Shelter medicine: A view from both sides

BossongEditor's note:We corresponded with Frank Bossong, DVM, an active leader in shelter medicine in the Southern California area, to get a view of what practice is like from both sides of this issue. Dr. Bossong started his career in general practice and then became the staff veterinarian at the San Gabriel Valley Humane Society in San Gabriel, California. In 2009, Dr. Bossong became an assistant professor at the College of Veterinary Medicine at Western University of Health Sciences in Pomona, California, where he has assisted the college in expanding and improving its curriculum in shelter medicine.

Q: You started out in private practice at an AAHA-certified practice. What prompted your switch to working in a shelter?

I had thought about working in a shelter setting when I first graduated from the University of Georgia College of Veterinary Medicine, but I felt that it would be best as a new graduate to work at a clinic that practiced “best medicine” so that I could develop a solid surgery and medicine background. After four years out in a multidoctor practice, I felt confident enough to go out on my own. Although I loved my clients, I felt that the majority of my time was spent with the owners in comparison to the time I was actually spending with their pets; I felt like I wanted to focus more on the animals. I also had a client who started to bring shelter animals for me to see at the clinic. She was trying to help the local shelter out. My bosses allowed me to provide these shelter dogs and cats with veterinary care and even discounted the services they received. A year or so later, I was beginning to see more shelter patients (unfortunately, the discounts ended). I also became more aware of the multiple problems these animals were facing at the shelter. The shelter had no registered veterinary technicians and no veterinarian. The facility also had a very bad reputation for housing sick and undesirable animals and had a high euthanasia rate.

Read the top myths that private veterinary practitioners and shelters have about each other. 

On the fourth anniversary of my starting date at the clinic, I began to do some soul searching and felt like I wanted to dedicate most of my time to the animals that seemed to be in desperate need of care. I also had received a complaint from a client who was concerned about one of the shelter animals being in the same lobby as her pet. This was the catalyst for one of those “clear-life moments” and I decided I would approach the director of the shelter to see if they would hire me as their staff veterinarian. This was 2005, and in 2001, when I graduated from veterinary school, I had never taken a shelter medicine course and I did not even really see it as a separate discipline. I simply wanted to use my veterinary skills at a facility that needed some assistance.

Q:What were the reactions of your colleagues when you made this decision?

A: My bosses and colleagues were initially shocked when I turned down the offer to renew my contract for another year. I had a large clientele and I had associates that I really loved working with and respected. One of my associates was also a very good mentor. The salary was competitive and the facility was upscale. At first my bosses were worried I was leaving to open my own practice. When I told them where I was going they initially looked relieved and then seemed a little surprised. My colleagues gave me the impression that I was making a mistake and that the facility that I was going to would reflect badly upon me as a veterinarian. They also were shocked at the significant pay cut I was going to be receiving.

More surprising was the reaction of my clients. Some were angry that I was leaving. Some clients requested to follow me to receive services at the shelter. Others thought that I must have been fired or did something wrong to be going to a “dirty shelter” and leaving a well-regarded AAHA-certified practice. I did have one client say that she was “not surprised” and was very supportive of me “helping more animals.” She was the only one.

Q:What did you find when you started working at the shelter?

A: Let's just start by saying that you can't make the really shocking stuff up. Where do I begin? The place was a real mess. The poor reputation was not totally unfounded. The place had been mismanaged for years by highly unqualified individuals. A donor to the facility had been the one to push for my hire.

During the first several weeks I was totally overwhelmed. My first shock was that none of the controlled drugs at the premises were properly locked away. There was an open drawer near the euthanasia room-a room that looked like it was out of a Stephen King novel. When I opened the drawer, several partially used bottles of euthanasia solution rolled to the front of the drawer and about 20 pages of “logged-out drugs” fell to the floor. By the end of my first day, I had called and made an appointment with someone from the local DEA office to stop by and advise me. They were very helpful and supportive in getting things in order before I registered my license there.

On my first surgery day, I was using an anesthesia machine from the 1950s. There was no pulse oximeter, and I was assigned one kennel worker to assist me. There were canister rolls of cat gut and stainless steel for suture material. Ironically, the surgical packs were OK and are still in use today; I was told they had been donated. There was no pharmacy to speak of and equipment was limited (e.g. no microscope, no otoscope).

There were no designated isolation areas for sick animals. There was a room called “infirmary” and one called “isolation,” but there was so much junk and such unclean (many wooden) cages that they were essentially unusable. In one of the back rooms, I was presented with 20 to 30 boxes of sharps in open Styrofoam containers. I was told that Stericycle had stopped coming a year or so prior (the account had not been renewed or kept current). One of the staff had covered everything with Christmas decorations!

I had to be careful in addressing these issues with the administrators at the time. I was successful in working out an arrangement with a medical waste company to address this situation. I, also, at a later date, invited OSHA to the facility after convincing the “powers that be” that they were not the enemy but rather there to protect us all by ensuring a safe work environment.

In addition to the shortcomings of the physical plant, I think the biggest shock was how untrained and unmotivated most of the staff was. The well-attended area was the smoking area. Animals were not being properly screened on intake. There was no standard operating procedure (SOP) for performing a health examination or determining an animal's sex (I did witness two dogs mating at a later date). Shots were sometimes given, sometimes not. I scanned animals that had been impounded for weeks and found microchips and started calling their owners.

Without any formal shelter training, my first impulse (common sense) was to deliver some basics to the staff. I started with training the staff to follow through on what I called the three Ss: determine Sex, Scan for a microchip, and give appropriate Shots upon intake. A more formal protocol on handling intake evolved from there as did additional training. The animal control officers were sent to Sacramento for certified euthanasia training.

I realize in retrospect that many other area shelters were not in such a bad state of affairs as this one. Somehow these transgressions were overlooked by many individuals in the area for quite some time. I was surprised that no intervention had occurred sooner, although most of these issues were not in public view.

Q:How is everything at the shelter today?

A: I am pleased to say that the facility has and is continuing to make real progress. When I left as the staff veterinarian about six years ago, there was a change in the board of directors, and a complete change in the management immediately followed. I joined the board at this time and remain a committed board member. During my three years there as the staff veterinarian, I managed to hire the facility's first registered veterinary technician (there are now three). The surgical suite was updated, and the facility provides low-cost spay and neuter for the public and covers the majority of the surgical procedures needed by the shelter animals they serve. We opened a low-cost vaccine clinic as well.

Within the last year, the facility finally transitioned from paper records to a shelter software system. The mission statement and bylaws have been updated and restated, and we have expanded our board. We have a website up and running. There are many written SOPs for managing infectious disease, cleaning and disinfection, vaccination, medical treatments, etc. Proper euthanasia protocols have been established and, that being said, the shelter is at the point where no “healthy adoptable” animals are put to sleep. The shelter now has an active volunteer program and they work with local registered veterinary technician programs and the shelter club at the local veterinary school. Much of the staff has received continuing education to improve their skills in serving the animals under their care. I'm really excited that the facility has survived and is being managed by ethical, caring employees and volunteers.

 Shelter medicine educational resources

> Most major veterinary conferences offer lectures in shelter medicine. (Join Cynthia Karsten, DVM, from the UC Davis Koret Shelter Medicine Program during the CVC in Washington, D.C., April 23-28, 2015.)

> The UC Davis Koret Shelter Medicine Program (sheltermedicine.com) has extensive online resources such as a shelter medicine lecture series, information sheets, and a reference library.

> The University of Florida has an online course that provides CE credit and work toward a graduate certificate in shelter medicine at sheltermedicine.vetmed.ufl.edu/certificate-programs/online.

> The Association of Shelter Veterinarian's website,sheltervet.org, provides information on how to apply for certification in shelter medicine and additional resources and guidelines for medical and surgical care of shelter animals. At sheltervet.org/smoc you'll find details regarding shelter medicine's official recognition as the newest veterinary specialty. 

Q:How is practicing shelter medicine different from general practice?

A: I think the main difference is that sometimes you have to make a decision about an animal that is in the best interest of the group or herd rather than the individuals themselves. I could give so many examples here. This can vary from facility to facility in terms of the care that a given shelter can afford to give. The shelter uses the Asilomar Accords for assessing the animals that come into their care. An “unhealthy, untreatable” animal for this shelter, for example, is a parvo-positive dog showing clinical signs. For other facilities this may be “treatable rehabilitatable.” However, this shelter does not have the funding, medical oversight, or physical plant (adequate isolation) necessary to treat that other facilities might. In this scenario, the shelter humanely euthanizes to protect further spread of infection to the rest of the young animals in their care. Out in practice, depending on the resources of an owner, one usually treats the individual-the clinician in practice is generally not thinking of herd safety per se.

Ironically, in both private practice and in a shelter setting finances play a role. Additionally, a general practitioner could see the rest of your clients (patients in your care) as a herd so the isolation and disinfection protocols should be the same. Actually I think some small-animal hospitals may have a lot to learn from proper isolation and disinfection protocols followed at our more cutting-edge shelters.

Another big difference is that in general practice, most people consider their pets as part of the family. Owners desire to keep their pets healthy and attempt to maximize their longevity. In the shelter setting, a shelter veterinarian is always considering how to best manage the patients to get them out of the shelter and into a home as soon as possible while at the same time protecting public health and safety. We are dealing with an “unwanted” population of individuals rather than a “cherished” group of dogs and cats. The shelter veterinarian's goal is to place as many of these shelter animals into the “cherished group” as efficiently as possible.

Q:What is your shelter's relationship like with veterinarians in your community?

A: Our shelter's relationship with the local veterinarians is evolving. Through communication and partnership it is changing in a good direction. Emergency clinics play a big role in our providing animal control services to the cities we serve. We also provide families that have recently adopted pets a list of names of area veterinarians that they can choose from to become the primary care giver for their pets. At the time of adoption we strongly suggest that although we provide some services, they need to choose a veterinarian out in private practice to provide their pets with the continued medical care it will need.

MORE RESOURCES 

> dvm360's complete Leadership Challenge coverage: dvm360.com/workingwithshelters

> Humane Society of the United States: humanesociety@hsus.org

> Maddie's Institute: maddiesinstitute.org

> ASPCA-free webinars recorded and posted along with slides and materials at aspcapro.org/training

> State Humane Association of California-webinars, euthanasia training, and more: californiastatehumane.org/training.htm

> Pet Smart Charities: learning@petsmartcharities.org

> VIN, Veterinary Information Network-consultation, courses, webinars: vin.com 

Q:What can veterinarians do to connect with shelters in their area, and why should they make the effort?

A: Call, volunteer, become a member of the board of directors. Find out how your local shelter impacts the health of the animals in your community. One example would be providing information or insight regarding the early detection of community outbreaks. As a clinic owner, you could add your clinic name to the shelter's list of veterinarians in the area for new pet owners to choose from. Your clinic could be a resource for referrals such as radiology or ultrasound (as many shelters lack this equipment), emergency care, or surgical overflow.

I think it is critical for private practitioners to establish a relationship with their local animal control and/or humane society so that they have a trusted resource if they are ever faced with suspected animal abuse or public health threats such as rabies or even animal hoarding.

It is also important to remember that many of our shelter animals are your future patients!

Q:Can you tell us a little about the upcoming shelter medicine specialty? Other advances in shelter medicine?

A: The American Board of Veterinary Specialties (ABVS) voted in February of 2014 to recommend provisional recognition for the shelter medicine practice specialty under the American Board of Veterinary Practitioners. In April of 2014, the AVMA executive board voted and officially recognized shelter medicine as the newest veterinary specialty. Additional information about shelter medicine and the proposed specialty is available at sheltervet.org/smoc.

The Association of Shelter Veterinarians (sheltervet.org) has been fundamental in advancing the field of shelter medicine. Their website provides information regarding the new shelter medicine specialty, how to apply for certification in shelter medicine, and additional resources/guidelines for medical and surgical care of shelter animals.