Need, fairness debated in nonprofit roles

Legislation could determine who receives subsidized care
Published on March 30, 2016
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Legislators and VMA leaders in several states have been pushing for limits on veterinary services provided by nonprofit organizations.

Veterinarian, client, and canine patient in exam roomThe Humane Society of the United States opposes those efforts and wants an agreement that could avoid future legislative fights.

The South Carolina Association of Veterinarians has advocated in favor of a state Senate bill that would limit who could receive nonemergency veterinary services from nonprofit organizations, where nonprofit mobile practices can operate, how nonprofits distribute pharmaceuticals, and what records they keep. The Idaho VMA sought similar legislation, then reached an agreement with the Idaho Humane Society a year ago that the latter would provide many veterinary services only to clients with incomes below a certain threshold.

New Jersey’s VMA backed legislation that was introduced and withdrawn this year that would have required that nonprofits render veterinary services only to clients receiving state or federal public assistance. A 2013 bill in Alabama would have limited veterinarians employed by spay-neuter clinics to sterilization, rabies vaccination, and antiparasitic treatments.

Richard Alampi, executive director of the New Jersey VMA, said that, in recent years, nonprofit organizations have caused financial pain for member veterinarians by providing veterinary services near private practices. The VMA takes no issue with clinics that perform high numbers of spay and neuter procedures, but routine heartworm tests and vaccinations are the bread and butter of small practices, he said.

Leaders of the HSUS and local humane societies argue that limiting services can hurt pets of families with financial shortfalls and that income from the clients who can afford to pay subsidizes services for those who cannot. VMA leaders argue that the tax benefits enjoyed by the nonprofits, as well as government funding for some organizations’ sterilization services, give them an unfair competitive advantage over private practices.

Dr. Michael Blackwell, chief veterinary officer for the HSUS, said the Humane Society VMA estimates millions, if not tens of millions, of people lack the money to give their pets adequate health care. This estimate is based on a mix of U.S. census data on incomes and AVMA pet population data. And he said an unknown number of communities lack veterinary clinics.

The HSVMA and its parent, the HSUS, have published guiding principles that express opposition to limiting the scope of services provided by nonprofit veterinary practices, including limits based on income. The HSUS is opposing the legislation under consideration in South Carolina.

Dr. Blackwell said HSUS leaders want a coalition of veterinarians across practice types and organizations in veterinary medicine to develop solutions to disputes over the role of nonprofit veterinary services and avoid airing disagreements before the public.

“As a veterinarian, I can tell you we don’t look good in the eyes of the public when it appears we are trying to block loving pet owners from having access to veterinary care,” he said.

He sees valid arguments for restrictions on government-funded services but is alarmed that veterinarians would petition for controls on who can be served with private nonprofit funds.

The HSVMA gave away about $1.5 million in veterinary care to about 8,000 animals in 2015, according to the organization.

Varied issues in South Carolina

The bill introduced in South Carolina’s state Senate in April 2015, S 687, would prescribe which procedures animal shelters could provide to the general public—such as sterilization, vaccination, or emergency care—with exceptions for clients who provide documentation they are unemployed, receiving public assistance, or otherwise in need. It also would prohibit mobile veterinary practices affiliated with or supported by nonprofit animal shelters from operating within 2 miles of private veterinary practices in the 24 counties with the combined highest unemployment rate and lowest per capita income and within 1 mile of private practices in the other 22 counties.

Dr. Patricia Hill, legislative chair for the South Carolina Association of Veterinarians, said the need for legislation arose as some nonprofits increasingly provided veterinary care to animals owned by the public, sometimes without oversight, accountability, or veterinarians. Shelters have been exempt from some oversight applied to private practitioners because of their history of caring for unowned animals, she said. SCAV members told her stories of animals receiving inadequate treatment or sent home with prescriptions lacking proper labels and packaging, she said.

“This is an issue of the public thinking they are getting well-managed veterinary care by a veterinarian, and in many of these shelters, they are not even seen by a veterinarian,” she said.

The legislation is aimed at limiting services provided by nonprofit organizations that receive state money for sterilization activities. She was involved in writing the legislation, which she said is intended to have no impact on services that improve public health.

Wayne Brennessel, executive director of the Humane Society in Columbia, South Carolina, said the Senate legislation would limit treatment of sick and injured pets owned by people unable to pay for full-price veterinary services. Families with mortgages and college tuition payments and seniors on fixed incomes are examples of people in need who could fail to qualify for care, he said.

He fears that pets will go without care or be forfeited to shelters already “bursting at the seams.”

Veterinarian and feline patient in exam roomWhile the Senate bill lists pay stubs and Medicaid documents among examples of proof pet owners can use to show they need subsidized veterinary services, Dr. Hill said the language in the bill would let people submit signed declarations instead.

Brennessel has heard horror stories of shelters giving pet owners unknown prescriptions in unlabeled plastic bags and failing to keep adequate treatment records. His organization agrees with the bill’s provisions on prescriptions and record keeping but disagrees with limits on who can be served and where.

Dr. Hill said the required distances between private practices and mobile clinics are a response to nonprofit organizations parking mobile clinics across the street from existing veterinary practices, sometimes across from the only private practice in a county. The different distance requirements are intended to address that problem by assigning greater minimum distances in rural counties.

Brennessel also has heard of other nonprofit organizations parking within sight of existing veterinary clinics, and he described the Humane Society as more conscientious than that. He and Dr. Hill both described the mobile clinic provisions as legislating manners, the former as a criticism and the latter as an unfortunate need.

Competition in Boise

Vicki Smith, executive director of the Idaho VMA, said an agreement between the IVMA and the Idaho Humane Society addresses the tough question of who should receive pet care from nonprofit organizations.

She said the humane society’s hospital in Boise had been providing middle-income clients some services at prices close to those provided by private practitioners—a few dollars difference, for example, on an annual examination. The issue gained importance in 2013 as news media published details on the Humane Society’s plans to build a multimillion-dollar hospital in Boise, enraging private practitioners concerned about what they saw as unfair competition with an organization with tax advantages and greater resources.

She said private practitioners are further disadvantaged because people feel good about buying services from a nonprofit.

Dr. Jeff Rosenthal, CEO of the Idaho Humane Society, said the hospital had provided a full range of veterinary services with a focus on low-income clients but no restrictions on access. Clients who could afford to pay were charged prices similar to those at private clinics, and that income subsidized care for those in need.

A copy of the agreement, provided by Smith, indicates the society will provide the following services only to pet owners with household income below 80 percent of their home county’s median: wellness care, annual examinations, preventive dentistry, vaccination, and nonemergency and nonreferral orthopedic surgeries. It includes exceptions for government agencies and humane society employees and volunteers, according to the copy, which is signed by two state representatives.

Humane society information indicates the organization is applying the limitations above 75 percent of the median annual household income, or $45,000 in Ada and Canyon counties, the state’s two most populous counties. Sterilization and microchip services are available without consideration of income.

The April 2015 agreement led to a substantial decline in income, Dr. Rosenthal said, but the hospital has increased fundraising and benefited from a fund established by a benefactor and income from training Washington State University veterinary students.

Dr. Rosenthal wants to work in harmony with colleagues in private practice, and he said the conflict has been difficult for veterinarians working for the humane society. But he is certain the society is doing what is right for the community, veterinary practices, and veterinary medicine.

He hopes the agreement will endure but expects courts and the Federal Trade Commission someday will determine the roles of nonprofits and limits on competition. 

Related JAVMA content:

Competition or coexistence? (Sept. 1, 2012)