California vet industry leader lashes AVMA for “fearmongering” and ‘protectionist’ positions on telehealth legislation
Telehealth legislation in California sparks key policy debate over how to define “VCPR” (veterinary-client-patient-relationship)
California Assembly bill 1399, a measure that would allow veterinary telemedicine in the state without an established veterinarian-client-patient-relationship (VCPR), has passed another legislative hurdle. On July 10, the State Senate Business, Professions and Economic Development Committee approved the bill by a 11-0 vote, with two members abstaining, absent, or not voting.
Ahead of the July 10 committee hearing, the Veterinary Medical Board and the CA Veterinary Medical Association spearheaded a key amendment to the bill. The amendment prohibits veterinary professionals in California from prescribing controlled substances through telemedicine or “virtual” appointments. The barred substances include xylazine, which is currently not a controlled substance, but has recently been used in street drug “tranq,” causing fatal overdoses when mixed with opiates such as fentanyl.
Interest groups largely supportive of veterinary telemedicine include the ASPCA, the San Diego Humane Society, and Social Compassion in Legislation, which championed more language about access to care for those with disabilities and how information about care is provided. A representative from the California Foundation of Independent Living Centers, a disability rights organization, was at the hearing in support of the bill.
“In California, you are not allowed to use vet telehealth to treat your animal, and we know that in California we have huge access issues,” said Assemblymember Laura Friedman. “We have been working very closely…with the veterinary industry to address their concerns. I want to be very clear that the bill is being co-sponsored by the ASPCA and by the Humane Society, not by the industry.”
Supporters of the bill also include disability rights advocates, who believe telemedicine to be a boon to access of care, and for veterinarians overloaded with in-office appointments who would like the option of seeing patients electronically without having to exam them in-office initially.
AB1399 would require vets to be licensed in California, and referring a patient to a local or nearby vet would be part of a telehealth appointment, if need be.
“The bill would require a veterinarian who practices veterinary medicine via telehealth, among other things, to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient…be able to refer the client to a nearby veterinarian provide the client with a list of nearby veterinarians who may be able to see the patient in person upon the request of the client, keep, maintain, and make a patient record summary available, provide the client with information about the veterinarian,” says the text of the bill.
Assemblymember Friedman, a Democrat representing the 44th district in Los Angeles, co-authored the bill, with Assemblymember Josh Lowenthal, a Democrat, representing the 69th district, in Long Beach. Friedman was present at the committee hearing to introduce the bill.
“If you have a baby whose got a rash, these days you can actually ask for a telehealth appointment, put your baby up to the screen and show it to the doctor, who will then tell you ‘Hey, you should bring junior in,’ or ‘Hey, all you need to do is put a little diaper cream on that,’” Friedman explained to the committee. “But, except for during COVID, we don’t allow the same practice for animals.” she said as she introduced the legislation to the committee.
The AVMA, the vet industry’s main lobbying arm, opposes the bill
Although the leaders of the vet industry’s main trade group, the AVMA, declined detailed requests to speak, Most opposition to AB1399, and bills in other states that would create a legal framework for veterinary professionals to practice telemedicine by broadening the definition of the VCPR centers around the vet industry’s main lobbying arm and trade association, the American Veterinary Medical Association (AVMA). In California, the state affiliate is the California Veterinary Medical Association (CVMA).
Dr. Keith Rode, the President of the CVMA attended the hearing, as one of the lead opposition speakers. “As the CVMA has been cautioning for weeks,” he argued “if this were just a bill about brick-and-mortar veterinary offices engaging with clients via telemedicine CVMA’s position would be different. Instead, this is a bill being driven by out-of-state telemedicine app companies like Dutch and Chewy who have been trying similar legislation in other states.”
“There can be no doubt that these app companies are looking to take business away from hard working veterinarians in your district,” Dr. Rode added. “We question if they care more about animals or profit margins and boosting subscription memberships.”
“This is something that would access more care, not less,” Friedman told the committee members before Dr. Rode spoke. “We know it is safe because it’s been done in several other states, and there have been no reports of harm because of this practice.”
Jessica Sieferman, of the California Veterinary Medical Board also spoke in opposition to bill:
“The hands-on examination is critical to diagnosing conditions in animal patients because they cannot speak and do not exhibit pain like humans,” she said.
At an annual veterinary conference in Denver on July 13, the AVMA’s president Dr. Lori Teller, who did not respond to multiple requests for comment for this story, addressed her colleagues, stressing the importance of the Veterinary Client Patient Relationship (VCPR). “Some people say some care is better than no care, but that’s not true if you have the wrong diagnosis and the wrong treatment plan,” she said. “Frankly, the ‘some care’ that most animals need is vaccinations and other tailored preventive care that cannot be delivered by telemedicine. Furthermore, animals—be they pets or otherwise—with gaps in seeing a veterinarian are more likely to have acute and complex problems that the ability to create an electronic VCPR isn’t going to solve.”
Wide Swath of Californians Bring Different Perspectives in Support
Brittany Benesi, the Senior Legislative Director for the Western Division of the ASPCA, a co-sponsor of the bill, told the committee, “Every year thousands of animals needlessly suffer experience pre-mature death or are relinquished to our shelters due to the existing gaps in veterinary care access….AB1399 will offer a lifeline to these often-overlooked pets and their families. The ASPCA recently released survey data, where two out of three respondents who had trouble accessing vet care in the last two years said that their pet would see a vet more often if telehealth were available,” Dr. Christie Long, Head of Veterinary Medicine at Modern Animal, a brick-and-mortar operation with clinics in California and Texas, also supported the bill, telling the committee, “I started Modern Animal because of the difficulties of accessing and of providing quality veterinary care. My field has not kept pace with the growth in pet ownership, and we are under tremendous strain as a workforce to ensure access to care.”
“Even if I examine a patient tomorrow and a new problem crops up on Wednesday,” Dr. Long added “I will have to see that patient and its owner in person again in order to render a diagnosis and prescribe treatment regardless of my medical judgement,” she added. “California regulations are preventing me and my doctors from helping the patients we know and the ones we don’t yet know.”
Several supporters called in to the hearing and identified themselves as veterinarians practicing in California.
One caller identifying himself as Dr. Brian Evans, a DVM in San Diego, expressed strong support of telemedicine in California.
“We are really not providing what our veterinarians are actually capable of doing,” said Dr. Evans in an interview with The Canine Review. Along with providing care at a brick-and-mortar clinic, Dr. Evans is currently the Medical Director of online vet care company Dutch and has been advising in telemedicine since 2014.
He told The Canine Review that Dutch is practicing telemedicine—making specific preliminary diagnoses and prescribing medications—in 30 states, but California is currently not one of them.
According to Dr. Evans, under current California law, Dutch operates more as an advice center and can work with pets giving general recommendations, not specific to a particular patient.
“You’re basically a personalized Google search,” he said. Currently, vets practicing telehealth for companies such as Dutch cannot prescribe medications, even over-the-counter drugs for specific ailments. “You say, ‘In general, dogs who are experiencing diarrhea may have parasites, or it may be something they ate.’ You talk in very broad terms,” he explained.
Dr. Evans also brought a perspective not often discussed— some veterinarians may prefer telehealth to in-person appointments. “There are a lot of veterinarians that cannot work in primary brick and mortar hospitals because it’s a very physical job,” he said. “People have bad backs, people are going through chemotherapy, people have small children at home. They need flexibility in their day to not show up in an office for scheduled appointments.”
“These organizations are stonewalling progress and innovation, and don’t have an answer to how we address veterinarian shortage [and] access to care issues,” he said.
The AVMA’s chief veterinary officer Dr. Gail Golab did not respond to detailed requests seeking comment, nor did outgoing AVMA President Dr. Lori Teller, when asked about CVMA member Dr. Brian Evans’ characterization of the AVMA’s position on telemedicine as “protectionist” and “fearmongering.”
The bill now heads to the senate Appropriations Committee, before continuing to a senate floor vote and then, assuming it clears these remaining hurdles, on to Governor Gavin Newsom for his signature. The California senate is on summer recess until August 14, and a date has not yet been scheduled for Appropriations to review the bill.
Related:
Trupanion’s Deal With The Chewy “Devil”: Veterinary Medicine’s Savior Or Insurance Industry Sellout?