Support for Substitute HB 4912 Veterinary Telemedicine - ASPCA (November 5, 2021)

Summary

Written support dated November 5, 2021, addressed to Chairman Lilly of the Rules and Competitiveness Committee, regarding Substitute HB 4912 Veterinary Telemedicine, on behalf of the American Society for the Prevention of Cruelty to Animals (ASPCA). It supports proposed language in the substitute, specifically lines 25-29, that would ensure veterinarians may continue to provide telehealth services for both new and existing patients. It states that, as filed, HB 4912 would roll back Michigan veterinary telemedicine policy by requiring an in-person visit to establish a veterinarian-client-patient relationship. It also cites the Veterinary Virtual Care Association as reporting that no U.S. or Canadian jurisdiction reports problems with harm to pets from telemedicine.

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November 5, 2021

Representative Jim Lilly
Chairman, Rules and Competitiveness Committee
Anderson House Office Building
PO Box 30014
Lansing, MI 48909-7514

RE: Support for Substitute HB 4912 Veterinary Telemedicine

Dear Chairman Lilly:

I’m writing on behalf of the American Society for the Prevention of Cruelty to Animals (ASPCA), North America’s
most longstanding animal welfare organization, and our Michigan supporters. We write in support of proposed
language in the substitute for HB 4912, specifically lines 25-29, that will ensure veterinarians may continue to
provide telehealth services for both new and existing patients. In an era when the benefits to public health of
telemedicine technology are widely recognized, ASPCA supports policy to ensure the broadest access to medically
appropriate veterinary telemedicine services.i

Current Michigan regulations adopted earlier this year permit a veterinarian to begin working with a client for
care of a patient using telehealth service R 338.4901a . However, as filed, HB 4912 would roll back Michigan’s
sound, forward-thinking veterinary telemedicine policy by requiring an in-person visit to establish a veterinarian-
client-patient relationship that legally allows a veterinarian to practice medicine. Such a policy would
unnecessarily restrict both professional and consumer access to the benefits of veterinary virtual care at a time
when ensuring access to care and supporting public health is needed most.

Modern telemedicine technology in a connected world offers veterinarians the ability to examine an animal in a
home environment for many medically appropriate, common situations, such as triage, quality of life assessment,
palliative or hospice care, management and monitoring of chronic conditions, behavioral consultations, nutritional
consultations, dermatological conditions, parasites such as fleas, ticks, or ear mites, and more.ii The current
American Association of Veterinary State Boards practice act model language supports allowing a licensed
veterinarian to establish a VCPR through telemedicine,iii iii and human doctors throughout the country can
establish new doctor-patient relationships over telemedicine, even for infants and nonverbal children.iv

Telemedicine is a proven, safe means for delivering care, and highly educated, licensed Michigan veterinarians can
be trusted to assess when an animal needs to have an in-person examination and when to ask the client to bring
the animal to a clinic. During the COVID-19 pandemic, governments relaxed longstanding state and federal rules
restricting telemedicine, and according to the Veterinary Virtual Care Association, no U.S. or Canadian jurisdiction
reports problems with harm to pets from telemedicine.v Ensuring broad access to telemedicine provides a public
benefit not only for professionals who wish to offer these services to both new and existing patients but also for
consumers eager to obtain greater access to veterinary care. As such, restricting telemedicine in the manner
proposed by HB 4912 as originally filed should give the state of Michigan pause considering recent litigation on
the issue.vi The rigorous education and Board-sanctioned licensing requirements that Michigan veterinarians
undertake to become licensed in the state prepare them to utilize professional judgement in determining whether
the use of telemedicine is appropriate in the care of a particular animal or a particular condition.
The ASPCA strongly believes that pets and people belong together; that financial circumstances alone are not a
reliable indication of the capacity to love and care for a companion animal; and that strong bonds between people
and pets make for stronger communities. Unfortunately, every year thousands of dogs and cats needlessly suffer,
experience premature death, or are relinquished to animal shelters due to gaps in veterinary access. The Access
to Veterinary Care Coalition (AVCC), formed in 2016 and committed to better understanding and addressing
barriers to veterinary care, conducted a national study that found one in four pet owners face obstacles in
accessing veterinary care, with the “overwhelming barrier for all groups of pet owners” being “financial for all
types of care (80.0% for preventative care, 73.8% for sick care, and 55.7% for emergency care).”vii A 2011 study
published in the Journal of the American Veterinary Medical Association found that cost of care was cited
frequently as an obstacle to veterinary care.viii While finances are a primary obstacle for all pet owners seeking
veterinary care, many people live in underserved urban or rural, remote areas or “veterinary deserts” with few or
no veterinary services. Especially when combined, these factors can force families to make difficult decisions to
forgo basic preventative care, as well as the urgent medical needs of their pets.ix Poverty, medical emergencies,
lack of mobility, and geographic isolation can force even the most devoted pet owner to make dire choices.
Access to telemedicine can help address these challenges and others, such as preventing unnecessary time off
work for pet owners and ameliorating difficulties bringing pets to the clinic for seniors, disabled individuals, and
those without transportation.x Telemedicine is a critical tool for the veterinary community to bridge these gaps in
care.

As we are coming out of this time of national crisis where social distancing has been required to protect public
health, personal protective equipment has been scarce, and animals have continued to be in need, ASPCA
supports the reduction of unnecessary legal barriers to veterinary telemedicine, something that has already been
embraced in human medicine and corresponding public policy increasingly over the past three decades.xi While
physical veterinary medical examinations are of course sometimes critical, responsible use of telemedicine can
bring essential care to more animals. Because expanding access to veterinary telemedicine holds great promise
for elevating pet wellness across the geographic and economic spectrum, we commend the Rules and
Competitiveness Committee for considering a substitute amendment that will ensure veterinarians and
consumers may continue to use telemedicine effectively. Thank you for your consideration of our views.

Sincerely,




Senior Manager, State Legislation Government Relations


i
   “ASPCA Statement of Support for Veterinary Telemedicine During the COVID-19 Pandemic.” 8 April 2020.
https://www.aspcapro.org/resource/aspca-statement-support-veterinary-telemedicine-during-covid-19-pandemic
ii
    Veterinary Virtual Care Association. “Best Practices: Evaluation and Treatment of Patients.” June 2020. Accessed online
September 10, 2021 at https://vvca.org/wp-content/uploads/2020/08/BP-Evaluation-and-Treatment_min.pdf
iii
    American Association of State Veterinary Boards. “AAVSB Recommended Guidelines for the Appropriate Use of Telehealth
Technologies in the Practice of Veterinary Medicine.” https://vvca.org/wp-content/uploads/2020/08/Guidelines-for-
TelehealthAAVSB2020_4_10_min.pdf
iv
    AMA’s 2018 “50-state survey: Establishment of a patient-physician relationship via telemedicine,” finds that “all states allow
a physician to establish a relationship with a new patient over telemedicine.” See https://www.ama-
assn.org/system/files/2018- 10/ama-chart-telemedicine-patient-physician-relationship.pdf. See also Curfman MD, MBA,
FAAP, et al. “Telehealth: Improving Access to and Quality of Pediatric Health Care.” Pediatrics Vol. 148. No 3 September 2021.
American Academy of Pediatrics. https://pediatrics.aappublications.org/content/pediatrics/early/2021/08/27/peds.2021-
053129.full.pdf
v
    Cushing, Mark, J.D. “Incremental Change is a Step Forward: Smart Veterinary Reform Strategies.” Veterinary Virtual Care
Association 2nd Annual Summit. August 18, 2021
vi
    See: North Carolina State Board of Dental Examiners, Petitioner v. Federal Trade Commission, 135 S. Ct. 1101, Feb. 25,
2015.See also:
Teladoc, Inc. v. Texas Medical Board, No. 1:15-CV-00343.
Hines v. Alldredge, 783 F.3d 197 (5th Cir. 2015)
Hines v. Quillivan, 982 F.3d 266 (5th. Cir. 2020)
San Francisco Society for the Prevention of Cruelty to Animals; et al. v. Jessica Sieferman, 2:21-cv-00786-TLN-KJN (E.D. Cal.
filed May 3, 2021).
vii
     Access to Veterinary Care Coalition. “Access to Veterinary Care: Barriers, Current Practices, and Public Policy.” December
17, 2018. https://pphe.utk.edu/wp-content/uploads/2020/09/avcc-report.pdf
viii
     Volk, JO et al, “Executive summary of the Bayer veterinary case usage study.” May 15 2011. Vol. 238, No. 10, p. 1275-1282.
ix
    Access to Veterinary Care Coalition, Id.
x
   Some of these findings have been consistent with research related to human medicine. See COVID-19 Healthcare Coalition
Telehealth Impact Study Work Group. “COVID-19 telehealth impact study.” Available at https://c19hcc.org/telehealth
xi
    Nesbitt, Thomas S., M.D., M.P.H. “The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary.”
2012 Nov
20. https://www.ncbi.nlm.nih.gov/books/NBK207141/.
Field MJ, editor. Telemedicine: A Guide to Assessing Telecommunications in Health Care. Institute of Medicine (US)
Committee on Evaluating Clinical Applications of Telemedicine. 1996. https://www.ncbi.nlm.nih.gov/books/NBK45445/
American Telemedicine Association. “Telehealth Basics.” https://www.americantelemed.org/resource/ & “Telehealth:
Defining 21st Century Care.” https://www.americantelemed.org/resource/why-telemedicine/
American Hospital Association. “Telehealth.” https://www.aha.org/telehealth.
American Hospital Association. “Fact Sheet: Telehalth” February 2019. https://www.aha.org/system/files/2019-02/fact-
sheet- telehealth-2-4-19.pdf
National Conference of State Legislatures. “Telehealth Policy Trends and Considerations.” 2015.
https://www.ncsl.org/documents/health/telehealth2015.pdf
State of Florida Agency for Health Care Administration. “Florida Report on Telehealth Utilization and Accessibility.” December
2016. https://ahca.myflorida.com/Publications/docs/Telehealth_Report_Final_12-28-16.pdf
“AMA supports Telehealth Initiative to improve health care access.” https://www.ama-assn.org/press-center/press-
releases/ama- supports-telehealth-initiative-improve-health-care-access
Centers for Disease Control. “Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic.”
Updated 10 June 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html#edn7
American Medical Association. “COVID-19 State Policy Guidance on Telemedicine.” https://www.ama-
assn.org/system/files/2020- 04/covid-19-state-policy-guidance-on-telemedicine.pdf
American Medical Association. “Telehealth: Ensuring access to quality care during and after the COVID-19 pandemic.
https://www.ama-assn.org/system/files/2020-12/issue-brief-state-telehealth-policies.pdf
Center for Connected Health Policy. “State Telehealth Laws and Reimbursement Policies.” Spring 2021.
https://www.cchpca.org/2021/04/Spring2021_ExecutiveSummary.pdf
Smith, Timothy M. “How the crucible of COVID-19 can help fix the health care system.” https://www.ama-
assn.org/delivering- care/public-health/how-crucible-covid-19-can-help-fix-health-care-system


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