COVID-19 RESOURCES

Updated 3/26/2020

Quick Links to COVID-19 Resources:

AVMA COVID-19 webpage
AVMA Webinar: “COVID-19: What Veterinarians Need to Know”
Infection Control in Veterinary Practices
Utilizing Telemedicine
Conserving Mask and Gown Resources
Hawaii State Updates on COVID-19

US Government Resources:

Coronavirus Response Business Toolkit
Disaster Assistance Loans from the SBA
Disaster Help Desk for Small Businesses

Join the Discussion

https://www.facebook.com/groups/808COVIDvets/

COVID-19 Vet Resource Survey

Please help Hawaii better understand our veterinary resources (PPE, ventilator equipment, staff) by filling out our survey.

Essential vs. Non-Essential Services

HVMA and AVMA are working to educate our state and local governments on the essential services that veterinarians provide. We strongly discourage veterinarians from offering non-essential services during this period as this undermines our efforts. Continuing to offer or promote non-essential services during this period of government-mandated social distancing increases the risk of virus transmission to our staff, our clients, and our communities at large. Additionally, continuing to perform non-essential procedures and surgeries uses up limited resources that are in short supply and may be necessary for essential procedures and surgeries in the near future. Please consider the serious consequences of continuing practice as usual in the face of the rapid and undetected spread of COVID-19. Below are several guidelines to help you determine which services are essential.

Update on Telemedicine

FDA announced today that they are taking steps to temporarily suspend enforcement of certain federal VCPR requirements as it relates to allowing veterinary telemedicine during this period of social distancing. This change only affects regulations regarding extralabel drug use in animals and veterinary feed directives. Read press announcement here.

Please consider using telemedicine as a way to continue to help your clients/patients and generate revenue, but minimize the spreading of COVID-19 during this critical time. The State of Hawaii Board of Veterinary Medicine follows the policies and guidelines of the AVMA. AVMA has laid out specific guidance on Telemedicine.

Many questions are arising on establishing a VCPR, and the limits on legal telemedicine practice. Here are some highlights from AVMA:

  • “A Veterinarian-Client-Patient Relationship cannot be established solely by telephonic or other electronic means.”
  • “Veterinary telemedicine should only be conducted within an existing VCPR. An exception may be made for advice given in an emergency situation until a patient can be seen by a veterinarian.”
  • “Without an established VCPR – The veterinarian may provide general advice but must specifically stay clear of diagnosing, prognosing, or treating patients. Advice should not be specific to an individual animal, diagnosis or treatment. Non-client electronic communications should be in the non-clinical realms of general advice, mHealth, web content, and other generalized messaging.”

Both TeleAdvice and TeleTriage are legal without establishment of a VCPR:

TeleAdvice
is “the provision of any health information, opinion, guidance or recommendation concerning prudent future actions that are not specific to a particular patient’s health, illness or injury, and that is not intended to diagnose, prognose, treat, correct, change, alleviate, or prevent animal disease, illness, pain, deformity, defect, injury, or other physical, dental, or mental conditions.”

TeleTriage is “the safe, appropriate, and timely assessment and management (immediate referral to a veterinarian or not) of animal patients via electronic consultation with their owners. The assessor determines urgency and the need for immediate referral to a veterinarian, based on the owner’s  (or responsible party’s) report of history and clinical signs, sometimes supplemented by visual (e.g., photographs, video) information. A diagnosis is not rendered.”

We are currently awaiting guidance from the state on whether veterinary clinics in Hawaii will be allowed to establish a VCPR electronically during the emergency response to the COVID-19 outbreak.

Statewide Stay-At-Home Order 3/25 – 4/30

Effective March 25 through April 30, 2020, everyone in the State of Hawai‘i is required to stay at home or in their place of residence. This supplement to Governor David Ige’s emergency proclamation was announced on March 23, 2020. Read more here.

Under the proclamation, individuals may leave their home or place of residence only for essential activities, to engage in essential businesses and operations, and only if their work cannot be conducted through remote technology from home.

Veterinarians are currently considered essential businesses. Please continue to refrain from offering non-essential services during this period so we can maintain this status. Offering or promoting non-essential services uses up limited resources that are in short supply and may be necessary for essential procedures and surgeries in the near future. Additionally, encouraging clients to come into public spaces during this period of government-mandated social distancing increases the risk of virus transmission to our staff, clients, and communities at large.

Self-Quarantine for Travelers Arriving After 3/26

Effective, Thursday, March 26, 2020, all persons entering the State of Hawai‘i must self-quarantine for 14 days or for the duration of their stay in Hawai‘i, whichever is shorter. Residents returning to Hawaii must also self-quarantine in a designated location in their residence. If you are assisting with pet travel into the state of Hawaii, please notify pet owners of the self-quarantine requirement.

The Rabies Quarantine Station in Halawa Valley is currently closed to visitors. Pets may be released from quarantine as soon as the mandatory quarantine period is completed.
Details on self-quarantine procedures (pdf)

State and Federal Tax Relief

Internal Revenue Service (IRS) and State of Hawaii Department of Taxation have postponed the due dates for payment and filing of 2019 Federal and State income tax returns to July 2020. Additional action is not needed by Income taxpayers to participate in this tax relief program.
IRS Website
State of Hawaii Department of Taxation Website
State of Hawaii Department of Taxation Announcement 2020-01 (pdf)

Am I Doing the Right Thing?

During this time of undetected spread of COVID-19, please protect your staff, your clients, and your community. If you or one of your staff becomes ill or is known to be exposed to COVID-19, in addition to concerns about your and their wellbeing, there is the possibility that you will be asked by public health officials to temporarily close your practice for personnel isolation and facility cleaning.

With this risk in mind, veterinarians should work to reschedule all nonessential appointments so as to limit public exposure. This includes wellness visits for vaccinations, spay/neuter procedures, routine dental procedures, and anything that can be safely delayed for a few weeks to months.

Veterinary staff members who have symptoms of acute respiratory illness should stay at home and should not return to work until they are free of fever (fever is defined as a temperature of 100.4F or higher, using an oral thermometer), signs of a fever, and any other symptoms for at least 24 hours without the use of fever-reducing or other symptom-altering medicine (e.g., cough suppressants).

In addition, veterinary clinics should be aware that the limit on statewide gatherings of 10 people applies to activity in their clinics.

Telemedicine and emergency teletriage within the context of an existing VCPR can be extremely helpful in limiting your staff’s exposure, and enable you to support and monitor the health of your patients and conform to local requirements, while preventing the potential spread of COVID-19. Conducting pre-visit triage can help protect you and your staff as you prioritize and determine which patients need to be seen at the clinic.

Please do the right thing to limit the spread of this disease in our community.

COVID-19 and Pets

  • Infectious disease experts and multiple international and domestic human and animal health organizations agree there is no evidence at this point to indicate that pets become ill with COVID-19 or that they spread it to other animals, including people.
  • If you are not ill with COVID-19, you can interact with your pet as you normally would, including walking, feeding, and playing. You should continue to practice good hygiene during those interactions (e.g., wash hands before and after interacting with your pet; ensure your pet is kept well-groomed; regularly clean your pet’s food and water bowls, bedding material, and toys).
  • Out of an abundance of caution, it is recommended that those ill with COVID-19 limit contact with animals until more information is known about the virus. Have another member of your household take care of walking, feeding, and playing with your pet. If you have a service animal or you must care for your pet, then wear a facemask; don’t share food, kiss, or hug them; and wash your hands before and after any contact with them.

Managing Veterinary Practice in a Pandemic:

Multiple universities and practices have implemented the following practices to protect the health of their employees, clients, and surrounding communities:

  • Limit patient care to acutely ill animals and/or emergencies. Animals that are sick or injured should receive veterinary attention.
  • Reschedule existing new and recheck appointments that are considered non-essential (unlikely to experience significant harm if treatment is not administered in a timely manner).
  • Reschedule elective procedures.
  • Utilize telemedicine to assess patient condition and needs.
  • If an animal needs to be seen in person, a healthy family member or friend should bring their sick animal to a veterinary hospital or clinic.
  • Have clients drop off their animal and remain in their cars during appointments.
  • When meeting clients, veterinary team members should wear appropriate PPE.
  • In light of limited supply, be strategic in the use of personal protective equipment (PPE), including masks, gowns, and gloves.
  • If a mobile or house call veterinarian must examine an animal in a home where someone is ill with COVID-19 and no other options are available, consult with local public health officials for guidance. Appropriate PPE and access to handwashing and disinfection materials should be considered in all cases.

Keeping Your Veterinary Team Healthy:

  • Veterinary healthcare team members who have symptoms of acute respiratory illness should stay at home and should not return to work until they are free of fever (100.4F or higher, using an oral thermometer) and any other symptoms for at least 24 hours without the use of fever-reducing or other symptom-altering medicine (e.g., cough suppressants).
  • Communicate about COVID-19 with your team. Flexible sick leave policies are important and team members should be made aware of these policies. Team members who appear to have symptoms of acute respiratory illness upon arrival at work or who become sick during the day should be separated from other team members and sent home immediately.
  • If a team member is confirmed to have COVID-19, the veterinary practice owner should inform other team members of their possible exposure to COVID-19, but maintain confidentiality as required by law. Team members who are exposed to another employee with confirmed COVID-19 should contact their physician or local health department to determine how best to proceed. 
  • Surfaces in the veterinary clinic/hospital that are touched frequently, such as workstations, keyboards, doorknobs, countertops, and stethoscopes, should be cleaned often and wiped down by employees with disposable wipes between cleanings.
  • Provide no-touch disposal receptacles.
  • Place hand sanitizers in multiple locations, including in exam rooms, offices, and conference rooms to encourage hand hygiene.
  • Team members should avoid close contact (within approximately 6 feet) with other people who are ill.
  • Avoid touching your eyes, nose, and mouth.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Wash your hands often with soap and water for at least 20 seconds, especially after coughing, sneezing, going to the bathroom, and before eating.
  • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol.

Families First Coronavirus Response Act:

On March 18, 2020, the President signed into law the Families First Coronavirus Response Act (H.R. 6201). 

The final bill included some significant policy changes from the original proposals that were intended to address both the impacts on small businesses and individuals. We expect lawmakers to continue to address economic measures for small businesses and individuals through future legislative packages.

Lawmakers and the Administration remain engaged in ongoing negotiations to produce additional measures, and AVMA continues to ensure the concerns of the profession are heard as this dynamic situation unfolds.

The final bill includes:

  1. FMLA COVID-19 benefit – This benefit provides up to 12 weeks of family and medical leave benefits related to the coronavirus to be paid at 2/3 of regular pay rates after the first 10 days, which are unpaid. The leave is only available for child care in the event of school closure or if the employee’s child care provider is unavailable due to the public health emergency.
  2. COVID-19 sick leave – This benefit applies up to 80 hours of additional paid sick leave for employees related to the coronavirus. There are daily and aggregate caps on the sick leave benefit of either $511 per day and $5,110 in the aggregate if the employee is sick or quarantined, and $200 per day and $2,000 in aggregate if the employee is caring for someone else.
  3. Potential exemption – There is language granting authority to the Department of Labor to create regulations that can exempt small businesses with fewer than 50 employees from the leave requirements when the imposition of the requirements would jeopardize the viability of the business as a going concern.
  4. Tax credits – There are tax credits for employers intended to mitigate the impacts of the expanded leave provisions; and
  5. COVID-19 testing – It provides for free testing for the coronavirus during the emergency.

Read more about the bill here.

3/24/2020 – The Department of Labor just released Frequently Asked Questions documents on the Families First Coronavirus Response Act:

1) DOL FAQ
2) DOL Fact Sheet for Employers
3) DOL Fact Sheet for Employees

  • Significantly, the FAQ DOL indicates the effective date for the Families First Coronavirus Response Act is April 1, 2020, and applies to leave taken between April 1, 2020, and December 31, 2020. 
  • For the exemption for business with fewer than 50 employees when providing the leave under the act would jeopardize the viability of the business, DOL advises that for now employers should document why they believe this to be the case.  DOL then indicates that more detail will be forthcoming in regulations.

Legislative Update – Jan 2020

HVMA has introduced HB 2528 and SB 2985 in the 2020 legislative session. These bills modify Hawaii’s veterinary practice act to 1) provide immunity in the absence of gross negligence to veterinarians who provide emergency care to an animal, and 2) clarify that the duty of a veterinarian includes reporting to law enforcement any cases of animal injury or death where there is reasonable cause to believe that it relates to dog fighting or animal abuse, while granting veterinarians immunity from any civil liability for such reporting. These additions to our veterinary practice act would put Hawaii in line with much of the rest of the United States. A big mahalo to Representative Hashem and Senator Baker for sponsoring the introduction of these bills to the legislature. Please thank them, particularly if you are from their districts!

1/28 Update: First round of SUPPORT testimony needed on this measure by Thursday 1/30! Submit online testimony here. Contact us if you have questions or comments on this measure, or if you are able to go down to the capitol and testify in person.

In Remembrance – Patrick Leadbeater

Patrick Leadbeater, DVM

The Hawaiian veterinary community has lost a familiar face and long time veterinarian in November 2019.

Dr. Patrick Leadbeater was born in 1943 in Sussex, England.  He was active in the Boy Scouts and loved the outdoors throughout his life. He graduated from the University of Guelph, Ontario Veterinary College of Veterinary College in 1974.  His first position was working with Dr. Robert Knowles in Miami, Florida. Dr. Knowles was instrumental in shaping Dr. Leadbeater’s practice.

He moved to Honolulu and worked at the the Animal Emergency Clinic which was located near the current Yanagi Sushi on Kapiolani Blvd.  He also worked as a staff veterinarian at the Honolulu Zoo.  In 1983, he opened the Veterinary Center of the Pacific on Koapaka Street near the Honolulu International Airport and continued working part-time at the Zoo.  In 1991, he purchased the Kahala Pet Hospital from Dr. Wayne Steckelberg and continued his veterinary career until late 2019.

Dr. Leadbeater was instrumental in advancing veterinary medical care in Hawaii.   He took on medical and surgical cases that other veterinarians referred to him.  This included  kidney transplants in cats, pacemaker implantation, TPLO, Total Hip Replacement surgery, and portal caval shunt implants, etc.

Submitted by Richard Fujie, DVM

Veterinary Leadership Conference 2020 Report

David Gans, DVM
Hawaii Kai Veterinary Clinic

This year’s Veterinary Leadership Conference (VLC) was a great experience that I would recommend to all veterinarians of any experience or position in Hawaii. The VLC is organized in a way to help “rising leaders, presiding leaders, and experienced leaders” in private practice and professional organizations such as the HVMA.

A big focus on the leadership presentations this year was on personal wellness. A growing concern that the AVMA is trying to address by spreading awareness, providing resources for outreach and management of mental health conditions/concerns, and education in techniques for prevention and risk reduction.

The HVMA’s generous support was a great experience and I would encourage any newer veterinarians to reach out for the 2021 VLC for the opportunity to attend with support. The AVMA and HVMA both are bending over backwards to support our amazing profession and it’s our role to reach out and use all of their resources.

David Gans, DVM

Letter from the President – Jan 2020

Aleisha Swartz, DVM
Aleisha Swartz, DVM
HVMA President

Hau‵oli Makahiki Hou!

Our 66th annual conference was a great success. Thank you to all who attended and those present in spirit. It was a time to catch up with old friends, meet new colleagues and learn in our ever-changing field. The connections with one another are a large part of our “why” as the HVMA and we are fortunate to have such a connected community. If you want to learn more about finding your “why” I highly recommend watching Simon Sinek’s Ted Talk on the subject, or even better, read the book Start with Why. If you have suggestions for future speaker topics, entertainment or anything you think would make the conference even more incredible in the future, please let us know.

Membership renewal is now open and I encourage you to renew early and encourage your colleagues to do so as well. Don’t forget that new graduates are eligible for waived or reduced fees depending on your graduation year! Your dues enable us to host great CE in addition to our other efforts including providing scholarships for veterinary and veterinary technician students, advocate on behalf of the veterinary profession in Hawaii, and give back to our community.

Some of the activities we are working on this winter are monitoring the state legislative session, participating in the AVMA HOD January meeting, judging at the upcoming 63rd Hawaii State Science and Engineering Fair (HSSEF), and reviewing our wellness committee functions. If you are interested in participating in any of these functions, please let us know as we can always use more volunteers!

On behalf of the board I wish you good health and well-being in the upcoming decade and I hope to hear more from you on what we can do to support you as a Hawaii veterinarian.

Aloha,
Aleisha Swartz

Meet a Member – Jennifer Ruby

Jennifer Ruby, DVM, DACVR

Dr. Jennifer Ruby is from the Hudson Valley, NY and pursued her veterinary education at Cornell University. She completed a rotating internship in medicine and surgery at Red Bank Veterinary Hospital in Red Bank, NJ, followed by a second internship in diagnostic imaging at the Veterinary Imaging Center of San Diego. In 2016, Dr. Ruby went on to complete a three year residency in diagnostic imaging at the University of Georgia, where she developed a strong interest in abdominal ultrasonography and neuroimaging in companion animals, and advanced imaging in exotic pets. One project that Dr. Ruby enjoyed completing during her residency was a study evaluating the brain of koi fish using magnetic resonance imaging. She became board certified in Diagnostic Imaging in September 2019 and joined Oahu Veterinary Radiology.

Dr. Ruby is excited to provide high quality diagnostic imaging services to the islands. She looks forward to reading CT and MRI cases, as well as providing radiograph interpretation and mobile ultrasound services to the local community. In her spare time, Dr. Ruby enjoys developing her burgeoning fruit garden, baking, hiking, scuba diving and traveling, as well as spending time with her two cats, Fergie and Muffin.

Letter from the President – Oct 2019

Aleisha Swartz, DVM

Dear Friends,

I hope to see each of you soon at our annual conference at the Hilton Waikiki Beach on November 7-10, 2019. We are fortunate to host AVMA President John Howe and District 10 representative George Bishop at the conference this year. Dr. Howe’s areas of focus for his tenure as president are member needs, veterinary technicians and One Health. Please give them a warm welcome if you see them. Even if you are not attending the conference for CE be sure to join us for our annual meeting at noon on Saturday.

Mental health and wellbeing concerns for veterinary professionals have been in the national news recently. Awareness of the increased risk for burnout, substance abuse, depression and suicide ideation in our profession is hopefully a first step toward finding solutions for this crisis. The AVMA has many resources for veterinarians on personal and workplace wellness, and the HVMA has a wellness committee to assist members in need. 

In 1976, Dr. Bill Hettler, co-founder of the National Wellness Institute in the US, developed a model of wellness that included six dimensions of health: physical, emotional, intellectual, spiritual, occupational, and social. Since then others have added three more to create the nine dimensions of wellbeing: financial, creative and environmental. Each dimension is interconnected and collectively contributes to our overall wellbeing, and when one area is lacking, the others and overall wellbeing are affected. I encourage you to follow the links to read and learn more about these areas and take a self-assessment to identify areas where you might focus your self-care.

For this message I want to focus on the social dimension. One stated purpose of the HVMA is to promote the spirit of community among members of the veterinary profession. Our annual conference is a time to get together and catch up on what is happening with one another: the success and challenges of our friends and colleagues we may not see as often as we would like to. It is also a chance to make new friends and welcome new colleagues into our community. Brené Brown, best-selling author and published researcher writes the following in the introduction to her book Daring Greatly: “the surest thing I took away from my BSW, MSW, and Ph.D. in social work is this: Connection is why we’re here. We are hardwired to connect with others, it’s what gives purpose and meaning to our lives, and without it there is suffering.” This includes connection with colleagues in the workplace. In Dare to Lead she says this about her research: “Daring Leaders must care for and be connected to the people they lead. The data made clear that care and connection are irreducible requirements for wholehearted, productive relationships between leaders and team members.” She defines a leader as “anyone who takes responsibility for finding the potential in people and processes, and who has the courage to develop that potential.” As veterinarians, we are all leaders and we must strive to build connection in our work and social lives to build resiliency.

I hope you can all take a moment during the next month to talk story and build those connections with one another. By doing this we will be taking a step in the right direction to improve our well-being. Please reach out to a colleague, friend, or professional if you are suffering. We are here to help one another. And if you are interested in learning more so that you can help those at risk, visit the AVMA’s website on Question-Persuade-Refer (QPR) training. There is currently a pilot program that will provide training to learn how to identify and refer colleagues who are at risk.

Aloha,

Aleisha Swartz, DVM
President, Hawaii Veterinary Medical Association

Cannabis Info from AVMA

AVMA submitted comments to the FDA regarding critical veterinary issues related to cannabis products, and the importance of addressing them. The AVMA submitted the comments following a public hearing held by the agency in late spring to gather stakeholder input while considering regulatory frameworks for hemp derivatives—including CBD—used for therapeutic purposes and as food additives.

“Veterinarians have a strong interest in, and enthusiastically support, exploring the therapeutic potential of cannabis-derived and cannabis-related products,” according to the AVMA comments. “But we want to be sure we can have continued confidence in the efficacy, quality, and safety of products used to treat our patients.”

The AVMA’s concerns stem largely from the widespread marketing of cannabis-derived products, including hemp products, with health claims that haven’t received the required FDA evaluation and approval. “The FDA should establish a clear and efficient process for approval of cannabis-derived and -related therapeutic products, and then conduct consistent enforcement against manufacturers and distributors who are noncompliant,” the AVMA said in their comments. Read full AVMA article here.

In addition to advocating for practitioners, the AVMA provides several resources regarding cannabis:

AVMA Report Summer 2019

Aloha HVMA Colleagues and Happy Summer!

We are preparing for the American Veterinary Medical Association (AVMA) Summer Session for the House of Delegates which will begin prior to the AVMA Convention – “A Monumental Experience.”

Here are the highlights for our session beginning on Thursday August 1, 2019 in Washington DC:

2019 D.C. Hill Visits: Because we are in DC, we are planning on visiting our legislators to discuss the issues that are important to the AVMA and the veterinary profession. With over 200 individual meetings, this will be the largest veterinary event on Capitol Hill ever conducted by the AVMA!

We are scheduled to meet with Hawaii’s Members of Congress or their staff – Senators Mazie Hirono and Brian Schatz; Representatives Ed Case and Tulsi Gabbard. We will be focusing on three issues for the visits: Veterinary Medicine Loan Repayment Enhancement Act (VMLRPEA); Fairness to Pet Owners Act (FTPOA) and Association Health Plans Act (AHP).

Resolutions to be discussed and voted by the House of Delegates:
a) Model Veterinary Practice Act: The AVMA adopt the revised policy Model Veterinary Practice Act
b) Revised Policy on Judicious Therapeutic Use of Antimicrobials
c) Revised joint AABP-AVMA Policy on Judicious Therapeutic Use of Antimicrobials in Cattle
d) Sexual Harassment Awareness
e) Revised Policy on Pet Heath Insurance
f) Revised Policy on Veterinary Dentistry

Proposed Bylaws Amendment:
a) Council on Research – Responsibility
b) Board of Directors – Qualifications
c) Board of Directors – Composition

AVMA Elections:
There are multiple positions that will be voted on by the House of Delegates:
a) President-Elect
b) House Advisory Committee
c) 6 Council Positions

Congratulations to Carolyn Naun who will be a speaker at this year’s AVMA Convention!

If you need to contact us with comments about the topics we mentioned, here is our email: AVMA_Delegate_HI@avma.org

Aloha!
Leianne K. Lee Loy
Hawaii Delegate

Carolyn Naun
Hawaii Alternate Delegate

Letter from the President – Aug 2019

Aleisha Swartz, DVM

Dear Colleagues,

Registration is now open for our 66th Annual Conference, which will be held November 7-10, 2019 at the Hilton Waikiki Beach Hotel. We are again offering RACE-approved CE with a great speaker and subject lineup including, dentistry, infectious disease, internal medicine, soft tissue surgery and more. We will also be offering a daylong equine track on Friday Nov 8th for the large animal practitioners. Register early and save.

The annual meeting for HVMA members will be Saturday, November 9 and all members are welcome and encouraged to join us even if you cannot attend the entire meeting. And this year’s cocktail hour and social on Saturday evening will be another great time for all, don’t miss it.

Another thing the HVMA board has been involved with is updating our agreement with Hi-EMA to provide support to those in need in the event of a natural disaster or other emergency. Did you know we participate at the state level as advisors on animal-related emergency sheltering? If you are interested in being involved with disaster assistance and planning, please fill out a quick survey or email us. Even if you are not able to volunteer, prepare yourself, your family and practice in case of a natural disaster. The AVMA has a disaster resource page with many great resources https://www.avma.org/KB/Resources/Reference/disaster/Pages/disaster-aid-veterinarians.aspx.

Finally, be sure to visit our classifieds if you are looking to advertise your services as a relief veterinarian or are in need of a veterinarian or other staff member. This is a fantastic resource available for members!

Aloha,

Aleisha Swartz, DVM
President, Hawaii Veterinary Medical Association