December 14, 2016
Caught in the middle
Will pets be the big loser in the battle over low-cost veterinary care?
One evening in late November 2015, after she put her daughter to bed, Stephanie Hall coaxed her German shepherd, Scout, into the tub for a medicated bath to treat the lesions that had spread over her body.
A month before, Scout had been a healthy, fun-loving dog and the constant companion of Stephanie’s husband, Steve. But then a record storm hit Charleston, South Carolina, and Scout contracted a rare and aggressive fungal infection from the floodwaters. What first seemed like a minor medical issue quickly escalated into a life-threatening condition. The Halls took their dog to three private veterinary hospitals and signed a title loan to pay for her care.
But on that night a few days before Thanksgiving, as Scout stood patiently in the tub accepting her latest treatment, her cracked skin began to bleed. Stephanie felt the panic set in. Their dog wasn’t getting any better, and they were out of money.
She called nearly two dozen veterinary practices in her area, pleading for help. She got the same response: Unless she could pay the bill at the time of service, they couldn’t treat her dog. Finally, she contacted a veteran services organization, which referred her to the Charleston Animal Society—a nonprofit that runs a shelter and a low-cost spay/neuter clinic.
When they arrived at the clinic, Stephanie was in tears. She told Kristin Kifer, the shelter’s outreach coordinator, how Scout had saved her family by helping Steve, a former Marine scout sniper, overcome severe post-traumatic stress disorder. She told Kifer that she’d give her right arm to save her dog, but that she didn’t have any money. Kifer hugged her and told her it was OK.
Over the next month, CAS veterinarians joined the fight to save Scout, and when they sent the dog to a specialty clinic, the shelter covered the bill.
Despite their efforts, Scout died a few days after Christmas. It was a devastating blow for the Halls, but they found consolation in knowing that Scout hadn’t died for lack of money or caring. It’s still painful for the Halls to talk about Scout. But for the sake of other families who could end up in a similar situation, they’re determined to share their story.
For the past four years, the South Carolina Association of Veterinarians has been pushing legislation that would restrict the veterinary care that nonprofits like CAS can provide to pets of financially strapped owners. Stephanie and Steve are new to the battle, but the issue feels deeply personal: If the veterinary association had been successful in previous years, CAS wouldn’t have been able to help them.
The care Scout received from CAS staff meant the world to the Hall family during a bleak time. “They never made us feel bad that we couldn’t pay them,” Stephanie told a roomful of legislators at a bill hearing last April. “In fact, they went above and beyond, and they made us feel special. They did everything they could to save that dog.”
South Carolina's battle over subsidized veterinary care began in 2013, when state legislators, at the urging of the veterinary association, introduced bills that would have restricted all nonprofit vet care, including spay/neuter, to pets of people who qualify as low-income. The bills also included provisions that would have crippled outreach programs that bring vaccinations and spay/neuter services to underserved communities. From an animal welfare standpoint, it was the most dangerous piece of legislation that Kimberly Kelly, HSUS South Carolina senior state director, had ever seen.
Since then, Kelly and like-minded advocates have testified again and again about the suffering humane organizations are working to end and the populations they’re trying to serve. “There’s no shortage of pet owners who are suffering some financial hardship in the state but either don’t legally qualify or don’t self-identify as low-income,” she said at the April hearing. “If shelters turn them away, it doesn’t mean they’ll go to a for-profit practice; it just means their pet will forgo care.”
Animal organizations around the country are echoing that argument as the controversy over subsidized veterinary care plays out in their states. In Alabama, a group of private practice owners has been waging a relentless campaign to shut down nonprofit spay/neuter clinics. Early last year, a bill was introduced in New Jersey that sought to limit nonprofit vet services, including spay/neuter, to animals whose owners receive public welfare assistance. While the New Jersey bill died quickly, the Idaho Humane Society in Boise signed an agreement in 2015 to limit the services of its new veterinary center to avoid a legislative battle with its state veterinary association.
If shelters turn them away, it doesn't mean they'll go to a for-profit practice; it just means their pet will forgo care."- Kimberly Kelly, HSUS South Carolina senior state director
“Tensions are definitely escalating,” says Inga Fricke, director of pet retention programs at The HSUS. “There’s been a more concerted effort, particularly by state veterinary associations and other groups, to try to limit the scope of work of these organizations, or close them altogether.”
It’s an issue that can arise anywhere, Fricke warns. But the most heated battles are playing out in states that can least afford to lose them. In South Carolina, “we still have a massive overpopulation problem,” Kelly says. “We still have shelters that euthanize the majority of animals in their care because there aren’t enough homes.” So far, animal welfare advocates have successfully fended off the worst of the proposed restrictions, but the fight is far from over. State senator Danny Verdin (R-Laurens), whose father and brother are private practice veterinarians, has said that he intends to introduce new legislation in the 2017-2018 legislative session.
It’s all based on the false belief that nonprofit clinics are affecting the profits of private practices, Kelly says. All based on a tragically false assumption that communities need fewer—rather than more— options for low-cost vet care.
And at the end of the day, it’s the shelters and rescue groups—not the private practices—that get the cats with upper-respiratory disease and the pets with broken legs whose heartbroken owners can’t afford veterinary care. And it’s the shelters and municipal agencies that often have to put those animals down or add to their overburdened kennels.
With their shared interest in animal health and well-being, veterinarians and humane organizations would seem like natural allies, and in most cases they are. Like people who work in shelters, most veterinarians got into their field to care for animals, and many have dedicated their careers to working for nonprofit programs or volunteer for them in their spare time.
It’s a minority of veterinarians who have a problem with nonprofit clinics, Fricke says. But they tend to be an extremely vocal group. For more than half a century, this outspoken fringe has launched a variety of legal, legislative and PR attacks against subsidized veterinary care. Even in places without overt conflict, the fear of antagonizing local private practitioners or triggering costly litigation has had an immeasurable impact on animal welfare in this country. “Sometimes it has manifested itself in actual closures of operations,” says Fricke, “but other times it really manifested just in terms of shelters or nonprofit organizations being afraid to even open and provide certain services, kind of voluntarily restricting their services because they knew they were going to face opposition from their veterinary community.”
In many communities, nonprofit clinics and for-profit practices coexist peacefully and commonly refer clients to each other. But in others, spay/neuter clinics are still a source of contention. And in some places where nonprofit spay/neuter programs have been largely accepted by private veterinarians, new rifts are forming over programs that provide other medical services for animals who otherwise wouldn’t receive them.
Veterinarian Will Mangham, a consultant with the HSUS Pets for Life program, sees the conflict as a reflection of the unprecedented financial pressures his profession is facing. According to a 2012 American Veterinary Medical Association survey, the typical vet school graduate carries $150,000 in student loan debt. Equipment and drug costs have soared. Corporate-owned practices are springing up in pet supply stores. Pet medications are now sold online and at discount pharmacies. And while the number of pets in the U.S. has grown, visits to veterinarians have declined.
For private practitioners who are feeling the pinch and looking for someone to blame, nonprofits are easy targets, says Mangham. “Because they feel someone is doing this to them, stealing their revenue, and surely it must be the nonprofits. But it’s not true.”
The 2011 Bayer Veterinary Care Usage Study identified key reasons for declining profits at veterinary practices. They included a weak economy, markets with too many practices in competition, a perception that routine wellness visits aren’t necessary, the challenges of transporting cats, sticker shock over the costs of care and people consulting the internet for veterinary advice. What the Bayer study didn’t cite as a major factor was competition from nonprofits. “It really demonstrates that vets have much bigger impediments to success in their practices than just the blip of a nonprofit,” says Fricke.
But the study also found that 20 percent of veterinarians perceive nonprofit clinics as a serious threat to their businesses. That’s because, Mangham says, many veterinarians don’t realize that the clients they see in their practices are just one subset of the pet-owning population. “Just because they’re veterinarians doesn’t mean they know how many animals are euthanized or die simply because of lack of care,” he says. “Because what little business strategy we’re taught [in veterinary school] says, ‘If you’re going to have a practice, have it in an affluent area where people can afford your services.’ So if you’re only in an affluent area and have no need to go to the municipal shelter, then you’re unaware of what’s going on.”
When veterinarians aren’t exposed to that reality, it can be hard to convince them that a nonprofit treating thousands of pets a year isn’t taking something out of their pockets. “But in most cases it’s not,” Mangham says.
To us, the important part is the animal is still receiving care."- Lucy Fuller, DVM, Charleston Animal Society
He cites the example of a spay/neuter clinic he helped establish in Athens, Georgia, in 2008. While local private practitioners expressed concerns about loss of income, they were willing to take a “wait and see” approach. Within a few years, the veterinarians reported that the clinic had not affected their revenues. Some of their clients had used the clinic, but not a significant number, and the clinic was in a small way sending them new clients. “So overall, they were fine with it,” Mangham says, “and that continues today.” Unfortunately, not all situations resolve this peaceably.
Like other social welfare programs, subsidized veterinary care elicits impassioned debates about personal responsibility and who deserves a helping hand. To CAS veterinarian Lucy Fuller, it doesn’t matter whether an owner has a “legitimate” reason, such as a job loss or a family illness, for not being able to afford private practice prices, or whether he is guilty of poor financial planning. “To us, the important part is the animal is still receiving care,” she says.
But not everyone feels this way. “I’ve heard some of these for-profit veterinarians [say] it’s not a right to have animals, it’s a privilege; they shouldn’t have them if they can’t afford them,” says CAS president Joe Elmore. “We deal with reality. And the reality is people are going to have pets regardless of whether they can afford them or not.” Another common bone of contention is the claim that nonprofits offer substandard care. Elmore has heard this argument many times over the past four years, and it still infuriates him. He’s quick to point out that veterinarians who work at nonprofits are subject to the same education and licensing requirements as their for-profit colleagues.
“It’s so hypocritical,” he says. “So you say we don’t provide high-quality vet care, but it’s OK if we provide it to low-income folks. It’s hard to sit down in the meetings and discuss these things intelligently when it’s this kind of response.” These are some of the issues that Michael Blackwell, HSUS chief veterinary officer and board member for the Humane Society Veterinary Medical Association, confronts as he works to mend a growing rift in his profession.
Blackwell has spent more than 40 years working for both private and nonprofit clinics, and he sympathizes with the challenges both camps face. Much of the conflict, he says, is fueled by the skyrocketing costs of veterinary care—something he says is largely outside of veterinarians’ control.
When he was a teenager, Blackwell helped manage his father’s mixed animal practice in Oklahoma. Like most private veterinarians at the time, his father didn’t have an X-ray machine. Pets getting blood work wasn’t common. But as public attitudes toward pets evolved and medicine advanced, standards for veterinary care began to change. “People’s expectations shifted, and that was good, but it means having to set up a veterinary medical practice that can provide 21stcentury medicine,” and veterinarians have been forced to pass on those costs to consumers, says Blackwell.
Today, people with means have more options than ever for treating their pets’ illnesses. At the same time, veterinary care has become unaffordable for a large segment of the pet-owning public, not just those who fall under the federal poverty guidelines. Private practitioners are business owners, responsible for their own and their staffs’ livelihoods. Blackwell doesn’t criticize those who choose not to serve the pets of people who can’t afford market rates. But he does fault those in his profession who try to pass laws that would prevent humane organizations and the veterinarians who work with them from meeting these needs.
Through a recently launched coalition, HSVMA is working to turn conflict into collaboration. Made up of nonprofit and private practice veterinarians, animal welfare leaders and representatives from veterinary medical associations, the Access to Veterinary Care Coalition is studying ways that for-profits and nonprofits can work together and exploring business models that would allow veterinarians to meet the needs of underserved communities and still make a profit.
At the same time, Blackwell is hoping to bridge a divide that is increasingly turning private vets against their nonprofit counterparts. “That’s the worst of this,” he says. “When veterinarians attack other veterinarians who are simply trying to help the pets and people most in need.”
In Alabama, which has witnessed the most intense vet-on-vet attacks, a peaceful resolution to the controversy will likely take time.
Over the past five years, HSUS Alabama state director Mindy Gilbert has been on the front lines of the battle to save the spay/ neuter clinics. She’s been called a troublemaker, a recruiter for the communist party and an enemy to veterinarians. “It’s been very ugly,” she says. “It has consumed my life.” There are just four nonprofit clinics in the entire state, and they only provide spay/neuter and vaccinations at the time of surgery. Yet even this limited role is too much for a group of private practice owners who have been uncompromising in their quest to shut them down.
The situation in Alabama is a warning, Gilbert says, of what can happen when veterinarians who are hostile to nonprofits occupy positions of power in the profession—in this case, by holding leadership positions on the Alabama State Board of Veterinary Medical Examiners, the agency that inspects veterinary facilities and issues premise permits and licenses to practice in the state.
In the February 2012 issue of the state board’s newsletter, then-president Robert Pitman wrote: “Are these non-profit clinics really necessary?? I submit to you that they are not.”
Steven Tears, executive director of the Montgomery Humane Society (MHS), has no doubt the spay/neuter clinics are needed. Before the first clinic opened in Montgomery in 2007, the euthanasia rate at MHS exceeded 80 percent, and intakes were rising every year. The shelter contracted out its pre-adoption spay/neuter work to local veterinarians, but there weren’t enough participating vets to handle the volume of surgeries, much less to offer low-cost spay/ neuter to the public, Tears says.
More than 60,000 surgeries later, intakes at MHS dropped by 45 percent. In 2015, the organization euthanized 4,500 fewer animals than it did in 2006.
It’s hard to argue with numbers like these, yet over the years, a handful of veterinarians on the state board have launched a series of regulatory and legislative attempts to close the clinics. They formed the Alabama Veterinary Practice Owners Association and urged the state’s veterinarians to oppose the “rabid s/n activists,” whom they characterize as radicals with “vet envy.”
Even veterinarians who support restrictions on nonprofits have voiced dismay at these tactics.
In a 2013 radio interview, veterinarian Bill Allen, then-president of the Alabama Veterinary Medical Association, said that while the practice owners association repeatedly stated that the nonprofit clinics were practicing substandard care, they could never produce any evidence to back up their claims. “That tells me that they trumped up these facts and don’t have anything of any substance,” he told the interviewer.
But the next year, the state board filed a litany of malpractice charges against two veterinarians with the Alabama Spay/Neuter Clinic in Irondale. For the nonprofits, it seemed that their worst fears were coming true.
“It was emotionally exhausting,” remembers Joy Baird, who was the lead veterinarian at the North Alabama Spay/Neuter Clinic in Huntsville at the time. “I was constantly worried, are they going to inspect me tomorrow? Am I going to get a subpoena tomorrow? I was in a constant state of worry about my livelihood, my employees’ livelihoods, my license.”
The state board was ultimately unsuccessful in its attempts to stop the Irondale vets from practicing, but the future of spay/neuter clinics in Alabama remains uncertain. Gilbert anticipates yet another year in which she and staff from other animal organizations will be forced to spend precious time, money and resources simply to keep their state from moving backward. “It’s going to be a struggle, and it’s so unfortunate,” she says.
Gilbert knows that a bad outcome in Alabama could set the wrong precedent for other states where nonprofit veterinary services are under attack. But most of all she worries about the impact on the animals in her state.
“We have so little going for us here, we really do,” she says. “One third of our state is not in compliance with the state law that requires a shelter of some kind. Most of the state is rural and doesn’t have local animal control ordinances. There’s a tremendous segment of the population that’s living at or below the national poverty level. We’re fighting to keep what little we have. If we don’t fight to keep this, we’re really going to sustain a terrible loss.”