States track dispensing to counter drug fraud

Rules on veterinarians inconsistent among states

By Greg Cima

Forty-nine states—all but Missouri—and the District of Columbia track controlled substance dispensing to thwart doctor shopping, the seeking of addictive or dangerous drugs from multiple doctors or pharmacists.

About a third require veterinarians to report to state databases when they dispense controlled substances, whereas about 40 require reports from dispensing physicians.

Alabama and Arizona have removed reporting requirements for veterinarians since the start of 2016, while Nebraska has formed a task force on implementing requirements starting in 2018, reflecting debate over whether the risk justifies the reporting burden. By one study's tally, national annual counts of doctor shoppers at veterinary clinics are in the single digits.

Dr. John Kuehn, a Nebraska state senator and large animal veterinarian, said veterinarians have professional obligations to the public to ensure appropriate drug use and help address a public health crisis.

“The opioid problem nationwide only serves to reinforce our role in ensuring that opioids don't enter inappropriately into the community,” he said.

He added that veterinarians should be aware that their clinics can be a source of abused drugs.

“Those of us in the large animal world have dealt with this issue with ketamine for quite some time,” he said.

Rise in overdoses

Drug overdose deaths have tripled since 1999, and prescription opioid deaths have quadrupled, according to data from the Centers for Disease Control and Prevention. About 500,000 people died from overdoses of prescription and illegal drugs from 2000–2014. In 2014, about 1.5 times as many people died from overdoses as from car collisions.

States have responded, in part, by implementing prescription drug monitoring programs, or PDMPs, which CDC information indicates have had promising results.

New York and Tennessee, for example, began requiring in 2012 that prescribers check their states’ monitoring programs before prescribing opioids, and in 2013, the numbers of people who saw multiple prescribers for the same drugs declined by 75 percent and 36 percent, respectively.

But one national survey of drug monitoring programs, regulators, and veterinary associations found that, in a typical year, fewer than 10 people were doctor shopping at U.S. veterinary clinics, and “veterinarians are a de minimus source of controlled substances.” The article (J Anim Environ Law 2014;5:1–42) was written by Dr. Robert J. Simpson, then president-elect of the American Veterinary Medical Law Association.

“When the known cases were adjusted based on state populations, there was an estimated one case per 30 million people, or 6.5 cases per year, in the United States,” he wrote.

Examples include an Ohio woman who visited five veterinarians to receive diazepam for a small dog said to have anxiety problems and a North Carolina woman who visited 24 veterinarians 180 times in one year to obtain butorphanol for a dog that she claimed had a prior prescription.

Dr. Simpson's article also described several scams used to gain various drugs from veterinarians: requests for controlled substances to calm a high-spirited horse during transportation, increase alertness and aggression in a guard or show dog, or aid weight loss in an overweight pet.

But he also wrote that the incidence of veterinary prescription drug diversion is “infinitesimal,” and requiring reports from veterinarians to PDMPs is “superfluous.”

However, Barbara L. Carreno, a spokeswoman for the Drug Enforcement Administration, said doctor shopping is a substantial problem for veterinary clinics, and the DEA is tracking reports. Veterinarians also have to deal with theft and misuse by employees, burglary, and possibly robbery.

“All the things that apply to a human doctor apply to a pet doctor,” she said.

She noted that addicts seek tramadol from veterinarians because it works in humans and has low cost, as well as narcotics such as benzodiazepines and hydrocodone. The DEA recommends vigilance, good record keeping, and secure storage.

Quoting a DEA colleague, Carreno said, “Addicts are very good at getting drugs.”

Against reporting

Dr. Larry Stutts, an Alabama state senator who worked in mixed animal practice before becoming a physician, proposed the legislation that removed reporting requirements for the state's dispensing veterinarians, effective Aug. 1, 2016.

“I felt it was an unnecessary interference with the private practitioners in the state,” he said.

He said the nation has an opioid abuse epidemic and isn't so naive to think no veterinarians were involved.

“But as a whole, veterinarians play a very minor, insignificant role in diversion of narcotics,” he said.

Dr. Brad Fields, assistant executive director of the Alabama VMA, also said the data collection on veterinary drugs was an undue burden.

“It wasn't valid or valuable data to the Department of Public Health and the PDMP program,” he said. “There hasn't been any doctor shopper identified in the veterinary world through the PDMP.”

Veterinarians were required to report prescriptions issued, starting with the database's implementation in April 2006. Dr. Fields said veterinary clinics lack the standardized software used by physicians and pharmacists to report dispensing, so veterinarians’ reports were more labor-intensive.

Dr. Simpson's article notes that veterinary practice management software systems are incompatible with many states’ PDMP reporting protocols, requiring that veterinarians submit reports through alternative means such as online forms or hard copies. The labor required for data entry in clinics and state offices was considered in excluding veterinarians from Kentucky's PDMP, he wrote.

In addition, Alabama's database lacked unique identifiers for veterinary patients, Dr. Fields said. Prescriptions for humans are tied to Social Security numbers, but information on animal patients is tied only to pet names out of concern that adding information to an owner's medical records could violate federal privacy laws, he said.

Dr. Fields also contends that seeking drugs from veterinary clinics requires bringing in an animal with clinical signs and the money to cover examination fees.

“I think the potential certainly exists,” he said. “I mean, anybody would be a fool to say it doesn't happen in the veterinary world, but it's much more difficult.”

The New York State VMS has issued a statement that the 2013 regulations broke a promise that veterinarians would be exempted from reporting requirements.

“The NYSVMS continues to maintain, in its most vehement and aggressive manner, that this regulatory change exposes pets in New York State to unnecessary suffering, is an unnecessary drain on veterinarian's (sic) resources, and increases the regulatory burden placed on small businesses in rural areas where access to 24-hour pharmacy services is unavailable,” the statement reads.

Bill Christian, a spokesman for the Tennessee Department of Health, said data on controlled substances dispensed by veterinarians were unavailable, since veterinary prescriptions are not distinguished from other entries in the state's Controlled Substance Monitoring Database. But, he said, all data in the database are “making an impact in how we address the opioid epidemic.”

In a March 2013 newsletter, then-Kansas VMA president Dr. Tom Jernigan wrote that a five-year state government study found veterinarians should not be included in the state prescription drug monitoring program. A six-member task force, comprising two representatives each from the Kansas Board of Pharmacy, Kansas Board of Veterinary Examiners, and KVMA, conducted the study.

The Minnesota Board of Pharmacy, in a 2011 report to the state legislature, found that the board's evidence did not support requirements that veterinarians report when they dispense controlled substances for outpatient administration. That report also indicates veterinarians routinely dispense these types of drugs in low quantities for short treatment durations and that 5 percent of veterinarians responding to a survey had seen overt doctor shopping.

In the Fall 2014 newsletter of the Minnesota Board of Veterinary Medicine, Barbara Carter, prescription drug monitoring program manager for the Minnesota Board of Pharmacy, wrote that veterinarians still could look up prescribing histories through the state database to help reduce availability of controlled substances for misuse or diversion, ongoing problems in the state. She noted that includes misuse or diversion of tramadol.

“Veterinarians can be unknowingly targeted by individuals diverting or using controlled substances for nonmedical purposes,” she wrote. Veterinarians in Minnesota are now also legally required to report any employees suspected to be diverting.

Minimizing risk

Sherry Green, president of the National Alliance for Model State Drug Laws, which drafts and analyzes drug and alcohol laws, policies, and regulations, said those misusing or selling drugs for nonmedical purposes tend to take the path of least resistance for acquiring those drugs. As states close routes to obtaining medications, addicts and sellers will choose others, she said. For that reasons, she supports requiring reports from all dispensers.

Green acknowledges she has seen no evidence of substantial diversion through veterinarians’ offices, and she would expect to have seen reports, studies, and discussions with colleagues if it were happening. That tells her veterinary clinics are not the easiest diversion route.

“You may not have a lot of diversion going on now, but, as you eliminate other opportunities and as you strengthen the monitoring, that suddenly may become a route that looks viable to someone who's trying to get their hands on the drugs,” she said.

While Green acknowledged the difficulties described by Dr. Fields in gaining veterinary prescription drugs, she said addicts and drug sellers consider risks and opportunities, including using animals toward their ends and stealing money to cover clinic fees. Severity of addiction or profit motive determines how hard someone looks for opportunities to feed those needs, she said, citing increases in drug seeking across state lines as some states implemented monitoring programs and recent concerns that legal exemptions for nursing homes were enabling diversion through home-based care.

She wants further consideration of how states could prevent veterinary clinics from becoming targets without undue burden. She said reporting by dispensers benefits all prescribers.

Rhode Island has had about 1,200 overdose deaths since 2011, exceeding the combined deaths from car crashes, shootings, and fires, according to information published by the governor's office in July 2016. The state requires dispensing reports from veterinarians.

Peter Karczmar, MD, the 2014–15 president of the Rhode Island Medical Society and husband of Dr. Cathy Lund, alternate representative from Rhode Island in the AVMA House of Delegates, was among those who helped incorporate the reporting and checking mechanism into the state's medical system. He also has confronted patients after seeing their prescription history in the database.

Dr. Karczmar said veterinarians need to be involved in efforts to reduce the risks of controlled substance abuse.

“I think it's important for veterinarians to understand there is a significant potential for diversion of controlled substances,” he said.

Dr. Lund, who described Rhode Island's requirements during an open discussion at the AVMA HOD regular annual session in August 2016, said in a later interview that the monitoring program has been important in dealing with the drug overdose crisis in Rhode Island, and physicians worked with veterinarians as colleagues in developing the solution.

Patrick Knue, director of the Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University, noted that, in the minority of states that require veterinarians report controlled substances dispensed, some are unable to identify fraud at veterinary clinics—especially when it is performed under multiple pet names. With programs that track prescriptions by the owners’ addresses, he said, veterinarians can at least use that information to see how many prescriptions are going to one residence.

“It's actually not evidence of anything,” he said. “It's just an indicator.”

He and colleagues at the center were unable to find any studies or research related to veterinarians’ use of prescription drug monitoring programs or potential diversion or abuse. From his previous experience working on Texas’ prescription drug monitoring program, he remembers only a few reports of inventory theft and improper ordering by clinic staff.

Burden and responsibility

The Nebraska state government's 10-member Veterinary Prescription Monitoring Program Task Force began studying in 2016 the types of drug dispensing that veterinarians should be required to report when their participation in the state's drug monitoring program becomes mandatory in January 2018.

Dr. Kuehn, the state senator, is chair of the task force, which he said is deliberating on how to make reporting work well for veterinarians and accomplish the PDMP goals. In mid-December 2016, he said that conflicts within the task force had delayed the report past its Dec. 1 deadline, but the group was making progress.

“What we're trying to figure out is how do we have a system that protects veterinarians, protects the public, and ensures the integrity of our ability to utilize controlled substances,” he said.

Because Nebraska has lagged in developing a monitoring program, Dr. Kuehn said, it has become a haven for drug-seeking activity and needs to act to close improper access to opioids.

If physicians, pharmacists, and dentists are expected to keep records of the controlled substances they send into the community, Dr. Kuehn questions why veterinarians would lack such an obligation. Spending less than one minute to fill in a form is, to him, a tiny obligation, especially in light of the risk that a misused prescription could kill someone.

“When is something a burden, and when does something become a professional obligation?” he asked.

If veterinarians want roles in combined medicine and public health, he questioned why they would not have the same responsibilities and obligations as other medical professionals.

“The idea that this is only a regulatory burden, without recognizing our responsibility to ensure the integrity of the controlled substances that we send into the community, is a discussion that, frankly, baffles me,” he said.

Practices encouraged to be proactive about antimicrobials

A report now available from the AVMA Task Force for Antimicrobial Stewardship in Companion Animal Practice provides a framework for instituting a clinic-level approach for judicious antimicrobial use, along with educational materials. The task force said this is an initial step to raise awareness and encourage broad action by companion animal veterinarians to help the profession combat the threat of antimicrobial resistance.

“Within the past decade, many companion animal practitioners have been confronted with multidrug resistant infections for which there are limited effective antimicrobials. Practitioners are not uncommonly presented with pets infected with multidrug-resistant Escherichia coli, Klebsiella spp, and Staphylococcus spp, including methicillin-resistant Staphylococcus pseudintermedius. Fortunately, methicillin-resistant Staphylococcus aureus infections are less common in pets than in humans, but they have become a concern in companion animal practice,” the authors wrote in the report, part of which also appeared as a commentary in JAVMA in 2015 (J Am Vet Med Assoc 2015;246:287–288). “Multidrug-resistant infections are often associated with poor treatment outcomes and longer hospital stays. The antimicrobials most effective for these infections are often more expensive than the most commonly used veterinary antimicrobials and can cause more adverse reactions. Additionally, many of these organisms are found in both humans and companion animals, highlighting the possibility of zoonotic transmission.”

A key focus of the task force was to assemble core elements of a companion animal stewardship program. They are as follows:

  • Each veterinary practice should commit to the reduction in antimicrobial resistance by creating and adopting a clinic-specific plan in which everyone contributes to effective antimicrobial stewardship.

  • Antimicrobial stewardship in a practice begins with the appointment of a principal person to lead the program and to support the practice stewardship goals with all available resources.

  • Practices should address issues of antimicrobial resistance by taking a proactive approach to antimicrobial use and infection control, using accepted guidelines, recommendations, and expertise.

  • Understanding what is working and what is not requires self-assessment and monitoring, with a goal of continual improvement.

The AVMA Board of Directors approved the release of the task force's final report this past November as information to the public and allied organizations—available at http://jav.ma/avmareports. However, the document has not been approved as policy by the Board or House of Delegates.

The task force was established by the Board in 2013 and had been chaired by Dr. Jeff B. Bender, professor of veterinary public health at the University of Minnesota College of Veterinary Medicine, until it was sunset in spring 2015. Its goal had been to consider the emerging impact of multidrug-resistant organisms in companion animal practice and design approaches to address this challenge. Some of the activities the task force developed to help the profession combat antimicrobial resistance were devising assessments to better understand laboratory practices and practitioner prescribing behaviors, developing general do's and don'ts of antimicrobial prescribing, and creating educational programs and materials for practitioners and clients. These are available at http://jav.ma/antimicrobialuse.

Additionally, the task force conducted a survey of AVMA members in 2015 about their attitudes toward antimicrobial stewardship (J Am Vet Med Assoc 2015;247:883–884). Forty-five percent of respondents expressed strong concern about antimicrobial-resistant infections in dogs and cats, and an additional 37 percent indicated that they were somewhat concerned. Most veterinarians surveyed (62 percent) thought that the way antimicrobials are used in small animal practice has an impact on the overall antimicrobial resistance issue.

The task force was also interested in exploring barriers to appropriate antimicrobial use in companion animal practice. Eighty-four percent of respondents strongly agreed or somewhat agreed that the cost of culture and susceptibility testing was a barrier to recommending these tests.

The AVMA Committee on Antimicrobials, which was created last June, has taken on the work in this area. The committee is developing an entity vision statement and strategies for antimicrobial stewardship and is reviewing the Association's antimicrobial use policies. Once the committee has had an opportunity to review the task force report in light of the committee's vision and strategies, it plans to introduce recommendations.

AVMA makes strategic investment in AVMF

Following a recommendation from the AVMA Budget and Financial Review Committee and the Strategy Management Committee, the AVMA Board of Directors at its November 2016 meeting approved a request of $450,000 in operational support for the American Veterinary Medical Foundation for 2017. The money will come from the Association's strategic operating plan fund. This support is in addition to staff support (finance, marketing, human resources, legal) the AVMA currently provides.

As the charitable arm of the AVMA, the AVMF develops resources to advance the science and practice of veterinary medicine to improve animal and human health. In the past couple years, the AVMF has aligned its strategic plan to mirror the AVMA's strategic objectives. The AVMF has provided products and services to AVMA and Student AVMA members, including veterinary student scholarships, Veterinary Care Charitable Fund grants for practice owners, and Our Oath in Action community service grants, and has supported research activities, including the Young Investigator Award.

Under new leadership, the AVMA and AVMF staff have created new accounts to better track unrestricted, temporarily restricted, and permanently restricted funds, according to the recommendation background. Unrestricted funds are used to support the operations of the Foundation, while restricted funds largely go toward specific projects.

For decades, the AVMF primarily sought temporarily restricted funds from corporations to support special projects and activities. However, the Foundation is limited to using only 8 to 12 percent of this type of grant funding for indirect costs or administrative expenses, the background stated. In the past five years alone, the AVMF says it has spent $2 million solely on programs, instead of also supporting its own fundraising and administrative expenses.

“This fundraising focus on ‘temporarily restricted’ funds put the Foundation in a recurring pattern of depleting the ‘unrestricted’ funds to cover the costs of operations. Considering most businesses spend well over 50 percent of their operational expenses on salaries and benefits alone, the idea that the Foundation would be able to spend only 8 percent to cover all of its operational costs has proven to be an unsustainable business model,” according to the document.

Consequently, the Foundation was less likely to grow its donor base, as it hadn't invested in its own fundraising capabilities, says Debborah Harp, AVMF executive director.

If the Foundation could plan for consistent operational support from the AVMA, fundraising progress and program successes would be more likely, she said.

Harp also pointed out that the practice of a medical association, academy, or society supporting the operational expenses of its own foundation is not uncommon, as do the American Medical Association and American Association of Equine Practitioners. The AVMF has received financial support from the AVMA at various levels throughout its history. For example, from 1995–1999, the AVMA provided $500,000 per year to the AVMF for operations.

The AVMF plans to request consistent operational support beyond 2017; AVMA's plans for that support are yet to be determined.

Tuskegee back to accredited status

The AVMA Council on Education has granted the Tuskegee University College of Veterinary Medicine accredited status. The council took this action during its Sept. 25–27, 2016, meeting; Tuskegee made the announcement Dec. 14.

Tuskegee was put on probationary accreditation status after a fall 2013 comprehensive site visit. Probationary accreditation is given to a college that has one or more major deficiencies that have more than minimal impact on student learning or safety. These deficiencies must be corrected within two years, and the colleges must submit reports to the council every six months. Tuskegee was cited for having major deficiencies in five areas and minor deficiencies in two areas.

The COE conducted a focused site visit in January 2016 at Tuskegee and during its March meeting granted a one-year extension for the veterinary college to meet the requirements. At that time, Tuskegee had only one remaining major deficiency, which has since been resolved, as indicated by the change in accreditation status.

“I am proud of our faculty, staff, and especially our students. The attainment of full accreditation status for the College of Veterinary Medicine would not have been possible without their dedication and commitment,” said Dr. Ruby Perry, dean of Tuskegee's veterinary college.

“This has truly been a team effort from within our college to our administration within the university and our dedicated friends and alumni as well.”

Notice of accreditation actions taken by the COE during its fall 2016 meeting is available at http://jav.ma/COEfall2016.

Powdered glove ban takes effect

Federal health officials have banned powdered gloves intended for use in surgery or examinations as well as absorbable powders for lubricating surgery gloves.

The prohibition took effect Jan. 18. The ban applies to the use of powdered gloves in both human and veterinary medicine.

The Food and Drug Administration implemented the rule to eliminate risks of inflammation, granulomas, and respiratory allergic reactions, according to a Dec. 19, 2016, Federal Register notice announcing the ban.

“A thorough review of all currently available information supports FDA's conclusion that powdered surgeon's gloves, powdered patient examination gloves, and absorbable powder for lubricating a surgeon's glove should be banned,” the notice states. “FDA has concluded that the risks posed by powdered gloves, including health care worker and patient sensitization to natural rubber latex (NRL) allergens, surgical complications related to peritoneal adhesions, and other adverse health events not necessarily related to surgery, such as inflammatory responses to glove powder, are important, material, and significant in relation to the benefit to public health from their continued marketing.”

The notice indicates nonpowdered alternatives are viable and that their use avoids “unreasonable and substantial” risks. Agency officials also expect minimal impact through costs or shortages. “Thus, a transition to alternatives in the marketplace should not result in any detriment to public health,” states the notice.

In spring 2016, the FDA had published the proposal to ban powdered surgery and examination gloves and glove powder (see JAVMA, Aug. 1, 2016, page 258). The risks outweigh the minimal benefits of increasing ease of donning and removing the gloves, according to the agency.

Powdered glove use already has been in decline following reports of adverse reactions and risks as well as industry initiatives to improve safe use of nonpowdered gloves, FDA information states. Glove sales projections indicate at least 93 percent of medical care providers use nonpowdered gloves, according to the agency.

Alternatives to powdered gloves are available at prices similar to those of powdered gloves, according to the FDA.

Dog monitor taken off the market

A wearable electronic device intended for use on dogs is no longer available, as enrollment in its veterinary monitoring program was slower than expected.

Intersections Inc. announced in a Dec. 1, 2016, press release it would close its pet health monitoring business, known as Voyce, effective immediately. The company's subsidiary, i4c Innovations Inc., created the Voyce Health Monitor, a device worn around the neck that was marketed to pet owners and veterinarians. It was developed in collaboration with biomedical engineers, veterinary experts, and Cornell University College of Veterinary Medicine.

Creation of the device was announced in early 2014, but the hardware had been delayed for developmental and regulatory reasons, and it wasn't made available to the public until more than a year later. The band cost $200 and carried a monthly subscription fee. One of a number of canine wearables on the market, the monitor was among the first capable of sharing resting heart and respiratory rates.

Voyce Pro, launched in mid-2015, was designed for and marketed to veterinarians as a way to remotely monitor their canine patients as well as help identify and manage issues such as heart, joint, or neuromuscular diseases. But enrollment in Voyce Pro was “slower than expected and therefore the Voyce business was unable to achieve an acceptable level of revenue,” according to the press release.

Michael Stanfield, Intersections’ chairman and CEO, was quoted as saying, “Efforts at Voyce have taken longer than expected, and the time required to introduce such a breakthrough technology to the veterinary market was greater than anticipated.”

The discontinuation and winding down of operations may include the sale of assets and other opportunities to monetize the Voyce technology. This process may include seeking partners to license the technology for purposes of developing products for the veterinary, pharmaceutical, and research markets. The Voyce website directs questions to customersupport@voyce.com.

Study suggests pets grieve

Findings from a recent study of owner-reported observations indicate dogs and cats engage in grieflike behavior after a companion animal in their home dies.

With funding from a Morris Animal Foundation grant, researchers surveyed 279 owners following the death of a pet. The questionnaire was distributed through veterinary clinics and several animal welfare organizations based in New Zealand and Australia. The two most common classes of behavioral change reported through the questionnaire were in affection behaviors and territory behaviors.

“Both dogs and cats were reported to demand more attention from their owners and/or display affiliative behavior, as well as spend time seeking out the deceased pet's favorite spot,” according to the study, titled “Owners’ perceptions of their animal's behavioural response to the loss of an animal companion,” which appeared Nov. 3, 2016, in the online, open-access journal Animals (http://jav.ma/animalgrief).

Dogs were reported to have decreased the amount of food and speed at which they ate, and to have increased the amount of time spent sleeping. Cats were reported to have increased the frequency and volume of their vocalizations. Researchers also looked at the practice of giving the surviving pet the opportunity to see the deceased pet's body.

The survey found no difference in behavioral responses between animals that saw the deceased pet and those that did not.

Authors of the study noted that there were limitations to interpretations of the study, particularly given the potential for anthropomorphism and owner bias, and that further investigations independent of owner interpretation are required. New investigations might help to establish whether the behavioral changes are a reflection of loss, a change in owner behavior following a loss, or the reduction in competition for owner attention and resources.

Elanco buys Boehringer animal health portfolio for $885M

Elanco U.S. Inc., a subsidiary of Eli Lilly and Company, announced this past October an agreement to acquire Boehringer Ingelheim Vetmedica Inc.'s U.S. feline, canine, and rabies vaccines businesses as well as a fully integrated manufacturing and research and development site for $885 million. The deal will diversify Elanco's companion animal portfolio.

Joining Elanco's U.S. portfolio, which currently includes parasiticides and medications to control pain and treat dermatologic disorders, will be routinely administered vaccines against Bordetella bronchiseptica infection, Lyme disease, rabies, and parvovirus infection, among others. Also included in the agreement are several pipeline assets.

“We understand the unique bond that owners share with pets and are committed to helping those pets live longer, healthier lives,” said Jeff Simmons, Elanco Animal Health president. “With a growing portfolio addressing both prevention and treatment of disease, Elanco can partner with veterinarians and pet caregivers to do just that.”

The acquisition is anticipated to close early this year, subject to approval by the Federal Trade Commission, compliance with antitrust laws, and closing of Boehringer Ingelheim's asset swap with Sanofi.

The sale of BIVI's U.S. pet vaccines business and its Fort Dodge, Iowa, manufacturing site is a required step toward the acquisition of Merial by Boehringer Ingelheim. France-based Sanofi SA and Germany-based Boehringer Ingelheim GmbH announced this past June that they had signed contracts to exchange Sanofi's animal health business—Merial—for Boehringer Ingelheim's consumer health care business (see JAVMA, Aug. 15, 2016, page 370).

John C. Lechleiter, PhD, Lilly's chairman, president, and CEO, said that the planned acquisition of BIVI's U.S. feline, canine, and rabies vaccines businesses reaffirms Lilly's confidence in Elanco's growth potential.

“As a result of the acquisition, Elanco will bring greater value to customers by providing a suite of options for preventing common diseases in companion animals,” Dr. Lechleiter said. “Coupled with our robust food animal portfolio, this addition further strengthens Elanco's position in the global animal health business.”

Contest challenges students’ welfare knowledge


Students evaluate the housing conditions for layer hens kept at The Ohio State University's poultry facility. (Photo by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242

More than 100 students representing 15 universities participated in the 16th annual Intercollegiate Animal Welfare Judging and Assessment Contest, Nov. 12–13, 2016, hosted by The Ohio State University.

Individual and team competitors in the AVMA- and Student AVMA–supported contest must analyze the welfare of animals presented in comparative scenarios, determine whether the animals’ welfare in one scenario is better or worse than in the other, and then explain their decisions to a panel of judges.

In 2016, students virtually assessed the welfare of meat sheep, guinea pigs, and purebred dogs purchased from breeders and assessed the welfare of laying hens in person by traveling to Ohio State's poultry facility.

Along with demonstrating the welfare needs of a range of species, the competition gives veterinary, undergraduate, and graduate students the opportunity to develop critical thinking and oral presentation skills. Enhanced knowledge of animal welfare, a strong analytic mindset, and well-honed communication skills are valuable takeaways that serve AWJAC participants throughout their education and careers. Results of the 2016 contest are as follows:

Veterinary Student Section: First place—Rachel Baumgardner, Michigan State University; second place—Angela Varnum, Colorado State University; third place— Louana Cheung, Colorado State University. Undergraduate Section: First place—Nevere Hammond, University of British Columbia; second place—Julia Rose, The Ohio State University; third place—Heather Pechtl, The Ohio State University. Graduate section: First place—Mariam Martin, Colorado State University; second place—Caroline von Waldburg-Zeil, University of Guelph; third place—Rachel West, Colorado State University.

Team Live Assessment Exercise, Veterinary Student Section: Iowa State University. Undergraduate Section: University of Wisconsin-River Falls. Graduate Section: Iowa State University. Individual Veterinary Student Live Assessment Exercise: Victoria Blake, University of Pennsylvania.

Overall Team Placing, Veterinary Student Section: First place—Colorado State University; second place—The Ohio State University; third place—Michigan State University. Undergraduate Section: First place—University of British Columbia; second place—University of Guelph; third place—The Ohio State University. Graduate Section: First place—Colorado State University; second place—University of Guelph; third place—Iowa State University.

The 2017 Intercollegiate Animal Welfare Judging and Assessment Contest will be held Nov. 18–19 at Iowa State University. Details will be posted at www.awjac.org.

Examining board gets new look, name

The National Board of Veterinary Medical Examiners announced that it has changed its name to the International Council for Veterinary Assessment in addition to taking on a new look.

The new name is part of a rebranding of the organization. Research showed that there was a general lack of awareness of what the organization does and the role that it plays in veterinary medicine.

The NBVME has done far more than provide the North American Veterinary Licensing Examination, according to Dr. Karen Lehe, ICVA chair, in a Nov. 28, 2016, press release. She cited the organization's Veterinary Educational Assessment, which allows veterinary colleges to evaluate students’ basic science knowledge, and its species-specific examinations, used by licensing boards for evaluating disciplinary cases and for other purposes. And, increasingly, the organization is working on an international level. The NAVLE is administered in 24 countries. International graduates must also take the NAVLE if they intend to practice in North America.

The rebranding process has also resulted in a new logo and various marketing materials, including a new website (www.icva.net) that was rolled out early this year. The name change to International Council for Veterinary Assessment is a more accurate reflection of what the organization already does rather than an indication of changes coming, according to the release. For more information, visit http://meeticva.com.

Association of Avian Veterinarians

Event: Annual meeting, Aug. 27-Sept. 1, 2016, Portland, Oregon

Awards: Dr. T.J. Lafeber Avian Practitioner Award: Dr. Gregory Rich (Louisiana State ‘85), Metairie, Louisiana, for advancing avian medicine and surgery while providing inspiration and showing compassion. Dr. Rich owns Avian & Exotic Animal Hospital of Louisiana. He has served multiple terms as president of the Southeast Louisiana VA and was a member of the AAV board of directors from 1995–98. Honorary Lifetime Membership Award: Drs. Patrick Redig (Minnesota ‘74), St. Paul, Minnesota, and Robert E. Schmidt (California ‘62), Anthem, Arizona. Dr. Redig is a professor in the Department of Veterinary Clinical Sciences at the veterinary college. He is also the founder and director emeritus of the university's Raptor Center. Dr. Redig served as treasurer of the AAV from 2015–16. Dr. Schmidt practices part time at Zoo/Exotic Pathology Service in Carmichael, California. He is a diplomate of the American College of Veterinary Pathologists and co-authored “Pathology of Pet and Aviary Birds.” Speaker of the Year: Dr. Natalie Antinoff (Wisconsin-Madison ‘92), Houston. Dr. Antinoff serves as director of the avian and exotic specialty at Gulf Coast Veterinary Specialists in Houston. She is a diplomate of the American Board of Veterinary Practitioners (avian practice). Dr. Antinoff was chosen as the favorite speaker from the 2015 AAV meeting. Donald W. Zantop Memorial Lecture Honoree: Dr. Marike Visser, Auburn, Alabama, for “Interpreting a Pharmacokinetic Study: Applying Research in the Clinic.” Student Manuscript Contest Award: Sarah Ozawa, Knoxville, Tennessee, for “Stifle disarticulation as a pelvic limb amputation technique in a cockatiel (Nymphicus hollandicus) and a northern cardinal (Cardinalis cardinalis).” House Officer Manuscript Competition Award: Dr. Noemie Summa, Davis, California, for “Evaluation of the effects of 4.7 mg deslorelin acetate implants on egg laying in cockatiels (Nymphicus hollandicus).” Research Grant Award: Drs. Yvonne van Zeeland, Utrecht, Netherlands, for “Therapeutic efficacy of paroxetine in feather damaging grey parrots,” and Emma Schachner, New Orleans, for “Lower respiratory system anatomy of the African grey parrot”


Dr. Gregory Rich

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242


Dr. Patrick Redig

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242


Dr. Robert E. Schmidt

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242


Dr. Michelle Hawkins

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242


Dr. Lauren V. Powers

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242

Officials: Drs. Michelle Hawkins, Davis, California, president; Lauren V. Powers, Huntersville, North Carolina, president-elect; Michael Lutz, Nashville, Tennessee, treasurer; and Kenneth Welle, Urbana, Illinois, immediate past president and conference chair

American College of Veterinary Ophthalmologists

Event: Annual meeting, Oct. 26–29, 2016, Monterey, California

Awards: Best Resident Manuscript Award: Case report—Dr. Kathryn Smith, Oklahoma State University, for “Utility of antigen testing for the diagnosis of ocular histoplasmosis in four cats: a case series and literature review”; Clinical research—Dr. Tomo Wiggans, University of California-Davis, for “Histologic and immunohistochemical predictors of clinical behavior for feline diffuse iris melanoma”; Basic science research—Dr. Ryan Boyd, Michigan State University, for “Photoreceptor-targeted gene delivery using intravitreally administered AAV vectors in dogs”

New diplomates: Twenty-five individuals were welcomed as diplomates of the ACVO. They are as follows:

Ryan Boyd, Mattawan, Michigan

Emily Conway, Warrensville Heights, Ohio

Elizabeth Curto, Monterey, California

Sarah Czerwinski, Athens, Georgia

Daniel Dorbandt, North Haven, Connecticut

Michele Edelmann, Staten Island, New York

Kara Gornik, Pittsburgh

Allyson Gosling, Vancouver, Washington

Angela Griggs, Arlington, Texas

Kristina Gronkiewicz, Rocklin, California

Kimberly Hsu, St. Charles, Illinois

Adam King, Naperville, Illinois

Rick Lanuza, Santa Barbara, California

Jennifer Lu, Ontario, California

Bianca Martins, Urbana, Illinois

Keiko Miyadera, Philadelphia

Caroline Monk, Atlanta

Audrey Pierson, Plano, Texas

Zoe Reed, Glendale, Arizona

Ronald Spatola, Chesapeake, Virginia

LaTisha Taylor, Nashville, Tennessee

Francesca Venturi, Tustin, California

Meredith Voyles, Nashville, Tennessee

Penelope Wooff, Edmonton, Alberta

Connie Yeh, New Castle, Delaware


Dr. Ralph Hamor

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242


Dr. Jane Cho

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242

Officials: Drs. Ralph Hamor, Gainesville, Florida, president; Jane Cho, Thornwood, New York, president-elect: Alexandra van der Woerdt, New York, secretary-treasurer; and Elizabeth Giuliano, Columbia, Missouri, immediate past president

Kentucky VMA

Event: Annual meeting, Sept. 23–25, 2016, Louisville

Awards: Veterinarian of the Year: Dr. Frank G. Vice, Flemingsburg. A 1986 graduate of the Auburn University College of Veterinary Medicine, Dr. Vice is a partner at Fleming County Animal Hospital in Flemingsburg. He also serves as a veterinary pharmacist in Flemingsburg, making regular presentations on issues facing the profession such as compounding drugs and other pharmaceutical topics. Distinguished Service Award: Dr. Steven J. Wills, Owensboro. A 1983 graduate of the Auburn University College of Veterinary Medicine, Dr. Wills co-owns Wills Animal Hospital in Owensboro. He is a past president of the association, serves as the association's delegate to the AVMA House of Delegates, and is a member of the Kentucky Board of Veterinary Examiners.


Dr. Frank G. Vice

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242


Dr. Steven J. Wills

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242


Dr. Walter G. Haines

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242


Dr. Douglas Peterson

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242

Officials: Drs. Walter G. Haines, Bowling Green, president; Douglas Peterson, Frankfort, president-elect; Jennifer K. Quammen, Walton, vice president; Andrew Roberts, Lexington, secretary-treasurer; and Alice W. Mills, Lexington, immediate past president

Wisconsin VMA

Event: Annual meeting, Oct. 14, 2016, Madison Awards: Veterinarian of the Year: Dr. Sheila McGuirk, Dodgeville. A 1977 graduate of the University of Georgia College of Veterinary Medicine, Dr. McGuirk was a professor of large animal internal medicine and food animal production medicine at the University of Wisconsin-Madison School of Veterinary Medicine prior to retirement in 2016. She is a diplomate of the American College of Veterinary Internal Medicine. Meritorious Service Award: Dr. James Ziegler, Weyauwega. A 1987 graduate of the Michigan State University College of Veterinary Medicine, Dr. Ziegler owns Wolf River Veterinary Clinic in New London. He has served on several WVMA committees and task forces and recently completed a four-year term on the association's executive board. WVMA Friend of Veterinary Medicine Award: The University of Wisconsin-Madison School of Veterinary Medicine won this award, given to an individual or organization in recognition of their service, commitment, and contributions specifically to veterinary medicine in Wisconsin. The UW-Madison veterinary school has helped the association organize wet labs, hosted executive board meetings, and allowed the WVMA to interact with students throughout the school year. The unwavering support of the veterinary school's dean, Dr. Mark Markel, for organized veterinary medicine has contributed to an increased number of students and faculty becoming members of the WVMA. Presidential Award: Dr. David Jeans, Evansville. A 1993 graduate of the University of Wisconsin-Madison School of Veterinary Medicine, Dr. Jeans is treasurer of the WVMA. He was recognized for keeping a steady hand and mind on the fiduciary aspects of the association.


Dr. Sheila McGuirk

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242


Dr. James Ziegler

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242


Dr. David Jeans

Citation: Journal of the American Veterinary Medical Association 250, 3; 10.2460/javma.250.3.242

Business: The association approved a new bylaw concerning the lifetime membership category.

Officials: Drs. Scott Spaulding, Milton, president; Robert Leder, Bear Creek, president-elect; David Jeans, Evansville, treasurer; and John T. Been, Prairie du Sac, immediate past president

Obituaries: AVMA member AVMA honor roll member Nonmember

Delbert O. Anthony

Dr. Anthony (California-Davis ‘52), 94, Kamas, Utah, died Sept. 3, 2016. He was a retired small animal practitioner.

J. Desmond Baggot

Dr. Baggot (Dublin ‘66), 76, Dublin, died June 27, 2016. He was a professor of veterinary pharmacology and toxicology and senior associate dean at the St. George's University School of Veterinary Medicine in Grenada, West Indies, prior to retirement in 2012. During his career, Dr. Baggot held research, teaching, and administrative appointments at universities in several countries, including Ireland, New Zealand, Australia, and the United States. While in Ireland, he served as director of the Irish Equine Centre in Johnstown for 10 years.

Known for his expertise in veterinary pharmacology, Dr. Baggot authored “Principles of Drug Disposition in Domestic Animals: The Basis of Veterinary Pharmacology” and “The Pharmacological Basis of Veterinary Clinical Pharmacology,” and he co-authored “Antimicrobial Therapy in Veterinary Medicine.” He was a past president of what was known as the World Association of Veterinary Physiologists, Pharmacologists, and Biochemists, and was a member of the founding committee of the Journal of Veterinary Pharmacology and Therapeutics, serving on the editorial board for 32 years. In 2012, the University of California-Davis honored him for his research in comparative pharmacology.

Dr. Baggot is survived by two daughters. One daughter, Dr. Siobhan Baggot Jones (Oregon State ‘01), practices veterinary medicine in Arizona.

Jerry F. Breuel

Dr. Breuel (Kansas State ‘62), 83, Taylorville, Illinois, died Aug. 29, 2016. He was a retired mixed animal veterinarian. Dr. Breuel is survived by a son, a daughter, and six grandchildren.

Malcolm D. Cameron

Dr. Cameron (Texas A&M ‘64), 81, Dallas, died Sept. 25, 2016. He was the founder of Preston Royal Animal Clinic in Dallas, where he practiced small animal medicine until retirement in 2011. Dr. Cameron also founded an emergency animal clinic in Dallas, subsequently serving as president. He was a past treasurer of the Dallas County VMA and a member of the Texas VMA.

A veteran of the Navy, Dr. Cameron attained the rank of lieutenant (junior grade). His wife, Beverly; a son and a daughter; and two grandchildren survive him. Memorials toward an educational fund, with checks made payable to the Texas A&M Foundation, and the memo line notated to Walk of Honor, In Memory of Malcolm Cameron DVM, may be made to the Texas A&M University College of Veterinary Medicine & Biomedical Sciences, Office of Development, 4461 TAMU, College Station, TX 77843.

Melani M. Freeman

Dr. Freeman (Texas A&M ‘79), 61, Bay City, Texas, died Sept. 17, 2016. She practiced small animal medicine in South Texas. Dr. Freeman's two daughters and two grandchildren survive her. Memorials may be made to Texas Blessings Rescue, P.O. Box 209, Blessing, TX 77419, or Make-A-Wish Texas Gulf Coast and Louisiana, 12625 Southwest Freeway, Stafford, TX 77477, www.texgulf.wish.org.

George A. Gates

Dr. Gates (Missouri ‘66), 74, Loch Lloyd, Missouri, died Sept. 1, 2016. He founded Prairie Village Animal Hospital in Prairie Village, Kansas, where he practiced small animal medicine until retirement in 2016. Dr. Gates also co-founded Land of Paws, a pet store in Prairie Village. He authored the book “A Dog in Hand: Teaching Your Puppy To Think.”

Dr. Gates’ wife, Pam; three sons; and seven grandchildren survive him. Memorials may be made to American Cancer Society, P.O. Box 22478, Oklahoma City, OK 73123, or Catholic Charities of Northeast Kansas, 9720 W. 87th St., Overland Park, KS 66222.

Oliver F. Goen

Dr. Goen (Texas A&M ‘48), 94, College Station, Texas, died Aug. 28, 2016. He began serving in the Air Force as a veterinary officer in 1953, retiring in 1975 as a lieutenant colonel. Dr. Goen was a veteran of the Korean and Vietnam wars, also serving in the Marine Corps during World War II. His honors included an Air Force Commendation Medal with two Oak Leaf Clusters. After retiring from the Air Force, Dr. Goen ranched in Texas’ Brazos County. Early in his career, he practiced in Brazos County for a year and served on the veterinary faculty of the University of Florida for four years.

Dr. Goen is survived by two sons, seven grandchildren, and nine great-grandchildren. Memorials may be made to Bright Light Free Will Baptist Church, 11200 State Highway 30, College Station, TX 77845.

R. Lamance Joyce

Dr. Joyce (Georgia ‘81), 63, Kilmarnock, Virginia, died June 20, 2016. A small animal veterinarian, he owned Bayside Animal Hospital and Pet Emporium in White Stone, Virginia. Dr. Joyce is survived by two daughters. Memorials may be made to White Stone Church of the Nazarene, P.O. Box 1270, White Stone, VA 22578, or Northern Neck Animal Welfare League, P.O. Box 975, White Stone, VA 22578.

Kenneth D. Quist

Dr. Quist (Minnesota ‘55), 87, Atlanta, died Aug. 17, 2016. He retired from the United States Public Health Service in 1985 with the rank of captain as director of scientific services at the Centers for Disease Control and Prevention's Office of Infectious Diseases. Dr. Quist began his career with the CDC's Epidemic Intelligence Service, serving as an epidemiologist in Texas, Nebraska, and Idaho. He subsequently earned a master's in public health from the University of California-Berkeley and moved to CDC headquarters in Atlanta. In the 1960s, Dr. Quist traveled to Switzerland, India, Pakistan, Bangladesh, Nepal, and Japan to study the cholera epidemic as part of a World Health Organization project. After retiring from the CDC, he practiced at Wieuca Animal Clinic in Atlanta for 10 years.

Dr. Quist was a past president of the southeastern branch of the American Association for Laboratory Animal Science and was a member of the Georgia VMA. His wife, Lois; three sons; six grandchildren; and a great-grandchild survive him.

Memorials may be made to the Shallowford Presbyterian Church Chapel Choir Fund, 2375 Shallowford Road NE, Atlanta, GA 30345.

Walter R. Rice

Dr. Rice (Auburn ‘61), 85, Jackson, Tennessee, died Aug. 6, 2016. He was a mixed animal veterinarian. Dr. Rice served in the Army. His wife, Virginia; a daughter and a son; and six grandchildren survive him.

John W. Seddon

Dr. Seddon (Pennsylvania ‘55), 84, Elkridge, Maryland, died June 7, 2016. He practiced small animal medicine in Elkridge, Maryland, for 50 years, retiring in 2007. Dr. Seddon was a veteran of the Army. He is survived by four sons, eight grandchildren, and a great-grandchild. One of Dr. Seddon's sons, Dr. John C. Seddon (Pennsylvania ‘86), is a veterinarian in Bowie, Maryland.

Memorials may be made to American Heart Association, 4217 Park Place Court, Glen Allen, VA 23060, or St. Jude Children's Research Hospital, P.O. Box 2151, 501 St. Jude Place, Memphis, TN 38101.