HB 156 allowing veterinarians to work at nonprofit facilities never reaches final vote; issues between clinics and ASBVME may be far from over.
Alabama House Bill 156, known in the state as the "spay-neuter bill," passed both houses of the state legislature. It survived amendment in conference committee. Then? Nothing. The bill that created more noise than a crowded animal shelter fell silent.
"It passed both houses, but the speaker wouldn't bring it out of the basket," says Rep. Patricia Todd, D-Birmingham, the bill's sponsor. What this means is that at his discretion, Speaker of the House Mike Hubbard, D-Auburn, did not present HB 156 to the legislature for a final vote before the 2012 regular session ended May 16. The bill that would have allowed veterinarians to be employed by nonveterinarians in Alabama's nonprofit spay-neuter facilities was dead in the water.
The bill, as approved by the conference committee, would have allowed those facilities owned by non-veterinarians to provide spay-neuter surgeries, along with limited vaccinations and leukemia and heartworm disease testing at the time of surgery. This would require a licensed veterinarian to supervise veterinary medical practice at these locations, provided the facility had obtained an approved premises permit from the Alabama State Board of Veterinary Medical Examiners (ASBVME).
The ASBVME made no secret of the fact that it was opposed to the bill. President Robert Pitman, DVM, and Vice President William Ronald Welch, DVM, both issued letters to members concerning their stance. Pitman's letter argued that enough licensed Alabama veterinarians provided affordable spay-neuter services and there was no need for low-cost spay-neuter clinics. (For purposes of comparison, it costs $228 to have a 15-pound female dog spayed at Welch Veterinary Clinic in Wetumpka, Ala., which is owned by the ASBVME vice president. Clients are charged $70 for the same service at the Alabama Animal Alliance Spay/Neuter Clinic, which is 20 miles away in Montgomery, Ala.).
Pitman's letter warned that under the proposed law any nonprofit organization, including "rescue groups, volunteer fire departments, wild turkey federations, bingo clubs, etc.," could own a veterinary practice. Both board members questioned the nonprofit facilities' ability to meet acceptable standards of care.
A request for comment from the ASBVME prompted an email response from Tammy Wallace, executive director of the ASBVME, July 10, alluding to problems between the clinics and the board as being far from over. "We are not in a position to respond on pending litigation at this point," Wallace wrote. Without official comment from the board, DVM Newsmagazine couldn't confirm at press time whether the regulatory board is planning to take legal action against the clinics.
When reached for comment, Welch said he could not provide a statement concerning HB 156. Pitman said the same, although he did pose this question: "If they [the clinics] were not operating illegally, why have they tried so hard to change our practice act?"
The ASBVME is responsible for licensing and inspecting nonprofit spay-neuter clinics in Alabama and has the authority to close them if legal statutes and standards of care are not met. In June 2011, the board served the Alabama Spay Neuter Clinic in Birmingham, Ala., with a cease-and-desist order, stating that the clinic was in violation of the Alabama Veterinary Practice Act requirement that a veterinarian own the clinic. The North Alabama Spay Neuter clinic in Huntsville, Ala., was denied its permit and closed from March 2011 through Jan. 1, 2012, during ownership turnover, according to clinic board member Jane Jatusso. She said Pitman refused to inspect the facility without a contract proving veterinary ownership. Pitman would not comment on the incident. The clinic was eventually purchased by Joy A. Baird, DVM, inspected and reopened in January.
In his letter to the ASBVME, Welch said, "By providing an environment of non-veterinarian supervision and non-veterinarian management of the entire veterinary facility, as evidenced in our investigations, the standard of care has been greatly compromised thus lending less protection to the public."
And yet, at the time of publication, all four of the state's nonprofit clinics, including the Alabama Animal Alliance Spay/Neuter Clinic in Montgomery, Ala., and the Wiregrass Spay/Neuter Alliance in Dothan, Ala., are open and continue to operate under the jurisdiction of the ASBVME.
The actions of the ASBVME, the temporary closing of the Huntsville clinic and the resulting public outcry from spay-neuter advocates throughout the state prompted the introduction of HB 156 earlier this year. Although the cease-and-desist order and the closure of the North Alabama Spay Neuter clinic were executed under the Veterinary Practice Act's veterinary ownership provisions, the ASBVME opposition to HB 156 has focused on quality of care. Welch did say he believes one cannot exist without the other.
"We're there to protect the public. We protect the public by regulating the profession," Welch said of the board's purpose. "Ownership ensures that the public knows that [a clinic's] veterinarian is regulated."
Mark Nelson, executive director of the Alabama Spay Neuter Clinic, maintains that the clinic practice was and is owned by William B. Weber, DVM. The 501(c)(3) owns the building. Nelson told DVM Newsmagazine that while he does not want to seem confrontational toward the ASBVME or opponents of HB 156, "I will defend our quality of care." He dismisses the notion that the care provided at Alabama's spay-neuter clinics is subpar. "We had a surprise inspection in 2011," Nelson says. "The inspector was very professional. He did a very good job."
Nelson says the Alabama Spay Neuter Clinic received a positive review: "The facility was in excellent shape." One of the few things the inspector requested was that the clinic post an Occupational Safety and Health Administration plan in the break room. "Quality of care—[this opposition] is not about quality of care—believe me," Nelson says.
Supporters of HB 156 allege that the bill didn't make it through the Alabama state legislature due to fears concerning money and politics. "I personally feel that it's the fear of the veterinary clinics that they're losing customers—that would of course decrease revenue," says Jacqueline Meyer, executive director of the Greater Birmingham Humane Society.
In supporting this view, some point to contracts held by ABSVME President Pitman totaling close to $300,000 a year to perform animal adoption, humane care— including spay and neuter surgeries— and humane euthanasia of animals for the city of Athens and Limestone County, Ala., animal control departments. Last year Pitman asked the county commissioners to increase his compensation for services. The county commission upped the county contract of $100,400 for fiscal year 2010-2011 to $215,895 for 2011-2012. In addition, his contract with the city for 2010-2011 was $66,400. His practice, Limestone Veterinary Clinic, and his shelter, The Dog Pound, both in Athens, are about 25 miles from the North Alabama Spay Neuter Clinic.
Despite rumors to the contrary, Jatusso, treasurer for the North clinic, said the clinic never made a bid for the contract. Pitman said the contracts have nothing to do with HB 156. Yet those at the clinics are proud to take credit for the decreasing intake numbers in the shelters around them.
"The shelter intake is reduced 10 percent to 20 percent, depending on the shelter," Nelson says. The Alabama Spay Neuter Clinic executive director believes he can see an identifiable difference within a 60-mile radius of a low-cost spay-neuter clinic.
According to Limestone County Animal Control (and not counting animals dropped directly at The Dog Pound), the department picked up 946 dogs and 569 cats in 2009. The number dropped to 740 dogs and 399 cats in 2010, the year the North clinic opened. The numbers picked up again in 2011, with 873 dogs and 363 cats. The clinic was closed for nine months during that year.
Jatusso says the clinic is not in competition for business with Pitman. "We're not in competition with anyone," Jatusso says. "Some of the vets see us as competition."
Meyer, of the Greater Birmingham Humane Society, doesn't believe that Alabama veterinarians as a whole oppose the bill. "The problem here is the Alabama State Veterinarians Medical Examiners Board. And the only people who can change that board are the veterinarians," she says.
Nelson agrees, and noted that most veterinarians have been very supportive of Alabama's spay-neuter clinics. "By and large, the veterinary community appreciates what we're doing here," he says. "We get referrals here on a regular basis."
However, Margaret Ferrell, DVM, who is contracted by Weber to perform spays and neuters at the Alabama Spay Neuter Clinic, feels there are misconceptions about the clinics within the veterinary community. She says it makes her feel extremely awkward—especially when she attends county meetings with her local Veterinary Medical Association—to hear those misconceptions, even accusations.
"I'm a licensed veterinarian. I went to the same college that you went to. I'm a colleague," Ferrell says. "It's very hurtful." She wishes those colleagues would visit her clinic. "Come and see the standard of care we provide. Come and see the protocols we have in place."
The Alabama Veterinary Medical Association (ALVMA) has not taken an official position on the bill, stating that a consensus could not be reached among constituents.
HB 156 sponsor Todd believes that ultimately it was veterinarians in Auburn, Ala.—home of the state's largest veterinary school and the alma mater of ASBVME President Pitman—who killed the bill. The Auburn University College of Veterinary Medicine resides in House District 79, the district served by Speaker of the House Mike Hubbard—the representative who prevented the bill's final vote. Hubbard's communications director, Todd Stacy, confirmed the allegation.
"Speaker Hubbard represents an area that is home to a veterinary school along with many small veterinarian businesses," Stacy said via e-mail to DVM Newsmagazine. "Many were concerned that not enough protections were put in place to ensure spay and neuter clinics would truly be limited from performing vaccinations, heartworm, leukemia/AIDS (FIV) treatments and other procedures outside their appropriate scope of service."
Nelson says the Alabama Spay Neuter Clinic doesn't want to expand its services. "We're not a full-service clinic and don't want to be one," he says. However, he does feel it's important to be able to appropriately vaccinate and treat animals while they are at the clinic. Rabies vaccinations, for example, are required by Alabama law. Plus, he resents what he sees as a double standard by the bill's opponents: on one hand denigrating the clinics' standard of care and on the other wanting to limit their services. "Why would you not want us to vaccinate or test for heartworms?" Nelson says. "That doesn't appear to me to be giving the best quality of care."
Meyer argues that the animals that show up at nonprofit clinics are not animals that will receive regular veterinary care. In the absence of low-cost clinics, she believes, the owners of these pets won't go to veterinary practices—instead, they won't go at all. "You will find these are pets that would never cross the doors of a veterinary practice," she says.
Nelson says that between 100,000 and 200,000 animals are euthanized in Alabama shelters every year. He feels the only solution to the problem is to provide affordable spay-neuter surgeries to control the pet population.
Supporters of HB 156 say they remain hopeful for the next legislative session. "We'll do it again next year and see if we can get any better outcome," Todd says.
Speaker Hubbard's office agrees, with the caveat that further compromises may have to be made in regard to scope of services. "Perhaps next year those concerns can be allayed and an acceptable bill can emerge," Stacy says.
Comments were solicited from the University of Auburn School of Veterinary Medicine and several Auburn area veterinarians, but phone calls were not returned.