constructed from an old car dealership in 2008. Owner Dr. Matthew B. Rooney says in the first year, the clinic saved 35 percent on electricity, more than 50 percent on water, and 40 percent on gas.

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462


Dr. Rooney says a little added insulation can go a long way in limiting heating and cooling needs as well as helping curb noise. In veterinary facilities, ailing patients, distraught clients, and triage can cause substantial noise, which can affect patient recovery and client experience, he says. (Photos courtesy of Dr. Matthew B. Rooney)

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462

And yet, clinics can't avoid some wasteful practices, he said, such as using a lot of water to spray down kennel runs and clean the rest of the hospital. Disinfectants, too, are not very environmentally friendly but are a must for killing bacteria and viruses. In addition, “Our lights are on all the time since we're open 24/7. It would be nice if we could lower that,” he said.

Dr. Rooney says he and his wife have always been very environmentally conscious, so there was no question his new facility would be a green build.

“It's who we are, and from a business standpoint, it's a core value—environmental and social consciousness,” he said.

Green builds show not only business ethics, he said, but also provide good will in the community, not to mention, private practices can use their ecofriendly credibility as a marketing tool and a way to differentiate themselves from competitors.

Dr. Rooney says the options and materials available today compared with six years ago when he redid his clinic have grown tremendously. The prices have also dropped a lot as green building has become more mainstream. He advises finding an architect or contractor who is experienced in green building because “they all know the secrets and nuances to getting it done.”

At the same time, Dr. Rooney cautions to choose wisely because of the abundance of “green washing,” which refers to products or individuals with more marketing hype than substance or experience.

“They'll say slate is natural and ecofriendly, but if it came from New Zealand, that's not really green,” Dr. Rooney said. “Or, they'll market plastics as green because they last a while, but they aren't green because they don't break down in landfills and are based in petroleum.”

Healthy habits

Ohana Pet Hospital, a five-doctor private practice in Ventura, California, went the new construction route in a leasehold space when it had the opportunity to do a startup practice.

One challenge was finding a model veterinary hospital that had done an ecofriendly renovation or build. “In our industry, not a lot of people build veterinary hospitals with this in mind,” said Dr. Janis Shinkawa, one of the practice's co-owners.

Through networking with the Ventura Chamber of Commerce's Green Task Force, she found a like-minded design consultant and others who guided the practice through the green building process. The new facility features zero-emission paints, use of natural lighting and light-emitting diodes, and recycled glass countertops, among other environmentally conscious options.

But the work on going green didn't stop after construction ended in November 2012. The practice's owners also eliminated waste from everyday causes, including a big one—medical supplies. They discovered they could recycle things such as packaging from fluid bags, the fluid bags themselves, pill bottles, vaccine vials, and syringe casings; however, Dr. Shinkawa recommends veterinarians check with their trash disposal company. Or practitioners could do what her practice did and tour their local recycling plant.

The practice also chose to go entirely paperless, from laboratory services to radiology to banking and payroll.


The Ohana Pet Hospital in Ventura, California, works with a program set up by the city and local human hospitals through which the used outer wraps of surgical packs are distributed to veterinary hospitals to use on their own surgical packs a few times before discarding. Because the wraps don't touch blood or other substances, they can be reused instead of thrown into the trash immediately. (Photos courtesy of Dr. Janis Shinkawa)

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462


The city of Ventura's Environmental Sustainability Office offers free visits to businesses to help with recycling needs, staff training, and the like. “It's a habit-changing thing you have to go through with staff, such as what items are recyclable,” said Dr. Janis Shinkawa, co-owner of Ohana Pet Hospital. “When we hire, we mention we are a green facility. It's understood upfront that they have to be good about recycling.”

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462

“That was a challenge initially, but it allowed us to save a lot on the cost of paper, manila folders, and ink toners,” she said. “It makes things so much easier. We're not looking for paper charts or employee files; it's online and easier to manage—that way, I can do payroll from home. It definitely was worth the time and investment put into it.”

Dr. Shinkawa continued, “This is an undertaking. I'm lucky to have three other partners who own the practice who were on board with it, and the staff, too. That's a huge part of it. Everyone has to be on board and pitch in, or it doesn't work.”

Going green has paid off in a number of ways. It not only reduces everyday costs at the clinic, but also provides a strong marketing tool. That's been particularly true after the clinic won three awards for being ecofriendly: one from the Ventura Chamber of Commerce, another from the Ventura County Board of Supervisors, and the last from the California Air Resources Board. All have resulted in lots of free press for the clinic, which Dr. Shinkawa says is invaluable, especially for a startup practice such as theirs.

“Our goal, though, is to primarily show that, if it can be done in a veterinary hospital, it can be done anywhere. I want to help colleagues figure out how to do this as well.

“Even if they can't change their buildings, what they can at least do with their floors or countertops to be ecofriendly can help, or even just have a recycling bin next to every trash bin,” Dr. Shinkawa said. “It's important to be sustainable and mindful of reducing our waste.”

Green projects for veterinary clinics

Environmentally friendly products have become abundant in recent years and less costly. The following are a few options to consider in making a veterinary practice more green:

  • Installing occupancy sensor switches.

  • Switching to compact fluorescent or LED light bulbs.

  • Installing a programmable, time-controlled thermostat.

  • Making better or more use of natural lighting.

  • Purchasing Energy Star products, including water heaters, washers and dryers, refrigerators, ceiling fans, and air-conditioning units.

  • Buying low-volume usage toilets.

  • Placing recycling bins throughout the clinic.

  • Using recycled-content paper for letters, postcards, and other documents.

  • Purchasing plant-based laundry detergent, soaps, and surface cleaners.

  • Using paint with no or low volatile organic compounds.

  • Using recycled-glass solid surfaces and recycled wood, vinyl, or aluminum flooring.

AAHA shifts focus from students to recent graduates

The American Animal Hospital Association has decided to redirect the AAHA Career Development Program to focus less on veterinary students and more on recent graduates.

Students are inundated with information from associations and companies, according to AAHA, while recent graduates are underserved and lack access to resources.

“We expect to announce significant additions and enhancements to this program as we direct additional resources to help meet the needs of the recent graduate,” wrote Dr. Michael Cavanaugh, AAHA chief executive officer, in a post on AAHA's Member Connection blog.

Existing resources for recent graduates include the Mentorship Toolkit from AAHA, VetPartners, and the Veterinary Business Management Association. For three years after graduation, veterinarians receive complimentary AAHA membership as well as complimentary online subscriptions to AAHA's Trends magazine and the Journal of the American Animal Hospital Association, a variety of resources through AAHA's My Veterinary Career website and the AAHA website, and 50 percent discount on registration to AAHA's annual conference.

Students receive the same benefits except that they receive complimentary conference registration.

Effective Aug. 1, AAHA discontinued on-campus programs that have included speakers and student leadership teams. The AAHA Student Committee also disbanded Aug. 1, and AAHA will work to involve interested volunteers with other volunteer groups.

The student website and social media channels closed July 1. Followers of these platforms may connect with AAHA online via the AAHA website, My Veterinary Career, Facebook, or Twitter.

AKC foundation launches Epilepsy Research Initiative

The American Kennel Club Canine Health Foundation has launched the Epilepsy Research Initiative to provide dog owners and the veterinary community with improved methods for preventing and treating epilepsy in dogs.

Dog clubs, owners, and veterinarians have identified epilepsy research as an unmet need in the field of canine health, according to the CHF. The seizure-related syndromes collectively known as epilepsy represent the most common neurologic disorders in dogs. About 30 percent of dogs in which epilepsy is diagnosed do not receive relief from seizures with current drug therapies, and these treatment options also carry possible adverse effects.

Dr. Shila Nordone, CHF chief scientific officer, said the Epilepsy Research Initiative “aims to fund research grants that will better classify the disease, provide a more thorough understanding of the underlying mechanisms that predispose dogs to epilepsy, and introduce new drugs into the canine epilepsy treatment pipeline.”

Information about the initiative and epilepsy is available at www.akcchf.org/canine-health by clicking on “Epilepsy” under “Your Dog's Health” on the left side. Resources for dog owners include “Understanding Canine Epilepsy,” a white paper on the state of epilepsy research that includes a seizure diary.

Veterinary technician contest underway

A new nationwide contest called “Why I Love Being a Vet Tech” is honoring the work of veterinary technicians. Pets Best Insurance and the National Association of Veterinary Technicians in America are sponsoring the contest.

Veterinary technicians are invited to submit an essay of up to 250 words explaining why they chose their profession and why they love being a veterinary technician. Veterinary technicians may submit entries by visiting www.petsbest.com/forms/vet-tech-contest; the submission deadline is Sept. 12.

A judging panel from Pets Best and NAVTA will review the essays and select eight finalists. The public will then have the opportunity to vote online at the Pets Best website, www.petsbest.com, and Facebook page from Sept. 26-Oct. 10.

The finalist who earns the most votes in the online poll will win a paid trip to the North American Veterinary Community Conference next January in Orlando, Florida. Finalists will also each win $200 plus a one-year NAVTA membership.

Phi Zeta presents research awards

Phi Zeta, the international honor society of veterinary medicine, recently presented two awards for research manuscripts. Each award consists of a plaque and $1,000.

Dr. Kevin S. Donnelly (Missouri ′10) received the 2014 Phi Zeta Research Award in the Basic Sciences category. The Pi chapter at the University of Missouri-Columbia submitted his winning manuscript, “Decorin-PEI nano-construct attenuates equine corneal fibroblast differentiation.”

Dr. Jaime L. Tarigo (Georgia ′02) received the 2014 Phi Zeta Research Award in the Clinical Sciences category. The Psi chapter at North Carolina State University submitted her winning manuscript, “A novel candidate vaccine for cytauxzoonosis Inferred from comparative apicomplexan genomics.”

Wyoming VMA

Event: Annual meeting, June 22–25, Lander

Business: The association is looking into a partially self-funded health insurance group plan. Members will be surveyed, and feasibility will be discussed and determined with the insurance actuary.

Officials: Drs. Brandi Hudson, Gillette, president; Katie Huber, Rawlins, president-elect; Amana Thoet, Worland, 2nd president-elect; Susan Walker, Torrington, treasurer; Jake Hall, Lander, immediate past president; and members-at-large—Drs. Erin Pederson, Powell, and Kevin Dickey, Thermopolis

Register for the AVMA symposium at www.avma.org humaneendings.

Alabama VMA

Event: Annual meeting, June 18–22, Sandestin, Fla.

Awards: Veterinarian of the Year: Dr. Allen Riley, Trussville. A 1985 graduate of the Auburn University College of Veterinary Medicine, Dr. Riley practiced at Becker Animal Hospital until retirement in 2011. Earlier in his career, he worked at Alford Avenue Veterinary Hospital. Dr. Riley is a past president of the Jefferson County VMA and has served as program chair of the Southern Veterinary Conference for the past 20 years. Service Award: Drs. Jennifer Dexter of Birmingham, Julie Gard of Auburn, Clayton Hilton of Birmingham, and Ken McMillan of Cropwell, for their contributions to the association and the advancement of the veterinary profession. A 2000 graduate of the Auburn University College of Veterinary Medicine, Dr. Dexter is an associate veterinarian at Hoke Animal Clinic and Green Springs Animal Clinic. Earlier in her career, she practiced at Cahaba Mountain Brook Animal Clinic. She is immediate past treasurer of the Jefferson County VMA. A 1996 graduate of the Auburn University College of Veterinary Medicine and a diplomate of the American College of Theriogenologists, Dr. Gard is an associate professor in the Department of Clinical Sciences at Auburn University's College of Veterinary Medicine. She guided and coordinated the Our Oath in Action projects at Auburn and Tuskegee universities, raising awareness of disaster preparedness and the importance of veterinarians in the planning process during the Auburn project, and providing complimentary physical examinations and education to the community during the Tuskegee project. A 1997 graduate of the Auburn University College of Veterinary Medicine, Dr. Hilton is vice president of animal care, education, and conservation at the Birmingham Zoo. He has been instrumental in establishing the zoo's all-male African elephant herd, the first at a facility accredited by the Association of Zoos and Aquariums. Earlier in his career, Dr. Hilton worked at the zoos in Montgomery, Alabama, and Abilene, Texas, and the Emergency Clinic of Abilene. A 1981 graduate of the Auburn University College of Veterinary Medicine, Dr. McMillan practices mixed animal medicine at Pell City Animal Hospital in Cropwell. He is chair of the ALVMA Legislative Committee and chaired a task force in 2014 to address issues related to tax-exempt entities in veterinary medicine and possible changes to the Alabama Veterinary Practice Act. Layman of the Year: Lorraine Alexander, Valley Grande, won this award, given to a nonveterinarian who has made outstanding contributions to the advancement of the veterinary profession and the association. Alexander is a rescue coordinator for Wannabe Rescued, a local pet rescue group that works with the Selma Animal Shelter. She has helped improve animal welfare at the shelter and coordinates treatments, spay-neuter procedures, inoculations, and pet adoption and transport.


Dr. Allen Riley

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462


Dr. Julie Gard

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462


Dr. Ken McMillan

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462


Lorraine Alexander

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462


Dr. John Hammons

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462


Dr. T.C. Branch

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462

Officials: Drs. John Hammons, Athens, president; T.C. Branch, Birmingham, president-elect; Harold Pate, Lowndesboro, vice president; H. Winston Pirtle Sr., Montgomery, treasurer; Charles Ashwander, Decatur, member-at-large; and William G. Bledsoe, Camden, immediate past president

Carney named Idaho's Veterinarian of the Year


Dr. Hazel C. Carney

Citation: Journal of the American Veterinary Medical Association 245, 5; 10.2460/javma.245.5.462

Dr. Hazel C. Carney was honored as Idaho's Veterinarian of the Year for 2014 on June 12 during the annual summer meeting of the Idaho VMA.

Dr. Carney (Colorado ‘81) treats cats at the WestVet Emergency and Specialty Center of Idaho in Boise and at Four Rivers Veterinary Clinic in Ontario, Oregon. She is a diplomate of the American Board of Veterinary Practitioners in Canine and Feline Practice. She has taught courses in the veterinary technology program at the College of Southern Idaho.

Dr. Carney is an active member of the American Association of Feline Practitioners. She has served on AAFP committees on public relations and membership. She currently serves as co-chair of the AAFP Guidelines Committee. She is president of the International Association of Cat Doctors.

Obituaries: AVMA member AVMA honor roll member Nonmember

Stanley R. Agenbroad

Dr. Agenbroad (Kansas ‘62), 87, Emmett, Idaho, died April 19, 2014. He practiced in Albuquerque, New Mexico, from 1965–1986. Earlier in his career, Dr. Agenbroad worked in Idaho at Nampa and Twin Falls. He was a veteran of the Marine Corps and a member of the American Legion. Dr. Agenbroad is survived by his wife, Evelyn; three sons and a daughter; seven grandchildren; and 11 great-grandchildren. Memorials may be made to Christian Veterinary Mission, 19303 Freemont Ave. N., Seattle, WA 98133, www.cvmusa.org

Philip H. Berends

Dr. Berends (Minnesota ‘70), 69, St. Charles, Minnesota, died May 27, 2014. A mixed animal veterinarian, he was a partner at St. Charles Veterinary Clinic prior to retirement in 2011. Dr. Berends served several years on the St. Charles School Board and Foundation for Academic Excellence Board. His wife, Barbara; a daughter and two sons; and six grandchildren survive him. Memorials may be made to St. Charles Borromeo Catholic Church, 1900 E. 6th St., St. Charles, MN 55972; or St. Charles Foundation for Academic Excellence, 600 E. 6th St., St. Charles, MN 55972.

Kenneth C. Bovee

Dr. Bovee (Ohio ‘61), 77, Deer Isle, Maine, died May 23, 2014. A past president of the American College of Veterinary Internal Medicine, he was professor emeritus of medicine at the University of Pennsylvania School of Veterinary Medicine since 1998. Dr. Bovee joined the veterinary faculty of the University of Pennsylvania as an associate professor in the mid-1960s. During his tenure at the university, he served as chief of medical studies, chaired the Department of Clinical Studies, and was honored with the first Henry and Corinne R. Bower Chair in Medicine. Dr. Bovee was also a member of the university's Faculty Senate and Academic Planning and Budget Committee and chaired the Graduate Group in Comparative Medical Sciences.

Known for his expertise in small animal urology and veterinary nephrology, he wrote the book “Canine Nephrology” and received the Ralston Purina Small Animal Research Award in 1980. Dr. Bovee was a member of the American and International societies of nephrology, American Society of Hypertension, American Heart Association, and College of Physicians of Philadelphia. He is survived by his wife, Terry, and two sons. One son, Dr. Brad Bovee (Pennsylvania ‘92), is a small animal veterinarian in Washington Crossing, Pennsylvania. Memorials may be made to the National Multiple Sclerosis Society, 30 S. 17th St., #800, Philadelphia, PA 19103.

Walter R. Chace Jr.

Dr. Chace (Iowa ‘52), 88, Laurel, Nebraska, died April 23, 2014. He was a mixed animal practitioner in Laurel. Dr. Chace served in the Navy during World War II. His wife, Alice; three daughters and a son; 14 grandchildren; and 12 great-grandchildren survive him.

James R. Collins

Dr. Collins (Iowa ‘60), 78, Dixon, Ill., died May 2, 2014. A mixed animal veterinarian, he owned Dixon Veterinary Clinic for 38 years prior to retirement. Dr. Collins was a past president of the American Embryo Transfer Association and Mississippi Valley VMA and a member of the Illinois State VMA. He served as a captain in the Army Veterinary Corps.

Dr. Collins is survived by his wife, Ellabeth; a son and two daughters; seven grandchildren; and a greatgrandchild. Memorials may be made to Iowa State University College of Veterinary Medicine, Ames, IA 50011; or First United Methodist Church, S. Peoria Ave., Dixon, IL 61021.

Otho C. Collins

Dr. Collins (Texas ‘52), 89, Midland, Texas, died April 23, 2014. A small animal veterinarian, he owned a practice in Midland for 33 years. After that, Dr. Collins served as a relief veterinarian for 24 years. He was a member of the Texas and Permian Basin VMAs.

An Army veteran of World War II, Dr. Collins earned a Bronze Star and Combat Infantryman Award and was a lifetime member of the Veterans of Foreign Wars. His wife, Frances; two sons and two daughters; 11 grandchildren; and 11 great-grandchildren survive him. Memorials may be made to Midland Christian School, 2001 Hughes, Midland, TX 79705; or Home Hospice House, 903 N. Sam Houston, Odessa, TX 79761.

Rae L. Cupp

Dr. Cupp (Ross ‘05), 53, Holly Springs, North Carolina, died March 8, 2014. A small animal veterinarian, she practiced at VCA Animal Hospital in Apex, North Carolina. Earlier in her career, Dr. Cupp worked at Colerain Animal Hospital in Cincinnati. Memorials, with the memo line of the check notated to “Rae Lynn Cupp,” may be made to Kanawha-Charleston Humane Association, 1248 Greenbrier St., Charleston, WV 25311.

Richard D. Elliott

Dr. Elliott (Kansas ‘50), 89, Lone Tree, Iowa, died April 8, 2014. A mixed animal veterinarian, he owned a practice in Lone Tree until retirement in 1989. Earlier in his career, Dr. Elliott worked in Riverside, Iowa. He was a life member of the Iowa VMA and a member of the Lone Tree School Board, Chamber of Commerce, and Masons. Dr. Elliott served in the Air Force during World War II and was a member of the American Legion. His wife, Grace; two daughters and a son; six grandchildren; and seven great-grandchildren survive him.

J. Ross Fleetwood Jr.

Dr. Fleetwood (Missouri ‘68), 74, Montgomery City, Missouri, died April 30, 2014. A mixed animal veterinarian, he owned Montgomery City Animal Clinic for 46 years. Dr. Fleetwood was a lifetime member of the Missouri and Northeast Missouri VMAs and a past president of the Montgomery County Fair Society and Missouri Association of Fairs and Festivals. He is survived by his wife, Marilyn; two sons; two granddaughters; a step-granddaughter; and two step-great-grandsons.

Floyd L. Gunn

Dr. Gunn (Texas ‘43), 94, College Station, Texas, died May 10, 2014. He served on the faculty of the Texas A&M University College of Veterinary Medicine & Biomedical Sciences from 1966 until retirement in 1982. Earlier in his career, Dr. Gunn was in private practice in La Grange, Texas. His two sons and a daughter; seven grandchildren; and four great-grandchildren survive him. Memorials toward the Dr. Floyd Gunn Scholarship Fund may be made to the Office of the Dean, College of Veterinary Medicine, TAMU Mail Stop 4461, College Station, TX 77843.

Klaus Hubben

Dr. Hubben (Pennsylvania ‘53), 84, Landenberg, Pennsylvania, died May 3, 2014. A diplomate of the American College of Veterinary Pathologists, he retired in 1989 as director of safety evaluation with Imperial Chemical Industries Americas Inc., in Wilmington, Delaware. Following graduation, Dr. Hubben worked briefly in Danville, Pennsylvania. From 1954–1956, he served with the rank of first lieutenant in the Air Force Veterinary Corps as base veterinarian and preventive medicine officer in Japan. Dr. Hubben then joined the veterinary faculty of the University of Pennsylvania, where he remained until 1967. During his tenure, he worked in the School of Veterinary Medicine's poultry diagnostic laboratory, earned his master's in veterinary pathology, served as an instructor in the Department of Veterinary Pathology, and was an assistant professor in the Department of Veterinary Biology.

In 1967, Dr. Hubben joined Atlas Chemical Industries, later acquired by ICI, as manager of the pathology section in Wilmington. In 1969, he became manager of the safety evaluation section, and in 1979, was named director.

In retirement, Dr. Hubben worked part time as a consultant with Pathology Associates International in Frederick, Maryland, for 10 years. He was a past secretary-treasurer of the Delaware VMA and a member of the Pennsylvania VMA, American Association for the Advancement of Science, Mid-Atlantic Society of Toxicology, Society of Pharmacological and Environmental Pathologists, and Society of Toxicologic Pathologists. Dr. Hubben was also a member of the American Academy of Veterinary and Comparative Toxicologists and New York Academy of Sciences.

His wife, Carol; four sons and two daughters; and three grandsons and three granddaughters survive him. Memorials toward the Veterinary Student Scholarship Fund may be made to the University of Pennsylvania School of Veterinary Medicine, c/o Jean Suta, 427 Franklin Building, 3451 Walnut St., Philadelphia, PA 19104.

Margaret J. Mason

Dr. Mason (Colorado ‘83), 57, Carpinteria, California, died Jan. 15, 2014. She owned House Call for Pets, a mobile practice serving the Santa Barbara area of California. Following graduation, Dr. Mason worked at the Lovelace Research Institute in New Mexico. She moved to California in 1987 and earned a master's in immunopathology from the University of New Mexico Medical School in 1989. During her career in California, Dr. Mason also practiced at Carpinteria Veterinary Hospital and served as a relief veterinarian. Memorials in her name may be made to ASAP Cat Shelter, 5473 Overpass Road, Santa Barbara, CA 93111, www.asapcats.org

Ralph W. McGrew

Dr. McGrew (Illinois ‘73), 69, Mount Horeb, Wisconsin, died March 5, 2014. Prior to retirement, he owned Ridglan Animal Care Systems and Ridglan Farms in Mount Horeb. Earlier in his career, Dr. McGrew owned Mount Horeb Animal Clinic, a mixed animal practice. He was a member of the Wisconsin VMA and American Association for Laboratory Animal Science. Dr. McGrew served in the Army during the Vietnam War. He is survived by his wife, Lillian; a son and a daughter; and three grandchildren.

Jack L. Nunnery

Dr. Nunnery (Auburn ‘55), 85, Magnolia, Mississippi, died Feb. 23, 2014. He owned a mixed animal practice in Magnolia for 58 years, prior to retirement. Dr. Nunnery also served as a preceptor instructor for the Mississippi State University College of Veterinary Medicine for several years. He was a past president of the Mississippi Board of Veterinary Medicine and Mississippi VMA and a past member of the former AVMA Committee on Wellness.

In 1985, Dr. Nunnery was named Mississippi Veterinarian of the Year, and, in 2001, he received the MVMA Service Award and was inducted into the MVMA Hall of Fame. Dr. Nunnery was honored with an Auburn University College of Veterinary Medicine Distinguished Alumnus Award in 2011. That same year, he was awarded the Lifetime Achievement Award by the McComb Enterprise-Journal. Dr. Nunnery's wife, Sue; six children; and nine grandchildren survive him.

David W. Rozanski

Dr. Rozanski (Ohio ‘99), 49, Carteret, New Jersey, died Feb. 23, 2014. During his career, he practiced small animal medicine in Toledo, Ohio. Memorials may be made to Divine Mercy Parish, 140 Emerson St., Carteret, NJ 07008.

Kurt A. Schilling

Dr. Schilling (Pennsylvania ‘54), 89, Woodland Hills, California, died May 1, 2014. A small animal practitioner, he owned Tarzana Pet Clinic in Tarzana, California, for more than 40 years. Dr. Schilling was a member of the Tarzana Encino Rotary Club. His wife, Lois; a daughter; and three grandsons survive him.

Tommy D. Williams

Dr. Williams (Texas ‘56), 79, Shreveport, Louisiana, died April 17, 2014. A small animal veterinarian, he founded North Shreveport Animal Hospital, where he practiced until retirement in 2013. Earlier in his career, Dr. Williams owned Agurs Animal Clinic. He was a past member of the Louisiana Board of Veterinary Medicine and a past president of the Louisiana VMA. Dr. Williams is survived by his wife, Barbara; two sons and a daughter; an adopted son; six grandchildren; and 11 great-grandchildren.

Jonita K. Woodbridge

Dr. Woodbridge (Iowa ‘80), 58, Sioux City, Iowa, died May 15, 2014. A small animal veterinarian, she practiced at Elk Creek Animal Hospital in Sioux City for 24 years. Dr. Woodbridge also served as the veterinarian for the Woodbury County Fair pet and cat shows. Earlier in her career, she worked in Illinois for several years. Dr. Woodbridge was a member of the Interstate VMA, serving in several leadership positions. She was active with the 4-H Club and Boy Scouts and received a District Award of Merit from the latter for her service.

Dr. Woodbridge is survived by her husband, Alan Jacobsen, and three sons. Her brother, Dr. Rick J. Woodbridge (Kansas ‘75), works for the Oklahoma Department of Agriculture, Food, and Forestry. Dr. Woodbridge's father, the late Dr. John P. Woodbridge (Kansas ‘46), was a large animal practitioner in Pierson, Iowa. Memorials may be made to Grace United Methodist Church, 1735 Morningside Ave., Sioux City, IA 51106; Iowa 4-H Foundation, Extension 4-H Youth Building, Iowa State University, Ames, IA 50011; or June E. Nylen Cancer Center, 230 Nebraska St., Sioux City, IA 51101.


The zip code for The Humane Society of New York, the suggested recipient of memorials for the late Dr. Shirley S. Koshi, whose obituary appeared on page 270 of the Aug. 1, 2014, issue of JAVMA, should be 10022.

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    Dr. Joseph H. Kinnarney

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    Dr. Rebecca E. Stinson

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    Dr. Thomas F. Meyer

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    Dr. V. Hugh “Chip” Price

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    Dr. John H. de Jong

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    Destruction from the May 2013 tornado in Moore, Oklahoma (Courtesy of FEMA)

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    Dr. John R. Clifford (Courtesy of USDA)

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    Aspen Meadow Veterinary Specialists in Longmont, Colorado, was constructed from an old car dealership in 2008. Owner Dr. Matthew B. Rooney says in the first year, the clinic saved 35 percent on electricity, more than 50 percent on water, and 40 percent on gas.

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    Dr. Rooney says a little added insulation can go a long way in limiting heating and cooling needs as well as helping curb noise. In veterinary facilities, ailing patients, distraught clients, and triage can cause substantial noise, which can affect patient recovery and client experience, he says. (Photos courtesy of Dr. Matthew B. Rooney)

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    The Ohana Pet Hospital in Ventura, California, works with a program set up by the city and local human hospitals through which the used outer wraps of surgical packs are distributed to veterinary hospitals to use on their own surgical packs a few times before discarding. Because the wraps don't touch blood or other substances, they can be reused instead of thrown into the trash immediately. (Photos courtesy of Dr. Janis Shinkawa)

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    The city of Ventura's Environmental Sustainability Office offers free visits to businesses to help with recycling needs, staff training, and the like. “It's a habit-changing thing you have to go through with staff, such as what items are recyclable,” said Dr. Janis Shinkawa, co-owner of Ohana Pet Hospital. “When we hire, we mention we are a green facility. It's understood upfront that they have to be good about recycling.”

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    Dr. Allen Riley

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    Dr. Julie Gard

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    Dr. Ken McMillan

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    Lorraine Alexander

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    Dr. John Hammons

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    Dr. T.C. Branch

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    Dr. Hazel C. Carney