Timely Topics

AVMA Update – January 2023

Your AVMA continues to advocate for the profession and animal welfare issues. As always, the House of Delegates met during the 2023 Veterinary Leadership Conference in balmy Chicago. We had a busy agenda and lively discussion. Keep reading to discover important resources available to you, our members, and find out what we made progress on this January!

If you aren’t already a member, consider joining over 100,000 veterinarians and gain access to valuable benefits. Some recent highlights of what AVMA has been doing for YOU:

AVMA has new and updated resources available for reputation management for your practice.

Be an industry leader in diversity, equity, and inclusion. Practices are encouraged to join Journey for Teams, an interactive program to educate and engage your workplace to make it a safer space for all. Get involved at journeyforteams.org

In the next newsletter we’ll take a deeper dive into what your AVMA has to offer. In the meantime, here are the updates from the winter meeting.

Veterinary Information Forum topics:

Every meeting, members of the AVMA House of Delegates meet to discuss some of the most pressing issues facing our profession. AVMA members shared their thoughts on the following topics:

Utilization of credentialed veterinary technicians and the creation of a “mid-level practitioner” role: It is no secret that we are facing serious workforce shortages. What is the best way to reduce burnout and better meet increased demand for our services? This topic generated over 160 pages worth of responses from constituents! While some favor the creation of a “Veterinary Professional Assistant” who could diagnose, prognose, prescribe, recommend treatment plans, and perform minor surgery, most members feel we are still underutilizing the skills of credentialed veterinary technicians and the focus should be there first. Creating a new position within the profession presents some significant challenges including:

The need to develop educational programs to train these individuals. Accredited institutions are already having trouble filling teaching positions for veterinary and veterinary technician programs
The need for changes to be made in federal laws and regulations as well as those in all 50 states

In short, implementing such a solution will be costly and could not be deployed in time to address the immediate workforce shortage.

We also had a lively discussion regarding workplace culture and how to improve quality of life for veterinary team members. A recurring theme was the need for leaders to set an example and demonstrate that it’s OK to ask for help. Practical suggestions included the use of Employee Assistance Programs (larger employers and some state VMAs already offer these as a member benefit) or providing access to free counseling to struggling veterinary professionals. There are many relevant AVMA resources available, including the Workplace Wellbeing Certificate program, the Brave Space Certificate program, the Train the Trainer program and Journey for Teams (diversity, equity, and inclusion training for your workplace). These resources are available to members at avma.org. Watch for more details about these programs in the next newsletter.

AVMA business and policy actions:

Several resolutions came before the House for a vote, touching on a variety of topics ranging from policy on dog bite prevention, service animals, horse racing, responsible breeding, dehorning and castration of cattle. Most were housekeeping and minor updates to existing AVMA policies.

Of interest was a new policy on so-called “bush track racing,” or unregulated horse racing, which presents grave animal welfare and public safety threats. Bush tracks operate with no veterinary oversight. Practices include the use of stimulants, electric shock and other abuses. Bush track operations have been linked to outbreaks of piroplasmosis (via use of contaminated needles to inject performance enhancing drugs) and equine infectious anemia. The HOD passed a resolution condemning unregulated horse racing. This is hopefully a first step in creating pressure to make unlicensed horse racing illegal. You can learn more about this issue at https://www.washingtonpost.com/sports/2022/08/05/bush-track-horse-racing-georgia/

With aloha,
Carolyn Naun, Hawaii Delegate
Jenee Odani, Hawaii Alternate Delegate

One Health Month

Governor Green has declared January 2023 as Hawai’i One Health Month! #OneHealth represents the intersection of human health, animal health, and environmental health, and helps us address complex health problems in Hawaii and beyond. See the proclamation here.

Awareness of the One Health approach helps to inform our decision-making, particularly for policy makers and leaders seeking to comprehensively address current issues such as climate change and emerging infectious diseases like COVID-19 or avian influenza. Thinking about how human health is inextricably related to animal health and environmental health also informs our individual everyday decisions: our food choices, the products we buy, appropriate use of antibiotics or other medications, how we care for the native species and habitats we live near, etc.

SARS-CoV-2, the virus that causes COVID-19, is a recent example of a zoonotic disease that can pass from humans to animals and vice versa, causing illness and death in multiple species. The more humans encroach on wild habitats and interact with non-domesticated animal species, the more opportunities there are for viruses or other infectious organisms to spread and mutate into forms that can cause global pandemics. But zoonotic disease spread is just one example of the interplay between human, animal, and environmental health. Other important examples include how the use of pesticides has decimated bee populations, which in turn decreased pollination, crop yields, and human food supply; or how medication prescribed in human and veterinary medicine can pass through their patients to enter the environment and cause developmental deformities in wildlife and drug-resistant infections; or how lead shot used in hunting has resulted in lead toxicity in scavenging animals such as birds of prey and humans alike.

One Health concepts have been a part of many veterinary curricula and may seem obvious to veterinarians, but many of our colleagues in other health and science disciplines were not trained to think outside of their specific fields. Keep the One Health perspective in mind, and encourage others to do the same!

Conservation Corner: Hawaiian green sea turtles

While there are several species of marine turtles that can be found in Hawai’i , the most common is the honu, or the Hawaiian green sea turtle (Chelonia mydas). Basking, or resting on the beach or at the water surface, is a behavior unique to this species in Hawai’i that is thought to have a thermoregulatory function. The green sea turtles that are found in Hawai’i are currently listed as threatened under the U.S. Endangered Species Act. The good news is that this population is showing some signs of improvement, and nesting is increasing at 3-5% per year. There is a lot that the species still has to contend with in order to be recovered, especially with sea level rise and storms affecting their low-lying nesting grounds: 96% of the population nests at one location, Lalo (French Frigate Shoals) which is located in the Northwestern Hawaiian Islands and part of Papahānaumokuākea Marine National Monument. Other threats to our honu include fisheries interactions, disease, and boat strikes. When turtles and fisheries interact, it is often the line, not the hook, that is most dangerous for the turtle: the line can cause strangulating injuries to the flippers and line ingestion can lead to GI obstruction. Prevention is always best, so if you enjoy fishing, please dispose of your line properly to keep it out of the marine environment and pick up discarded line anytime you see it. NOAA Fisheries’ FAST (Fishing Around Seals and Turtles) guidelines also say that if you accidentally hook a sea turtle, it is okay to reel it in, cut the line as close to the hook as possible, and release the turtle – IF you feel safe doing so.

As veterinarians, you can also help sea turtles by being knowledgeable about what to do if you are contacted or come across wild turtles that are in trouble. First, pause before taking any immediate veterinary action. Dead turtles or those that are entangled, hooked, injured, or appear sick, should be immediately reported to the Hawaiʻi statewide NOAA Marine Wildlife Hotline at (888) 256-9840. Call this number and wait for a return call for further guidance. If you observe illegal activity, such as harassment or illegal fishing/gear, send photos or video (including contact information of the suspected perpetrators) to RespectWildlife@noaa.gov and the Hawaiʻi Department of Land and Natural Resources (the DLNRTip app is a rapid and effective way of filing such reports, or you can contact DLNR at (808) 643-DLNR).

Recover CPR Lab at HVMA

When an arrest happens, are you and your team prepared??

Get certified in RECOVER CPR at the Hawaii Veterinary Medical Association Conference on Thursday November 9, 2023.

Hands on practice of chest compressions and ventilation.

AVMA House of Delegates Report

AVMA House of Delegates (HOD) Summer Session: July 28-29, 2022 Philadelphia

Aloha mai kakou! (Greetings to all of you!) I share with you the topics of discussion during the meeting of the AVMA House of Delegates:

RESOLUTIONS
Resolution 6 – New policy on use of prescription drugs in veterinary medicine.
Resolution 7 – New policy on adverse event reporting
Resolution 8 – Revised policy on genetic modification of animals in agriculture
Resolution 9 – Revised policy on approval and availability of antimicrobials for use in food-producing animals
Resolution 10 – Revised policy on raw milk
All resolutions were passed by the AVMA House of Delegates.

VETERINARY INFORMATION FORUM
HOD’s Veterinary Information Forum was devoted to the topics of:
1) Updates to the AVMA Model Veterinary Practice Act— including updates related to license portability, veterinary technicians, and telehealth.

Ahead of the HOD meeting, most of the comments from AVMA members about updating the AVMA Model Veterinary Practice Act were to support the idea of providing license portability from state to state. Regarding veterinary technicians, Veterinarians are pushing to define the duties of certified veterinary technicians versus noncertified veterinarians in the practice act. Pertaining to telehealth, an emphasis in the model practice act for the requirement of an in-person examination to establish a veterinarian-client-patient relationship before initiating telehealth.

2) The responsibility to provide emergency care

The reference committee that discussed the responsibility to provide emergency care suggested the following points for the Council on Veterinary Service to consider while reviewing the Principles of Veterinary Medical Ethics.
• Define “emergencies.” Is this meant to refer to immediate life-threatening situations and situations in which the animal is in intractable pain and suffering?
• Address payment.
• Add wording regarding whether providing the emergency care is prudent, with considerations to include the following:
◦ The number and skill level of available staff members.
◦ Available equipment.
◦ Working conditions that are safe for veterinary team personnel.
◦ Sufficient knowledge of the species.
◦ Geography or location of the emergency, particularly for large animal or mobile practices.
◦ Whether a veterinarian-client-patient relationship has been established. In other words, is it an established client and patient?
• Clarify that euthanasia is acceptable to prevent intractable pain and suffering even if a client is not identified, for example, an animal brought in by animal control or other government agency.

OFFICER ELECTION RESULTS
Dr. Lori Teller assumed the presidency of the American Veterinary Medical Association (AVMA) with a pledge to strengthen the profession through collaboration and a focus on wellbeing.

AVMA President-elect 2022-2023: Dr. Rena Carlson
AVMA Board Chair 2022-2023: Ronald E. Gill
AVMA Vice President 2022-2024: Jennifer Quammen
House Advisory Committee: Libby Todd (Alabama), Diana Thome
(Washington) and Stuart Brown (AAEP)

Elections for 2023-2024
Three individuals have announced their candidacy for 2023-24 AVMA
president-elect; they will campaign for one year, with the election in Summer 2023:
Sandra Faeh Butler (past AVMA Vice-President)
Arnie Goldman (current AVMA Treasurer)
Bob Murtaugh

JOURNEY FOR TEAMS
The AVMA is co-launching a multiyear educational initiative to help veterinary workplaces become more diverse, equitable, and inclusive. The upcoming Journey for Teams program is under development by the AVMA and the Veterinary Medical Association Executives. Details were provided in an announcement event July 30 at AVMA Convention 2022 in Philadelphia, and program content will be released in stages beginning this fall. There will be webinars and booklets that will help your team with improving diversity in your workplace. All resources can be found at https://www.journeyforteams.org/ .

FDA COMPOUNDING GUIDANCE
FDA finalized and published Guidance for Industry (GFI) #256 which describes the agency’s approach to situations where veterinarians need access to unapproved drugs compounded from bulk drug substances (BDS) to provide appropriate care for the medical needs of the diverse species they treat when no FDA-approved (including conditionally approved ) or indexed drug can be used to treat the animal. This means FDA is granting use of drugs compounding from FDA-approved animal and human bulk drug substances list. The good news is it places few restrictions on patient-specific prescriptions for nonfood-producing species. There is a call for nominations to attempt to get bulk drug substances (BDS) on the FDA list for use. Consult the Appendix of GFI #256 for needed information and submit our request for AVMA assistance to compounding@avma.org .

AVMA GOVERNMENT RELATIONS DIVISION
Although the political world appears to be polarized, the AVMA remains non-partisan. The AVMA builds relationship with those individuals in congress that want to work with AVMA on veterinary issues such as: Veterinary Medicine Loan Repayment Program (VMLRP), Improve Loan Options for Veterinarians, Prevent All Soring Tactics (PAST) Act (H.R. 5441/S. 2295), and the Healthy Dog Importation Act.

Just announced:
The National Institute of Food and Agriculture within the U.S. Department of Agriculture announced Aug. 31 that it had awarded $3.2 million in grants to support rural veterinary services though the Veterinary Services Grant Program. The AVMA was instrumental in pushing Congress to create and fund the program, which was authorized by the 2014 Farm Bill. The first grants were announced in 2016.

AVMA PAC
The AVMA Political Action Committee (AVMA PAC) helps veterinarians build relationships with lawmakers, amplifying the AVMA’s voice in policy discussions on Capitol Hill. The AVMA Political Action Committee has grown 30% over this time last year and a new goal is $400k by the end of 2022. Membership support is so important. PAC funds are distributed on a non-partisan basis focused on veterinary issues and therefore allows AVMA access to both sides of the political aisle.

FINANCIAL UPDATE 2022:
• Receipts to-date: $85,865 (33% higher than 2021!)
• Portion of AVMA Members contributing in 2021-22: 2%
• 2022 Election Disbursements made: $86,500
• Funds available for new disbursements: $213,375

AVMF
The American Veterinary Medical Foundation (AVMF) is the charitable arm of the American Veterinary Medical Association (AVMA), mission of the AVMF is to raise funds to improve animal health. The AVMF has raised over half a million dollars for Ukraine relief including supplies, care, food, etc. You can visit the website AVMF.org where you can find stories and heartbreaking images of what our colleagues are going through in this part of the world. New this year to the AVMF mission is education. There is an educational debt problem and workforce shortage, so AVMF plans to award $300,000 in scholarships for veterinary technicians.

AVMA TRUST
Insurance and risk solutions for every stage of your career – providing new/better ways to help members at every step of the journey.

AVMA ONLINE EDUCATOR COMMUNITY
The AVMA Online Educator community has continued to grow. Individuals involved in academia and the education of the next generation of our colleagues are invited to join this online educator community. This is a place to exchange ideas, learn about AVMA resources that may make jobs easier, and discuss challenges and opportunities unique to the world of academia.

FUTURE DATES TO REMEMBER:
Veterinary Leadership Conference: Leadership in a New Era
January 5-7, 2023 Chicago, IL

AVMA Summer Convention
July 14-18, 2023 Denver, CO

…..and that’s a wrap!

Mahalo from your Hawaii AVMA Delegate – Leianne Lee Loy
and Hawaii AVMA Alt Delegate – Carolyn Naun

Please feel free to contact us on any of these topics or about the AVMA. It
has been an honor to represent Hawaii. Aloha!

AVMA Update Summer 2022

The AVMA House of Delegates (HOD) convened in Philadelphia on July 28-29 in conjunction with the annual convention. The House of Delegates are the principal body within the Association responsible for establishing policy and providing direction for matters relating to veterinary medicine and shall be the representative body of the Principal and Constituent Allied Veterinary Organizations of the Association. This is Hawaii’s opportunity to weigh in on upcoming policy updates and other topics relating to our profession.

On the agenda for this meeting:
● Resolutions:
– New policy on use of prescription drugs in Veterinary Medicine
– New policy on Adverse Event Reporting
– Revised policy on genetic modification of animals in agriculture
– Revised policy on the approval and availability of antimicrobials for use in food-producing animals
– Revised policy on raw milk

● Elections:
– President Elect Candidates: Drs Grace Bransford and Rena Carlson-Lammers
– Vice-President Candidate: Dr. Jennifer Quammen
– Other: Councils, House Advisory Committee

● Veterinary Information Forum: at each semi-annual meeting, HOD members seek your input on current issues in the profession and bring your thoughts to the House Floor for discussion. The debate is sometimes quite lively with diverse perspectives brought to the table. Often the VIF is the birthplace of new AVMA policies, programs, and initiatives. Thank you to our colleagues who have contributed to the discussion. Topics on the docket for the summer 2022 meeting are: (we have included a comment from our colleagues and look forward to hearing from you too.)
○ Needed Updates to the Model Veterinary Practice Act (MVPA). We are seeking feedback on whether the MVPA language might be revised to better support license portability; whether the MVPA should provide more detail around the roles and supervision of veterinary technicians and veterinary assistants; and provide more guidance around the practice of veterinary telehealth, including telemedicine.

○ Comment: License portability would be the biggest help in my area, which has a serious lack of veterinarians. It is expensive to live in Hawaii so it is difficult to get vets to commit to owning a practice here. Telemedicine would be helpful as well, especially for some emergency services, since we have no emergency clinics on our island and the existing practices are functioning at beyond capacity already. We need help here!

○ Responsibility to Provide Emergency Care. What is the ethical responsibility to provide essential services for animals when necessary to save life or relieve suffering? When not available, what should our responsibility be to provide readily accessible information to assist clients in obtaining emergency services? How do these obligations fit with maintaining a sustainable work-life balance and protecting the safety of our workforce?

○ Comment (partial): I think providing emergency care for your patients is important. Providing emergency care for all animals regardless of whether they have ever been to a veterinarian or not or whether they have an ability to pay or not seems to be an unfair burden for the veterinarian. The vast majority of emergency cases are the result of owners not taking proper care of their pets. Where I live veterinarians don’t answer their phones after hours to avoid taking care of emergencies when with a cell phone and call forwarding it is easy to answer the phone. We are on an island so there is no driving to an emergency clinic elsewhere. There are none. People want pets but don’t want to take good care of them in a manner that would avoid emergencies. Most emergencies are avoidable or could be handled in regular hours. We have enough trouble taking care of those who have been willing to try to care for their animals.

Please feel free to share your thoughts by contacting Leianne Lee Loy and Carolyn Naun.

Highlights of recent AVMA activities

● AVMA Annual report
● AVMF has funneled over $500,000 to relief efforts in Ukraine. Funds are being directed to groups working on the ground to help people and animals affected by the crisis. Read more.

● The annual AVMA Legislative Fly-In brings veterinary professionals from across the country together with their members of congress to discuss matters important to our profession. It also provides us with the opportunity to position ourselves as nonpartisan experts on animal related matters within their constituencies. This year’s fly-in was, once again, virtual and involved 200 of our colleagues across 49 states. Dr. Jenee Odani and Dr. Carolyn Naun met with the offices of Senators Hirono and Schatz and Representative Kahele, and directly with Representative Case and asked them to cosponsor or support the following pieces of legislation:
○ The Healthy Dog Importation Act would require all dogs entering the US to be accompanied by a health certificate signed by a licensed veterinarian and to create a database of this information to enable disease tracking and increase biosecurity.

○ The Veterinary Medicine Loan Repayment Program Enhancement Act would make the awards non-taxable, thus freeing up additional funds and allowing more positions in USDA designated shortage areas to be filled.

○ Veterinarians press lawmakers on rural veterinary shortages, dog importation

● AVMA has created free printable resources for members to quickly reference antibiotic prescription recommendations. Two are handouts that can be given to cat and dog owners or printed as posters, and two are white sheets for practitioners, one for cats and one for dogs, both broken down by location of infection and/or disease. Read more and access the downloads (AVMA members only) here: When do cats and dogs need antibiotics?

Thank you for your engagement and we look forward to continue to represent your voices!

Leianne Lee Loy (Delegate – Hawaii)
Carolyn Naun (Alternate Delegate – Hawaii)