May 2016 - The Gallop: Where Does Rehab Belong?

Animal Rehab’s place in veterinary medicine continues to be a hot and complicated topic.

by Kim F. Miller

Equinology founder Debranne Pattillo operates one of most credentialed equine bodywork institutions in the world, but she’s always lived with the spectre of “being told we can’t do what we do.”

Had a proposal from the California Veterinary Medical Board to put a broad definition of “Animal Rehabilitation” into the Veterinary Medical Practice Act gone through, that spectre might have become a reality.

It didn’t.

In the roughly two years that this issue has been under discussion, Deb is pleased with the Board’s response to input from the animal-owning public and animal health practitioners, including veterinarians and complimentary care providers. But the question of who can legally provide various types of care for animals is still under review and thus a subject she and others advise horse owners to stay abreast of.

The original proposal regarding what constitutes animal rehab and who can perform it was approved by the CVMB last April. In October, the Board issued notice of its decision not to proceed with the rule making action. That was after considerable feedback, much of which was outlined at a September 10 meeting of the CVMB, which falls under the auspices of California’s Department of Consumer Affairs.

In the original wording of the regulatory proposal (to amend the California Code of Regulations Title 16, Division 20, Article 4) the Board determined Animal Rehabilitation “is the practice of veterinary medicine” and proposed that it be defined as follows:

“The use of physical, chemical, and other properties of thermal, magnetic, biofeedback technology, hydrotherapy (such as underwater treadmills), electricity, sound, therapeutic massage, manual therapy and active, passive, and resistive exercise for the prevention, cure, or relief of a wound, fracture, bodily injury or disease of animals. AR includes evaluation, treatment, instruction and consultative services.”

The proposal defined who could perform AR as a “veterinarian or a California licensed physical therapist or registered veterinary technician (RVT) working under the direct supervision of a veterinarian” and meeting various criteria meant to ensure safety, capability and follow-up consistent with other forms of veterinary care.

Complaints and concerns were many. Loss of the right to choose care providers for their own animals and the added cost and logistical hurdles of requiring direct veterinary supervision were chief among those. The idea that a highly trained and experienced complementary therapy provider would not be able to work without direct vet supervision was unacceptable to many. The impact of regulations on practitioners’ livelihoods was another issue, and it was noted that the Board only has authority over veterinarians and RVTs, not physical therapists.

The latest development was to unfold during an April 20 meeting of the CVMB during an agenda item titled “Discuss composition of the task force to examine goals for regulating the practice of animal rehabilitation.” That follows an October Board meeting mandate to “redefine animal rehabilitation, to define what animal rehabilitation is doing, to address whether minimum education requirements for individuals who participate in the services of animal rehabilitation is necessary in regulation to address the possible change in level of supervision, to discuss the requirement for a premises permit whenever veterinary medicine is being practiced, and to identify the issue of physical therapists being exempt and how to include or remove from the regulations as a barrier to moving forward.”

Protective Intent

Protecting animals and consumers from incompetent care in the face of a growing array of services and providers was the CVMB’s motivation for the proposal. There is plenty of agreement that the animal care industry needs methods for vetting care providers, but not much agreement on who should do it and how it can be done fairly and without increasing the cost and availability of care.

Carrie Schlachter, VMD, medical director of Circle Oak Equine Sports Medicine & Rehabilitation in Petaluma, is among those who believe “the state needs to regulate animal rehabilitation, like many other states do.” In a letter responding to the proposal’s original wording, Dr. Schlachter wrote “We understand and applaud the desire of the VMB to protect the public and the health and well-being of animals by explicitly prohibiting the practice of veterinary medicine by unlicensed and unqualified persons in the context of Animal Rehabilitation.”

She was concerned that the original wording was “unnecessarily restrictive” and would make AR cost-prohibitive, thus reducing the overall quality of care.

Regulation should vary depending on the service, Dr. Schlachter says. “I certainly think that shockwave should be administered by a licensed vet, but massage could be performed by a non-vet.” The proposal included “therapeutic massage,” which is different, Dr. Schlachter explains, than a general wellness massage. Lack of a defined distinction between the two is one example of a lack of clarity that was criticized in the original proposal.

At present, “Anybody can hang out their plaque and say, ‘I do massage,’ ‘I do rehab’,” Dr. Schlachter notes. “It could be your neighbor who has never touched a horse. People read the plaque and, because they are used to the human world, they assume that because it goes along with physical therapy, the person must be licensed.”

“I would love for animal massage practitioners to get together and regulate themselves,” she adds.

The prospect of getting insurance to cover some of these modalities is a strong case for bringing them under veterinary regulations, Dr. Schlachter asserts. In the human world, insurance usually covers therapeutic massage.

“Because there are no regulations surrounding it (in the animal care world), the insurance companies can ignore it.”

Animal Owners Rights

Debranne has interacted with the VMB for many years and is optimistic that they will do the right thing. The equine and canine body work schools she founded, Equinology® and Caninology®, are the only such horse and dog programs to be approved by the Bureau for Private Postsecondary Education. Because of its credibility, the programs produce graduates who were not the intended subjects of various Board proposals in the past, Debranne says she has been assured.

At the same time, she supports efforts by the California Alliance for Animal Owners Rights to create legislation that would protect freedom of choice in animal care, regardless of veterinary regulations.

Per its website, CalAAOR “is a group of animal owners, veterinarians and alternative/complementary care providers trying to find a state legislator to sponsor a bill modeled after SB 577. This will allow owners to choose non-veterinarians for animal care services and for care providers and consultants to operate without threat of action by the CVMB. This bill requires service providers to disclose in a waiver what their training is and the fact that they are not veterinarians. Owners have recourse against unscrupulous and incompetent care providers through the civil courts.”

Marta Williams got the Alliance started last fall. An author and an animal communicator, she is not worried that her practice will be put under veterinary industry jurisdiction. But she would like to add animal massage to her services and, moreover, is worried about the reach of veterinary governance in general.

Of the California proposal, she says, “They may have abandoned the original language, but not the effort. They’ve been hacking away at this for years and they are never giving up. They’ve already made it illegal for anybody doing acupuncture, chiropractic and dental work unless a veterinarian is paid to be present.”

She is not opposed to the idea that para-veterinary practitioners be required to have some proof of their training and competency, but questions what entity should be entitled to carry that out. In other states, she notes, one bodywork organization got “favored status” as the place where people could earn the required certification. “Wait a minute! We have TTouch, the Masterson Method and others. I don’t want all the other methods thrown out!”

The Alliance asserts that “it’s all about money” and suggests that anti-trust laws could come into play if some of the CVMB’s original proposals became regulations. “The majority of the Board Members are licensed veterinarians who have everything to gain by eliminating competition from non-veterinarians.”

The legislation the Alliance proposes would “supercede and nullify any proposed regulations,” Marta says.  She is not optimistic that public outcry will alter the CVMB’s course of action, thus the need for the Alliance’s proactive proposal. That may be a long, uphill haul, she acknowledges. The group was launched last September and, at present, has the interest of a few California lawmakers

“As everyone recognizes, veterinary fees have skyrocketed; people find it increasingly difficult to afford care for even the simplest issues,” the Alliance’s website states. “For the CVMB to pass new regulations that require that a veterinarian perform massage, water therapy and other types of care now available through lay practitioners will make these services inaccessible to most of us. Also, many veterinarians are not trained to perform what they are proposing to perform or supervise, but legally they can do it anyway. Alternative/complementary practitioners have years of study and expertise in their fields - this would all be lost to the animals and animal owners of California if these regulations go through.”

Deciding which animal rehab services to put under veterinary industry governance and how to regulate that is a complicated process. CVMB operations manager Ethan Mathes estimates it may take another year to make those decisions and hammer out an acceptable proposal.

Public comment has been a big influence at each stage of the process and that will continue to be the case, he says. Animal owners are encouraged to follow and weigh in on the issue by attending the Veterinary Board and Multidisciplinary Committee meetings, in person in Sacramento, via live webcasts or look for the meeting minutes available shortly after the sessions take place.

Resources
•    California Alliance for Animal Owners Rights: www.calaaor.com
•    California Veterinary Medical Association: www.cvma.net
•    California Veterinary Medical Board: www.vmb.ca.gov
•    Website where CVMB meetings are webcast and past meeting minutes can be found: http://www.vmb.ca.gov/about_us/meetings.shtml




The Gallop welcomes news, tips and photos. Contact Kim F. Miller at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 949-644-2165.