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defining relationships

AVMA considering what medical services can be provided at a distance

By Greg Cima

For Dr. Christopher B. Meehl, nothing can replace a physical examination.

“We give great service by being physically present with our clients,” he said.

The Massachusetts veterinarian is a practice owner of 34 years, the son and nephew of veterinarians. He is also the owner of LiveVet, a service he is developing to increase access to veterinarian advice. He said pet owners already have access to other sources, such as breeders and pet food companies, that sell products or services rather than provide medical care.

However, he has suspended some development pending results of the AVMA's deliberations on telemedicine, to ensure his work is consistent with any new guidelines.

A proposal before the AVMA's governing bodies would have the Association advocate for limiting use of telemedicine to follow-up care and consultation with patients or herds already seen in person, with exceptions for emergency services such as poison control center calls. The proposal, made in a January report from the AVMA Practice Advisory Panel, aligns with a statement in the AVMA Model Veterinary Practice Act that the relationship needed to practice veterinary medicine cannot be established through electronic communication alone.

The American Association of Veterinary State Boards contends that, with a new patient, some medicine could be practiced from a distance, and the standards of care are more important than the tools used. Plus, AAVSB representatives said AVMA policies should be able to accommodate developments that could benefit veterinarians and their patients. Notably, restrictions on human telemedicine have drawn scrutiny from federal regulators.

Dr. Meehl is among the veterinarians who offer or plan to offer advice from a distance but stop short of providing medical care, a limit set under most state laws. Action by the AVMA could reinforce those regulations or encourage expansion of the range of services that can be offered.

The AVMA House of Delegates has recommended that the AVMA Board consider modifying the AVMA Model Veterinary Practice Act to state that telemedicine shall be conducted only within an existing veterinarian-client-patient relationship, as described in the panel report. The AVMA Board also approved in April spending $135,000 through 2018 on advocacy, member education, and public information on telehealth.

The AVMA Board could act on the panel and House recommendations as early as June, which could send the matter to the House of Delegates for consideration during its regular annual session in July in Indianapolis.

Advice short of medicine

Dr. Meehl agrees with the proposal described in the January report, a position that aligns with existing state regulations in Massachusetts, where the VCPR definition is based on the AVMA definition. About 40 states require a patient examination or premises visit to establish a VCPR, typically using language similar to that in the AVMA model, according to AVMA information. The Food and Drug Administration's definition, which applies in connection with some federally regulated practices, includes similar language.

Dr. George E. Robinson III, chair of the AVMA Practice Advisory Panel, said the panel and its working groups developed a reasonable working document, intended to guide a new area of medicine that otherwise could develop unchecked.

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James T. Penrod, executive director of the American Association of Veterinary State Boards, describes the AAVSB position on telemedicine during the April meeting of the AVMA Board of Directors. (Photo by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

“It's a work in progress that should be adjusted, adapted, reintroduced, redeveloped as time and technology changes,” he said.

States will develop exceptions, such as accommodations for people living in isolated areas, he said. In the absence of AVMA guidance, veterinary telemedicine has been a free-for-all, with companies developing their own interpretations of rules and regulations.

Dr. Robinson said it is obvious some are establishing as their niche the notion that they can help a pet owner avoid a trip to a veterinarian's office or an appointment with a house call veterinarian.

“The general advertising is to try to get that person who thinks they may save a little money by getting a quick answer and not necessarily having their pet seen by a veterinarian,” he said. “Some people have used telemedicine for second opinions—for confirmations, things like that—but I don't think that's as frequent, and they're not really marketing to those individuals.”

As the Practice Advisory Panel report states, state laws determine when advice crosses into the practice of veterinary medicine, and the definition of practice varies by state.

Complaints and prosecutions over veterinary telemedicine have been rare. The AVMA panel's telemedicine report, for example, cites only one 2015 court case involving a Texas veterinarian who was found to have violated the state practice act by performing veterinary medicine without a physical examination or premises visit.

Companies offering remote advice to pet owners within current laws and regulations will praise the medical expertise of their staff but state in their terms of service that they provide no medical care.

One company, for prices starting at $13, offers answers from an experienced veterinarian for “educational and entertainment purposes only.” Another provides a forum connecting pet owners with health, nutrition, and behavior experts—for 40 percent of any fees charged—but the forum owners claim no responsibility for information or advice, and they stipulate that “Consultations should not be intended for nutritional, fitness or other health-related diagnosis, prescription or treatment.”

Dr. Edward Blach is president and chief medical officer for Vet24seven, which operates the text message-based ask.vet. The company advertises access to veterinarians through subscriptions starting at $10 per month as well as a subscription service to field calls for veterinary clinics. He said the sessions tend to provide general education, nutrition advice, and thoughts on behaviors, with veterinarians answering basic questions that many veterinary practices don't want to deal with.

“Clients get access to every other service at their fingertips, and they get it right now,” he said. “And yet we, as veterinarians, our model typically has been, ‘We don't answer questions over the phone, you need to come in,’ right?”

Dr. Blach said his company makes clear to clients that the service cannot diagnose, prescribe, prognose, or treat, and tries to be transparent, having given demonstrations to groups including the AVMA and AAVSB. He also said most interactions with clients end in referral to a veterinary clinic.

While ask.vet offers advice from veterinarians, the terms of service clarify that information provided “does not constitute veterinary or any other professional advice.”

“Our doctors will have a conversation; it'll be educational, they provide listening, education, guidance in the form of ‘with what you're describing, you might be facing one of these three or four things,'” he said.

They also may describe the tests another veterinarian may perform and the expected price range.

Dr. Blach sees potential to expand access to veterinarians by offering services beyond those that clinics are willing to deliver.

“We believe there's a much larger demand out there amongst the customer base to access the expertise and guidance that veterinarians have in many of those non-injury and -illness areas,” he said.

Definitions vary

The AVMA, Food and Drug Administration, and states have various definitions for the veterinarian-client-patient relationship, although many state definitions are close to the AVMA model. Here are a few of the variations:

AVMA:

A VCPR means that all of the following are fulfilled:

  1. The veterinarian has assumed the responsibility for making medical judgments regarding the health of the patient and the client has agreed to follow the veterinarian's instructions.

  2. The veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient. This means that the veterinarian is personally acquainted with the keeping and care of the patient by virtue of:

    1. a timely examination of the patient by the veterinarian, or

    2. medically appropriate and timely visits by the veterinarian to the operation where the patient is managed.

  3. The veterinarian is readily available for follow-up evaluation or has arranged for the following:

    1. veterinary emergency coverage, and

    2. continuing care and treatment.

  4. The veterinarian provides oversight of treatment, compliance and outcome.

  5. Patient records are maintained.

FDA:

A valid veterinarian-client-patient relationship is one in which:

  1. A veterinarian has assumed the responsibility for making medical judgments regarding the health of (an) animal(s) and the need for medical treatment, and the client (the owner of the animal or animals or other caretaker) has agreed to follow the instructions of the veterinarian;

  2. There is sufficient knowledge of the animal(s) by the veterinarian to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s); and

  3. The practicing veterinarian is readily available for followup in case of adverse reactions or failure of the regimen of therapy. Such a relationship can exist only when the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal(s) by virtue of examination of the animal(s), and/or by medically appropriate and timely visits to the premises where the animal(s) are kept.

Oregon:

“Veterinary Client Patient Relationship (VCPR)”: Except where the patient is a wild or feral animal or its owner is unknown; a VCPR shall exist when the following conditions exist: The veterinarian must have sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis of the medical condition of the animal. This means that the veterinarian has seen the animal within the last year and is personally acquainted with the care of the animal by virtue of a physical examination of the animal or by medically appropriate and timely visits to the premises where the animal is kept.

California:

A veterinarian-client-patient relationship shall be established by the following:

  1. The client has authorized the veterinarian to assume responsibility for making medical judgments regarding the health of the animal, including the need for medical treatment,

  2. The veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s). This means that the veterinarian is personally acquainted with the care of the animal(s) by virtue of an examination of the animal or by medically appropriate and timely visits to the premises where the animals are kept, and

  3. The veterinarian has assumed responsibility for making medical judgments regarding the health of the animal and has communicated with the client a course of treatment appropriate to the circumstance.

Alabama:

Veterinarian-Client-Patient relationship (VCPR). A relationship when the veterinarian has assumed responsibility for making medical judgments regarding the health of the animal or animals and the need for medical treatment and is created by actual examination by the veterinarian of the animal or a representative segment of a consignment or herd.

Equal standards of care

James T. Penrod, executive director of the American Association of Veterinary State Boards, said the AAVSB board of directors sees potential for veterinarians to establish VCPRs from a distance when circumstances allow the practice of medicine performed this way to be consistent with traditional standards of care. Those situations would vary by clinical situation, he said in an interview.

The AAVSB board members think veterinarians must be licensed or within the jurisdiction of the veterinary board where a patient is located, and clients should know the veterinarian's identity, location, and license status as well as the privacy and security risks involved in the service. Owners also should be able to seek follow-up care from the veterinarian or a designee.

The AVMA advisory panel report recommends that, for interstate telemedicine, legal accountability and recourse should be available in the states where the veterinarian and patient are located. And establishing legal accountability is critical for liability purposes when interstate or international telemedicine is performed outside a VCPR, the report states.

The AAVSB is planning discussions later this year on prescribing in connection with telemedicine and whether a licensing compact among states would be appropriate in veterinary medicine, Penrod said.

In April, Penrod read to the AVMA Board of Directors a statement by Dr. Frank Walker, AAVSB president, that the AAVSB sees telemedicine as a tool. When it is used, a veterinarian still needs sufficient information to make judgments in an animal's best interest.

Penrod also said Federal Trade Commission staff have expressed concerns in human medicine when statutes and regulations of telemedicine have been more stringent than those for in-person visits. He also said in the interview that companies developing telehealth technologies have the financial backing and opportunities to influence how those technologies could be viewed in medicine, including veterinary medicine.

An FTC spokeswoman said the agency had no comment on the AVMA advisory panel's proposal to require an in-person visit prior to veterinary care.

In an August 2016 letter to the Delaware Board of Dietetics/Nutrition, FTC staff members wrote that a proposal to require face-to-face initial evaluations by dietitians or nutritionists “could unnecessarily discourage the use of telehealth for assessment and diagnosis and restrict consumer choice.” Telehealth could increase practitioner supply, encourage competition, improve access to affordable health care, and improve health care quality, the letter states.

“Because of the importance of health care competition to the economy and consumer welfare, anticompetitive conduct in health care markets has long been a key focus of FTC law enforcement, research, and advocacy,” the letter states. “In particular, many of our recent state advocacy comments have addressed scope of practice and supervision provisions that unnecessarily limit the range of procedures or services a practitioner may provide, or unnecessarily restrict a particular type of practitioner from competing in the market.”

Penrod noted to the AVMA Board that, on March 29, the Texas Senate passed a bill that would eliminate a requirement for a face-to-face consultation between a patient and physician following a telemedicine service if the two had not met in person as well as state that a practitioner-patient relationship can exist in telemedicine. The Texas House of Representatives had not voted on the bill by press time.

Board members for the Veterinary Innovation Council, a nonprofit started by the North American Veterinary Community, wrote in a March 1 letter to AVMA CEO Dr. Janet Donlin that they want organized veterinary medicine to place more confidence in individual veterinarians' judgment when it comes to telemedicine. Confidence, they said, has proved pivotal in 20 years of debate over telemedicine in human health care.

Dr. Meehl said that, as communication technology changes, veterinarians should embrace evolution with care. He said there is no substitute for in-person contact, but veterinary medicine needs economical means for veterinarians to increase interactions with clients.

If they don't, others will find ways to give out their own information.

Telehealth CE available at AVMA Convention 2017

The AVMA plans to include a two-hour, seven-speaker session on telehealth during the AVMA convention in Indianapolis. The session, “How does telehealth work in veterinary medicine?” was scheduled at press time for 4 p.m. Sunday, July 23, in rooms 138–139.

Board advances items, some directly benefiting students

CPAC gets student representation, SAVMA reorganization continues

By Malinda Larkin

The AVMA's nondiscrimination policy now includes both gender identity and expression as well as parental, marital, and pregnancy status (see page 1207). Other items that received approval by the AVMA Board of Directors during its April 6–8 meeting were a new electronic accreditation management system for veterinary colleges and veterinary technology programs (see page 1206) and funding for Cuban veterinarians to attend AVMA Convention 2017. The Board referred to the AVMA House of Delegates proposed policies relating to assistance and therapy animals as well as use of stem cells and other regenerative therapies (see page 1204).

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The AVMA Board of Directors approved a comprehensive review of the current and potential roles and responsibilities of the AVMA vice president during its April 6–8 meeting, among other actions. Dr. Mark P. Helfat (center), Board chair, presided over the meeting. (Photo by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

The Board also approved a handful of recommendations that pertain to veterinary students.

For one, the Clinical Practitioners Advisory Committee, which advises the Council on Biologic and Therapeutic Agents, will now have a student join its ranks after the Board approved its request for one. In the committee's recommendation, members argued that having a student “is essential for gaining needed contributions by the veterinary student perspective and for fostering student interest in veterinary biologics and therapeutics as well as organized veterinary medicine in general.”

The Student AVMA will nominate candidates and approve two SAVMA members to serve as its representative and alternate representative for one-year terms, with a maximum of two terms. Because SAVMA rather than the Board nominates the person for the position, the student will be a nonvoting member, which is also the case for other entities such as the AVMA Council on Research.

SAVMA reorganization

There was further movement on transferring the student chapters of the AVMA to the Student AVMA, with the AVMA Board agreeing to initiate proposed AVMA Bylaws amendments relevant to that initiative. The goal is to streamline the structure of organized veterinary medicine for students and eliminate confusion. The proposed amendments would remove SCAVMA from the AVMA Bylaws and authorize SAVMA to establish its own chapters under the Charter Agreement between AVMA and SAVMA, whereby all chapters and their assets will be transferred to SAVMA, according to the recommendation background.

The amended bylaws will become effective likely this fall when the other necessary documents are ready, including the amended SAVMA bylaws, the Chapter Charter Agreement between SAVMA and each of its chapters, and the amended bylaws for each chapter.

AVMA vice president's role

In other actions, the Board voted to have its Governance Committee conduct a comprehensive review of the current and potential roles and responsibilities of the AVMA vice president, who is currently the AVMA liaison to veterinary students. The committee said in its recommendation background to the Board that the review was needed given current conditions.

The committee had received a request to consider extending the term of the vice president from two years to three years because of the large increase in the number of visits to accredited veterinary colleges and student chapters as well as the number of other appearances and opportunities available to support the development of veterinary students.

“The opportunity to optimize the value provided to students and increase the conversion rate to long term membership in the AVMA were important factors in the decision to recommend creation of a seven-member task force comprised of primary stakeholders to conduct a comprehensive evaluation of the role of the Vice President,” according to the background.

JAVMA mobile app to debut

The AVMA Board of Directors approved development of a JAVMA mobile app that will deliver a digital version of the Journal suitable for reading on tablets and smartphones.

Although electronic versions of the AVMA journals have been published for more than a decade— available at www.avma.org/journals and https://avmajournals.avma.org—members are increasingly demanding expanded options to electronically access journals content. According to JAVMA readership surveys, the percentage of subscribers interested in accessing JAVMA through a smartphone or tablet increased from 25 percent in 2012 to 35 percent in 2016, and the percentage not interested decreased from 62 percent to 47 percent. Notably, for the 2016 survey, 42 percent of subscribers between 40 and 49 years old and 49 percent of readers less than 40 years old were interested in accessing JAVMA through a smartphone or tablet.

The aim is to launch the JAVMA mobile app in time for AVMA Convention 2017.

AVMA to deliberate on assistance animals, stem cells

By Malinda Larkin and R. Scott Nolen

Service, emotional support, and therapy animals provide therapeutic interventions and assist individuals with disabilities, but the growing number of animals being falsely identified as assistance animals has caused increased scrutiny of their use. Part of the difficulty in detecting abuse of these designations, and the privileges that go with them, is that under the Americans with Disabilities Act, service dogs and emotional support animals do not require specific certification, so there is no simple method to detect fraud.

“A market has emerged for falsely certifying pets as an assistant animal,” according to an AVMA@Work blog post written by AVMA student extern Monica Chen, a third-year student at the University of California-Davis, at http://jav.ma/assistanceanimalsblogpost. “The problem is influencing state lawmakers to come up with legislation that attempts to fix the influx of fakes.”

To be proactive on the matter, the AVMA Steering Committee on Human-Animal Interactions has proposed a policy to serve as a foundation for further educational and lobbying efforts to promote appropriate use of assistance and therapy animals and discourage misunderstandings or fraud, according to a statement by the steering committee to the AVMA Board of Directors.

The steering committee has been researching the role of service, emotional support, and therapy animals for at least two years. It has already created three policies: “Emotional Support Animals,” which was approved by the Board this past August, as well as “Animal Assisted Interventions: Definitions” and “Animal Assisted Interventions: Guidelines,” which were approved in April 2015 by the Board.

Assistance animals and veterinarians

During its 2017 regular annual session, July 20–21 in Indianapolis, the AVMA House of Delegates will consider a resolution from the Board to approve the proposed AVMA policy “The Veterinarian's Role in Supporting Appropriate Selection and Use of Service, Assistance and Therapy Animals.” The steering committee created the policy, and the Board voted April 7 to refer the resolution to the House with a recommendation for approval. The proposed policy reads as follows:

The Veterinarian's Role in Supporting Appropriate Selection and Use of Service, Assistance and Therapy Animals

Service, assistance and therapy animals provide valuable help, support, and comfort for people. Once it has been determined that use of a service, assistance, or therapy animal is appropriate, veterinarians have the opportunity to assist their clients in selecting the right animal for the right task, see that the animal receives appropriate training for its intended role, and ensure that the health and welfare of that animal is protected.

The AVMA encourages veterinarians to be familiar with the legal status and protections accorded to service, assistance, and therapy animals and their owners, and should discourage inaccurate or misleading descriptions of these animals' roles (e.g., “emotional support animals” status should be supported by a statement of need from a licensed mental health professional). Veterinarians should actively seek opportunities to work collaboratively with their human health and other human service-provider colleagues in developing and supporting guidance for the appropriate use of animals for therapeutic purposes and to assist people with disabilities.

To go with the proposed policy, the steering committee wrote a draft white paper with the help of Monica Chen. Titled “Assistance Animals: Rights of Access and the Problem of Fraud,” the white paper touches on the following:

  • Legal definitions of the various types of assistance animals and a summary of legal rights of access for each, including by state.

  • A summary of assistance animal fraud as well as current attempts at reducing fraud.

  • Strategies that might be used to simultaneously promote the appropriate use of assistance animals and discourage fraudulent activities.

According to the white paper: “Rather than attempting to fix the situation with more laws that potentially contradict the ADA, the current laws should be revised or amended to be more uniform which could prevent this situation from occurring. Where this is not possible additional laws should be as consistent as possible with Federal law. If state action is inevitable a model bill might be prepared to minimize these problems and seek to maintain similar standards between states.

“Furthermore, there needs to be some system in place that deters people from wanting to falsely certify their pet as an (emotional support animal) or service animal and deters companies from distributing these false certificates. Eighteen states currently have laws in place to punish people who knowingly misrepresent their pet as a service animal. Reputable authorities, including the AVMA, should advise private companies such as search engines to take action against fraudulent sites.”

The steering committee is helping develop educational materials and exploring other collaborative activities that may assist members, policymakers, businesses, and others in supporting the appropriate use of these animals. The Board approved the release of the white paper as information to the public and allied organizations—available at http://jav.ma/animalwelfarehub.

Regenerative medicine

The House of Delegates this July will consider another policy proposal, this one offering guidance to veterinarians concerning the use of stem cells and other regenerative therapies. The Board voted to refer the proposal to the HOD with a recommendation that delegates approve the policy.

The AVMA Council on Biologic and Therapeutic Agents wrote “Therapeutic Use of Stem Cells and Regenerative Medicine” with input from the Clinical Practitioners Advisory Committee because, as the council explained in the recommendation background, COBTA “is keenly aware” of the need for an AVMA policy on the therapeutic use of stem cells and other regenerative medicine.

“While regenerative medicine holds promise of improvements in the treatment of a variety of diseases, many of which lack adequately effective treatments, questions remain,” COBTA stated. “Thus it is imperative that the AVMA advocate for continued scientific development of these modalities while at the same time encouraging its members to employ caution with respect to their use.”

The proposed policy provides needed guidance to veterinarians and can be used to advocate on behalf of the AVMA's positions on the issue to policymakers and other stakeholders, the council explained.

Proposals going to the House of Delegates are available at www.avma.org/about/governance. Members of the AVMA can find contact information for delegates by visiting www.avma.org/members and clicking on “My AVMA Leaders.”

Veterinary accreditors going paperless

The accrediting bodies for veterinary colleges and veterinary technology programs got the green light for a new accreditation management software system. The AVMA Council on Education and the Committee on Veterinary Technician Education and Activities say the electronic system will streamline the accreditation process and allow for more effective use of staff's talents. The AVMA Board of Directors approved the recommendation April 7.

The online platform will allow veterinary colleges and veterinary technology programs to submit their self-studies and annual reports electronically. The software also better allows the COE and CVTEA—via individual portals—to keep track of and review the various institutions' reports, conduct site visits, and compose reports of evaluation. Plus, it “makes it possible to analyze data from every aspect of the process, perform trends analyses, and make evidence-based decisions to ensure continuous improvement,” according to the recommendation background.

Dr. Karen Martens Brandt, director of the AVMA Education and Research Division and staff consultant to the COE, told the Board, “The veterinary colleges want this kind of evidence, and it's all done by hand right now.”

The quality assurance requirements and accompanying evidence needed by the COE to satisfy recognition requirements of the Department of Education and the Council for Higher Education Accreditation would also be streamlined via this system, according to the background.

The AVMA Enterprise Accreditation Management System is expected to roll out within 18 months. The plan is to implement the first phase of the project by the spring 2018 COE and CVTEA meetings and achieve full implementation of the system by the end of 2018.

The cost estimate for the software from Armature Solutions is nearly $293,295 for 2017 and $236,751 for the following year. The cost then tapers off to around $43,000 annually.

NAVTA to work closer with AVMA

The AVMA Board of Directors authorized the Association to pursue an agreement to provide management services to the National Association of Veterinary Technicians in America “given they have goals that complement each other and wish to enhance their mutually beneficial relationship to promote the entire veterinary health care team,” according to the recommendation background.

The AVMA would provide NAVTA with advice and assistance from its leadership. In addition, the AVMA would provide administrative services to NAVTA on a part-time basis. In return, the technician association would assist the AVMA in communicating with the roughly 9,000 veterinary technician members of NAVTA about various products, services, and initiatives. The NAVTA board of directors would retain ultimate control over NAVTA's affairs.

The agreement after being drafted will be pending each board's approval.

Julie Legred, executive director of NAVTA, said, “I think there is so much that NAVTA and AVMA can do, working collaboratively. It sets an example for best practices working as a team and will also show how much we can achieve together. It is very exciting to think about all of the possibilities.”

NAVTA has been self-managed since November 2015 after breaking ties with the North American Veterinary Community. Legred said the association has seen growth in membership, expanded its member benefits, worked to communicate better, and provided a platform for its members to better connect and interact with each other, as well as increased its partners and sponsors.

“And, of course, we are making great strides in our veterinary nurse initiative as well,” she added. NAVTA began the initiative last year that would potentially rename veterinary technicians as veterinary nurses and try to establish a national standard for credentialing.

Dr. Janet Donlin, AVMA CEO, said she and the AVMA leadership team are thrilled to enter into a closer relationship with NAVTA. “AVMA is committed to supporting the entire veterinary team, and assisting NAVTA with management services is a real win-win for our organizations.”

Nondiscrimination language added to diversity policy

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Dr. Karen Bradley, District I representative, and Jeff Olivarez, Student AVMA president, listen during the AVMA Board of Directors' April 6–8 meeting. (Photo by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

The AVMA Board of Directors agreed April 7 to update the “AVMA Policy on Diversity and Inclusion” to add nondiscrimination language that includes, among other things, both gender identity and expression as well as parental, marital, and pregnancy status. The modifications reflect the importance of diversity and inclusion in ensuring access to veterinary care for all segments of the U.S. population, according to the recommendation background.

The diversity and inclusion policy, available at http://jav.ma/policyondiversity, now reads as follows:

Diversity and Inclusion

The AVMA is committed to diversity and inclusion in all aspects of the profession of veterinary medicine so that we can best serve the animals, the public, and our members. Our goal is to mirror the growing diversity of the communities we serve and to promote an understanding of their varied needs. To this end, we are committed to actively promoting and maintaining diversity and inclusion in our membership, leadership, and organization, and educating our members regarding the value of diversity and inclusion. This commitment embraces the value of the many areas of the veterinary profession, and the value of our members' and their clients' varied backgrounds, including but not limited to race; ethnicity; physical and mental abilities; gender; sexual orientation; gender identity or expression; parental, marital, or pregnancy status; religious or political beliefs; military or veteran status; and geographic, socioeconomic, and educational backgrounds.

The first AVMA Policy on Diversity, adopted in 2004, simply stated that “The AVMA is committed to diversity in all aspects of the profession so that we can best serve the animals and public. This commitment to diversity pertains to professional areas of service and to cultural, ethnic, gender, and racial representations.”

The policy was revised in 2012 with changes suggested by the now-sunset AVMA Member Services Committee. The revisions added language to the policy primarily in three areas:

  • Promotion of inclusion.

  • Acknowledgment that veterinarians live and work within communities that are constantly changing.

  • Recognition and valuing of the many different aspects of diversity.

Regarding the last point, the MSC had noted that the preceding three or four decades had presented the profession with a huge gender shift and exposure to new cultures, concepts, and challenges.

Review of the “AVMA Policy on Diversity and Inclusion” was initiated in 2015 in response to discussions at the House of Delegates regular annual session that year and comments received through the AVMA@ Work blog, and in preparation for the standard five-year review as directed by AVMA policy. More recently, the Lesbian and Gay VMA started a letter-writing campaign to encourage the addition of wording on gender identity and expression.

Finally, the change establishes consistency among AVMA policies following revisions to the AVMA Principles of Veterinary Medical Ethics, to which similar nondiscrimination language was added at the April 2016 Board meeting. The document had been amended at the behest of the House of Delegates and Dr. Elizabeth Sabin, associate director for international and diversity initiatives.

AVMA continues opposition to pet prescription legislation

The AVMA has renewed its opposition to federal legislation that would require a veterinarian to provide a client with a written prescription for a companion animal's medication, whether the client requests it or not.

The Board of Directors on April 7 approved a recommendation of “nonsupport” from its Legislative Advisory Committee for the Fairness to Pet Owners Act (HR 623), which was introduced in three previous congressional sessions, starting in 2011, but never enacted.

House Republican Jason Chaffetz of Utah reintroduced the bill this January, purportedly as a means of promoting competition and helping consumers save money by giving them the freedom to choose where they buy prescription pet medications.

The bill directs the Federal Trade Commission to promulgate rules requiring a veterinarian to provide a copy of the prescription every time a medication is prescribed for a companion animal.

Additionally, the veterinarian would have to provide a written disclosure that clients may fill prescriptions at the veterinary clinic or at an off-site pharmacy and verify a prescription electronically or by other means consistent with applicable state law.

The AVMA's opposition to the bill stems from its longstanding policy encouraging veterinarians to write a prescription in lieu of dispensing a medication when the client requests it. The Association believes HR 623 is not only redundant but also will cause undue regulatory and administrative burdens on veterinary practices.

The LAC also noted in its recommendation to the Board that individual states are the appropriate governmental bodies to regulate the practice of veterinary medicine.

More information about the AVMA's legislative priorities are available at www.avma.org in the Advocacy section.

AVMA supports safety of GMO and GE foods

Given the safety of genetically modified organisms and genetically engineered foods, mandatory labeling of GMO and GE foods and food products is unnecessary, according to a new AVMA policy.

Proposed by the AVMA Food Safety Advisory Committee and approved by the Board of Directors April 7, the policy reads as follows:

Safety of Genetically Modified Organisms (GMO) and Genetically Engineered (GE) Food

The AVMA recognizes there is concern about the safety of consuming genetically modified organisms and genetically engineered food products. The broad scientific consensus is that approved GMO and GE crops and foods are safe for human and animal consumption. Our current safe, affordable, abundant food supply has been made possible, in part, through advances in this scientific technology. The AVMA does not believe mandatory labeling of GMO and GE foods or food products is necessary. The presence or absence of GMO or GE ingredients is not an indication of quality or food safety.

The Food Safety Advisory Committee had been developing a policy on GMO and GE foods for a number of years. Recent legislation requiring the labeling of GMO and GE foods prompted the committee to focus on the food safety aspect of such foods.

Recognizing that mandatory labeling can send the message of a food safety hazard when, in fact, there is none, the committee believed it was necessary to emphasize the safety and contribution to the food supply of such products while addressing the labeling component within the policy.

The committee recommended the Board approve the policy to address a gap within AVMA position statements.

AVMA supports plan for research advocacy

The AVMA is helping support development of a 10-year research plan intended to increase research spending and address challenges in food and agricultural production.

In April, the AVMA Board of Directors approved giving $5,000 toward the project Science Breakthroughs 2030, which was started by Supporters of Agriculture Research, of which the AVMA is a founding member. Science Breakthroughs 2030 is intended to give stakeholder organizations strategies for their advocacy toward increasing Department of Agriculture funding of agricultural research, according to the recommendation submitted to Board members.

The National Academies of Sciences, Engineering, and Medicine is forming the committee that will develop the strategy for future food and agriculture research and produce a report recommending future research directions. The information given to Board members indicates the report likely will be published during debate of the 2018 farm bill.

Deadlines removed for some volunteer nominations

The AVMA removed deadlines for submitting nominations to fill vacancies on many AVMA entities.

The change affects appointments by the AVMA Board of Directors to entities including committees, trusts, commissions, and task forces. The Board members voted in April to change their protocols to state that candidates should, rather than must, provide nomination forms and resumes at least 45 days before the Board meeting at which their appointment would be considered. The Board plans to make some appointments at its June 20–21 meeting in Washington, D.C.

The Board's Governance Committee recommended the change to increase member participation, according to the recommendation document.

The AVMA accepts nominations from veterinary associations and individual members. Volunteer information is available at www.avma.org/members/volunteer.

Veterinary specialty colleges receive AVMA recognition

The AVMA Board of Directors approved the indicated level of AVMA recognition for each of the following veterinary specialty organizations, on the basis of the American Board of Veterinary Specialties' review and acceptance of the organization's submitted report.

Continued full recognition based on a 2016 five-year, in-depth report: American Board of Veterinary Toxicology, American College of Veterinary Anesthesia and Analgesia, American College of Veterinary Emergency and Critical Care, American College of Veterinary Nutrition, and American Veterinary Dental College.

Continued full recognition based on a 2016 annual report: American Board of Veterinary Practitioners, American College of Laboratory Animal Medicine, American College of Poultry Veterinarians, American College of Theriogenologists, American College of Veterinary Behaviorists, American College of Veterinary Dermatology, American College of Clinical Pharmacology, American College of Veterinary Internal Medicine, American College of Veterinary Microbiologists, American College of Veterinary Ophthalmologists, American College of Veterinary Pathologists, American College of Veterinary Preventive Medicine, American College of Veterinary Radiology, American College of Veterinary Surgeons, and American College of Zoological Medicine.

Continued provisional recognition based on a 2016 interim report: American College of Animal Welfare and American College of Veterinary Sports Medicine and Rehabilitation.

At its March meeting, the ABVS reviewed, evaluated, and approved those reports. Per the ABVS Policy and Procedures manual, the level of recognition is granted for one year, coinciding with the AVMA Association year.

Board makes appointments

The AVMA Board of Directors, meeting April 7 at Association headquarters in Schaumburg, Illinois, named the following individuals to the entities indicated, representing the designated areas. The duration of each term varies.

Animal Welfare Committee

American Animal Hospital Association, alternate— Dr. Jodi Wiktorowski, Creswell, Oregon; American Association of Feline Practitioners, alternate— Dr. Nancy Suska, Alexandria, Virginia; American Association of Industry Veterinarians—Dr. Whitney Miller, Boerne, Texas; American Society of Laboratory Animal Practitioners—Dr. Leanne Alworth, Athens, Georgia; and ASLAP, alternate—Dr. Philippe Baneux, Ithaca, New York

Aquatic Veterinary Medicine Committee

Private or public practice, food animal production— Dr. Jessica Koppien-Fox, Marshall, Minnesota; private clinical practice, companion aquatic animal—Dr. Jessie Sanders, Santa Cruz, California; and public health or epidemiology—Dr. Karen Alroy, Atlanta

AVMA Life

Trustees—Dr. David Koncal, Sagamore Hills, Ohio, and Dr. Renee Schmid, Scribner, Nebraska

AVMA PLIT

Trustee—Dr. Kent McClure, Washington, D.C.

Clinical Practitioners Advisory Committee

American Animal Hospital Association—Dr. Martha DeWees, Springfield, Oregon; AAHA, alternate—Dr. Laura Niman, Eugene, Oregon; American Association of Avian Pathologists—Dr. Hector Cervantes, Watkinsville, Georgia; American Association of Bovine Practitioners— Dr. Sarah Giebel, Canyon, Texas; American Association of Small Ruminant Practitioners, alternate—Dr. Kimberly Brinton, Bethany, Connecticut; and zoo and wildlife medicine—Dr. Donald Stremme, Cape May Beach, New Jersey

Committee on Antimicrobials

American Animal Hospital Association—Dr. Erin Frey, Raleigh, North Carolina; AAHA, alternate—Dr. Lindsey Wright, Salt Lake City; American Association of Equine Practitioners—Dr. Mark Papich, Raleigh, North Carolina; AAEP, alternate—Dr. Lauren Schnabel, Raleigh, North Carolina; American Association of Small Ruminant Practitioners—Dr. Virginia Fajt, College Station, Texas; and AASRP, alternate—Dr. Paul Plummer, Ames, Iowa

Committee on Disaster and Emergency Issues

Equine medicine—Dr. Karie Vander Werf, Palm City, Florida; and Veterinary Medical Assistance Teams— Dr. Patrice Klein, Washington Grove, Maryland

Committee on Environmental Issues

Avian medicine—Dr. Marcy Souza, Knoxville, Tennessee; bovine practice—Dr. Michael Capel, Geneseo, New York; and veterinary toxicology—Dr. Karyn Bischoff, Ithaca, New York

Committee on International Veterinary Affairs

Association of American Veterinary Medical Colleges—Dr. Lee Willingham, Basseterre, St. Kitts; and recent graduates or emerging leaders—Dr. Shannon Mesenhowski, Seattle

Committee on Veterinary Technician Education and Activities

Faculties of colleges of veterinary medicine— Dr. Elizabeth Thompson, Harrogate, Tennessee; and veterinary technicians—Mary Berg, Lawrence, Kansas; Kelly Foltz, Notasulga, Alabama; and Sandra Foster, Homewood, Alabama

Convention Education Program Committee

Chair-elect—Dr. Mark Alley, Cary, North Carolina

Council on Education Selection Committee

At-large—Dr. Douglas Aspros, Pound Ridge, New York

Early Career Development Committee

Emerging leader—Dr. Jeremy Keen, Collierville, Tennessee; recent graduates—Dr. Kristina Baltutis, Burlington, North Carolina; and Dr. Emily Tincher, Shelbyville, Kentucky

Food Safety Advisory Committee

American Association of Food Safety and Public Health Veterinarians—Dr. Candace Jacobs, Olympia, Washington; AAFSPHV, alternate—Dr. Nicole Chevalier, Marina del Ray, California; and American Association of Small Ruminant Practitioners, alternate—Dr. Signe Balch, Larkspur, Colorado

Governance Performance Review Committee

At-large—Dr. Saundra Willis, Tacoma, Washington; and AVMA committees—Dr. Will McCauley, Dallas

Political Action Committee Board

At-large—Dr. Bernadine Cruz, Laguna Niguel, California, and Dr. Eva Evans, Old Hickory, Tennessee; and Area 1 (Eastern states) representative—Dr. Rebecca Stinson, Reidsville, North Carolina

State Advocacy Committee

At-large—Dr. Dan Segna, Santa Barbara, California

Steering Committee on Human-Animal Interactions

Veterinarian or scientist with expertise in domestic animal relationships—Dr. Zenithson Ng, Knoxville, Tennessee

Veterinary Economics Strategy Committee

At-large—Camala Bailey, Tempe, Arizona; Dawn Burdette, Taylorsville, Kentucky; and Dr. David Gerber, Coeur d'Alene, Idaho

Legislative Advisory Committee

American Animal Hospital Association—Dr. Peter Hellyer, Fort Collins, Colorado; AAHA, alternate— Dr. William Fredregill, Sterling, Colorado; American Association of Small Ruminant Practitioners—Dr. Kelly Still Brooks, Stanhope, Iowa; AASRP, alternate—Dr. Margaret Masterson, Plain City, Ohio; House of Delegates—Dr. Gary Cowan, Wichita, Kansas; and HOD, alternate—Dr. James Weber, Alexandria, Kentucky

AVMA liaisons

Alliance of Marine Mammal Parks and Aquariums— Dr. Esteban Soto, Davis, California; American Association for Laboratory Animal Science—Dr. Kristin Evans, Woodland, California; Codex Alimentarius Commission Committee on Food Hygiene—Dr. Gilbert Patterson, Johnson City, Tennessee; Committee on Psittacosis Control Compendium—Dr. Karen Ehnert, Los Angeles; National Association of State Public Health Veterinarians Committee to Develop a Compendium of Measures to Control Disease and Injury from Contacts with Animals in Public Settings— Dr. Eileen Wolfe, Brownington, Vermont; North American councilor to World Veterinary Association—Dr. Cassandra Tansey, Tucker, Georgia; One Health Commission Council of Advisors—Dr. Mark Starr, Rocklin, California; Pan American Association of Veterinary Sciences Directive Council—Dr. Karen Jacobsen, Athens, Georgia; and Working Group on Aquaculture Drugs, Chemicals, and Biologics—Dr. Katherine Haman, Kalama, Washington

Application period open for AVMA vice president, president-elect

Applications are now being accepted for two AVMA leadership positions. One is the position of vice president for a two-year term from July 2018-August 2020. The other is the position of AVMA president-elect for a one-year term from July 2018-August 2019.

Candidates for both positions are elected by the AVMA House of Delegates; their terms begin at the first regular meeting of the AVMA Board of Directors following the close of the regular annual session of the House at which they were elected. The president-elect and vice president must be voting members of the Association for at least 10 years immediately preceding their election. For more information and further requirements, visit http://jav.ma/avmaofficer.

The deadline for applications for the vice president position is July 9, 2018, and the deadline for the president-elect position is July 10, 2018. Interested candidates should submit an application, a completed campaign guide form, and a resume by email to OfficeEVP@avma.org; by fax to (847) 925-0944; or by mail to AVMA Office of the Executive Vice President, 1931 N. Meacham Rd., Suite 100, Schaumburg, IL, 60173.

AAHA narrows its focus to accredited hospitals

Survey results indicate pet owners increasingly aware of AAHA accreditation

By Katie Burns

The American Animal Hospital Association is altering its membership model and annual meeting to focus on what leaders see as the association's foundation: the AAHA accreditation program for animal hospitals.

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Stunt Dog Productions' Chris Perondi and rescue dog Spinelli show off their moves during the opening session of the annual meeting of the American Animal Hospital Association, March 31–April 2 in Nashville, Tennessee. (Photos by Mark Skalny)

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

In October 2016, the association announced that it is discontinuing hospital membership for nonaccredited practices. Nonaccredited AAHA member hospitals have until June 30 to enter into an agreement to become an accredited practice or to have a staff member become an individual member. As of April 5, the association's membership encompassed 3,741 AAHA-accredited practices and 1,510 nonaccredited practices.

In March, the association announced that it is discontinuing the traditional annual meeting. Instead, AAHA will hold an interactive conference for attendees from accredited hospitals, starting in September 2018. The association also is partnering with the North American Veterinary Community to offer continuing education, activities, and a headquarters hotel at the NAVC annual conference in February 2018.

The final traditional AAHA meeting, March 31-April 2 in Nashville, Tennessee, drew a total of 4,361 attendees, including 1,549 veterinarians, 439 veterinary technicians, 351 practice managers, 270 veterinary assistants and other members of support staff, and 72 veterinary and veterinary technology students.

During the opening session, the association released results of a survey of pet owners indicating that appraisals of veterinary hospitals have declined in a number of areas, while awareness of AAHA accreditation has increased.

The scientific program included a track on biosecurity in companion animal practice (see page 1214). Partners for Healthy Pets released a white paper about the PHP reminder program to re-engage inactive clients (see page 1216). The North American Pet Health Insurance Association shared top ways that practices can promote pet insurance (see page 1218).

Also during the conference, Dr. Mark McConnell assumed the office of president (see page 1217), and the association gave the AAHA-Accredited Practice of the Year Award (see page 1218).

Changes for AAHA

“AAHA does not tell me how to practice medicine,” said Dr. Nancy Soares, outgoing AAHA president and owner of an AAHA-accredited hospital, during the opening session. “AAHA provides me with the tools so I can practice my best medicine.”

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A conference attendee cuddles kittens at the AAHA Cat Lounge in the exhibit hall. The association teamed up with Nashville Cat Rescue to offer the lounge. Four cats were adopted from the lounge, and AAHA matched attendees' donations to raise $3,514 for the rescue.

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

Having a category of hospital membership for nonaccredited practices created confusion between AAHA member hospitals and AAHA-accredited hospitals. Dr. Soares said, “We're inviting the nonaccredited members to see what accreditation can do for them.”

By June 30, 2018, all AAHA member hospitals will be accredited hospitals. Any practices that have not earned accreditation will have the owner or medical director converted to individual membership.

During the opening session, AAHA introduced its new interactive conference, Connexity. The name combines “connecting” and “community.” Connexity will focus on networking, attendees learning from one another and from experts, and learning techniques such as field trips, work on case studies, and problem-solving in small groups.

The first conference will be Sept. 13–16, 2018, in Denver, with attendance limited to 700 individuals from AAHA-accredited hospitals.

At the NAVC annual conference, now known as the Veterinary Meeting & Expo, AAHA will invite individuals from accredited hospitals to stay at the Rosen Centre Hotel, which will be the association's headquarters hotel. Members of AAHA who attend VMX will have access to exclusive activities at the Rosen Centre. The association will offer symposiums and select sessions at the hotel.

Also at the Nashville meeting, AAHA launched a purchasing program for AAHA-accredited hospitals, AAHA Advantage.

According to an announcement, accredited members who participate in the program can take advantage of preferred offers from top manufacturers and receive exclusive discounts, preferred pricing, or rebates on veterinary products and services.

The program is free for accredited members to try until Sept. 30. After that, an annual membership fee of $300 will apply. Fees go toward covering the administrative costs of the program, with any proceeds from the program going back into AAHA initiatives such as practice guidelines and other programs that benefit the veterinary profession.

Pet owners' perceptions

The association contracted with Trone Brand Energy to conduct a survey of pet owners in fall 2016 as a follow-up to research that Trone had conducted for AAHA in 2013.

Results indicated that pet owners' appraisals of veterinary hospitals have declined as follows:

  • Seventy-nine percent of pet owners believe their veterinary hospital provides appropriate staff education and training, compared with 84 percent in 2013.

  • Seventy-five percent of pet owners believe their veterinary hospital adheres to the latest standards, compared with 83 percent in 2013.

  • Seventy-six percent of pet owners believe their veterinary hospital has appropriate facilities, compared with 82 percent in 2013.

  • Eighty percent of pet owners believe their veterinary staff works as a team, compared with 86 percent in 2013.

  • Seventy percent of pet owners believe their veterinary hospital provides good value, compared with 76 percent in 2013.

Pet owners' awareness of AAHA accreditation appears to have increased. Thirty percent of pet owners reported that they looked for an accredited hospital the last time they chose a veterinary hospital, compared with 16 percent in 2013. Sixty-two percent of pet owners reported that it is important to find an accredited veterinary hospital, compared with 51 percent in 2013.

After learning what AAHA accreditation is, pet owners said they would do the following:

  • Eighty-five percent of pet owners would choose an AAHA-accredited hospital over a nonaccredited hospital, compared with 81 percent in 2013.

  • Fifty-eight percent of pet owners would pay more for the assurance that comes from choosing an AAHA-accredited hospital, compared with 44 percent in 2013.

  • Sixty-three percent of pet owners would drive farther for an AAHA-accredited hospital, compared with 51 percent in 2013.

The survey results also appeared to reveal an increasing opportunity to reach pet owners online. Word-of-mouth is still the primary factor for selecting a new veterinarian but has decreased to 53 percent, compared with 62 percent in 2013. Finding an AAHA-accredited hospital through an online directory has increased from 68 percent to 79 percent, and looking for accreditation on veterinary websites has increased from 38 percent to 44 percent.

Speaker: Animal hospitals must practice infection control

By Katie Burns

There's a difference between biosecurity and infection control.

“Biosecurity is something that is much more rigid. You're thinking about keeping disease out,” said Dr. Lucas Pantaleon, a former equine practitioner and current veterinary industry adviser. “Infection control is what we do in our veterinary practice.”

Dr. Pantaleon presented three sessions on biosecurity—and infection control—during a daylong track at the annual meeting of the American Animal Hospital Association, March 30-April 2 in Nashville, Tennessee. He also is senior clinical veterinarian adviser for Virox Animal Health, which makes disinfectants.

The middle talk was a wide-ranging discussion of “Biosecurity and One Health,” particularly relative to companion animal practice. The one-health concept is that human, animal, and environmental health are inextricably intertwined. Dr. Pantaleon said biosecurity and infection control both involve protecting humans, animals, and the environment from pathogens.

In animal hospitals, the risks vary, depending on the type of practice. Specialty and emergency practices tend to have high-risk patients, but general practices have a lot of puppies that can catch and spread disease.

“You're not going to be able to keep everything sterile; diseases are going to happen,” Dr. Pantaleon said. But you can have things in place to prevent or limit the spread.

Infectious diseases can lead to outbreaks, which can lead to epidemics or pandemics. Dr. Pantaleon argued that advances in medicine and technology have led to better preparedness. Among these are better hygiene, a limited number of new antimicrobials, other ways to treat antimicrobial-resistant infections, rapid diagnostic tools, and new vaccines.

Dr. Pantaleon displayed a long list of zoonotic diseases of pets. He noted that a veterinarian contracted H7N2 avian influenza during a recent outbreak of the virus among cats in New York City animal shelters, observing that the virus in this case had moved from wildlife to domestic animals to humans.

Risk of zoonoses also arises with therapy dogs in human hospitals. The dogs go through screening but could bring zoonoses from the hospital back into the community.

Dr. Pantaleon said preventing infection in a veterinary practice provides a better outcome at a lower cost than treating infection.

According to “Characteristics of biosecurity and infection control programs at veterinary teaching hospitals” (J Am Vet Med Assoc 2008;233:767–773), a 2006–2007 survey of 38 veterinary teaching hospitals revealed that 82 percent reported an outbreak of an infectious disease during the preceding five years. According to other sources, veterinary teaching hospitals have reported direct costs of thousands to millions of dollars from outbreaks.

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This digitally colorized image from a scanning electron microscope depicts four magenta-colored, spherical, methicillin-resistant Staphylococcus aureus bacteria being phagocytized by blue-colored human neutrophils. MRSA bacteria are among the most commonly detected microorganisms associated with outbreaks of infectious disease at veterinary teaching hospitals. (Courtesy of the National Institute of Allergy and Infectious Diseases)

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

“Investing in infection prevention should pay out, should be part of what you do to provide good care to your patients,” Dr. Pantaleon said.

In addition to prevention, he recommended that companion animal practices should implement surveillance to monitor everything from cases of parvovirus infections to surgical-site infections.

Report: Free reminder program re-engages inactive clients

A free reminder program from Partners for Healthy Pets successfully re-engages inactive clients at companion animal practices, according to a new report.

Partners for Healthy Pets released the white paper on the final day of the annual meeting of the American Animal Hospital Association, March 30-April 2 in Nashville, Tennessee.

PHP partnered with Vetstreet, a marketing company, to develop the reminder program. In 2015 and 2016, 1,612 practices enrolled. Within 180 days of implementing the program, the practices had the following results:

  • A mean of 128 patient visits per practice from formerly inactive clients.

  • An overall 8.5 percent inactive-patient return rate, with a total of 126,576 returning patients.

  • A mean of $20,574 in revenue per practice.

  • Good results with owners of senior pets, cat owners, and long-term inactive owners.

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Template for an email message through the Partners for Healthy Pets reminder program

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

Forty-five percent of the returning patients were dogs and cats age 7 or older. The return rate within 90 days of practices' enrollment averaged 7.2 percent for feline patients, compared with 6.2 percent for canine patients. Of patients that returned within two months of practices' enrollment, 38 percent had been absent for more than two years, including many patients that were absent for more than three years.

The PHP reminder program asks practices to identify pet owners who have been inactive for a specific time period. Practices can target pet owners who have been absent for 14 months or longer, for example.

Instead of service-specific reminders, the program consists of a message that emphasizes the following ideas:

  • Recognition that pet owners want to provide great care for their pets, but they often have busy lives, making it difficult for them to bring their pets in for regular examinations.

  • Sincere concern from the practice for their pets' health by emphasizing the importance of regular checkups.

  • The PHP theme that a pet's annual examination is as important as food and love.

The reminder program, featuring Henley the dog and Oz the cat, is available for free to veterinary practices at www.partnersforhealthypets.org/inactive_client_program.aspx. Program materials have been designed so they can be used with a variety of practice management software systems or by general-use email servers.

Campaign focuses on forward booking appointments

Veterinary Medical Association Executives has collaborated with Partners for Healthy Pets on a campaign primarily through state veterinary associations that focuses on forward booking, which means scheduling each patient's next appointment before the patient leaves the practice premises.

The campaign directs veterinary teams to a free, straightforward, step-by-step guide to forward booking from the PHP. The toolkit provides a suite of resources to train the practice team in the skills necessary to be successful with forward booking. The toolkit also offers materials to promote forward booking in practices—“Don't Forget to Book My Appointment” buttons, with an image of a ribbon tied around a dog or cat paw, and professionally designed, downloadable posters.

As of press time, 43 state veterinary associations along with the American Association of Small Ruminant Practitioners, Canadian VMA, Chicago VMA, District of Columbia VMA, and Portland VMA had committed to promoting forward booking within their memberships.

Resources for practice teams are at www.partnersforhealthypets.org/forward_booking.aspx. Resources for veterinary associations are at www.vmaexecs.org.

Leading AAHA in a time of change

By Katie Burns

Becoming a veterinarian was the natural path for Dr. Mark McConnell, but he came later to his appreciation of the American Animal Hospital Association.

Dr. McConnell assumed the office of AAHA president during the association's annual meeting, March 31-April 2 in Nashville, Tennessee. His term coincides with major changes to the association's membership model and annual meeting.

He grew up in the state of New York in an outdoorsy family, in a house that was a menagerie. The youngest of five, Dr. McConnell has two older brothers also who became veterinarians.

He never had an epiphany about his career choice, but he truly didn't know what else he would do. He loved science, working with animals, and helping people. Scottish by blood, he earned his veterinary degree in 1992 from the University of Glasgow School of Veterinary Medicine in Glasgow, Scotland.

He spent a year at a mixed animal practice in Southern California before joining the Emergency Veterinary Hospital in Springfield, Oregon. He and another veterinarian bought the practice in 2006, turned it 24/7, and added more veterinarians.

“I am passionate about emergency medicine,” Dr. McConnell said. “I like not knowing what's coming in the door next. I like the challenges of emergency medicine. I learn something about myself every shift.”

Along the way, Dr. McConnell attended an AAHA conference and thought, “These guys really know what they're doing.” His practice earned AAHA accreditation in 2008. He joined the AAHA board as a director in 2015.

“When I was a younger veterinarian, I never thought I would be involved with organized veterinary medicine. At the time, I was very focused on honing my own skills, providing excellent client service,” Dr. McConnell said. “As I've gotten older, I've realized that organized veterinary medicine has made me a better veterinarian.”

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Dr. Mark McConnell at his practice, Emergency Veterinary Hospital in Springfield, Oregon (Courtesy of American Animal Hospital Association)

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

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Dr. Darren Taul

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

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Dr. Guylaine Charette

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

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Dr. Nancy Soares

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

His involvement has allowed him to confer with colleagues about the practice of veterinary medicine as well as to see the profession from a 30,000-foot view.

“I've learned that veterinary medicine is a huge part of our society and a huge part of our culture,” he said.

In addition to his involvement with AAHA, Dr. McConnell is a member and past chair of the Oregon Veterinary Medical Examining Board and currently serves on two committees for the American Association of Veterinary State Boards.

During Dr. McConnell's term as president of AAHA, the association is discontinuing hospital membership for nonaccredited practices. The association also is discontinuing the traditional annual meeting in favor of an interactive conference for attendees from accredited hospitals, plus offerings at the annual conference of the North American Veterinary Community.

“AAHA is very proud of its reputation for veterinary excellence, and the association continually strives to be a leader in the profession,” Dr. McConnell said. “We were trying to be too many things to too many people.”

He said the association is focusing on accredited hospitals, supporting members by providing tools for a thriving practice culture. Dr. McConnell would love for AAHA-accredited hospitals to be known for not only providing great medicine but also being the best hospitals to work in.

As AAHA president, Dr. McConnell furthermore will continue to participate in the Champions for Excellent Care program to help accredited hospitals promote themselves to pet owners.

Joining Dr. McConnell as AAHA officers are Drs. Darren Taul, Lancaster, Kentucky, president-elect; Guylaine Charette, Pembroke, Ontario, vice president; Nancy Soares, Macungie, Pennsylvania, immediate past president; and Dermot Jevens, Greenville, South Carolina, secretary-treasurer.

Practices share top 10 ways to promote pet insurance

The North American Pet Health Insurance Association recently shared the top 10 ways that veterinary practices can promote pet health insurance.

John Volk, senior consultant for Brakke Consulting, presented the list on behalf of NAPHIA during the annual meeting of the American Animal Hospital Association, March 31-April 2 in Nashville, Tennessee.

Volk and NAPHIA conducted in-depth interviews at veterinary practices that had higher-than-average numbers of insured patients. The following 10 things were common to a majority of the practices. They:

  1. Selected one or two pet insurance companies to support.

  2. Designated one or two key staff members as the pet insurance specialists.

  3. Talked to clients about pet health insurance.

  4. Provided a link on the practice website to the pet insurance company or companies recommended by the practice.

  5. Determined which clients already have pet health insurance.

  6. Noted the pet health insurance company and claim number in the patient record.

  7. Submitted claims.

  8. Made pet insurance an employee benefit.

  9. Recommended 30-day, no-cost trial policies.

  10. Engaged the whole practice.

The Pet Insurance Best Practices Guide for Veterinary Teams is at www.naphia.org/veterinary-professionals.

AAHA recognizes 2017 accredited practice of the year

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Loving Family Animal Hospital (Photo by Kenneth MacMillan Photography)

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

The American Animal Hospital Association has recognized Loving Family Animal Hospital of Aurora, Colorado, as the 2017 AAHA-Accredited Practice of the Year.

Dedication to community is one reason that AAHA chose Loving Family Animal Hospital as practice of the year. Dr. Monique Weldon wants everyone who comes into her small, family-oriented animal hospital and grooming salon to feel like part of a loving family. She appreciates AAHA's focus not only on medicine but also on community service, communication, and grief counseling. These aspects make Loving Family a well-rounded hospital and help the hospital carry out its family-focused mission.

Loving Family offers an annual pet health check for the community, providing free examinations and vaccinations for pets of underprivileged owners. The hospital does food drives and medicine drives. The hospital also is committed to animal rescue, providing veterinary care for 10 rescue organizations at a 50 percent discount.

Animal Medical Center of the Village of Houston was the other finalist for practice of the year.

Winn Feline Foundation awards grants, requests proposals

The Winn Feline Foundation announced in April that it had awarded $214,017 for feline health studies. The foundation also called for proposals for feline health studies, including research specifically on feline infectious peritonitis.

The foundation awarded grants for the following studies:

  • “Generating and using adult stem cells to treat feline diabetes;” Dr. Mandi Lopez, Louisiana State University; $23,825.

  • “Evaluating new treatments for feline hepatic lipidosis;” Dr. Hedwig Kruitwagen and Bart Spee, PhD, Utrecht University; $12,987.

  • “Evaluating the prolonged use of an antacid, famotidine, in cats;” Drs. M. Katherine Tolbert and Adesola Odunayo, University of Tennessee; $19,668.

  • “Evaluating the effect of probiotic therapy on feline Tritrichomonas foetus infection;” Dr. M. Katherine Tolbert and Rachel Dickson at the University of Tennessee; Dr. Jody Gookin at North Carolina State University; $17,864.

  • “Mechanisms by which feline mesenchymal stem cells regulate T-cell activation and proliferation;” Dr. Dori Borjesson, University of California-Davis; $13,000.

  • “Cryopreservation of feline red blood cells for transfusions using different solutions;” Drs. Marcelle Hon and Elizabeth Thomovsky, Purdue University; $11,666.

  • “Shelter cat adoption in families of children with autism;” Gretchen Carlisle, PhD, and Rebecca Johnson, PhD, University of Missouri; $24,996.

  • “Foraging behavior under threat and enrichment in confined cats;” Drs. Melissa Bain and Tony Buffington, University of California-Davis; $24,780.

  • “Analysis of plasma to identify biomarkers for the diagnosis and prognosis of FIP;” Drs. Gregg Dean and Kelly Santangelo, Colorado State University; $25,000.

  • “Growing heart muscle cells in a dish in the lab to test HCM treatments;” Dr. David Connolly at the Royal Veterinary College; Debbie Guest, PhD, at the Animal Health Trust; Cesare Terracciano, MD, at Imperial College London; $17,158.

  • “A viral gene expression analysis towards preventing feline lymphoma;” Julia Beatty, PhD; Mahdis Aghazadeh, PhD; Vanessa Barrs, PhD, University of Sydney; $23,073.

Through a grant from the George Sydney and Phyllis Redman Miller Trust, Winn Feline Foundation is able to fund additional feline health studies each year. In a special funding opportunity through the Bria Fund for FIP research, the foundation also is calling for research proposals that address FIP genetics and molecular biology, prevention, novel diagnostics, and safe and effective treatments.

Aug. 7 is the deadline for receipt of applications for Miller Trust and FIP grants. The maximum grant is $35,000. Details are available at www.winnfelinefoundation.org/grants/grant-process.

Veterinarian honored for work against dangerous pathogens

The Centers for Disease Control and Prevention honored a veterinary medical officer for her work on disease prevention and control of disease agents including the Ebola virus.

Lt. Cmdr. Ilana Schafer received the 2017 James H. Steele Veterinary Public Health Award in April at the 66th annual Epidemic Intelligence Service Conference. The award was given to recognize her domestic and international contributions toward Ebola prevention and control of Ebola virus and other hemorrhagic fever–causing viruses, such as those responsible for lymphocytic choriomeningitis and leptospirosis.

Dr. Schafer is a veterinary medical officer in the Bacterial Special Pathogens Branch of the CDC Division of High Consequence Pathogens and Pathology.

Dr. Steele was the first chief of the CDC Veterinary Public Health Division, and the award bearing his name is given to EIS officers for contributions to veterinary public health and one health, or the concept of interconnection of human, animal, and environmental health.

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Lt. Cmdr. Ilana Schafer

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

Georgia alumni recognized by college

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Dr. Jarred M. Williams

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

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Dr. Jamie C. Brown

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

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Dr. David G. Pugh

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

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Dr. Karen M. Bradley

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

The University of Georgia College of Veterinary Medicine honored four alumni with awards for service to the veterinary college and the veterinary profession during its 54th Annual Veterinary Conference and Alumni Weekend, March 24.

Drs. Jarred M. Williams (Georgia ‘06) of Athens, Georgia, and Jamie C. Brown (Georgia ‘07) of San Antonio each won the Young Achiever Award.

Dr. Williams has amassed a set of credentials and secured his foothold in veterinary academia, specifically in the budding area of large animal emergency and critical care medicine, during the 11 years since his graduation.

After receiving his DVM degree, Dr. Williams undertook an internship in equine medicine and surgery at the Alamo Pintado Equine Medical Center in Los Olivos, California. He then tackled two residencies and a doctoral program—within a span of six years—at The Ohio State University College of Veterinary Medicine. Dr. Williams is certified by the American College of Veterinary Surgeons, in Large Animal, and by the American College of Veterinary Emergency and Critical Care.

He returned to the University of Georgia in 2013 as a clinical assistant professor of large animal emergency medicine and surgery.

Dr. Brown currently serves as chief of surgery at the Department of Defense Holland Military Working Dog Hospital. He oversees surgical care of more than 800 dogs in training and a worldwide referral network for military and governmental agency working dogs.

Dr. Brown entered the U.S. Army Veterinary Corps as a captain; in 2012, he was promoted to major. He has deployed to Mali and other parts of Africa as well as Afghanistan in support of Operation Enduring Freedom, providing humanitarian support, coordinating evacuation plans for working dogs, and training human emergency personnel for veterinary emergencies. He served five years supporting special operations forces, including the 75th Ranger Regiment. As regimental veterinarian, he designed and implemented canine trauma training for handlers and medics and ensured deployment readiness for working dogs.

Dr. Brown returned to Georgia's veterinary college in 2013 for a small animal surgical residency and became a diplomate of the American College of Veterinary Surgeons this March.

Dr. David G. Pugh (Georgia ‘81) of Waverly, Alabama, received the Distinguished Alumnus Award. Following veterinary college, he completed a postdoctoral program at Virginia Tech, a residency at Texas A&M University, and, after he turned 60, a second master's degree in entomology and external parasites from Auburn University. He is a diplomate of the American College of Theriogenologists, American College of Veterinary Nutrition, and American College of Veterinary Microbiologists.

Dr. Pugh is currently the director of the Alabama Veterinary Diagnostic Laboratory System and a clinical professor in the Department of Pathobiology at Auburn's College of Veterinary Medicine.

As an equine and small ruminant veterinarian, Dr. Pugh has contributed to 14 textbooks as author and editor, and has authored or co-authored more than 600 publications. He has also served on more than three dozen committees with outcomes directly impacting animal health at the state, regional, and national levels.

Dr. Karen M. Bradley (Georgia ‘96) is a small animal practitioner and owner of Onion River Animal Hospital in Middlesex, Vermont. She is active in leadership roles at the state and national levels, and encourages other women to become leaders, too.

Recently elected to a six-year term as the District I member of the AVMA Board of Directors, Dr. Bradley represented the Vermont VMA in the AVMA House of Delegates from 2008–15 as its alternate delegate and then delegate. She served three years on the House Advisory Committee, including as both vice chair and chair. From 2013–14, she chaired the AVMA Governance Engagement Team.

In 2013, Dr. Bradley helped found the Women's Veterinary Leadership Development Initiative, which inspires and supports women in seeking leadership, policy, and decision-making positions within all areas of veterinary medicine.

National Academies of Practice accepts two veterinary fellows

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Dr. Brad Fenwick

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

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Dr. Ted Y. Mashima

Citation: Journal of the American Veterinary Medical Association 250, 11; 10.2460/javma.250.11.1196

The National Academies of Practice, an interdisciplinary organization of health care practitioners and scholars, held a March 17–18 forum on “Interprofessional Partnerships: Advancing Collaborative Practice, Education, Research and Policy” in Philadelphia. The NAP accepted the following veterinarians as new fellows of the Veterinary Medicine Academy.

Dr. Brad Fenwick (Kansas State ‘81) is senior vice president for global strategic alliances with Elsevier. His career in academia included positions as vice chancellor for research and engagement and a professor of pathobiology at the University of Tennessee and as vice president for research and a professor at Virginia Tech. He holds several patents, founded a biotechnology company, served as a science adviser for the Department of Agriculture, and consults globally.

Dr. Ted Y. Mashima (Colorado State ‘92) is the associate executive director for academic and research affairs for the Association of American Veterinary Medical Colleges. He previously served as president and executive director of the Asian & Pacific Islander American Scholarship Fund, associate director for the Center for Public and Corporate Veterinary Medicine at the Virginia-Maryland College of Veterinary Medicine, and projects director for the National Association of Physicians for the Environment.

Obituaries AVMA member AVMA honor roll member Nonmember

Jock R. Collins

Dr. Collins (Texas A&M ‘57), 84, Houston, died March 31, 2017. Following graduation, he worked as a federal regulatory veterinarian in animal inspection and quarantine and as a meat inspector before joining his brother, Dr. James R. Collins (Texas A&M ‘56), in practice at Briar Tanglewood Animal Clinic in Houston. Dr. Jock R. Collins later established Westwood Animal Clinic in Houston, where he practiced until retirement.

He was a past president of the Harris County VMA and a member of the Texas VMA. In 1988, Dr. Collins was named TVMA Outstanding Companion Animal Practitioner of the Year, and, in 2006, he received a Texas A&M University College of Veterinary Medicine & Biomedical Sciences Outstanding Alumnus Award. He was a Mark Francis Fellow at the veterinary college, where he established an endowed scholarship.

Dr. Collins is survived by his wife, Vicki; two daughters; and seven grandchildren. Memorials may be made to the Texas A&M Foundation (with the memo line of the check notated to the Jock R. Collins, DVM ‘57 Endowed Scholarship), College of Veterinary Medicine, Office of Development, 4461 TAMU, College Station, TX 77843.

John G. Debbie

Dr. Debbie (Guelph ‘65), 80, Saranac Lake, New York, died Dec. 4, 2016. He retired in 1996 as New York state public health veterinarian. Following graduation, Dr. Debbie joined the New York State Department of Health as an associate research scientist. From 1968–70, he worked on a United Nations–funded project in Nairobi, Kenya, to study the effects of new game parks on the biology of African wildlife.

On his return to the United States, Dr. Debbie accepted the position of head of the state rabies section of the NYSDH in Guilderland. His work, studying the biology of the rabies virus and its impact on wildlife and human populations, included the development of an oral rabies vaccine program for wildlife. In 1979, Dr. Debbie became the public health director for Franklin County. He traveled to Geneva in 1986 to work two years with the World Health Organization eradicating rabies in underdeveloped countries before being named NYS public health veterinarian.

Dr. Debbie was a past president of the Wildlife Disease Association and served as an adjunct professor at North Country Community College in Saranac Lake. He was a member of the Rotary Club of Saranac Lake and Elks Club, and an honorary life member of the Saranac Lake Elks Lodge.

Dr. Debbie's two daughters, a son, and six grandchildren survive him. Memorials, designated to the local scholarship fund, may be made to the Saranac Lake Elks Lodge, P.O. Box 325, Saranac Lake, NY 12983.

John D. Fuhr

Dr. Fuhr (Colorado State ‘56), 88, Spearfish, South Dakota, died Feb. 1, 2017. A small animal veterinarian, he moved to Aurora, Colorado, following graduation, and established Broadview Animal Clinic and, later, Aurora Veterinary Clinic. Dr. Fuhr also owned cattle ranches in Colorado at Kiowa and Greeley.

He was a past president of the Denver Area VMS, a past chair of the Colorado VMA State Legislative Committee, and an honorary lifetime member of the Colorado Cattlemen's Association. Dr. Fuhr served on the Colorado state legislature from 1967–74 and was speaker of its house from 1971–74. He was a past president of the Aurora Chamber of Commerce and Aurora Rotary Club, was a past Rotary Club district governor, and served on the Arapahoe County Fair Board. Dr. Fuhr helped establish the Aurora YMCA, serving on the board of directors for several years. He was a veteran of the Army Veterinary Corps.

Dr. Fuhr is survived by his companion, Coco Villard; three sons; five grandchildren; and five great-grandchildren. Memorials may be made to Countryside Church, 625 Woodland Drive, Spearfish, SD 57783.

John R. Kruckeberg

Dr. Kruckeberg (Ohio State ‘76), 66, Williamsport, Tennessee, died Oct. 31, 2016. A mixed animal veterinarian, he co-owned Animal Medical Clinic in Columbia, Tennessee, with his wife, Dr. Linda Kruckeberg (Ohio State ‘78), for 30 years. He also farmed in Williamsport. In later years, Dr. Kruckeberg worked part time at several local veterinary clinics and at the Maury County Animal Shelter. Early in his career, he served in the Army Veterinary Corps for three years. Dr. Kruckeberg was active with the Christian Veterinary Mission.

He is survived by his wife, two sons and two daughters, and a grandchild. Memorials may be made to Christian Veterinary Mission, 19303 Fremont Ave. N., Seattle, WA 98133, www.cvmusa.org; Zion Presbyterian Church Mission Committee, 2322 Zion Road, Columbia, TN 38401; or Maury County Animal Shelter, 1233 Mapleash Ave., Columbia, TN 38401.

Roger W. Meads

Dr. Meads (Minnesota ‘63), 83, Hortonville, Wisconsin, died April 7, 2017. A large animal practitioner, he focused on dairy medicine at Heritage Animal Hospital in Hortonville for more than 40 years. Dr. Meads also served as a dairy herd consultant and was known for his leadership and efforts to promote preventive herd health management. He invented a milking system to help reduce infection and increase productivity, and a radio frequency identification system to help farmers track cattle, combined with a device that continually monitors each cow's temperature for illness and fertility cycles. Dr. Meads conducted dairy seminars for farmers and other veterinarians, served as an expert witness during lawsuits, and was involved in field tests in dairy product development.

He was a veteran of the Army, serving as a 1st lieutenant. Dr. Meads is survived by his wife, Stannye; a son and two daughters; eight grandchildren; and a great-grandchild. Memorials may be made to Fox West YMCA, W6931 School Rd., Greenville, WI 54942.

Carl D. Nelson

Dr. Nelson (Cornell ‘59), 81, Laconia, New Hampshire, died March 15, 2017. He was the co-founder of Cheshire Animal Hospital in Keene, New Hampshire. Dr. Nelson was a past president of the American Association of Veterinary State Boards and a member of the New Hampshire VMA. He served as a captain in the Air Force.

Dr. Nelson's wife, Judith; a daughter and a son; five grandchildren; and a great-grandchild survive him. Memorials may be made to the New Hampshire Humane Society, P.O. Box 572, Laconia, NH 03247; Wounded Warrior Project, P.O. Box 758540, Topeka, KS 66674; or Shriners Hospitals for Children, Boston Burns Unit, 51 Blossom St., Boston, MA 02114.

Harold W. Ray

Dr. Ray (Texas A&M ‘71), 70, Orange, Texas, died Feb. 16, 2017. He began his career practicing mixed animal medicine in Weslaco, Texas. Dr. Ray subsequently established North Orange Veterinary Clinic, where he practiced primarily small animal medicine until retirement.

He is survived by his companion, Janice Ustinovich; a son; two grandchildren; and a great-grandchild. Memorials may be made to Texas A&M University College of Veterinary Medicine & Biomedical Sciences, College Station, TX 77843.

Robert W. Sagehorn

Dr. Sagehorn (California-Davis ‘88), 78, Davis, California, died March 11, 2017. Following graduation, he practiced small animal medicine, before joining Hill's Pet Products as a nutritional consultant for the western states. Dr. Sagehorn retired in 2004.

He was a Navy veteran of the Vietnam War and attained the rank of lieutenant commander. Dr. Sagehorn received the Combat Action Ribbon, Purple Heart, and Bronze Star with V.

His wife, Elizabeth; two daughters; and three grandchildren survive him. Memorials toward the Vet Med Class of ‘88 Scholarship Fund Endowment may be made to UC Regents, The Waltons Class of 1988 Scholarship V7D0426, UC-Davis Advancement Services, 1460 Drew Ave. Suite 100, Davis, CA 95618, https://give.ucdavis.edu/VDEA/123075.

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