Full Veterinary Care by Shelters: SB 6196 and its implications
In January, the Humane Society for Southwest Washington authored legislation, Senate Bill 6196, that would grant registered animal care and control agencies and humane societies in Washington the ability to provide full veterinary services to low income pet owners who fall below the 80% median income level. The intent of the legislation is to expand the law that currently limits shelter organizations to sterilization, vaccination and electronic identification.
When a bill is introduced in the legislature that would affect veterinarians and veterinary practice, the WSVMA wants adequate opportunity to gain member feedback to give us a clear mandate on whether to support the bill, oppose it or remain neutral. This year, the legislative session was a “short” 60-day period, not enough time for us to hear from members and employ a legislative strategy.
A hearing was held on the bill in February in the Senate Healthcare Committee. At the hearing, the WSVMA requested that the legislative sponsors not act on the bill in 2018, but instead allow the Association to discuss the issue during the interim, and to meet with the proponents of the bill to see if a consensus could be reached through collaboration and discussion of the issues. Our request was granted.
Earlier this month, the WSVMA sent out a survey and held a town hall webinar. Results of the survey and webinar indicate there’s a range of opinion on whether shelter organizations should provide full veterinary services. And judging by responses to the survey, it’s clear that there are some misunderstandings on what registered organizations are allowed to do, and how they’re regulated.
RCW 18.92.260, enacted in 2002, gives authority to animal care and control agencies and non-profit humane societies to provide limited services of sterilization, vaccination and electronic identification to low-income households. “Low-income household” means a single person, family or unrelated persons living together whose income is less than eighty percent of the median family income, adjusted for household size, for the county where the project is located.
Any shelter organization that intends to provide veterinary services to the low-income public must register with the Veterinary Board of Governors (VBOG), which has authority over veterinary facilities and their employed licensed veterinary professionals, no different than private practice. If a shelter organization is found to be non-compliant with state law, VBOG can decide to revoke their registration.
Both VBOG and the Washington State Pharmacy Quality Assurance Commission (PQAC) have oversight on the purchase and use of drugs. VBOG regulates drug purchases and the shelter veterinarian is responsible for hospital policy as it pertains to ordering, purchasing, safe storage, dispensing and administration of all drugs. Like all veterinarians, they must follow state and federal pharmacy laws.
Licensed veterinarians employed by shelter organizations have authority over all medical decisions without interference from shelter personnel. They’re subject to the same legal requirements as any veterinary professional and all laws pertaining to veterinary medical facilities and practice standards must be followed.
In addition to veterinary related state and federal laws, veterinarians and registered shelter organizations also follow other laws the same as private veterinarians and practices, including OSHA/WISHA regulations and medical waste laws.
Currently, there are 19 shelter organizations that are registered to provide limited veterinary services in the state. When the law was passed, the city of Seattle had an ordinance in place that allowed Seattle Animal Shelter to provide veterinary services to the general public, so they are exempted from the law.
The law is not without its problems. If a dog is brought in by a low-income owner for a spay or neuter surgery, and it’s found to have a broken tooth, the shelter is prohibited from relieving the condition. The pet owner has to be referred to a private veterinarian, which may prove to be cost prohibitive unless the practice decides to work with them on price. If the condition makes it unlikely the pet will survive, the pet owner has to surrender the pet in order to save its’ life. Southwest Humane Society reports that 70% of their surrendered pets are because their owners could not afford veterinary care.
Another oversight in the law is that while they’re limited to serving a low-income segment of the population, it doesn’t address how shelters are required to verify that they are low income.
Many members in the survey expressed their frustration that shelter organizations pose an unfair competitive advantage. What does that mean?
Shelter organizations have two different models. 501c3 non-profit shelters are supported by grants and donations and unlike for-profit private veterinary practice, are exempt from paying federal income tax. Shelter organizations that also provide animal control services are primarily supported with taxpayer dollars in addition to receiving grants and donations.
Shelter organizations have some similarities to private business. They’re required to pay B&O tax on pet adoption fees and income from retailing activities such as selling pet food, leashes, collars, medicine or other items. Like other Washington businesses, sales and use tax is also required on purchases for consumable items. And because they do employ staff, all state and federal employment taxes must be paid.
But unlike owners of private veterinary businesses, the profits they earn do not benefit the managers or directors of animal care organizations. The money must go back into the organization in order for them to carry out their mission. Shelters are mission-driven rather than profit-motivated.
What upsets some veterinarians is that the pet owner who receives these services is unaware that the cost is subsidized and so they don’t realize the true value of what they’re receiving. Many believe shelter organizations should point this out to clients. The CATalyst Council recommends shelters use the term “subsidized care,” a more accurate term than “low-cost care.”
How Washington compares to other states
Members have asked how other states regulate shelter organizations that provide veterinary services to the general public. Washington is the only state that limits what services they can provide and to whom. In every other state, non-profit shelter organizations are allowed to perform all manner of veterinary services for pet owners of any income level. But not all of them do. Many stick to their core mission of reducing overpopulation, intake, and adoption.
A few years ago, expansion of the Idaho Humane Society (IHS) in Boise caused concern for veterinarians after they decided to move and expand their facilities. IHS operated a full service veterinary clinic to the general public but it was small and located outside of town. The new campus would include a 6,000 square foot animal hospital and teaching facilities for veterinary students centered in the middle of the city. Local veterinarians worried they would be competing for the same clients.
The Idaho Veterinary Medical Association (IVMA) worked together with IHS to develop a suitable solution for both organizations. Under the Memorandum of Understanding (MOU), IHS would provide annual exams, preventive dentistry and vaccinations for pet owners who fall below 75% of the median income level. They would continue to provide sterilization, electronic identification and treatment for urgent and emergency cases to the general public.
In Washington, shelter representatives estimate that only a handful of organizations are large enough and have enough resources to be able to offer full service veterinary care. And it’s unlikely that many of the smaller shelters would be able to go the route of IHS and expand into huge facilities, at least not for several years.
Shelter organization trends
According to a recent presentation by the Society of Animal Welfare Administrators (SAWA), shelter organizations are undergoing major shifts, not unlike the veterinary profession. Reducing overpopulation has always been a primary part of their mission, and thanks to effective policies, intake is declining. Euthanasia continues to decline to current levels of less than 20 per 1,000 residents. The role of shelter organizations is changing from intake and adoption to an increased level of animal services and community outreach initiatives. Aside from adoption and veterinary care, they provide education, herd health, and behavior training.
Shelters are also experiencing consolidation with mergers becoming more common. It makes sense as shelters within close proximity to one another have to compete for donor dollars and attention within the community. Over the last few years, many shelters have merged as they look to consolidate staff and facilities, allowing them to help more animals than they could on their own.
Supply and demand of adoptable animals is uneven around the country and this, in part, is increasing the number of transfers between shelters. Since Hurricane Katrina, there’s been an explosion of transfers of animals between shelters in areas where there are too many animals to areas where there is a dearth of adoptable pets. In 2016 alone, 778,000 dogs moved to a new location.
These changes have brought a more sophisticated level of communication between shelter organizations and they’ve developed into a major voice in their communities creating a halo effect that has a greater impact than any tax advantage. In fact, shelter organizations don’t see themselves as having a tax advantage. They see their mission as serving the underserved, and the greater number of underserved pet owners they provide services to, the more money they have to raise. As long as they’re fulfilling their mission, they’re not getting rich.
Underserved pet owners
Of the over 180 million dogs and cats in the United States it’s estimated that 23 million pets live below the federal poverty level. Within these communities, 77% of these pets never have contact with a veterinarian, 80% never have contact with a shelter and 87% are not spayed or neutered. The majority get their pets from a friend or family member. They receive little or no positive messaging on pet care issues, have little or no access to veterinary care, and often don’t have transportation.
That doesn’t mean they don’t want care for their pet. According to a recent presentation given by PetSmart Charities at the Veterinary Innovation Summit at Texas A&M, 32% of the population earns less than $31,000 per year and of those who are pet owners, it’s estimated that they have a willingness to spend approximately $200 per year on veterinary services – as long as they’re low cost. What prevents them from getting care is the uncertainty around those costs.
Several members who answered the survey feel pet ownership is a privilege, not a right, that if they can’t pay for their pet, they shouldn’t have them. For the homeless dog owner, the elderly cat owner on a fixed income, or pet owners who are members of the working poor, their pets can be their entire world, no different than someone who can afford veterinary care. They work hard to provide for their pet, yet they’re often judged as irresponsible or uncaring. Poverty doesn’t affect a person’s desire to have a pet, nor does it diminish the ability a pet has to enhance a person’s life. Their reasons for not having enough money to pay for veterinary care — let alone their own care – can range from systemic poverty to situational or conditional poverty. They may live on fixed incomes. They may have lost their job or suffered a catastrophic illness. It’s a lack of material resources rather than a lack of love or desire to care for their animal.
Recent data taken from Thurston County shows 42% of the population is at risk of losing their homes and they’re paying more than 45% of their monthly budget for housing. It leaves little or no room to pay for things like veterinary care.
Consider the real costs of taking a dog to the veterinarian by someone who is low income. Jerry’s friend gave him a dog to provide companionship and now Jerry wants to get the dog spayed. To do so, he has to take off four hours of work without pay. He has to have enough gas in his car, or if he doesn’t own a car, he has to pay for public transportation or get a ride from a friend. The spay may cost him $50 – $100 at a local shelter. A private veterinarian is higher.
As a profession, it’s not in our best interest to say we’re all about the animals, but only if their owners can pay. As new data continues to emerge about the health benefits pet owners receive from having a furry family member, it would be a black eye on the veterinary profession to dismiss a segment of the population because they don’t match an ideal of what responsible pet ownership looks like, or because of a fear of losing revenue. Low-income pet owners the legislation intends to help rarely see the inside of a veterinary practice. These are not the profitable clients that veterinary practices are seeking.
Furthermore, veterinarians take their role as health professionals seriously. In a time when veterinary wellbeing is a major professional concern, especially for our younger colleagues, having to turn away clients or offer substandard care takes a toll on the emotional health of many veterinarians. With the cost of care continuing to rise, it would improve job satisfaction and reduce stress to be able to refer low-income pet owners to the local shelter so they could get affordable care for their pets. One survey respondent raised the point that veterinarians refer to specialists all the time for difficult cases. How is referring to a shelter for someone with no money any different?
Current Washington law stipulates that shelters can only provide limited veterinary services to pet owners who earn below 80% of the median family income adjusted for size and county of residence. The law doesn’t address how the organizations are to verify that their clients meet the income requirements.
It’s unknown how all 19 registered organizations in Washington address means testing. 17 of them state on their websites that they serve low-income qualified pet owners only. Seven of those provide income tables and one provides an attestation form for downloading. It’s also unknown how many pet owners above the income level receive services, although the (possibly apocryphal) stories about seeing expensive cars in their parking lots abound. Society will always have those who cheat, but the majority of pet owners who are receiving the services are the ones who can’t afford a regular veterinary hospital.
AVMA’s policy “Delivery of Veterinary Services by Not-for-profit/Tax Exempt Organizations” states, “where applicable, means testing to determine eligibility should be conducted in compliance with each organization’s internal documents for clients accessing veterinary services.” An overwhelming majority of survey respondents agreed that means testing should be conducted. But there are some veterinarians who disagree.
Veterinarians with experience working in shelters say means testing prevents pet owners from getting care for their pets. The main reason cited is that having to prove income discourages pet owners from seeking care, which has been well-documented in human healthcare. Low-income individuals often don’t have ID, paystubs or proof of participation in a government program. Some are above the poverty line but may still be impoverished. Plenty of families who earn too much for food stamps or Medicaid are struggling financially, especially in parts of Washington where housing costs have exploded over the last few years.
Shelter veterinarians also say that it takes a tremendous amount of shelter resources to means test, which places a burden especially on smaller non-profits. Also, in an emergency, it’s highly difficult to address income when the animal is in need of immediate life-saving care.
Out of 1,269 members who were sent the survey, 230 responded for an 18% response rate. 55% of respondents are over the age of 50, while only 4% are under 30. 65% of members who completed the survey are female. Practice owners and associate veterinarians are equally represented in the survey. 18% of respondents work in academia, government, non-profit organizations, industry, as locums, or are retired from practice. 80% of those who completed the survey are small animal veterinarians and 81% work in either a sole proprietorship or partnership type practice.
Just under half of the respondents practice in suburban areas. 32% practice in urban areas and the other 21% practice in rural parts of the state. 46% answered that they practice within economically diverse areas, followed by 35% in middle income populated areas. At opposite ends of the spectrum, 11% practice in high-income areas with 7% in low-income areas.
When asked how much of a problem underserved pets are in their community, 56% see it as a moderate to a serious problem, 39% see it as a minor to a non-existent problem and 5% are unsure.
Veterinarians employ a variety of financial strategies to help clients in need, but they are still faced with turning away clients for the lack of ability to pay for care. Only 13% reported they never turn away clients and of those, 57% are located in either low income or economically diverse areas. 60% reported that they only turn away clients a handful of times per year and 20% indicated they had to turn away clients a few times monthly.
When it came to asking if animal control agencies and humane societies should be allowed to provide full veterinary services, the membership was evenly split. Interestingly, practices located closest to shelters indicated more openness to allowing shelter organizations to provide full services. Older male practice owners disagreed with the change at a higher rate than their younger female associates. As veterinary students routinely gain surgery and community practice experience within the shelter setting, one might speculate that new graduates will be more open to referring less fortunate pet owners to shelter practices after they graduate.
We also asked about the relationship members have with shelters. Veterinarians overwhelmingly consider shelters as valued community partners and viewed their relationships as positive. 56% work with shelters to provide various services, and 50% reported that they receive new clients from local shelters. But when asked if members believe that clients who can afford to pay for veterinary care are receiving it from their local shelter, 39% answered in the affirmative.
Finally, when it comes to requiring shelters to means test, 88% think it should be required. Only 4% answered that means testing shouldn’t be required at all and 8% suggested lowering the income threshold.
In the coming weeks and months, we’ll meet with representatives of the Humane Society for Southwest Washington and the Washington Federation of Animal Care and Control Agencies (WFACCA). Just like many of our members who carry on meaningful collaboration with their local shelter, the WSVMA has enjoyed positive relationships with shelter organizations. We’ve worked together on legislation to strengthen animal cruelty laws, address dangerous dogs, incorporate tethering regulations and more. Additionally, representatives from WFACCA and the WSVMA meet regularly to discuss issues of mutual concern and share insights and information to improve pet health and welfare in Washington.
Regardless of the outcome of our discussions, the legislation will return in some form in the 2019 session. The legislative climate in Washington right now is such that opposing the legislation outright would prove very difficult. And that wouldn’t get us to where many of our members want us to be.
As we hold our discussions over the summer to prepare for the next legislative session, we’ll seek common ground and ways to work cooperatively.
Because as advocates for animals, we’re all in this together.
Candace Joy is the WSVMA Executive Vice President. This article was reviewed and approved by the WSVMA Board of Directors.
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Posted May 25, 2018
Update: The article has been updated to more accurately reflect the outcome of the agreement between the Idaho VMA and the Idaho Humane Society.