Laws and consequences: Texas legal changes in excruciating detail

On the face of it, the recent changes to Texas state law appear to be a good idea, aimed at preventing non-veterinarians from practicing veterinary medicine. But as is often the case with legislation, digging in to the situation a little deeper uncovers a load of unintended consequences, in this case in animal shelters. The whole story makes a great teaching case for how population medicine differs from individual medicine. There's a lot to cover, so let's get going.

The body of law in question is the Veterinary Practice Act. This Act covers, you guessed it, the practice of veterinary medicine. Among the basic rules that the Act lays out is the rule that in order for veterinary medicine to be legally practiced on an animal, there must exist a valid veterinary-client-patient relationship. That statement takes quite a lot of unpacking, so here you go:

• Veterinary medicine: in this case, giving a vaccination
• Valid veterinary-client-patient relationship: the relationship between the veterinarian, the client, and the patient. The veterinarian must have actually met both the client and the patient. Usually this must be renewed yearly -- so if you call your veterinarian and ask for a refill on your pet's medication, but you haven't had your pet in to the clinic for more than a year, the veterinarian must ask you to bring your pet back in for a checkup, or the veterinarian is at risk of losing their license. (Seriously. That's why they won't refill over the phone after a particular period of time.)
• But there is an exception made for herd health. If the veterinarian is treating a herd of animals (commonly livestock such as cows) then the relationship is with the herd, not the individual animal. So the vet can prescribe treatments over the phone for a herd member that they haven't ever seen, if they have recent experience with that herd as a whole.

In the case of an animal shelter, some states treat animals in a single shelter as a herd. This is entirely appropriate. In a shelter, medicine should be practiced with the good of the population at heart, not the individual animal. I promise that this is not as heartless as it sounds, and ends up actually being better for the individual in the end. If you let parvovirus get a hold in your shelter, it is the herd that is sick, but it is individuals that die. It is best for individuals to be in a healthy herd.

Until recently, the situation in Texas was that it was legal for a non-veterinarian shelter employee to give vaccines to animals in the shelter because they were members of a herd, so the veterinarian could write general herd health protocols ("give the core vaccines to all animals at intake") without having to see each individual animal. Now that's changed.

The problem is with stray animals. Shelters don't own stray animals for the first few days that they are in the shelter. This is called the animal's "stray hold," and is intended to give the owner a chance to reclaim their animal before it is put up for adoption. The number of reclaimed stray animals is typically low, especially for cats; often only 2% of stray cats are ever reclaimed. The majority of stray animals go on to be owned by the shelter.

Texas has changed the wording of their Animal Practice Act to specify that dogs and cats cannot be considered herd animals. Yes, it has really taken me this much explanation to get to the actual change in wording, but here it is: in the middle of a definition of the veterinary-patient-client relationship, the Act states (newly added text in italics):

A veterinarian possesses sufficient knowledge of the animal for purposes of Subsection (a)(2) [having a valid veterinary-patient-client relationship] if the veterinarian has recently seen, or is personally acquainted with, the keeping and care of the animal by:
(1) examining the animal; or
(2) making medically appropriate and timely visits to the premises on which the animal is kept. (NOTE: Per TAC 573.20(b) and 573.80(14), this section only applies to herd animals not including cats and dogs.)

On the one hand, it does seem silly to think of a "herd" of dogs and cats. But if you forget about the fact that the word "herd" has other meanings in other contexts, the real question that this change in wording is addressing is: Should shelters be allowed to practice population medicine on their animals?

In this particular instance, the fallout goes like this:

• By default, shelter animals in Texas cannot be treated as "herd" animals.
• Animals which are owned by the shelter are exempt from the Veterinary Practice Act, and therefore may still be treated as a herd.
• Stray animals which are still in their stray holding period, however, are not yet owned by the shelter and therefore are not part of the shelter's herd.
• Therefore, stray animals in their stray hold period must be examined by a veterinarian before receiving any treatment, including initial vaccines.

Not a big deal. Surely all shelter animals are examined by a veterinarian, right?

Actually, in quite a few shelters, veterinarians are only called in to treat sick animals, and the healthy animals are managed by technicians. Even in shelters which have a veterinarian, it is common for the veterinarian to only see sick animals. Of course, it is in the best interest of the animals for a veterinarian to see all of them as they come in the door, to establish a baseline of health status and to identify any problems that a technician might miss. But even in shelters with this policy, an animal may not be seen by a veterinarian for several days. Shelters are chronically understaffed and the vets are often behind on performing physical exams, as they have to prioritize treating sick animals more highly than checking on healthy ones.

Even in shelters which are fully staffed, it may be the next day before an animal is seen. If an animal comes in at the end of the day, the veterinarian may be in surgery the next morning and not get to physical exams until the following afternoon, so that the animal isn't seen for about 24 hours.

So the animal isn't seen by a vet for a day or three. If it's healthy, that shouldn't be a problem.

In the case of a shelter animal, one thing must happen the minute it comes in the door to the shelter: it must receive its vaccines. Prompt vaccination, right at the time of intake, is crucial in keeping animals healthy in shelters. Vaccination takes several weeks to bring the immune system up to its full efficiency in dealing with a pathogen, but there does seem to be an effect much earlier than that. Just a few hours one way or the other can actually make a difference, most critically in the very young and susceptible animals (did I mention in any previous posts how crazy kitten season can be in some areas?) and in the very dangerous diseases (such as parvovirus, which often simply manifests as dead animals with no warning). But don't take my word for it. The bible of shelter medicine, the Guidelines for Standards of Care in Animal Shelters, has this to say about prompt vaccination:

Because risk of disease exposure is often high in shelters, animals must be vaccinated at or prior to intake with core vaccines... Shelters that do not vaccinate with core vaccines immediately on entry, or do not vaccinate all animals, are much more likely to experience deadly outbreaks of vaccine preventable disease (Larson 2009).

This is how it works: the animal comes in to the shelter, either as a stray or surrendered by an owner. It gets processed, minimally receiving an identifying number, and is placed in a cage or run. Whoever performs this processing can either stick the animal with vaccines (and give it dewormers) at that time, or call a technician to do it. Giving vaccines isn't hard and you can train just about anyone to do it: it's technically easy (though it's nice to have someone else around to hold the animal still), and no decisions are really necessary. If the animal is too sick to receive its core vaccines against the most dangerous shelter diseases, it is too sick to be in the shelter and should get transferred to a hospital or other off-site care. Period. They all need their vaccines.

I'm saying this as someone who vaccinates her own animals much less often than conventional veterinary wisdom would have me do it. Shelters are full of disease and stress, and decisions about when and how to vaccinate there are going to be very different from decisions about animals in a home environment. I can't say it too often: without prompt vaccination, animals in shelters will die. The first question a shelter medicine specialist asks upon being confronted with an outbreak of parvovirus or distemper is "Are your animals vaccinated on intake?"

So, finally, on to this recent legal change in Texas. What shelter specialists see coming like an impending train wreck is lots of stray animals in Texas not getting seen by a veterinarian as soon as they are brought in to the shelter (it is not reasonable to expect that the vet could see them immediately); therefore, those animals not getting prompt vaccination; therefore, sick animals in shelters. Lots of them.

There is legal recourse at the city or county level: each city or county with a municipal shelter can change its ordinances to appoint the shelter the "designated caretaker" of stray animals during their hold periods. This allows the shelter to once again consider stray animals as part of the shelter herd, so that the veterinarian may ask someone else to give the vaccines before a physical exam has been performed. I have no real idea how likely it is that cities and counties will pass such ordinances, but I am guessing that the rate of adoption won't be anywhere near complete, and that the speed of adoption won't be blinding.

What's the moral of this story? I'm not really sure, but I think it has something to do with how complicated the consequences of legal wording can be, and how important it is to take the advice of specialists into account. I send my sympathies to Texas shelter veterinarians, who now will be faced with the scramble to still vaccinate stray animals on intake despite the change in laws.

Looking at dog brains

Today I was privileged to visit Dr. Greg Berns' laboratory to see awake dogs in an fMRI. In vet school, of course I saw dogs getting MRIs of their brains as part of medical diagnostics, in hunts for cancer, stroke, inflammation, etc. But because an MRI requires that the subject hold perfectly still for several minutes at a time, these dogs were under general anesthesia, which is both expensive for the owner and physically difficult on the dog.

In humans, we can use the related technology, functional MRI (fMRI), to see changes in brain activity in response to different stimuli, such as music, smells, or looking at pictures. This is a useful tool in research, for example as we try to figure out which brain areas perform which tasks. In dogs, we haven't been able to do such studies, because the only way to keep dogs still enough for an fMRI has been to anesthetize them, and obviously a sleeping dog isn't going to have a meaningful reaction to external stimuli.

At Dr. Berns' lab, they have trained dogs to hold still in an fMRI machine while resting their chins on a chin rest. Can your dog hold its head perfectly still for minutes at a time? What about in a strange room, with loud machine noises all around, with ear muffs on to protect their hearing? It's an impressive feat, and done using entirely positive methods. (The training protocol was developed by Mark Spivak of Comprehensive Pet Therapy, Inc.)

I was most impressed by the dogs' relaxed body language. They entered the machine willingly, when their owners asked them to. They lay down with their chins on the rest and waited. As I watched from behind, I could see that many of the dogs were lying on one hip or even frog-legged, in very relaxed postures, suggesting that they were comfortable being in the machine. (Have you ever had an MRI? It is a claustrophobic experience. Humans getting MRIs would benefit from the extensive conditioning preparation that these dogs had, as well as having a loved one present to feed them treats periodically!) Some dogs would balk at some points and exit the machine, at which point their handler would ask them to return and they would. Dogs always had the opportunity to leave. At the end of the test, they came out happy and wriggly.

Highlights of the day for me:

• The Boston terrier who hurled himself into the fMRI at full speed and then became rock-still for as long as his owner asked him to. That dog was committed to his fMRI experience! (Who would expect the Boston to be the calmest dog in the magnet?)
• The dogs with their ear protectors wrapped onto their heads with an elastic material normally used to attach catheters and the like. They looked hilarious.
• The treats fed to dogs on the end of long sticks so that they're easier to deliver inside the magnet. Ingenious.
• Personally getting to participate in experiments by giving hand signals to dogs who were in the magnet, watching me intently as they waited for their treats.

The joke around the lab is that these tests will tell us why our dogs really love us: are we best friends or just food dispensers? It is a joke because of course fMRI is not a test for love; science has some trouble testing for squishy concepts like that. But fMRI does give us a new  tool for guessing at what goes on in doggy heads, in addition to having to muck around with hormones like cortisol (as I have done) or strange little cognition tests like separation experiments or pointing experiments, as others have done. We have never been able to use this tool on awake animals before, so this is a huge step forward.

It was a fascinating day. I am deeply happy to see non-invasive research going on which takes the welfare of its canine participants into account, and waiting with bated breath to find out the results of the experiments I saw.


Further reading
 

• Greg Berns' home page at Emory

• Functional fMRI in awake unrestrained dogs (open access)
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Health care agents on mobile phones for pets?

I was just listening to a podcast about new health care technology using mobile phones. For example: someone wants to start eating healthier food. They install an agent on their mobile device which checks in with them every few days, asking things like How’s it going? Not so well? Why not? These agents are interactive, so if the user complains that things are not going well, it can understand the answer and reply: Here are some ideas to help you get past that particular hurdle. So I thought: why not for pets?

Imagine that when someone adopts a new dog (from a breeder or a shelter) they are asked if they’re willing to be signed up for a free preventive health care service. When they agree, they give their mobile phone number to the service. The shelter also provides some information about the animal: age, gender, if it is already spayed/neutered, and anything they think might need followup (such as if the animal is not housetrained, or if it is a jumpy-mouthy dog).

A week later, the new adopter gets a text message: How’s it going? Have you made your first vet appointment for Buster yet? No? Would you like some suggestions of veterinarians located near your home?

A few weeks later: How’s Buster? How is housetraining going? Not so well? Would you like some suggestions of dog trainers located in your area? The application might also alert the shelter that there is a training problem, so that the shelter can provide some followup if they have the resources.

And perhaps yearly: How’s Buster? Have you gotten his yearly checkup?

It would make an interesting study: are owners randomized into this service less likely to return their new pets than owners who are randomized out of it? How many owners continue to use the service (and how many request being removed from it)? Do owners find it helpful or annoying?

The first step, I imagine, is for me to do some reading on how these agents are implemented on the human side. I don’t know anything about this particular area, so anyone out there in internet land who has ideas for where to start (specifically, suggestions of peer-reviewed papers), they’d be welcome!

Is the flood of animals receding?

I got a great question from Christopher of Border Wars on my last post. He wrote: “From the data I’ve seen, shelter intakes are dropping in real numbers and have been for decades despite constant growth in both population and animal ownership. So aren't the flood waters already going out?” I answered there, but have been feeling that there’s more to say on the topic.

As I wrote back to Christopher, the numbers of animals surrendered to shelters and the numbers of stray animals are definitely dropping in most (but not all) communities. Does this mean our work is done? Below you will find rampant over-generalization! Enjoy.

Location, location, location
Things are pretty good in the northeastern United States. When I started this blog, I lived in New England. Shelters there certainly had their problems, but they weren’t nearly as overwhelmed as the shelters that I have seen this year in the South. Northeastern shelters often import dogs (particularly puppies) from Southern shelters. So when you’re looking at intake numbers, think about what part of the country you’re in. The problems in the South are still intense, as I can attest from first-hand experience this year.

Dogs vs cats
When I was in New England, I observed that many shelters were managing their dog populations very well. Dogs in most shelters had a very high adoption rate there; healthy, behaviorally stable dogs in New England shelters had little to fear. Cats were an entirely different story. Plenty of shelters were euthanizing cats for space, and the others were stuck holding cats for months before finding homes for them.

Ironically, the tide is turning with the new programs in which cats who have been successfully following a healthy free-roaming lifestyle are simply sterilized, vaccinated, and returned to the neighborhood in which they were living. This has dropped cat euthanasia rates dramatically in participating communities. (See my previous post on leaving outdoor cats where they are.) You can’t really do this with dogs, so suddenly some shelters are finding themselves euthanizing more dogs than cats!

A dog problem or a pit bull problem?
I have been told that New England doesn’t have an unwanted dog problem, but it does have an unwanted pit bull problem. By that, of course, I mean pit bull type dogs, as the “pit bull” designation does not refer to a specific breed and is often used loosely to describe mixed-breed dogs who have a certain look.

For sure, in almost any shelter you go to, you’ll see many more pit bull types than dogs of any other breed. (The exception is shelters in communities with breed specific bans, in which those types of dogs may not be allowed in the shelters, or are immediately shipped out or euthanized.) This type of dog is harder to adopt out of shelters, as many adopters are looking for a different type of pet. They also do poorly in shelters, because they are highly social, smart, and energetic. Many shelters are specifically struggling with how to stem the flood of pit bull type dogs; the various programs that have been tried are a topic for a different post.

Some improvement is not enough

And finally, as I said to Christopher in my answer to his comment, we may have seen some improvement, but it is nowhere near enough. Appalling numbers of animals were euthanized in shelters in the past. Somewhat less appalling animals are euthanized now. The Humane Society of the United States estimates that the numbers have dropped from 12-20 million shelter euthanasias per year in the 1970s to 2.7 million shelter euthanasias today. It’s all guesswork, because there is no centralized reporting for animal shelters; we don’t even know how many shelters are in the U.S., let alone how many animals they process and how many animals survive. Remember, though, that those numbers don’t include animals trapped in inhumane conditions in long-term facilities, sometimes for years (again, this is from personal experience). It does not account for overcrowding at shelters causing welfare problems, even short-term, for the animals who stay there. Nor does it account for animals dying of disease in shelters which do not have the resources to manage their populations. And it probably accounts for spectacular changes in some shelters, but much less change in others.

The trend is in a good direction, but we’re not done, and the trend won’t continue in this direction without more work. So get your animals spayed or neutered, don’t buy animals from pet stores or flea markets or online, take your dog to a training class to prevent behavior problems, exercise your dog for the same reason, and volunteer at your local shelter.

Stemming the flood of animals

This past week I was at one of the largest shelters in the United States. At one point, I was standing by a door chatting with some of my co-workers for ten minutes, and during those ten minutes we saw three sets of people coming in to surrender their dogs. This shelter takes in about 100 animals a day, 30,000 animals a year.

My co-workers and I realized that the biggest problem this shelter faced was its massive intake. Nothing else they could do to solve their problems would be more effective than reducing that. In fact, it has been shown again and again that euthanasia in shelters mirrors intake: more intake means more euthanasia, and less intake means less euthanasia. But how do you reduce intake?

When I was catching up on my life this morning with my husband, I told him about managed intake: the shelter only accepts owner-surrendered animals that they have room for. If they don’t have space, they don’t accept the animal. The animal may be put on a waiting list, and ideally the shelter offers support during the wait (food if the owner can’t afford to feed the animal, behavioral advice, help finding animal-friendly housing).

In the case of animals that the shelter knows that they will have great difficulty placing (old, sick, etc.), they will let the owner know that they will immediately euthanize the animal. This sounds cold, but the alternative that many shelters practice is to take the animal in and euthanize it without warning the owner that this is inevitable. (No one likes conflict, least of all institutions run by local government.) This approach shifts the responsibility onto the owner. Although many people who surrender animals to shelters know that the animal may be killed, it is much easier to convince yourself that that could never happen to your animal (which you know is so wonderful) if there is some chance that the animal will survive. This puts the choice of euthanasia onto the shelter, and the blame onto the shelter. But moving the decision back to the owner means that the owner has to deal with the decision, and hopefully find another solution, or at least take the experience into account the next time they acquire an animal or have difficulties with a pet. (Is the experience of surrendering a pet to an unknown fate more difficult than the experience of having a healthy pet euthanized? I have my own guess, and you can make yours.)

My husband (kindly playing the foil in the Socratic dialogues of this blog) asked me about the unintended consequences of such a policy. The shelter is mandated by the county to accept stray dogs. Will the policy result in more people untruthfully representing their surrendered pets as strays? Will it even result in more animals being abandoned on the street?

We don’t know; the research hasn’t been done. Some shelters have experimented with managed intake, and their experience has been that this policy does not actually cause very many people to do reprehensible things. Mostly, people will put their animals on the waiting list (perhaps with some yelling at the shelter employees first), and then some of them will surrender the animal when room is available, and some will find other options (like a friend who wants a dog), and some will decide to keep the animal after all. And some will be lost to follow up, so perhaps those people do put the animal on the street.

But here is what I think about it: abandoning an animal on the street is illegal. So if a shelter institutes managed intake, and as a result some people break the law, whose fault is that? Is it the shelter’s fault? In my book, the shelter is behaving very responsibly by refusing to accept animals that they cannot care for, and by being honest that a new animal which is accepted must be euthanized. Some support for owners who need it is essential, and should be considered a part of managed intake. If an owner responds to this policy by breaking the law, I feel that the blame is with them. Perhaps increased enforcement of animal cruelty laws (which include neglect) is the proper answer to this problem.

More and more shelters are considering managed intake. I think there will be anger in some communities at first, but I am very hopeful that if enough shelters institute this policy, there will eventually be a sea change in our culture’s approach to unwanted animals. Whose problem is an unwanted animal? The owner's.

Social epidemiology recommendation

I am totally digging the first week of Social Epidemiology, a course on Coursera. (Quick summary of Coursera: free classes; you don’t have to commit, can just watch the lectures if that’s all you want; entirely online and open.) Epidemiology is of course the study of disease at a population level, and most people think of classic epidemiology cases like Ebola virus (who got it first? how is it transmitted in the population? who’s most at risk? how do we stop its spread?). But social epidemiology is about the social factors in disease — most commonly chronic diseases like diabetes and heart disease. What social factors cause people to live unhealthy lives?

This is obviously applicable to veterinary preventive medicine (though not directly addressed in the class; it takes some extrapolation). Why don’t people vaccinate their animals? Why don’t they exercise their animals? My personal interest is in how to prevent these sorts of problems, so I’m very much hoping that later in the class it will address preventive medicine and policy (how do we help people live healthier lives?). But if I wait until that happens to recommend it, it will be too late! Take it now! No committment! You can just listen to the lectures (or just do the readings). Only take the quizzes if you want to (though the first one wasn’t difficult). Just learn!

Hopefully a few years from now I will be offering the world’s first Social Veterinary Epidemiology class online. A girl can hope.

The point of all this

I was on the phone with my mom yesterday, and she asked what I was doing next week. “Going to a large shelter in [big Southern city,]” I say.

“I’m not sure what the point of all this is,” says my mom with her PhD, who had been so enthusiastic when I told her that I was planning to do a PhD in the genetics of dog behavior after I finished my internship. “But you have known what you’re doing before, so I guess you do this time too.”

“Do you want me to try to explain it?” I ask, and she allows that this would be acceptable.

So I try to explain why I’m doing a year of clinical work in shelters if I am so interested in dog brains. The thing is that I have always been interested in both research (and teaching and writing peer-reviewed papers and being hidden in the ivory tower) and in being in a shelter or in the field and getting my hands dirty and making a tangible difference. I do want to figure out the mechanisms behind pathological fearfulness in dogs, and what makes domesticated animals like dogs different from wild animals like wolves. But I also want to keep connected to the world of the animals who are actually suffering from shyness, both so I can get new ideas about what needs studied, and so that I can try to apply some of what I learn.

I have always felt that my two interests, in fearfulness in dogs and in clinical shelter behavior, are closely intertwined. But the institutions I’ve learned from don’t seem to see it that way. Four years of clinical work for a DVM degree (in which we were told again and again that more veterinarians are needed in research, but in which we had no classes about research topics). One year of a research Masters. One year of a clinical internship. Next, several more years of research. My internship mentors worry that I am too interested in research and not enough in clinical work. My PhD mentor worries that I am too interested in clinical work and not enough in research. When do I get to do both at once?

After I’m done with schooling, maybe. I’ve learned a lot about how shelters work in my internship, and maybe even more importantly, I’ve seen some possible career paths in consulting for me. Part time work, called in on a temporary basis to work for large animal welfare groups dealing with issues such as enrichment in temporary shelters after large seizures of hundreds of animals, or behavioral evaluations of large numbers of seized fighting dogs. The other parts of my time spent teaching? Doing some research? It’s way too soon to try to figure out the details, but at least I have ideas of where to look to put together my perfect patchwork of jobs. And hopefully with my internship under my belt I will have the street cred to say that I know how shelters work and what their common problems are.

Maybe I should have just said that there are lots of broken dog brains in shelters, and left it at that!