Conflict over nonprofit veterinary clinics escalates in Alabama

Alabama Veterinary Medical Association (ALVMA) President William M. Allen, DVM, says opinions on nonprofit spay-neuter clinics in Alabama are like noses. Everybody has one.

The Alabama State Board of Veterinary Medical Examiners’ (ASBVME’s) opposition to the nonprofit clinics has been well-known since the introduction and ultimate demise of House Bill 156 to amend the veterinary practice act with language that would allow veterinarians to work for nonprofit organizations. The board has now decided to amend the act itself in an attempt to close what it sees as a loophole in the business arrangements of nonprofit clinics and veterinarians (and which others see as an outright attempt to shut the nonprofit clinics down).

The amendments put forth by the ASBVME, which were scheduled to be discussed Oct. 10 at the board’s public rule-making hearing, state that no one other than a veterinarian can employ a veterinarian or veterinary technician. In addition, no other person can provide “veterinary material or equipment as may be necessary for the management of a veterinary facility” or “retain ownership or control of veterinary equipment, material or office and make the same available in any manner for the use of a veterinarian, veterinary technician or other agent.”

The Alabama Spay/Neuter Clinic in Irondale, Ala., is owned by William B. Weber, DVM. The nonprofit organization rents the building to Weber but owns the building and the equipment. Margaret Ferrell, DVM, is contracted by Weber to be the clinic’s veterinarian and medical director.

“If the new rules pass, I imagine the board will come after my clinic for being out of compliance sooner rather than later and will make another attempt to close the doors,” Ferrell wrote in an e-mail to DVM Newsmagazine. “If they are successful (we will fight, of course), I will not be practicing and will not be earning a paycheck to support my spouse and three children.”

While public support seems to favor the nonprofit spay-neuter clinics—the Irondale City Council passed a resolution in support of Alabama Spay/Neuter in early October—it’s not so clear-cut in the veterinary community. Allen says members of the ALVMA are truly divided over the board’s actions, and lack of consensus prevents the association from taking a position.

Allen concedes that right now it’s hard to know who’s right or wrong. “I think the board is doing what the law says and what they think is in the best interest of the veterinary profession,” he says. But he says there are potential problems with the proposed rules, such as how those rules will affect ownership after the death of a veterinarian. “(There are) a number of issues with the rules they’re making,” he says.

Still, Allen continues, regardless of what happens Oct. 10, the process won’t end there. “I personally think you’ll see court action—it’s inevitable,” he says. “The nonprofit clinics won’t just roll over—the courts are where it will be decided. We’ll see what the answer is going to be. It won’t be up to Alabama. It may be decided in Alabama, but not because of our great wisdom.”

Under pressure

Despite never referencing them by name, the ASBVME leaves little doubt that it’s the nonprofit spay-neuter clinics they’re targeting in the amended rules. It clarifies that the rules would not apply to “bona fide” sales of equipment, material or office space secured by a mortgage or title agreement or the rental of equipment or office space by means of a lease. It also reiterates that in such an agreement, veterinarians must maintain complete control of the equipment and practice.

Ferrell says 501(c)(3) nonprofit organizations are legally prohibited from selling equipment to a for-profit entity—they can sell or donate only to other nonprofits. Even if that weren’t the case, purchasing equipment is not feasible for her at this time. Ferrell believes that if the board is truly concerned about standard of care, a more effective approach would be to require clinics to provide proof that surgical equipment is regularly serviced. “Whether I own, lease or use someone else’s equipment it’s the same equipment and does not affect the quality of medicine I produce,” Ferrell says. “I make sure the equipment I use meets my standards.”

The amendment states that its purpose is to prevent nonveterinarians from influencing or interfering with a veterinarian’s independent professional judgment. But Ferrell says any veterinarian who values his or her license should practice according to the ideals of the profession—standing rules have long enforced that.

“If veterinarians are lowering their standards because they feel influenced to do so by working with nonveterinarians, then those veterinarians need to learn how to stick up for their license,” she says. “If they can’t do that and are practicing with substandard care, then I fully support an investigation by the state board to see if any action needs to be taken. ... Veterinarians are always in charge of the quality of medicine and care that they produce—no matter for whom they are working.”

Ferrell says personnel at Alabama Spay/Neuter have never attempted to influence or pressure her in her practice of veterinary medicine. “I am also the medical director of the practice, which gives me full rein to choose the drugs and instruments I want to use,” she says. “The 501(c)(3) has always provided everything I have ever needed without question.”

The ALVMA’s Allen says quality of care at nonprofit clinics has always been a topic of concern among veterinarians. He admits that the number of surgeries performed in a day worries him. “You can’t do 50 a day. It’s just math—it can’t be done,” Allen says. “I have some real difficulty with the numbers I hear they’re doing. How can you do it with quality of care?”

Ferrell says to be a high-quality, high-volume spay-neuter surgeon, veterinarians have to train for it like a runner trains for a marathon. “You practice perfect technique and gradually build your speed and stamina,” she says. “It took about six months before I was really doing 30 to 40 a day.”

She insists there is no quota or pressure to achieve a certain number of surgeries. “Some days I do less,” she says. “If I’m tired or I have several big tough female dogs that wear me out, it’s not uncommon for me to hold over appointments for the next day or reschedule them altogether. I always stop before I’m fatigued, so I don’t put my patients at risk. It’s always been my choice to do as many surgeries as I’m comfortable doing and no one has ever made me feel uncomfortable for leaving surgeries unfinished at the end of the day.”

The bigger issue

Despite differing opinions, most stakeholders agree that in a state that reportedly euthanizes around 100,000 animals a year, controlling the pet population is the bigger issue. “It’s awful—I heard someone speak of the Birmingham Humane Society—it’s really horrifying; it’s huge numbers,” Allen says. But he doesn’t think spay-neuter clinics are the sole solution. “Spay and neuter is shown to make a dent in overpopulation, but it’s by no means the answer,” he says.

Allen says this viewpoint isn’t shaped by financial motivations, as is often alleged by nonprofit clinic supporters. “Spays and neuters probably have never made veterinarians any money—it’s always been a low-cost item, even below cost to keep clients happy,” he says. “Losing it or gaining it is really not that big of a factor.”

Rather, he says, there are simply not enough hours in a day to control high pet population numbers with sterilization alone. “It’s going to take government assistance in the form of education on a large scale. It just needs a massive effort. Client education is really the answer to it,” he says.

Until an agreement is reached or a court rules, conflict between the ASBVME and nonprofit clinics is likely to continue. And while opinions may be as plentiful as noses, it may be too early to say if either side of the debate is cutting off its nose to spite its face.

Representatives of the ASBVME did not respond to repeated requests for comment by DVM Newsmagazine.