Colorado bill would open practice of alternative modalities

DENVER, COLO. — Veterinary organizations lost the first round in a fight to quash a controversial bill that would allow unlicensed professionals to perform certain health services without veterinary referral or supervision.

At press time, strong opposition from the American Veterinary Medical Association and Colorado Veterinary Medical Association could not quell the lobbying success of a newly formed alliance that pushed HB 1296 through the state House and into the Senate Agriculture Committee, where it was being discussed in a hearing late last month.

The bill would allow pet owners, without veterinary referral or supervision, to employ an unlicensed practitioner to treat, care for, train or assist their animals — services that bill supporters say are not included in the practice of veterinary medicine. Opponents argue the measure would increase risks of improper animal care, spread of disease and undermine the DVM licensing system.

"This will be the first legislation that expressly authorizes complementary and alternative-medicine practitioners to practice without supervision, direction or referral," says Adrian Hochstadt, AVMA's assistant director of state legislative and regulatory affairs.

Introduced by State Rep. Wes McKinley, (D-64), the bill is titled "Animal Owner's Right to Choose Maintenance Care without Veterinary Supervision." The brainchild of the Colorado Alliance for Animal Owners' Rights (CAAOR), the bill is seeding other grassroots efforts for similar legislation in other states. With CAAOR backing, the bill proposes not only a change in veterinary medical standards, but also in how this type of legislation is introduced and supported.

"More of these alliances are being formed, and I suspect our colleagues in other states will be seeing alliances formed in their areas, too. I think this reflects the desire of a growing number of lay practitioners who believe they can deliver benefits to animals and have the right to do so," says CVMA Executive Director Ralph Johnson.

While CAAOR members say bills mirroring HB 1296 are already enacted in Illinois and Florida, Johnson counters that the legislation pending in Colorado raises far more concerns than existing laws. "They like to claim they have been successful in other states with this proposal, but the changes (there) have been much more limited to the free range, not anybody-can-do-anything-to-any-animal," he says.

Bill breakdown

The present Colorado Veterinary Practice Act requires that anyone practicing veterinary medicine must be licensed by the state, or operating under direct referral and supervision by a veterinarian. All services deemed "veterinary medicine" fall under the jurisdiction of the Colorado State Board of Veterinary Medicine, says Diane Balkin, board member and senior deputy district attorney in Denver.

"The bill goes too far because AVMA practice language refers to these therapy modalities as being part of veterinary medicine," Hochstadt says.

The inherent problem, according to the CAAOR, is the definition of veterinary medicine.

"I thought the language seemed so broadly worded that conceivably anyone touching an animal could be getting themselves into trouble," says Lisa Speaker, CAAOR president and founder and owner of the Rocky Mountain School of Animal Acupressure Massage.

"So I wrote a bill that I thought supported the owners' rights. We need to allow these people the freedom to make those smart decisions for their animals, the same way they do for their families and themselves," she says.

Bill language, while intended for those practitioners in massage and acupressure and muscle work, generally allows pet owners to employ any unlicensed practitioner without veterinary approval. Hoping to amend the bill before the Senate vote, Speaker says she wants to enumerate what practices the bill encompasses.

Despite vague therapy modality limits, the legislation carries specific stipulations for practitioners: They must follow Colorado animal laws; must not identify themselves as veterinarians; must not perform surgery, offer diagnosis or prescribe drugs; and must obtain the owner's approval before services in the form of a signed consent agreement that acknowledges all aforementioned guidelines.

Care concerns

The authority to provide training and assisting without first obtaining the diagnosis of a licensed veterinarian is a primary concern by bill opponents who fear increased risk to an animal's health.

It is not the risks to the animal, but the rights of animal owners that should be focal, counters Carol Komistor, CAAOR board member and instructor at Healing Touch for Animals in Highlands Ranch, Colo.

"It is a right of any of us in the United States to have a choice. So, part of our job as holistic health-care providers, as well as veterinarians, is to educate people and show them they do have a choice," says Komistor, who testified on behalf of the bill before the House Committee on Agriculture, Livestock and Natural Resources in a February hearing. "There are people of integrity on both sides."

One of the bill's goals, through the proposed pet-owner acknowledgment form, is to ensure the animal is receiving regular veterinary care, says Speaker, who also testified before the committee.

Abandoning the bill and leaving the DVM oversight system as is can put animals in danger of improper care, says one Colorado DVM. "From the veterinary perspective, I think the way the law is written, I have to supervise, so I have to charge the owner for me to stand there and watch a procedure that I don't know anything about. And, in addition, I am liable for the work these people do," says Turie Norman, DVM and CAAOR board member.

But allowing veterinarians to supervise these alternative therapies is in the best interest of the animal, Balkin says. "One danger is the practitioner not knowing the species. If they don't, a therapy could be toxic or dangerous and cause suffering in the animal," she says, citing the example of herbal therapy. Herbs used on humans may be deadly when administered to animals.

Protecting the owner is also a concern. "These alternative therapies could give an owner false hope and exploit them financially," Balkin says.

Disease debates

Non-licensed practitioners improperly or unknowingly handling disease-infected animals is a risk the bill creates for both animals and humans, says Barbara Powers, DVM and certified pathologist who opposed the bill during the house committee hearing.

"If you take your sick animal to people who don't know how to diagnose serious diseases, it is a huge threat for both the human and animal population," says Powers, also the director of the Colorado State University Veterinary Diagnostic Lab.

Veterinarians are required to report diseases of human significance to the department of health and those of animal significance to the department of agriculture, Powers says. "Those laws don't apply to non-veterinarians, or they don't know about it, or could miss the diagnosis altogether," she says.

CAAOR reinforces the importance of the owner-consent form, which clearly states the animal receives regular veterinary care, which would limit any risks for the spread of disease. "There is no greater risk of someone giving a massage and spreading disease than someone grooming your horse and spreading disease," Norman says.

Corroding cooperation?

CAAOR and CVMA officials agree that mutual cooperation may be the key to developing legislative language all can agree on, thereby ensuring future partnerships. But so far the parties have not been able to meet in the middle.

During a meeting earlier this year, Johnson says CAAOR avoided all CVMA suggestions. "We tried to provide our viewpoints, but it was clear they had no interest in discussing alternatives, Johnson says.

Speaker counters that CVMA was inflexible in considering options other than direct veterinary supervision for practitioners. CVMA balked at a stipulation requiring a veterinarian name and number on the owner-acknowledgment form to help ensure proper care, she contends.

Yet both remain adamant that an agreement and partnership are necessary for future industry success. "This is not to cause a feud and create hostility between holistic health-care providers and veterinarians. It is to let them see we are of integrity and willing to work in conjunction with them," Komitor says.

Veterinary opposition to the bill could lessen with certain amendments to the language. "We're hoping at this point, and have reason to believe, the Senate will make some modifications to make this bill acceptable," Hochstadt says. By acceptable, he suggests "changing the bill in some way to ensure veterinary input through some method."

Veterinarians and physical therapists have been able to reach general agreements over HB 1126, which Johnson backed in February during a hearing with the state's Health and Human Services Committee. The bill, which has not yet been voted into law, would allow physical therapists to practice on animals without a veterinary license, but under the supervision of a licensed DVM.

"Here is a licensed profession that had extensive discussions with another licensed profession, so it has regulatory oversight, and there's public and consumer protection. It's in stark contrast to the anything-goes attitude of HB 1296," Johnson says. "This is just incredibly poor public policy."

The bills are inherently different because of the services they address and should not be compared, Speaker argues.

"This bill is not about physical therapy. We're talking about maintenance work, not addressing disease or doing corrective work. It is an entirely different thing," Speaker says of HB 1296. "I don't see the need for direct supervision."