at fear-free we're very excited to support the aspca's approach to Tele medicine and legislative review our mission at fear-free is to prevent and alleviate fear anxiety and stress in pets and educate those who care for them tele medicine and telea Health appointments provide an opportunity to give vetenary care to patients in a more relaxed and comfortable environment as well as allowing pet owners to be less stressed they can request and receive vetenary Care on demand there's a lot of misconception um and misunderstanding about the current state of Veterinary legislature surrounding tele medicine and telea health so I'm excited to introduce our friends at the ASPCA to help us decipher not only the benefits of Tel medicine and telea health but also provide some up-to-date information on current legislature and provide us with tangible ways to get involved we're very excited to have the team from the aspa ASPCA join us today to share their know surrounding this issue I'd like to pass this over to Dr D Clemente who's going to introduce the ASPCA team and begin our presentation thank you so much and very um grateful for fear free bringing us all together and um you'll be hearing from all of us at the ASPCA I'm Dr Camille declen and I'm I work in our ASPC Animal Hospital you'll also hear from Jen Brittany and Amy who are part of our government relations team and we hope to have a fun uh enjoyable session today so thank you for joining us on our first slide here is a painting from 1903 which is hard for me to believe when I take a look at that painting it looks very relevant um the painting is by cm kulage and it's called a friend need and even though this painting is you know more than a hundred years old we think it does a good job representing the Contemporary topic we're talking about which is the role of tele medicine in the future of animal welfare and the shifting political landscape around Veterinary tele medicine as you might know the phrase in the cards means that something is likely to happen and things are happening around tele medicine right now so in our discussion today we're going to look into the future where we believe that effective and responsible use of tele medicine will move us closer to fear-free accessible veterinary care for our Animal Companions um slide two so this is the group that is joining you today with our much nicer pictures than what you see in person of course and slide three please yes so this is a kitty a senior Kitty that demonstrates the type of pet we think that would benefit from better Access to teleah Health Care um from the comfort of their own home and today we're going to talk about what we believe the asbca believes about tele medicine why we believe leave it what are the laws how we're working to change those laws how you can get involved and then there'll be time for question and answer and please do put your questions in the chat and we will try to get to them at the end slide four so first we will talk about what we believe at the ASPCA around veterinary medicine so we believe that tele medicine has the potential to increase access to care to reduce unnecessary fear anxiety and stress so FAS and extend the capacity of animal shelters to serve their their communities all of that together should increase and improve Animal Welfare across the geographic and economic spectrum Slide Five please so basically what we believe is that veterinarians can be trusted to decide when a case is appropriate for tele medicine and when it's not these are highly skilled highly educated people and we believe they can be trusted so we support the reduction of limit legal limitations to Tele medicine access and with that I'm GNA turn you over to Jen hobgood hi so H my name is Jen hobgood and I'm with the government relations team at ASPCA and so right now what we're going to do is we're going to look a bit more closely at why ASPCA believes expanding access to Tele medicine holds so much promise for improving Animal Welfare the three main reasons are that helps Bridge care gaps for owners reduce unnecessary animal stress and extend shelter capacity yes there is an animal shortage sorry an animal Vetinarian shortage we hear from some of our colleagues in the Veterinary Medical Association world that that that's not true but there is a documented shortage of veterinarians Nationwide it's becoming crisis in many areas of veterinary medicine and if you take a look at this map if you're not familiar with it the Veterinary Care accessibility project is an excellent resource for looking at access to care at both the state and the county level so vcap has taken data from the US Census Bureau the CDC and avma and they've come up with an access to care score for those areas throughout the country at down to the county level we know that studies indicate that many pets do not see a veterinarian regularly often because their owners confront significant barriers to care whether it's affordability or accessibility due to the shortage and those obstacles can result in pet owners for going care or postponing Veterinary visits or even relinquishing their pets to animal shelters in 2020 the chief Economist for the abma estimated that over 50 million pets in the United States approximately oneir do not see aaran at least once a year and we know that in September 2020 study by a former University of Florida College of veterinary medicine Dean Dr James Lloyd found that 75 million pets in the US could be without Veterinary Care by 2030 if we do not update our approach to providing these Services tele medicine has the potential to address many common barriers to care you know we Financial barriers in particular we know that so many pet owners can't afford veterinary care and if costeffective virtual care services are available and research shows promise here tele medicine can help address one major barrier to care and that's cost which is currently escalating to the point that Veterinary Care is rapidly becoming a luxury item for so many pet owners tele medicine can also help address those ancillary expenses related to you know cost of Transportation if folks don't have a vehicle travel time missed work and so forth tele medicine can help address Geographic and logistical problems with bringing pets to the clinic faced by seniors you know we know their pets are often a Lifeline for them particularly if they live alone but higher rates of transportation and Mobility difficulties are are found within this demographic and so disabled individuals can benefit from expanded access to telea health for pets those lacking Transportation those who face difficulties transporting large dogs or reactive animals to clinics those spicy dogs like I have a little spicy Terrier in the back background here you might hear from momentarily she's bomb proof at home but take her to a vet clinic and take me out of the equation out of the room and she has a lot to to say the vet staff and mostly with their teeth so spicy cats who don't do well with staff or other animals or travel phobic animals can benefit from expanded access to vetenary telea health and especially those who live in underserved Urban or rural areas the availability of vet services in the shortage is becoming a huge problem we're seeing emergency clinics close or curtail their hours and folks having to wait days weeks sometimes months to get that care that their pet needs tele medicine can also address barriers to care for large animals we know the veterinary shortage is especially acute in rural areas where there are more large animals owners of large animals face those Geographic transportation and financial barriers to care that better access to Tele medicine can help overcome an expanded use of tele medicine technology we know can help bridge those gaps in care that are caused by Workforce shortages and increase access to the veterinary Health Care System helping keep pets and people together we wanted to highlight just a few bits of research there's so much out there now and it's really promising this this first though is is a statistic that's important to keep in mind when we talk about the escalating costs and people's ability to access care for affordability reasons this is from the Consumer Price Index that the cost of Veterinary Services increased almost 11% last year alone and we know that many pet owners have visited a veterinarian at any time but only 40% visit vet annually the research goes anywhere from you know 28% to 40% but this is obviously a huge percentage of the public that is not being served by the current model of care that is riant on brick and mortar clinics access to Tele medicine now this next study is from Human Healthcare but demonstrates that access to Tele medicine reduces those cost barriers and place-based disparities and this last one I find just fascinating this is a study of over 21,000 virtual consults and the conclusion was overwhelmingly clear that there were low prescribing rates and that includes antimicrobials treatments were effective and no harm was done to pets by prescribing remotely via a Veterinary consult app in fact folks got access to Safe convenient veterinary care if you look at the last data point there the last bullet point you'll see that 99.3% of those prescriptions were green first line antibacterials very few were yellow and none were the red so we sometimes hear in these debates oh it'll you know Hess a tele medicine it's going to lead to overprescribing of antimicrobials but that's just not what dat is showing that we what it's showing is that it's the same veterinarian in the clinic as of tah health and they make judicious decisions about antibiotic stewardship an ASPCA survey of pet owners that we conducted last year to dig a little deeper into this our strategy and research Department did a survey of pet owners and we wanted to look at how people are accessing veterinary care and about one in four PE of the people that we surveyed reported there was a time in the past two years when they wanted or needed vet care and were not able to access that that care so among those about 50% said they weren't able to get preventive care 43% couldn't afford care 19% said they didn't have a way to so what are they doing instead you might not be surprised Dr Google 30% said they went to the internet to find a way to fix it 23% said they asked a friend and 15% which is which is not insignificant said that they gave their pet to a shelter or rescue so they could fix the problem they severed that Bond and and surrendered the pet when they weren't able to access care 47% though said that that they were more likely to try tele medicine if they knew it tele medicine services were available and affordable to them and 40% said they'd see a that more often and these are folks we surveying in 20122 when Veterinary Tel medicine really still isn't known to most pet owners so we just kind of ask them about it and we're getting a very positive reception that it could help expand access to care pet health generally and end of Life Care specifically can be improved by greater access to Tele medicine because so many pet owners don't want to cause their pet stress they delay care uh even at the end of life when we could significantly help these animals with veterinary care we know that tele medicine can reduce suffering as well as compassion fatigue for veterinarians and staff who are sometimes forced to to euthanize animals for economic reasons or or they see these animals at the end of their lives that have gone without care for so long tele medicine could also expand access to hospice care but what I think is interesting about this lap of love this is an unpublished just inquiry they made through vet success they wanted to look at euthanasia performed in a clinic and see how long has it been since that animal has been seen before youth 18 months prior just a year and a half well over half the cats 40% of the dogs hadn't been to a clinic if you look at 12 months 58% 44% of dogs it just gets higher so animals at the end of life aren't getting the veterinary care they need and tella health will open those doors to these animals especially when owners are concerned about taking their pets and causing them stress and I maybe preach into the choir here when when we talk about research documenting that clinical Veterinary examinations are stressful for most dogs and cats fear Free's website has an excellent extensive research list but I want to highlight just a couple here one study found that almost 78% of Dogs showed fearful behavior during a standardized clinical examination with 133% of those so terrified they had to be physically dragged or carried into the exam room we know dogs that are generally friendly to people can become reactive or extremely fearful when handled by Veterinary medical personnel especially if they're in pain and oftentimes in a clinic environment dogs and cats are sometimes separated from their owners for medical exams and in many cases that separation results in even greater stress than if the owner remained with the pet there's there's a well-known study from 2011 uh the bear study revealed that 40% of cat owners hadn't taken to their cat their cat to a veterinarian in the past year and some of the some of the wording in the study is really interesting the cat owners and and none of you will probably be surprised by this anyone that owns a cat knows that it is highly stressful for the animals and the people to get cats to the vet they hide when the carrier appears aggressively physically resist being put into the carrier cry during car or bus ride to the Veterinary Clinic show signs of stress and fear in the waiting area particularly when unfamiliar animals like dogs are present display physical signs of attention during the examination and even act remote and unfriendly for uh several days after returning home and in that study cat owners Express the desire to avoid the difficulties and unpleasantness associated with bringing the cat to the veterinarian so we know cats aren't getting enough care for those reasons we love how the veterinary um and shelter certification program fear free has the model taking the pet out of petrified and one of the key tactics that fear-free emphasizes is the use of previsit for Pharmaceuticals admin administered out prior to coming to the clinic to prevent that anxiety and fear and stress and that sort of a a best practice is not available under laws that require a Vetinarian to put hands on the animal before that animal has access to remote prescribing we believe that when a veterinarian feels they can safely diagnose and treat an animal based on a tele Health examination it can spare anxious Pets the unnecessary stress of a clinic visit this a really interesting study uh from January 2023 it was funded in part by the ASPCA this is a UC Davis study where researchers found that cats showed signs of increase stress in office appointments in home appointments better reflected the health and behavior of cats and that and they found and concluded that tele medicine could be in effective for routine consults or in rural areas with little access to care um the researchers what they did was documented pupil dilation respiratory rate lip licking and ear position in these home sessions participants would lift the cats for visual inspection and and they would count the breaths all appointments were recorded and photos of the cat's eyes were taken as you can see here to measure the pupils the research found that cats took more breaths had larger pupil dilation and more negative ear positions during the in-person examinations as compared to the home assessments which of course indicates increased stress and arousal in the clinic setting and this is a quote from from one of the researchers these results support the idea that video appointments could help reduce stress surrounding Veterinary appointments in cats and they found inhome assessments could better reflect the health and behavior issues because cats of course are both predator and prey they don't want to show their vulnerabilities they might be sick and acting like nothing is wrong in a clinic whereas being comfortable in their home environment can better reflect how a cat is feeling or if they're in pain so for these fear pets whose owners May postpone those clinic visits out of a desire to to not subject their pet to undo stress tele medicine can provide more options from care to be accessed from the Pet's comfortable home environment or for mitigating that fear and stress when they have to be transported to a clinic quality of life assessment paliative care and end of life or hospice care provided through Veterinary tele medicine technologies have the potential to reduce those unnecessary clinic visits minimize stress and lessen animal suffering especially for for senior or terminal animal patients so in this next section we want to briefly go over the the benefits uh to animal Sheltering of Veterinary tele medicine we do know that you know many people um when the subject comes up they say well the the animal shelter owns the animals in their care that is not always the case depending on state law California has a particularly thorny law about this um but they don't own all the an animals in their care they don't own the Stray holds that the veterinarians do make medically appropriate And Timely visits to the premises but this is a gray area of law it's very murky for certain animals whether or not the veterinarian can treat them depending on the legal status so what we want to look at first is is a study out of California and then we'll get to the benefits we want to look at part of the problem that we're seeing in shelter medicine this is one of the areas where the shortage is so acute so uh out of this re a recent survey in among California shelters conduct by the San Francisco SPCA in partnership with some other folks UC Davis and so forth found that of the shelters that had budgeted vets and vet teexs more than 50% were remaining vacant due to the lack of candidates over 2third 68% of the shelters cannot consistently provide care to treat conditions commonly seen in shelters and this is a quote from the study survey and I think it's so important to read it because because of uh what we find out here survey respondents agree that a lack of access to Veterinary Care has numerous Downstream effects notably nearly 80% of respondents identify that increased length of stay results from inadequate access to vetare and that increases the cost to house animals strongly contributes to behavioral degeneration in shelter and increases the number of animals that staff need to care for at any given time other major Downstream effects include inability to provide intake prevention programs limitations on adoption programs and limitations on community cap programs and this the uh study author say these programs are all pillars of a modern approach to Community Animal Care therefore a lack of access to care hinders organizations abilities to meet current best practices in animal Sheltering and this is a graphic that we developed at ASPCA to kind of demonstrate this problem it's a cycle so we have unmet needs in the community unmet medical needs leading to longer lengths of stay in the shelter environment which of course to make those sick animals healthier it takes longer so that's leading to larger shelter populations which of course leads to a reduced capacity for care and can contribute to unmet needs in the community so it's a cycle that expanding access to care such as tele medicine can can help us disrupt in the field except for stray holds you know we know shelters typically own the animals and they make those timely visits to the premises but um animal shelters need the flexibility to use tele medicine because of this this can be such a gray area of law animals in the custody of shelter programs who need Veterinary Care like potentially owned animals who are currently lost or animals in foster homes that are not owned by the shelter but are but are the pets of the foster parent stand to benefit directly and indirectly from expanded access to Tele medicine so shelters benefit in a number of ways first of all animal shelters with veterinarians on staff can face situations where these veterinarians can't be on the premises but can still be able to provide care through tele medicine and for animal shelters without veterinarians on staff life-saving services can be provided through tele Medicine by third-party veterinarians Community cats raise a whole host of questions like who's the owner how do we adapt these herd Health Concepts how you you can't perform an in-person exam on a feral cat every year without major major intervention here most private practices don't accept feral cats as patients so so how can tele medicine help us serve that population in particular and of course Health Equity we want to give all patients the care they need when they need it they deserve it and if more than one onethird of pets in our communities don't regularly see a Vetinarian this can stretch shelter resources one last fact here a national study showed that 40% of low-income owners who rehome their pet reported that access to affordable vet care would have helped them keep their pet so we can keep those animals in homes and out of animal shelters and that of course protects our animal Sheltering facilities also animal Sheltering facilities that operate clinics that are open to the public can increase their community's access to care through tele medicine offering different Services quality of life assessments and and treatments for routine conditions that can help keep animals in homes and out of shelters and can help prevent disease spread and conserve shelters limited resources and that's why we're seeing groups like The Association of shelter veterinarians coming up with a very strong tele medicine position statement you can find this on their website and I won't read it but they have a very similar policy to the ASPCA which is that veterinarians at their discretion should be enabled to create new patient relationships over tele medicine same for the association of Animal Welfare advancement you can find both of these position statements on the web so I won't Bel labor this point but it's it's both of these groups support new patient relation ships over tele medicine which are currently blocked in many states so now that brings us to the policy where are we and where can we go from here right now where we are is that many laws unnecessarily constrain Veterinary tele medicine so we're going to look at what the what where we are now where we can go historically some Physicians resisted emergent tele medicine expansion for similar reasons that we're hearing in in legislatures across the country nowadays they claim that that claimed back then that the laying on of hands was absolutely vital to any proper diagnosis and treatment for many years there were some Physicians um who who felt that way but as all the way back to the early 90s that's that's not been the case of resistance in human medicine pretty much evaporated in the early 90s to t a medicine so all 50 states in all 50 states human providers can create and not just doctors not just Physicians but nurse practitioners and so forth and many states can also create new patient relationships over tah Health but certainly Physicians can and human tah Health really recognizes that in-person physical examinations may not be necessary in many cases that tele medicine can expand access to health care and offer people a convenient safe way to stay more connected with care and keep sick people out of waiting rooms when it's not necessary and that includes for all human patients babies and other nonverbal people in all 50 states Physicians can establish relationships with these patients to deliver better care I love this ad in the most recent Stanford magazine that says whether you are a firsttime or established patient a video visit can be appropriate for both primary and Specialty Care appointments to diagnose and treat many conditions we have figured it out in human health care and veterinarians need to have this capacity as well but what is blocking it this right here you didn't hear a lot about this until recent years right the vcpr what is that the debate about Veterinary tele medicine centers around a component of legal practice that's long been settled in human healthare the flexibility of the healthcare provider to establish a new patient relationship over tele medicine in veterinary medicine uh many state and federal laws though have been outdated laying on of hands ideology hardwired into their laws so the correlation of course to the doctor patient relation ship The Physician patient relationship is the veterinarian client patient relationship or vcpr and the sometimes decades old federal and state laws require requiring a recent examination sometimes within 12 months for a valid bcpr and this Remains the abma's model policy uh that a Veterinary of vcpr cannot be established electronically so so we're at a pivotal point where we need to update these laws and first we want to look at at the Federal Regulations because sometimes lobbying this issue we he oh we hear the federal federal laws prohibit establishing a vcpr over tele medicine can't do it that's that's misleading at best um and at worst an outright lie at the federal at the federal level only two Provisions require a vcpr and that's the usda's regulations relating to extra label drug prescribing which is a significant amount of prescribing in the veterinary world as well and Veterinary feed directives and what the regulation say here is that have a valid vcpr and that can only exist when the veterinarian you can hear my I don't know if you can hear my vious attack toy poodle in the background that the bcpr can only exist when the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal by virtue of an examination of the animal and or by medically appropriate And Timely visits to the premises that latter part is for hert health for Farms primarily so that's the extra label drug Reg ulation and the similar one is used in the veterinary feed directives language um those Federal Regulations are you know they were enacted with the animal medical drug use clarification act in the 90s at least the extra label drug regulation was and with Veterinary feed directives it was just repeated a little bit later when that was enacted they're decades old at least the extra label is but in 20 2023 when the FDA withdrew its temporary enforcement weight where you know during Co the FDA wanted to make sure we could maximum maximum use of tele medicine could be enabled and that that laws weren't getting in the way of that they said we're not going to be enforcing those Federal vcpr rules because we want people to be able to use tele medicine but when they withdrew that guidance they did say even though the the rule doesn't specify physical they said the federal vcpr definition cannot be met solely through tele medicine so for those two situations vetenary feed directives extra label drug use you need a physical examination but those laws were enacted when our technology wasn't nearly as advanced and looked a little bit something like this so I think you could probably guess what world event uh catapulted Veterinary tele medicine to the Forefront of our policy discussions the covid-19 pandemic of course so other than the extra label drug prescribing and vfds the vetenary feed directive state laws govern the practice of veterinary medicine within each state and that includes the vcpr most state laws require veterinarians to establish a vcpr or obtain sufficient knowledge of a patient before they can legally practice veterinary medicine or treat an animal patient but this landscape is changing um the definition of tele medicine for the purposes of this map it's a kind of inine print but it's this is to demonstrate the lack of discretion in the law once a veterian has that inperson bcpr they can use tele medicine but they can't at their discretion with new patients so what you see here is what it looks like uh in veterinary medicine right now Most states don't enable veterinarians to have discretion over that choice though it is changing which is what we're going to talk about here in a second just real quick you see that on the on the support side a number of organizations but don't let this look lopsided the abma is on the other side and the abma sponsored Coalition for connected Veterinary Care includes a large number of of that state bmas and some other National groups so it is it is a divided industry right now and what we are seeing is that some of the recent legislation is not to expand access to Tel medicine but but contain it with an in-person vcpr requirement so we have to ask the question you know is this is this kind of stacking the deck here in some way so if we look at the legislation that passed in recent years to require a physical exam or prohibit a tele medicine vcpr this is what it looks like red the red States would be those States in California has changed which you'll hear about momentarily but California's law prohibited prohibited veterinarians from establishing a vcpr and then seeing that patient again within 12 months for something else they had to reestablish the vcpr through a physical examination for each medical condition and the West Virginia bill that passed mandated a face Toof face that even had these words in it inperson examin of the patient within 12 months so so I want you to remember this map because I think you're going to see it's it's changing the question is in a post-pandemic world where tele medicine is a proven effective tool for expanding access to care why are some folks doubling down to require a physical examination before a Vetinarian can treat a patient and we know a bluff is like um it's a it's it's a bet that you make with a weak hand hoping your opponent will fold a stronger hand and and a tell is an unconscious indication from your opponent that he has a certain type of hand so I think if you look at this it speaks to what one veterinarian Dr Patty says is you know that that it's it's almost like political subterfuge we're saying oh it's about quality of care oh it's about animals can't talk when really she says is this a is this a genuine ethical argument about quality of care or is it disingenuously fabricated to serve a protectionist position favoring brick and mortar medicine uh is the is the limitation based on the ability to speak a specious argument in service of the status quo so what you see now the the maps are starting to look different there's an uptick in some more Progressive Forward Thinking legislation that looks at expanding access to Tele medicine so in 2023 this is what the map looks like you can think green means go red means stop in Alaska and Illinois there was legislation to require an in-person exam prohibit tele medicine vcpr but in the other states Progressive legislation and in Florida there was one of each filed in 2023 and then this is what it looks like this year you know in Colorado we have competing proposals that in many other states Progressive legislation New Jersey who has a really great law uh for some reason is there's there's a legislation that would repeal veterinarians ability to establish a vcpr virtually these I just wanted to quickly look at in Arizona last year we had a a victory for incremental progress on Veterinary tele medicine it's a a veter virtual vcpr but there were limitations on prescribing so 14-day duration of a prescription with one refill with another tah Health exam and then after that patients would have to come in for additional refills in New York New York doesn't have a vcpr in law or regulation they have guidelines that the veteranary medical board has issued those don't have the force of law so there's both legislation and potentially pending regulation in New York for legal clarification on that AR tele medicine in Florida we have a bill going through the legislature right now called the pets act providing equity in telea Health Services it has unanimously passed the House of Representatives and is in its second senate committee with the legislature slated to adjourn March 88th and then in Michigan Michigan we don't know where the were coming are going on tele medicine at first Michigan had a great rule that they enacted and it was in place for about a year before the board got pressure from the state BMA to repeal it and now there's Progressive legislation that's been filed at the Capitol in Michigan so that's where we're at in those States and now I'd like to hand it off to Britany briefly to look at California and what's happening out west thanks so much Jen all right so we had a very exciting 2023 in California uh as some of you are likely aware and as Jen just mentioned prior to this year California had some of the country's most restrictive rules regarding tele medicine and the vcpr Not only was an in-person exam required to establish a relation ship but the vcpr had to be reestablished via another in-person exam for each new ailment this created a significant challenge for pet owners and vets alike amidst the access to care crisis not to mention a hardship for the pets who get fearful anxious or stressed going to a clinic so what did the California Bill do as of January 1 California now allows veterinarians to establish their VC PR using synchronous video so basically a FaceTime or a zoom call or other similar technology once the vcpr has been established treatment can be maintained using other modes of tele medicine such as such as a phone call the law allows for six-month prescription durations for most prescriptions uh which can be renewed via another video exam or of course an inperson exam as needed the law prohibits the prescribing of Controlled Substances uh using tele medicine and follows federal law regarding extra label and food directives uh and limits any antibiotic prescrip Ron to 14 days this was a um a big change or a big amendment that we took at the end realizing that um as has been um discussed a bit in the chat today that any antibiotic that isn't working by 14 days that animal needs an iners exam uh one of the areas most dis most discussed including the antibiotic uh provision around the development in advocacy of this bill um was establishing appropriate guard rails to ensure that the same standards of care are met as seen in an in-person appointment so the guard rails in California include requirements for instate licensure so a vet practicing tele medicine on a patient in California has to be licensed in California that they be able to provide a list of local clinics in case an in-person exam is needed and that vet is not available to conduct it um and that the veterinarian provide information about tele medicine and obtain informed consent from the client before any tele medicine exam occurs I'm happy to share that with with these requirements unique to um unique to California the State Veterinary Medical Board ultimately supported the bill which felt like a huge win for us um mired in this battle and we passed the legislature with a nearly unanimous vote California veterinarians and pet owners alike can now utilize this key tool in the access to care toolkit next slide please and while California may have appeared from outside as a pretty smooth path to Tele medicine it was as I mentioned a battle and one that has spread to two other Western States this year in Colorado after two years of trying to find Common Ground uh bill is moving through the legislature that would entrench in statute the requirement for an in-person exam to be established via um to to establish a vcpr this is problematic for the many reasons we've discussed so far today at a time when people are struggling to access in-person appointments and when logistical and financial challenges make an in-person exam a barrier to care we should instead be trusting veterinarians to determine whether an in-person exam is needed rather than further limiting their options so this is a bill that we are working uh to stop this year and one of the ways that we are doing that is by running a ballot initiative with local partners for the November ballot that would expand tele medicine and allow for a virtual vcpr this is uh pretty exciting uh keing research actually conducted polling of Colorado voters and found that by wide margins voters support allowing vets to use tele medicine at their discretion including during initial visits 72% of respondents said that they would support the measure with only 8% reporting that they would oppose it we gearing up for Signature gathering on this measure which has been approved by the title board um as initiative 144 so you can find more information by searching initiative 144 we'll talk about uh getting involved a little bit more uh in the later in the presentation but we really hope that you'll join in Colorado and getting the word out then over in Washington the State Vet board has actually been considering a rule change since the co exensions allowing for a virtual vcpr uh over the last couple of years the board has been pretty evenly split on this issue however so we are working with lawmakers there to introduce a pro Tel medicine bill unsurprisingly as we've seen in other states uh the Washington Veterinary Medical Association is opposed to a virtual vcpr so we are working with um with our uh Partners in the legislature and kicking off a working group in Olympia this week to see what we where we can find some common ground and what a bill uh might look like this week is going to be the first meeting of many so if there are any washingtonians on the call interested in being a part of those discussions we'd love to hear from you that's where the state legislation at is at in our Western Division uh I'll kick it back to Jen and Dr D Clemente to go over some case studies with you all thank you so much yeah so now that you've you've heard what the States look like we'd like to demonstrate how this varies from state to state with a couple of case studies so first we're gonna I'll introduce each case and then Dr declen will talk about the medical aspects the potential treatments for these animals so the first one and and I shout out to Dr Brian Dei we've given similar presentations in the past and this is one of the photos that and case studies that Dr Dei created originally so this is fleas um the patient is a five-month-old intact female puppy with you know you don't need to be a veterinarian probably to look at this animal and see what's wrong but a veterinarian surely could especially over at Hell Health as well as in person um this dog has a flea infestation and lived outdoors in her former home the the client because it's important that we think about when we do this not just what's best for the veterinarian but what's best for the patient and the client as well so the client acquired this dog from a neighbor they've never had a pet before firsttime pet owner the first Veterinary appointment they could get is three weeks away so they have an appointment but they don't know what to do right now and they they live in an area like I live in Tallahassee where you know the over-the-counter stuff just does not cut it you're going to have fleas in your house if that's what you try to rely on so she loves to sleep with my kids but scratches nonstop doc what can I do so here's here's what she could do Camille you want to take this one yeah yes thank you so in this particular case we trying to point out what would happen in or what was what's legal in different states so in Arizona under the new law there the virtual VP vcpr is permitted and they can make a prescription up to 14 days so we can't prescribe anything that would last longer than 14 days so um on label usage in this case would be Capstar so this dog could receive Capstar which would provide some help um in Illinois there are no virtual vcpr options and so in that case they would probably have to find another veterinarian who might be able to see them if they can get in anything anytime before three weeks um that would be a more difficult space and then in Idaho because they allow a virtual vcpr that veterinarian could prescribe rcto which is a longer lasting product more than 14 days so that's how it plays out in an actual case and then the second case study that we have this actually also came from lap of love and and Dr dangi um brought this over from Dr Danny mcvety so this is a in this case Compassionate Care case study a 15-year-old neutered male lab mix 85 pounds with Advanced arthritis this this patient has difficulty getting up and down panting and pacing at night um but until recently has been doing pretty well the hates going into the Vetinarian so the the pet has not been to see a Vetinarian in at least 18 months over the years he's had arthritis a long time she I'm sorry he has had arthritis a long time so when the family could afford it they might take him in and get uh get some medication and they so they know what worked in the past but this animal hasn't been to a vet clinic in a long time because so stressed out about going to the vet the client um is a an older woman with physical limitations they again they don't have a veterinarian the spouse is away on a business trip and this is The spouse's baby and so the client says I just want to keep him comfortable until my husband can come home and we can say goodbye together I don't want to try to haul this dog into a clinic just to get some comfort but but the dog is very uncomfortable and at the end of life um so what can we do doc so this is another one where it would depend on where they are so if they lived in Louisiana the laws there State personally acquainted and recently seen but we know that this dog hasn't been into a Veterinary practice for multiple years so in that situation could the veterinarian use a photo or video to become personally acquainted and recently seen and that would be up to them but knowing that the board might inter interpret that law differently in Mississippi there is no virtual vcpr so there is no option you know they're they that any veteran in that state would not be able to help this dog out without an in-person situation and in Virginia a virtual vcpr is permitted so using an onlab drug for this dog uh carprofen would be an option and now we'll hand it over to Amy who's gonna talk about how how you can get involved thank you so much Dr de Clen Jen Brittney and thank you to Dr Mero the fear-free team te for hosting this webinar today um and thanks to everyone who's joining us we know you're all super busy and we really appreciate your time and interest and I'm absolutely loving the active conversation in the chat thanks for for that um um so you've heard all about the veterinary tele medicine um that's going on the good the bad the legislation there's a lot happening so um how can you help um I hear all the time from people that they would love to get involved but have absolutely no idea where to start and it's super common and you know the legislative process can be unnecessarily confusing um but that's what my team the ASPCA legislative engagement team is here for and I'm so excited to tell you that it is really easy it's much easier than you think to get involved so um I know we have many folks joining us today who are experts in your field um veterinarians shelter and rescue leadership and so on um but I would bet there's a wide variety of policy experience here in the audience so bear with me um if you're a season if you're seasoned in the policy space um but let's just start with a quick and really important 101 so how do you know who your legislators are um the ASPCA has a really awesome tool um it's aspca.org lookup you can see that link right at the bottom of this slide um and you just type in your address and what it'll do is generate all of your legislators from the very local level all the way up to your federal Representatives um and once you have that information you'll be able to connect with your legislators and this is super important because your legislators do need to hear from you they need to hear from the people they're representing to know what their constituents care about um and I could go on and on about how much of an impact it makes for your representatives to hear from you um but for the sake of time and I know we have a Q&A at right at the end um I'll just say that your voice is absolutely critical so we'll go on to the actions that you can take there's something for everyone regardless of experience level um with legislation so we have quick and easy actions like a um letter to the editor uh in your local publication um our team can help you with that it's actually one of the first actions that I took um as far as legislative advocacy and I heard back from my legislators saying that they were going to co-sponsor a bill this was years ago but it was very validating and um I have to say it's it's it's fairly easy and not very timec consuming so like I said we're happy to help you if you want to get involved that way um you can uh write a letter to your legislature you can meet with your elected officials um those things we can certainly help you out with um if you know if you've never done it before um we can help facilitate that um and so something we're always looking for is field experts like veterinarians or people with lived experience related to Veterinary tele medicine to testify in hearings um in Florida that looks like attending the hearing in person to testify which is not as convenient but um it's it's really impactful when it does happen um and in other states like Colorado the options to testify remotely um uh or submit written testimony are available so it's much more convenient in States like that um if you're in Florida and or Colorado specifically and interested in contributing testimony please reach out to me at the end of this webinar um and if you're a veterinarian or vettech tell avma n nvta and your state VMA um that you support a virtual vcpr um and lastly we oftentimes circulate Co Coalition letters to demonstrate support and we absolutely love for any veterinarians on this call um to join those letters and um we'll we'll tell you how you can stay in touch on the next slide so if you don't mind um advancing that slide um so how can you stay looped in after this webinar if you're a Veterinary professional and this includes students um we recently launched a brand new Veterinary policy committee that we call the veterinary engagement team or vet for short um there's no time commitment required whatsoever we recognize how busy you all are but it's a really great way to stay up to date on calls to action in your state and get involved um and we'll share updates and actions you can take that will take two minutes from the comfort of your home all the way to asking for testimony and the great thing is is that it's just designed to accommodate any schedule and any experience level um so you can go to aspca.org vet Advocates to um sign up for that and if you're not a Veterinary professional that's okay um join The Advocate advocacy Brigade to stay up to date on legislation calls to action um and that is in right at the bottom of the screen I think it's a little bit small but um you can go to that link and sign up to get updates on our legislation and stay involved there um and anyone from the following states um if you're in Florida if you're in Washington if you're in Colorado Michigan or New Jersey um you heard about legislation happening in those States and we really really need your involvement um so I would highly encourage if you're from those States reach out to me join the uh the um vet engagement team join the advocacy Brigade um we really want to hear from you that's that's happening right now um and so um as a mom of two large young dogs who are a complete handful at the vet um if you know my dogs you know what I'm talking about but um I can say I've already experienced the great benefits of Veterinary tele medicine and we're super excited to work with all of you to help get this important legislation passed