NARROW EXCEPTIONS

Dr. Amber McCoig, deputy director of the FDA Center for Veterinary Medicine's Division of Compliance, said in a video presentation in November that the Animal Medicinal Drug Use Clarification Act, passed in 1994, lets veterinarians administer or authorize approved drugs outside their labeled indications, and that allowance applies to compounded drugs made from approved products. But it doesn't allow administration of drugs compounded from raw active ingredients, even if the compounded products contain the same active ingredients as approved drugs.

FDA officials have received reports of illnesses and deaths associated with compounded drugs made from bulk ingredients that were too potent, contained incorrect ingredients, or contained contaminants, Dr. McCoig said. She cited three examples since 2009 of compounded equine-use drugs that contained too much selenium or pyrimethamine and killed at least 28 ponies and horses.

Dr. McCoig also noted that improper compounding can discourage investment in new animal drugs and undermine approved drugs.

Janice Steinschneider, regulatory counsel for the FDA CVM, said during the same presentation that veterinarians who prescribe or make a compounded animal drug need to work within a veterinarian-client-patient relationship. They also should report adverse events to the FDA.

Steinschneider said FDA policy will, under the draft guidance, let veterinarians and pharmacists use raw active ingredients to make drugs for specific, identified, non–food-producing animals when the final products need to differ from existing drugs on the basis of contents or administration route. If the compound and an approved or indexed drug have the same active ingredients, same routes of administration, and similar strength, the veterinarian should say in the prescription why the animal needed a product compounded from raw active ingredients.

The draft guidance allows making office stock of certain compounded substances that may be needed more quickly than compounding allows; those drugs are included in a list from the FDA. Plus, the bulk substances on the list can be used to make antidotes for food-producing animals, provided veterinarians tell clients how long the animals need to be held or their products discarded to keep the drugs out of the human food supply.

The list of stock compounds can be found at jav.ma/compoundstock. FDA officials are accepting nominations to the list.

CONCERNS FROM COMPOUNDERS

Soon after the draft's publication, AVMA volunteers started reviewing it with plans to send comments to the FDA, according to a Nov. 19, 2019, post on the AVMA@Work blog. The post states that the AVMA is committed to preserving veterinarians' access to compounded drugs and the FDA drug approval process.

Leaders of the Alliance for Pharmacy Compounding, formerly the International Academy of Compounding Pharmacists, said they disagree with the FDA's interpretation that the law restricts compounding animal drugs from raw active ingredients and with the agency's plan to apply policy through guidance rather than regulations. David Pore, governmental affairs counsel for the APC, said in late November the organization was studying details of the policy ahead of submitting comments.

Under the draft guidance, compounders would rely on enforcement discretion, he said.

Anthony Grzib, who is chair of the APC's legislative committee and a compounding pharmacist for Wedgewood Pharmacy in Swedesboro, New Jersey, noted that the FDA's list of approved compounds for office stock started with eight active pharmaceutical ingredients and a call to nominate more. Wedgewood uses such raw active pharmaceutical ingredients in about 2,000 animal products that account for half the company's veterinary-use compounding, he said.

“It's difficult to imagine how we're going to be able to serve patients with only being able to use eight APIs,” he said.

Grzib said the guidance language also would limit compounding that modifies only the flavor or dosage form of a drug. A liquid and a chewable treat, for example, could deliver a drug in different forms but the same route of administration.

An FDA spokeswoman clarified that, while such a product would be considered a copy, a pharmacist can compound such a product when a veterinarian determines the change would be a clinical benefit for the veterinarian's patient. The veterinarian needs to explain that decision in the prescription, and the pharmacist needs to document why the drug could not be compounded from an approved product.

Grzib said having office stocks of compounded medicines available also benefits veterinarians who travel to animals.

“The veterinarians don't always know which animals are going to need what medication when they visit a barn or a zoo,” he said. “And so that's why office use is much more prevalent in animal health than in human health.”

The FDA also maintains lists of bulk drug substances that can be used in compounding human medicines to address shortages or unmet clinical needs. Pore said adding drugs to those lists involves a restrictive nomination and approval process, and he expects similar scrutiny of compounded animal drugs.

FDA officials published another draft guide on compounding in May 2015 and withdrew it in November 2017 in response to comments. In that document, FDA officials described compounding animal drugs from raw ingredients as manufacturing but said they would allow limited uses for patient care.

At the time, AVMA leaders responded that they thought the proposed guidance could limit treatment options and harm animals. In an 18-page letter from then–AVMA CEO Dr. W. Ron DeHaven, the AVMA criticized provisions that would have restricted administration of drugs compounded from raw drug substances to individually identified animals, which would exclude populations in zoos and aquariums; limited veterinarians' abilities to stock emergency-use doses of compounded drugs; and required a clinical benefit from compounding from raw ingredients over approved products, which would have prevented compounding of drugs that were approved but unavailable.

FROM GOODS TO SERVICES

The first state sales tax laws were enacted during the 1930s when the U.S. was primarily a manufacturing economy. States started collecting taxes on sales of tangible goods, such as food and houses, but exempted fees charged for professional services.

Then, during the 1960s, the services portion of the economy began to expand and continued to grow to a point where it now contributes almost half of the nation's GDP, according to the federal Bureau of Economic Analysis.

Five states—Alaska, Delaware, Montana, New Hampshire, and Oregon—impose no general, statewide sales tax on either goods or services.

Given the shift from a manufacturing to service-based economy, state officials often describe sales tax laws that exempt professional services as antiquated. In a 2017 budget message, former Oklahoma Gov. Mary Fallin said, “The way we impose taxes and collect revenue no longer reflects the current economy, but an outdated system that has not changed much since its inception.”

Attempts to amend sales tax laws to reflect the new economic reality are rarely successful as they are met with strong opposition from coalitions comprising diverse professional organizations. The three times Ohio's former governor attempted to tax professional services, the state VMA joined with organizations representing auto dealers, accountants, and lawyers to defeat the initiative each time.

“They loved us,” Advent recalled. “While we were certainly not the biggest organization in the coalition, they loved us because the average consumer holds veterinarians in high regard. And our message was simple: The governor wants to tax the health care of your pet.”

Even when legislators tried “cherry picking” a handful of services to tax, the coalition returned in force. “It's like Benjamin Franklin said, ‘Either we hang together, or we hang separately.‘ We understand that it may not be us today, but in a few more years it might be,” Advent said.

THE FINE PRINT

No two states have the same tax laws, which can be so nuanced as to be confusing. For instance, some states exempt animal products from sales tax when purchased by a livestock producer or used in food animals. Last year, the Vermont VMA successfully advocated the passage of legislation clarifying a 50-year-old law exempting veterinary supplies from sales tax.

“The tax department wanted to strictly interpret the existing language to only allow exemptions for supplies for agricultural animals,” Finnie explained. “Passage of clarifying legislation was necessary to preserve our exemption, and veterinarians actively lobbied their legislators and testified in House and Senate committee hearings.”

The legislation that passed exempted veterinary supplies and pharmaceuticals, including vaccines, as well as durable medical equipment but not over-the-counter medicines.

“At a time when the legislature was looking to find money under any rock, this was considered a big accomplishment for our members,” Finnie said.

1. ESTABLISH ENOUGH LEADERSHIP BUY-IN.

Studies have shown that well-being programs reduce health costs and lead to higher engagement, improved productivity, higher retention, easier recruiting, reduced absenteeism, better company culture, and higher job satisfaction.

2. CONDUCT A NEEDS ASSESSMENT.

The needs assessment can look at resource allocation; the current culture, including values, and the hidden culture; and what is currently being offered for well-being as well as whether employees are happy with those offerings. Conduct a survey open to all members and departments. Collecting demographics is a good idea, too.

The second part of this step is data analysis. Identify stress points for the community, whether those are individual factors such as skills or competencies, systemic factors such as organizational communication or processes, or external factors such as clients, the economy, or industry trends. Also, look at capacity to see what well-being offerings can feasibly be made available and what can be outsourced or done as a partnership.

“The essence of strategy is determining what not to do,” Peterson said. “What national and community organization can you partner with to fill in the gaps?”

Finally, assign people or ask for volunteers in the organization for a further deep dive to develop suggested solutions based on the needs assessment.

3. CHOOSE YOUR OWN ADVENTURE.

Based on the needs assessment data, leaders should determine which change management and well-being approaches they'd like to take.

The three top models for organizational culture change are the Lewin Change Management Model, meant for large shifts and deep analysis; the McKinsey 7S Model, which is good for small organizations to analyze how coherent or in sync an organization is; and Kotter's Theory, a top-down approach that generates momentum and drive toward change. This last option helps implement either of the first two models, Peterson said.

Culture change should touch everything from recruiting, hiring, and orientation to performance evaluations, staff training, and support.

As for drafting the well-being approach, Peterson recommends designing the program for the marginalized, the people who have to navigate the most barriers and need the most support. This way, the program will automatically cover those who need less support.

Further, let the needs assessment be a road map, have defined roles and responsibilities for action steps, and don't subscribe to the thinking that you have to offer it all. Don't offer gym memberships when people can't even take a lunch break or programming that people don't want or won't use.

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Above all else, “we need to see modeled behavior to have culture change,” especially leadership modeling behavior that promotes well-being, Peterson said. “Maybe being the best team player is going home and taking care of yourself instead of staying 12 hours when you only needed to be there eight hours.”

4. CONDUCT A STAKEHOLDER ASSESSMENT.

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More than 260 people attended the 2019 Veterinary Wellbeing Summit. They heard from industry experts and colleagues how to make individual and organizational well-being an everyday part of their personal life and professional practice.

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

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Who are the stakeholders? Are they donors, leadership, veterinarians, technicians, staff, clients, students, or alumni?

Once the groups are determined, sort them by who is supportive, on the fence, unsupportive, and unknown. Consider what the groups value and who influences them.

5. ADDRESS BARRIERS TO CHANGE.

Barriers to change can involve closed attitudes, not accounting for differences among departments or divisions, unclear culture goals, bias or stigma, poor communication strategy around changes, or lack of employee engagement, expertise, or data.

To manage resistance is to expect it and plan for it. Addressing resistance formally, identifying the root causes of resistance, and being able to answer “What's in it for me?” can all go a long way, Peterson said.

Grissett, the wellness coordinator at Oklahoma State's veterinary college, encounters resistance to change frequently in his work as a licensed therapist. When a client is resistant, he takes a step back and reassesses.

“The process of feedback with a client is the same as what we might go through with the teaching hospital,” he said. “If we encounter that (resistance to change), we'll make sure we have a core group, not necessarily the ones heading up the initiative, but the ones guiding it, that will be open to feedback, which will be vital for us so we can address and move forward with changes in the most effective way possible.”

When there is resistance, he said, it's important to not push through, but to think of why there is resistance. Is it an obstacle to go around? Is there another way to get through it better? Or do we need to rethink the plan in general because it's not going to work?

“You can learn a lot from resistance; you just have to listen to it,” Grissett said.

MEANS TO AN END

Researchers from the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health looked at mortality rates from suicide among 11,620 veterinarians who died from 1979–2015. They concluded that male veterinarians were 2.1 times as likely and female veterinarians were 3.5 times as likely to die from suicide as were members of the U.S. general population, and these higher suicide mortality rates extended the entire 36-year period (J Am Vet Med Assoc 2019;254:104–112).

When looking at methods of suicide, the researchers found notable differences.

Fifty-one percent of male veterinarians who died by suicide used firearms, and 33% overdosed, compared with 18% of female veterinarians who used firearms and 64% who overdosed.

For both male and female veterinarians, those in clinical positions more often used pharmaceuticals than did those in nonclinical positions.

Tracy Witte, PhD, a professor in the Auburn University psychology department, then built on the CDC's work by looking more specifically at methods of suicide.

Dr. Witte's research, published in September, showed not only that overdoses were the most common suicide means for veterinarians, but also that pentobarbital was the most common substance used, which is different from what's seen in the general population (J Am Vet Med Assoc 2019;255:595–608).

“In some ways, this isn't a shocking finding because people have speculated for a while, and there was indirect evidence that veterinarians are more likely to overdose. And reading between the lines, people assumed they overdosed on pento,” Dr. Witte said.

Further, 89% of the pentobarbital-caused deaths did not occur at work—most of the time they were at home (72%).

Taking it one step further, the researchers reanalyzed their data after excluding those veterinarians who used pentobarbital, and they found that suicide rates for male and female veterinarians were no different from those for the general population.

“So, the idea is the people who used pentobarbital, theoretically, if that had been prevented, we would have a similar suicide rate in vets as we do in the general population,” Dr. Witte said. “This gives credence to the idea that if we made it a little more difficult for veterinarians to die by suicide, we could prevent suicide, not just make them switch to something else.

“Moreover, our finding that most of the suicides involving pentobarbital occurred outside the workplace suggests any new policies should consider guidelines for when and how pento can be removed from a clinical setting.”

ONE DAY AT A TIME

On average, 129 Americans died by suicide each day in 2017, and upwards of 90% of those individuals had a diagnosable mental health condition at the time of their death, according to the American Foundation for Suicide Prevention.

There is no single cause of suicide, but a convergence of biological, psychological, social, and environmental factors contribute, and all of these factors interact with external life events every day. Suicide most often occurs when stressors exceed the current coping abilities of someone suffering from a mental health condition, the AFSP states.

Christine Yu Moutier, MD, chief medical officer for the AFSP, gave a talk during the 2019 Veterinary Wellbeing Summit, held Nov. 17–19 in Rosemont, Illinois, on preventing suicide and building resilience.

People experience negative life events all the time, she said, from bullying to crises, and the rule is resilience, not suicide. The latter happens when “those natural ways of resilience and protective factors are temporarily dismantled. In those moments, you don't have access to a sense of connectivity, for example. That cognitive constriction lasts for a short period of time, but if you can allow a person to get through moments to hours of that high acute period and keep them away from lethal means, you don't just save their life for a moment” but possibly for a lifetime, Dr. Moutier said.

Limiting access to lethal means is effective, as the data show that most people don't opt for another method. Dr. Moutier cited a 2010 study that examined rates of suicide after a policy change in the Israeli Defense Forces that reduced adolescents' access to firearms. Following the policy change, suicide rates decreased by 40%.

TOOLKIT TO HELP VETERINARY COLLEGES DEAL WITH SUICIDE

To help support veterinary colleges in the aftermath of a student's death by suicide, the American Foundation for Suicide Prevention, AVMA, and Association of American Veterinary Medical Colleges have released a new resource, “After a Suicide: A Toolkit for Colleges of Veterinary Medicine.”

The toolkit provides a best-practices approach to effectively managing the impact of suicide in academic communities, said Dr. Andrew T. Maccabe, AAVMC CEO, in a Nov. 18, 2019, press release. The launch coincided with the 2019 Veterinary Wellbeing Summit (see page 148).

Developed by experts in veterinary medicine and suicide prevention as well as survivors of suicide loss in the veterinary community, this free toolkit includes the following:

• • Best practices for how school administrators and staff should respond in the immediate aftermath of a suicide.

• • Guidance on helping students, faculty, and staff cope in the short and long term.

• • Tips on working with the media and community partners such as the coroner's office, local police departments, funeral directors, faith leaders, and mental health professionals.

• • Tools for deciding how to safely memorialize students.

• • Information on how to identify and support members of the community who may be vulnerable and reduce the risk of suicide contagion.

“This toolkit addresses many of the questions that schools have following a suicide death, while also giving them a framework through which to effectively respond to students' questions and needs,” said AVMA President Dr. John Howe in the release. “Collaborating with AFSP provided the expertise and insight necessary in the development of these tools, and AAVMC's reach within the colleges and schools gives us confidence that they will make a significant difference in the future of veterinary medicine.”

Christine Moutier, MD, AFSP chief medical officer, said in the release: “Because suicide loss survivors can develop elevated risk of suicide if not appropriately supported, postvention is a critical component of suicide prevention. The appropriate handling of the aftermath of a suicide often paves the way for effective prevention strategies to be developed and employed at the next phase after the grief period.”

To view the toolkit, go to afsp.org/veterinarians.

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Further, a 2017 study in the online journal BMC Psychiatry found that people in jobs with access to firearms, medicines or drugs, or carbon monoxide more frequently used these methods to end their lives than those without access to lethal means.

Women in jobs with access to lethal means had suicide rates that were 3.02 times the rates for those without access at their work. Men in jobs with access had suicide rates that were 1.24 times the rates for those without access.

“The findings of this study suggest the importance of controlling access to lethal methods in occupations where these are readily available,” the authors concluded.

KEEPING TABS

All health professionals licensed to dispense, administer, or prescribe controlled drugs, such as pentobarbital, must register with the Drug Enforcement Administration. Registrants must comply with regulatory requirements relating to drug security and record keeping. Prescription drugs should be stored separately from over-the-counter drugs and in a secure manner, with access limited to key personnel. But that's not always the case, said Dr. Suzanne E. Tomasi, an epidemiologist at NIOSH and lead researcher on the CDC study.

“Once staff gets in for the day, they're constantly in and out of the drug box,” said Dr. Tomasi, a former practicing veterinarian. “You have the morning appointments while the surgery technician is prepping for surgery and hope to get one done in time for lunch. As the vet, you unlock the controlled box so the tech can start dosing meds and calculating surgery meds. Usually, I would double-check doses before giving to patients, but you're running around and doing your stuff, and the box is basically open.” She says the profession needs to come up with ways to look at better administrative controls in various situations, from a small rural clinic to a big multidoctor practice to an ambulatory clinic.

“That's where the paper in September was driving that point home. We're working on the mental health part—changing stigma, looking at the business model, improving work-life balance, and educating the public when they say these things that are a form of bullying and hurting the profession—but that's going to take time,” Dr. Tomasi said. “Changing administrative controls that change how clinics view and access the drug box could be an immediate lifesaving change for a certain percentage of the profession.”

FINDING WHAT WORKS

Of course, the devil lies in the details.

There are the quick and easy solutions, such as putting a sticker on drug boxes with the phone number of a suicide prevention lifeline. But other solutions will take greater effort to thwart veterinarians from diverting pentobarbital.

Dr. Andy Roark, a practicing veterinarian at Cleveland Park Animal Hospital in Greenville, South Carolina, and an author and speaker, started the Four Eyes campaign last year. He's advocating that accessing controlled drugs should require two people in every clinic possible.

But the campaign has seen pushback. For example, solo mobile practitioners have said they wouldn't have a second person around to sign off.

“And my response is, if you have something great for 90–95% of the profession, and 5–10% percent can't do it, it doesn't mean 90–95% can't,” he said.

Other criticisms include that a two-person system wouldn't work as quickly as veterinarians would need access to drugs in some cases or that implementing a new system would be expensive. Dr. Roark says he doesn't buy the quickness argument because human emergency rooms have been able to make the same system work. And drug management systems range in cost, from those that require thumbprint recognition from two approved people before allowing access to just having two locks on a drug box, which the DEA already requires, and committing to a key management system.

Regarding the latter, Dr. Roark said, “It has to come from leadership. You can't have doctors hiding keys. I think a lot of people think it (suicide) can't happen in their practice. The truth is you don't know what's going on in the mind of colleagues.”

He thinks the hesitation he's seen about his idea is that veterinarians worry they will lose access to important drugs they need to do their job.

“That's why us choosing to do this (voluntarily) and do it well is important to get people on board,” he said.

Meanwhile, Dr. Witte's research group is planning to get feedback from practitioners on a variety of ideas on how to implement better controls and seeing whether they work.

“We shouldn't have one solution for everybody,” she said. “What needs to be done is a bottom-up approach to identify things that might work and be viewed as acceptable by people who would need to use them.”

WHEN WORDS CAN HURT

“Culture shapes a lot of the lenses that we operate through,” Santiago said. “We know what we know, but what happens when you encounter people that are different? … Our cultural lenses help us navigate the world, but they are also a source of some blind spots, and a lot of the mismatches or miscues in communication come out of our blind spots.”

For example, a person may be trying to communicate and connect with someone, but because of his blind spots, he may inadvertently be harming that individual, Santiago said.

Elements of culture include nationality, ethnicity, religion, sexual orientation, and language.

Lisa Greenhill, EdD, senior director for institutional research and diversity at the Association of American Veterinary Medical Colleges, discussed microaggression in an AAVMC DiVersity Matters podcast in 2017 with Kathleen Wong, PhD, chief diversity officer at San Jose State University.

It is important to inform and educate people about microaggressions because they are difficult to deal with, and they're not necessarily seen as very severe from outside observers or perpetrators, Dr. Wong said.

“They are so micro,” she said. “But we know from research that microaggressions take a huge psychological toll and contribute a lot to organizational culture and perceptions of safety, welcomeness, or warmness. … We generally don't talk to people about them, and so you have this other whammy, where people have no idea that they have done something wrong.”

Dr. Wong said that some examples of microaggressions for someone in veterinary medicine might be: So do you guys get to do any real doctoring? Did you really study medicine? Are you a real doctor?

BE POLITE

“Not all insults are the same,” Santiago said. “A microaggression is an equal opportunity offender. They're not limited to race.” There are microaggressions related to religion and sexual orientation, among others.

Santiago broke microaggressions into the following three categories:

• • Microassaults: An insult that is overt, conscious, and with a goal to hurt someone's feelings and to further marginalize or isolate an individual. For example: “It's a shame you decided to have kids in veterinary school; you could have gone far.”

• • Microinsults: A “bless your heart” insult or a statement that is not intentionally mean or demoralizing. For example: “Wow, you speak good English” or “You graduated from that veterinary school? There's probably a lot I'm going to have to teach you here in the practice.”

• • Microinvalidations: An insult that negates or nullifies the thoughts or experiences of a certain group of people. For example: “Why is everything about race with you?”

“I have experienced my share of microaggressions, and a lot of times I experience them in the rearview mirror,” Santiago said. “So, someone will say something. Something doesn't feel right about it, but I'll process it later. When you think about it, every time an individual experiences something like this and they have to go back and look at it, it builds what I call a callus because you are not able to process or address it in real time.”

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Attendees at the 2019 Veterinary Wellbeing Summit, Nov. 17–19, in Rosemont, Illinois (Photo by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

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Dr. Stacie Gallenstein, an anatomy professor at North Carolina State University College of Veterinary Medicine who is white, knows she has implicit bias.

“I made an unfortunate comment that President Obama was an amazing speaker,” Dr. Gallenstein said at the summit. “What I meant was that he is one of the best speakers I have ever seen, period. But what I learned was that a lot of my African-American students read that as, ‘He's one of the best speakers; he speaks so well as a black person.‘ My intent was completely different than what they had interpreted.”

Dr. Gallenstein said she is on the committee for diversity and inclusion at the veterinary college, and she is working to be a good ally, but it's a learning process.

Santiago argues that you can't control an individual's response, but you can be vulnerable and open to feedback. “My personal belief is that as long as you don't stop trying, as long as you open yourself to be vulnerable—and that goes for the dominant culture as well as members of underrepresented groups—as long as your goal is constantly moving towards better understanding through communication, and you don't shut yourself off and retreat into your tribe, then you'll get closer than where you were before,” to being more aware of microaggressions.

EVENT

25th International Veterinary Emergency and Critical Care Symposium, Sept. 6–10, 2019, Washington, D.C.

PROGRAM

This year's symposium focused on the critical kidney in veterinary emergency and critical care. The symposium was conducted jointly by the Veterinary Emergency & Critical Care Society, American College of Veterinary Emergency and Critical Care, Academy of Veterinary Emergency and Critical Care Technicians and Nurses, American College of Veterinary Anesthesia and Analgesia, Academy of Veterinary Technicians in Anesthesia and Analgesia, International Veterinary Academy of Pain Management, and Association of Veterinary Hematology and Transfusion Medicine. The symposium also served as the venue for the annual meeting of the Veterinary Emergency and Critical Care Foundation. Dr. Cynthia Otto, Philadelphia, presented the Knowles Memorial Keynote Lecture, discussing the vital role that dogs in the military and law enforcement play in saving lives.

AWARDS

Ira M. Zaslow VECCS Distinguished Service Award

Dr. Elizabeth Rozanski (Illinois '92), Norwalk, Connecticut. Dr. Rozanski serves as an associate professor of respiratory disease, hematology, and emergency and critical care at the Cummings School of Veterinary Medicine at Tufts University. She is a past president of the ACVECC and a diplomate of the American College of Veterinary Internal Medicine.

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Dr. Elizabeth Rozanski

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

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Hill's Dr. Jack Mara ACVECC Achievement Award

Drs. Daniel J. Fletcher, Ithaca, New York, and Manuel Boller, Werribee, Australia. A 2002 veterinary graduate of the University of California-Davis,

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Dr. Daniel J. Fletcher

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

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Dr. Manuel Boller

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

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Dr. Fletcher serves as an associate professor in the Section of Emergency and Critical Care and is associate chair for the Department of Clinical Sciences at Cornell University College of Veterinary Medicine. He is president of the ACVECC and a co-chair of the Reassessment Campaign on Veterinary Resuscitation initiative, a nonprofit, volunteer-based program within the ACVECC and VECCS dedicated to conducting high-quality education, evidence review, and guideline creation. A 1997 veterinary graduate of the University of Zurich in Switzerland, Dr. Boller is a senior lecturer in small animal emergency and critical care at the University of Melbourne, Melbourne Veterinary School. He is a co-chair of the RECOVER initiative and the SnakeMap project in Australia. The project aims to better predict, prevent, diagnose, and treat snakebites in animals as well as people. Dr. Boller is a diplomate of the ACVECC.

T. Douglas Byars Boehringer Ingelheim Equine Emergency & Critical Care Educator of the Year

Dr. Pamela Wilkins (Cornell '86), Urbana, Illinois. Dr. Wilkins is a professor of veterinary clinical medicine at the University of Illinois College of Veterinary Medicine. Her clinical interests include cardiovascular and respiratory problems of critically ill foals and horses and bacterial blood cultures in foals and horses as indicators of disease severity and prognosis. Dr. Wilkins is a diplomate of the ACVIM and ACVECC.

Hill's-VECCS Distinguished Award and VECCS Presidential Award

Dr. Gary L. Stamp (see obituary, Sept. 1, 2019, JAVMA, page 517), was posthumously honored for his years of commitment to advancing emergency medicine and critical care worldwide. Dr. Stamp was a founding member and a past president of the VECCS and ACVECC and a co-founder of the IVECCS. Dr. Stamp served as executive director of the VECCS from 1999 until his death.

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Dr. Gary L. Stamp

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

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Gary L. Stamp Award

Dr. Dennis Burkett (Pennsylvania '84), Malvern, Pennsylvania, was honored for his years of commitment to advancing emergency medicine and critical care worldwide. Dr. Burkett is a veterinary cardiologist and an emergency and critical care specialist at Hope Veterinary Specialists in Malvern. He is a diplomate of the ACVIM and ACVECC.

VECCS Practice Manager of the Year, sponsored by Nationwide Insurance

Kate Parker, Arvada, Colorado. Parker is the hospital manager at Animal Urgent Care in Arvada.

ACVECC Research Grant Award ($9,990)

Dr. Galina Hayes, Cornell University, for “Before and after parallel group controlled trial investigating the effects of a bundled anti-burnout intervention measure on burnout severity in veterinary technicians”

ACVECC CPR Research Grant Award ($7,250)

Dr. Karin Unger, Washington State University, for “The effect of the use of an impedance threshold device on end-tidal carbon dioxide partial pressure and return of spontaneous circulation in dogs undergoing cardiopulmonary resuscitation after in-hospital cardiac arrest”

VECCF Research Grant Award ($6,700)

Dr. Michael Kato, North Carolina State University, for “Comparison of platelet function between canine fresh whole blood, cold whole blood, and platelet concentrate”

Small Animal Resident Abstract Award

A $500 stipend was awarded to Dr. Christiana Fischer, Philadelphia, for “Evaluation of subcutaneous versus intravenous apomorphine for emesis induction in dogs.”

Large Animal Resident Abstract Award

A $500 stipend was awarded to Dr. Jamie Kopper, Washington State University, for “The effect of proximal gastrointestinal conditions and storage on viability of fecal microbiota transfaunation.”

ACVAA Resident Abstract Award, sponsored by Smiths Medical/SurgiVet

First place, small animal—Dr. Marta Garbin, University of Florida, for “Injectate spread following ultrasound-guided lateral quadratus lumborum block in dogs: A cadaveric study;” first place, large animal: Dr. Nicole Trenholme, University of Georgia, for “Effects of a 5-degree head-up incline on arterial oxygenation in anesthetized horses”

Case Report Award

A stipend of $300 was awarded to Dr. Kaila Rizzo, University of Pennsylvania, for “Trippin topiramate.”

Technician Case Report Award, sponsored by Animal Blood Resources International

A stipend of $300 was awarded to Bonnie Lockridge, University of Georgia, for “Spontaneous atrial fibrillation in an anesthetized patient for PDA ligation.”

IVAPM Case Report Award

Mylissa Fitzpatrick, Gansevoort, New York, for “Managing osteoarthritis and severe elbow dysplasia after an acute ITP event.”

Royal Canin Nutritional Case Report Award

Dr. Lisa Gretebeck, Alexandria, Virginia, for “But it is grain free!”

Poster Abstract Award, sponsored by Abaxis

A stipend of $500 was awarded to Dr. Marcelle Hon, Honolulu, for “Cryopreservation of feline red blood cells in liquid nitrogen using glycerol and hydroxyethyl starch.”

VETERINARY EMERGENCY AND CRITICAL CARE SOCIETY

Business

It was announced that membership numbers are almost the same as the previous year, and finances are strong. The society has moved to a true accrual system. This year, $79,000 in additional scholarships were given to veterinary students and to certified facilities to provide pro bono services. The Journal of Veterinary Emergency and Critical Care has an additional copy editor to assist with journal backlog. Online continuing education offerings to membership have risen and will continue to expand. Participation in social media has increased visibility and exposure for the society. A task force with the ACVECC to address the shortage of veterinary emergency and critical care staff, announced last year, has resulted in a three-prong approach, with the task force working on new certification for veterinary technicians, separate from that of the AVECCTN; mentorship for young veterinarians with experienced emergency room doctors; and increased knowledge and career advancements.

Officials

Dr. Linda Martin, Pullman, Washington, president; Dr. Elisa Mazzaferro, Norwalk, Connecticut, president-elect; Dr. Chris Gray, East Lansing, Michigan, treasurer; Kenichiro Yagi, Ithaca, New York, recording secretary; Dr. Robert Messenger, Charlotte, North Carolina, immediate past president; P.J. Andrus, Chicago, chief executive officer; and members-at-large—Drs. Julie Dechant, Davis, California, and Steven Epstein, Davis, California

AMERICAN COLLEGE OF VETERINARY EMERGENCY AND CRITICAL CARE

Program

The ACVECC conducted its certification examination and held its annual business meeting.

New diplomates

Fifty-three individuals passed the certification examination

They are as follows:

Rachel Acciacca, U.S. armed forces

Maia Ramirez Aitken, Kennett Square, Pennsylvania

Daniel Avenick, Santa Barbara, California

Amy Bell, Redwood City, California

Steven Todd Berkowitz, Hamilton, New Jersey

Alexander “Alex” Bluntinger, Washington, D.C.

Heike Botha, San Diego

Laura A. Cagle, Davis, California

Dana J. Caldwell, Gilbert, Arizona

Laura Cole, London

Emma Lindsey Deane, Rocklin, California

Samuel Avram Dicker, Great Neck, New York

Liam R. Donaldson, Newstead, Australia

Rebekah E. Donaldson, Aspley, Australia

Kerry Doolin, Paisley, Scotland

Emily T. Dozeman, Chicago

Brittany Enders, Cary, North Carolina

Katherine K. Gerken, Opelika, Alabama

Clayton David Greenway, Lewisville, Texas

Simon Paul Hagley, Manchester, England

Jeanette Hendricks, Woodland Hills, California

Aubrey Lynn Hnatusko, Edmond, Oklahoma

Marcelle Hon, Honolulu

Jennifer A. Hoose, Chino, California

Danielle M. Hundley, Omaha, Nebraska

Claudia Iannucci, Bern, Switzerland

Christopher R. Kennedy, Vancouver, British Columbia

Jessica Kielb, Cary, North Carolina

Terence Krentz, Los Gatos, California

William G. Lane, Boston

Hendrik Lehmann, Giessen, Germany

PenTing Liao, Ames, Iowa

Bridget M. Lyons, Columbia, Missouri

John Michael Mallard, Los Angeles

Ingrid O. Manhart, Deerfield, Illinois

Hannah Rose Marshall, Portland, Oregon

Pia Martiny, Salt Lake City

Rebecca McQuitty, San Jose, California

Emiliana Rose Meroni, Philadelphia

Jennifer Lynne Morris, Philadelphia

Michael R. Nystorm, Durham, North Carolina

Laura Osborne, Calgary, Alberta

Kirsty L. Royle, Vancouver, British Columbia

Jonathan Schaefer, Columbia, Missouri

Katherine Maria Scotti, Greenville, South Carolina

Susanna Solbak, Guildford, England

Stanley Sowy, Houston

Jessica L. Wallis, Calgary, Alberta

Jessica Marie Weeks, Brandon, Florida

Elodie Yam, Morley, Washington

Igor Yankin, College Station, Texas

Xiu Ting Yiew, Guelph, Ontario

Kristin Marie Zersen, Fort Collins, Colorado

Officials

Drs. Daniel Fletcher, Ithaca, New York, president; Ken Drobatz, Philadelphia, president-elect; Beth Davidow, Seattle, vice president; Scott Shaw, Oxford, Massachusetts, treasurer; Armelle de Laforcade, North Grafton, Massachusetts, executive secretary; Elisa Mazzaferro, Norwalk, Connecticut, immediate past president; and regents—Drs. Kira Epstein, Athens, Georgia; Erica Reineke, Devon, Pennsylvania; Lisa Powell, Golden Valley, Minnesota; Greg Lisciandro, Spicewood, Texas; Maurine Luschini, East Syracuse, New York; and Deborah Silverstein, Philadelphia

ACADEMY OF VETERINARY EMERGENCY AND CRITICAL CARE TECHNICIANS

Program

The academy conducted its 22nd certification examination and held a pinning ceremony and reception for the class of 2018. Louise O'Dwyer was posthumously honored as Technician of the Year.

Business

Committee reports were presented and ratified.

Officials

Megan Brashear, Portland, Oregon, president; Trisha Farry, Brisbane, Australia, president-elect; Kenichiro Yagi, Ithaca, New York, treasurer; Andrea Steele, Guelph, Ontario, executive secretary; Amy Newfield, Tewksbury, Massachusetts, immediate past president; and members-at-large—Justin Chandler, Matawan, New Jersey; Jess Kerr, Clifton, New Jersey; and Katy Waddell, College Station, Texas

AMERICAN COLLEGE OF VETERINARY ANESTHESIA AND ANALGESIA

Program

Forty abstracts were presented. A review day was held for residents enrolled in ACVAA programs with a focus on respiratory physiology and pathophysiology. Lectures for the review day were presented by Drs. John Dodam, University of Missouri, and Peter Pascoe, University of California-Davis. Also on offer were two days of special-focus lectures, with Drs. Michael Walsh of McMaster University, Michael Seneff of The George Washington University Hospital, Carrie Palm of the University of California-Davis, and Pascoe speaking on perioperative management of the patient with renal insufficiency; Dr. Luis Campoy, Cornell University, lecturing on the use of perioperative maropitant and local anesthetic techniques; and Dr. Manuel Martin-Flores, Cornell University, speaking on recent information on the recovery from neuromuscular blocking agents. The 2019 ACVAA Career Achievement Award was given to Dr. Thomas J. Doherty, Knoxville, Tennessee. A 1974 veterinary graduate of the University College Dublin in Ireland, Dr. Doherty serves as a professor of large animal clinical sciences at the University of Tennessee College of Veterinary Medicine. He is a diplomate of the ACVAA. Drs. Lawrence R. Soma (Pennsylvania ‘57), Glenn Mills, Pennsylvania, and Robert Bruce Heath (Iowa State ‘62), Fort Collins, Colorado, received the 2019 President's Award for Meritorious Service. Dr. Soma is an emeritus professor of anesthesia and clinical pharmacology at the University of Pennsylvania School of Veterinary Medicine. He is charter president of the ACVAA. Dr. Heath is professor emeritus at Colorado State University College of Veterinary Medicine & Biomedical Sciences. He is a charter diplomate of the ACVAA.

New diplomates

Eighteen individuals passed the certification examination. They are as follows:

Sarah Bigby, Elanora, Australia

Katherine Bennett, Knoxville, Tennessee

Joana Chagas, Palmerston North, New Zealand

Renata Costa, North Grafton, Massachusetts

Graeme Doodnaught, Sainte Hyacinthe, Quebec

Kimberly Hassen, Raleigh, North Carolina

Teela Jones, Saskatoon, Saskatchewan

Krista Mitchell, Athens, Georgia

Ashley Mitek, Urbana, Illinois

Kirk Munoz, East Lansing, Michigan

Vaidehi Paranjape, Gainesville, Florida

Marco Ruffato, Boca Raton, Florida

Adrianna Sage, Urbana, Illinois

Stefania Scarabelli, Montecalvo Versiggia, Italy

Chia Tseng, Ames, Iowa

Raphaël Vézina-Audette, Philadelphia

Keely Wilson, Stratford-upon-Avon, England

Kathryn Zatroch, Ithaca, New York

Business

Discussions were held on changes to the language of ACVAA bylaw amendments that need to be voted on by the end of 2019. Also discussed were updates on requirements for maintenance of certification and the North American Veterinary Anesthesia Society. Nominees for the 2020 Region 1 and at-large board of director positions were announced, with additional nominations welcomed.

Officials

Drs. Christine Egger, Knoxville, Tennessee, president; Colin Dunlop, Gladesville, Australia, president-elect; Lynne Kushner, Portsmouth, Rhode Island, executive secretary; and Lesley Smith, Madison, Wisconsin, immediate past president

ACADEMY OF VETERINARY TECHNICIANS IN ANESTHESIA AND ANALGESIA

Program

The academy celebrated its 20th anniversary at the symposium and conducted its certification examination.

Business

The academy met with the ACVAA and discussed issues facing both organizations. Katy Waddell, the president of the academy, outlined short- and long-term goals for the AVTAA.

Officials

Katy Waddell, College Station, Texas, president; Jennifer Sager, Gainesville, Florida, president-elect; Lynette DeGouff, Cortland, New York, treasurer; Darci Palmer, Auburn, Alabama, executive secretary; Brenda Feller, Fort Myers, Florida, immediate past president; and members-at-large—Jody Nugent-Deal, Davis, California; Brynn Schmidt, Los Angeles; and Amanda Shelby, Avon, Indiana

VETERINARY EMERGENCY AND CRITICAL CARE FOUNDATION

Program

The foundation partnered with the Society for the Prevention of Cruelty to Animals/Humane Society of Prince George's County to provide preventive services and basic medical care for 150 pets in an underserved community. It also hosted its sixth annual K9 ER Care and CPR Course. More than 30 first responders attended the all-day course, which included hands-on instruction and lectures on anatomy, wound management, CPR in the field, exposure to toxins, and common traumas. The foundation raised more than $25,000, some of which was donated to the Prince George's SPCA and a portion of which will be directed toward the Dougie Fund for Disaster Relief, to help veterinary practices and animal caregivers impacted by natural disasters.

Officials

Alyce D'Amato, Appleton, Wisconsin, president; Dr. Deborah Silverstein, Philadelphia, secretary; Dr. Robert Messenger, Charlotte, North Carolina, treasurer; Dr. Bill Smith, Seale, Alabama, immediate past president; and board members—Dr. Susan Barnes, Leesburg, Virginia; Chris Kotnaur, Crystal Lake, Illinois; Dr. Lorna Lanman, Sun City West, Arizona; and Deanne Pawlisch, Schaumburg, Illinois