02/20/2012 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB251 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 251 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
February 20, 2012
3:20 p.m.
MEMBERS PRESENT
Representative Kurt Olson, Chair
Representative Mike Chenault
Representative Dan Saddler
Representative Steve Thompson
Representative Lindsey Holmes
Representative Bob Miller
MEMBERS ABSENT
Representative Craig Johnson, Vice Chair
COMMITTEE CALENDAR
HOUSE BILL NO. 251
"An Act relating to the Board of Veterinary Examiners and the
practice of veterinary medicine."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 251
SHORT TITLE: PRACTICE OF VETERINARY MEDICINE
SPONSOR(s): REPRESENTATIVE(s) DICK, JOULE
01/17/12 (H) PREFILE RELEASED 1/6/12
01/17/12 (H) READ THE FIRST TIME - REFERRALS
01/17/12 (H) L&C, FIN
01/20/12 (H) SPONSOR SUBSTITUTE INTRODUCED
01/20/12 (H) READ THE FIRST TIME - REFERRALS
01/20/12 (H) L&C, FIN
02/15/12 (H) L&C AT 3:15 PM BARNES 124
02/15/12 (H) Scheduled But Not Heard
02/20/12 (H) L&C AT 3:15 PM BARNES 124
WITNESS REGISTER
REPRESENTATIVE ALAN DICK
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 251 as one of the joint prime
sponsors of the bill.
ANNETTE KREITZER, Staff
Representative Alan Dick
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions on HB 251.
DON HABEGER, Director
Division of Corporations, Business, and Professional Licensing
(DCBPL)
Department of Commerce, Community, & Economic Development
(DCCED)
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during the
discussion of HB 251.
JAMES DELKER, Veterinarian
Soldotna, Alaska
POSITION STATEMENT: Testified during the discussion of HB 251.
VICKY THOMAS
Fort Yukon, Alaska
POSITION STATEMENT: Testified in support of HB 251.
LIZ HOFFMAN, Veterinarian
Christian Veterinary Mission
Veneta, Oregon
POSITION STATEMENT: Testified during the discussion of HB 251.
BOB SEPT, Veterinarian
Bering Sea Animal Clinic
Chugiak, Alaska
POSITION STATEMENT: Testified during the discussion of HB 251.
DENALI LOVELY, Veterinarian
Fairbanks, Alaska
POSITION STATEMENT: Testified in opposition to HB 251.
DOUG BOWERS
Nenana, Alaska
POSITION STATEMENT: Testified during the discussion of HB 251.
STEVEN MERSCH, Veterinarian
Soldotna, Alaska
POSITION STATEMENT: Testified during the discussion of HB 251.
HAYDEN E. NEVILL, Veterinarian
Fairbanks, Alaska
POSITION STATEMENT: Testified during the discussion of HB 251
and suggested the bill be killed.
SARAH LOVE, Veterinarian
Fairbanks, Alaska
POSITION STATEMENT: Testified in opposition to HB 251.
MYRA WILSON, Veterinarian
Anchorage Animal Care and Control
Anchorage, Alaska
POSITION STATEMENT: Testified during the discussion of HB 251.
TIM HUNT, Veterinarian
South Marquette, Michigan
POSITION STATEMENT: Testified during the discussion of HB 251.
DR. JON BASLER, Veterinarian
Delegate; National Alaska Veterinary Medical Association (AVMA)
Anchorage, Alaska
POSITION STATEMENT: Testified during the discussion of HB 251.
PAIGE HEYWOOD, Veterinarian
Fairbanks, Alaska
POSITION STATEMENT: Testified in opposition to HB 251.
MORGAN PETERMAN, Veterinarian;
Veterinary Skills Director,
Humane Society of Veterinary Medical Association (HSVMA)
Unknown, Michigan
POSITION STATEMENT: Testified in support of HB 251.
ANGIE FITCH
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 251.
ACTION NARRATIVE
3:20:42 PM
CHAIR KURT OLSON called the House Labor and Commerce Standing
Committee meeting to order at 3:20 p.m. Representatives
Chenault, Saddler, Thompson, Miller, and Olson were present at
the call to order. Representative Holmes arrived as the meeting
was in progress.
HB 251-PRACTICE OF VETERINARY MEDICINE
3:21:05 PM
CHAIR OLSON announced that the only order of business would be,
SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 251, "An Act relating to
the Board of Veterinary Examiners and the practice of veterinary
medicine."
3:21:26 PM
REPRESENTATIVE ALAN DICK, Alaska State Legislature, offered his
belief that this issue represents one of the strongest
constituent issues he has encountered thus far. This bill has
come about as a result of painful experiences, in particular,
represents what has not worked for rural veterinarians. He
stated that his constituents were so frustrated with the Board
of Veterinary Examiners (BVE) that they wanted to create a rural
veterinarian board. He characterized this bill as a
governmental response to the people. He offered his belief that
if the state were on trial there would not be any evidence
submitted to demonstrate that the state cares about animals in
the Bush. He acknowledged that Alaskans welcome volunteerism in
many aspects of Alaska, but in terms of rural veterinarian care
the volunteer effort has been stonewalled. Volunteers from
international organizations would be glad to have opportunities
to work in rural Alaska and provide clinics to offer spay and
neuter clinics or rabies shots. However, the political climate
is not favorable. He stressed that the Bush is not looking for
great veterinarian care, but is seeking regular care. He
recalled that as a dog musher he administered his own rabies
shots, which is no longer allowed. He highlighted a significant
number of dogs roam in rural Alaska since people can't afford to
fly animals to and from their towns.
3:25:03 PM
REPRESENTATIVE DICK stated he promised his constituents that he
would work to achieve a veterinary care system that works for
them. He emphasized the goal is to achieve safe conditions for
professional veterinarian volunteers to travel to Bush Alaska in
order to perform services, such as spay and neuter clinics, and
to administer rabies shots without political hassles. This bill
has strong Alaska Federation of Native (AFN) support, including
a resolution passed at their last meeting. He urged members to
create a level playing field or at least to create one to play
on.
3:26:15 PM
ANNETTE KREITZER, Staff, Representative Alan Dick, Alaska State
Legislature, stated that the genesis of the bill came from a
constituent complaint about a specific veterinarian and from the
loss of affordable care in rural Alaska. She said that she has
reviewed the past legislative audits and annual reports to
determine what the Board of Veterinary Examiners (BVE) has done
to address the issue of rural veterinary care. Despite a
permissive statute, AS 08.98.057, enacted to monitor the
standards of veterinary provided in the state, no one in the
department could remember when such a request was made to the
BVE. She pointed out that the statute has been in place since
1981. She suggested due to the angst in the Bush over the
surrender of a veterinarian's license, that it seems reasonable
to expect the department and the BVE would have exercised their
statutory responsibilities. In fact, the past president of the
BVE told the Fairbanks News Miner in February 2010 that, "the
board doesn't track veterinarians unless someone complains about
them." Thus it is not clear how many veterinarians work in the
Bush. She highlighted the past president was not aware the BVE
could monitor the availability of veterinary services despite
intentions to fill the departure of two veterinarians in the
Interior is significant. The frustration caused by the exit of
the second veterinarian, who had served Interior Alaska through
Tanana Chiefs Conference, resulted in the AFN passing a
resolution calling for a separate rural veterinarian board.
MS. KREITZER speaking as a former rural health care provider
understood rural Alaskans' frustration. She offered her belief
that medical professionals are sometimes willing to offer a
clinic if they could hunt and fish, often at the provider's
convenience and not necessarily when the community needs the
care. She emphasized the need for veterinary care in rural
Alaska is acute. She pointed out that frequently the Alaska
State Veterinary Medical Association (AKVMA) has expressed
concern about anything that might create a lower standard of
care for rural residents. This exemplifies the misunderstanding
of how rural Alaskans face risks every day. When compared to
the Lower 48, Alaska's Emergency Medical Technicians routinely
practice a level above their certification due to circumstances
in rural Alaska. She also offered her belief that most people
will stop using an incompetent practitioner. In April 2005, the
Board of Dental Examiners (BDE) ruled that the dental health
aide therapist services constituted the unlawful practice of
dentistry in Alaska, which was later overturned. She suggested
many parallels between the dental health aide therapists and
rural veterinary services. She cited an article in which the
head of the American Dental Association expressed his fears. At
the time he said, "I've had patients in my chair have heart
attacks. I've had people have strokes. I've had people that
have life-threatening allergic reactions to medications they
took before they came in the office. You do not have a lot of
time to think when you react to that." She could relate to that
as an EMT II, who previously served in a remote community. She
suggested that the ADA was worried about more than safety. A
recent survey of over 100,000 ADA members showed that members
felt some uncertainty over about their economic stability. She
related her understanding that is also true in Alaska with
respect to veterinarians over economic stability.
3:30:38 PM
MS. KREITZER related her understanding some veterinarians in
Alaska had to close their doors due to competition and economic
conditions. The sponsor has worked with the Governor's office
to ensure that the board has members with a rural perspective
and are committed to make it easier for pro bono care in Alaska.
In addition to the licensed out-of-state veterinarians who have
been able to practice outside the purview of the BVE for 30-40
years, health care workers not license in Alaska have been
providing health care within the Native health care system.
Registered nurses, pharmacists, and others provide this care,
she stated. She offered that a senior policy advisor at the
Indian Health Service believes veterinarians fall into the same
category of providers of health care. The Western Interstate
Commission on Health Education (WICHE) and the U.S. Public
considers veterinary health crucial to the overall health of
communities.
3:32:19 PM
MS. KREITZER provided a sectional analysis of the bill. Section
1 would make certain that a person may volunteer veterinary
services and receive coffee, housing, and meals or other
compensation. She pointed out that a letter in members' packets
from the BVE states that regulations do not prohibit it, but she
said that is incorrect. She emphasized that legislative legal
agrees that the BVE interprets this, but current regulations and
statutes do not address compensation. She highlighted that
licensed out-of-state veterinarians can practice outside the
scope of the BVE. Section 1 would broaden this exemption to in-
state licensed veterinarians. She emphasized that under the
bill the volunteer services would be performed by licensed
veterinarians. However, Section 1 would also allow these pro
bono licensed veterinarians to identify themselves as such. She
reiterated that under current law, although they can practice
pro bono, veterinarians cannot use their earned title, which is
confusing to the public.
MS. KREITZER continued, stating that licensed veterinarians,
while acting in a pro bono capacity, are exempt from the
courtesy license requirements of the veterinary board and
oversight of the board. However, out-of-state veterinarians who
are already exempt may not use the title. Under the bill,
volunteers are not immune from legal action resulting from gross
negligence, reckless or intentional misconduct while
volunteering services. Nothing in the bill says licensed
veterinarians shouldn't meet the standard of care that they
swore an oath to when they graduated from Veterinary School,
which she read, as follows:
Being admitted to the profession of veterinary
medicine, I solemnly swear to use my scientific
knowledge and skills for the benefit of society
through the protection of animal health and welfare,
the prevention and relief of animal suffering, the
conservation of animal resources, the promotion of
public health, and the advancement of medical
knowledge.
I will practice my profession conscientiously, with
dignity, and in keeping with the principles of
veterinary medical ethics.
I accept as a lifelong obligation the continual
improvement of my professional knowledge and
competence.
3:34:27 PM
MS. KREITZER turned to Section 2. She stated that currently
there is no statutory allowance for a simple surrender of a
veterinarian license for someone who wants to retire. Although
this section doesn't require the board to determine competency
for reinstatement, the regulation at 12 AAC 68.048 which
determines good standing is sufficient to cover physical/mental
impairment or civil or criminal issues. This proposed section
addresses the process for a surrendered license, and how a
surrendered license within a specific timeframe may be
reinstated. A person may only surrender under this section if
not under investigation and the surrender is not due to a
sanction in Alaska or any other state. The only time surrender
of a license is mentioned in either the department's centralized
licensing or the BVE statutes is in reference to surrendering in
lieu of something else. If a veterinarian renews a license and
then decides he or she wants to retire, this section lays out
the process for that. If the ASVMA or the board has a better
suggestion for that process, the sponsor is willing to work with
them on it, she stated.
3:35:31 PM
MS. KREITZER turned to Section 3. She pointed out that the BVE
and the ASVMA have criticized this section by saying it could
lead to substandard care; however, this language is the same
language used for human medical providers. The sponsor used an
example from the Board of Medical Examiner statutes under AS
08.64.326-331 to clarify that the BVE may not base a finding of
"professional incompetence" solely on unconventional or
experimental treatments in the absence of harm to an animal.
3:35:59 PM
MS. KREITZER explained that Section 4 sets out the complaint
process. Complaints may only be filed by persons who own or are
responsible for the animal seen by the veterinarian. A
complaint may only be filed against a licensee who treated the
animal. Complaints must include documentation of the alleged
mistreatment, be made under oath, be filed within six months of
the date of the act or omission, and must be sent to the subject
of the complaint allegation.
MS. KREITZER related that under this provision, during the
investigation the department shall interview, under oath, the
complainant, the licensee, and any technician or assistant to
the veterinarian. The investigation must determine whether the
complainant followed aftercare procedures and must include in
its report all relevant information and exculpatory evidence.
Finally, board members within five miles of a licensee's
principal place of business may not participate in a
disciplinary hearing relating to that licensee.
3:37:11 PM
REPRESENTATIVE SADDLER asked what types of conditions would
warrant surrender of a license that is later reinstated. He
suggested that it seems like this would address a temporary
surrender.
MS. KREITZER offered her belief that people interpret statutes
in different ways. She explained this provision would cover
instances in which veterinarians renew their licenses, but
decide to retire before their license has lapsed. She offered
that current statutes do not include a provision for
veterinarians who have decided to retire, yet still hold active
licenses. These veterinarians may wish to help their neighbor
and this would allow them to do so without incurring liability.
The provision is not a temporary license, although veterinarians
could reinstate their licenses if they chose to do so. In
further response to Representative Saddler, she said the sponsor
is willing to work with the ASVMA on another approach to address
this issue. She agreed that people are not "banging at the
door" to get their licenses reinstated.
3:39:27 PM
CHAIR OLSON offered his goal is to have the veterinarians, the
Bush, and the sponsor reach common ground, which might result in
a bill that no one likes.
3:39:52 PM
REPRESENTATIVE MILLER referred to page 3, lines 26-27, to
"unconventional or experimental nature ... in the absence of
demonstrable physical harm...." He suggested the language
seemed broad and asked for the intent of this provision.
MS. KREITZER responded that the language the bill parallels is
existing language for the medical profession. She identified
this subparagraph as the definition of what constitutes
professional incompetence. The intent of the definition is to
eliminate complaints based solely on economics.
3:41:35 PM
REPRESENTATIVE MILLER asked for an example.
MS. KREITZER related her understanding that a veterinarian may
need to perform an operation in rural Alaska on a dining room
table, in a gym, or in an ambulance bay, which is
unconventional. She did not think anyone would think of this
treatment as experimental treatment. She recalled a single
complaint in which a veterinarian complained another
veterinarian did not shave an area for the procedure adequately,
criticizing that the shaved area was too small of an area. She
suggested if any procedure was performed differently than
another veterinarian might normally do, that veterinarian may
consider the care as unconventional or experimental. She stated
that this language is meant to provide a definition without
being explicit in the kind of care or the way a veterinarian
performs surgeries in rural Alaska.
3:43:25 PM
REPRESENTATIVE MILLER recalled three common procedures provided
by veterinarians as spaying, neutering, and administering rabies
vaccinations. He inquired as to whether those procedures could
be specifically identified in the bill and perhaps the bill
could also identify other types of routine procedures.
MS. KREITZER said the sponsor would not be opposed to an attempt
to do so.
3:44:12 PM
REPRESENTATIVE MILLER referred to page 2, line 29, to the
license surrender provision which indicates a license could be
reinstated if the licensee is in good standing. He asked how a
licensee could be in good standing if the veterinarian no longer
is licensed.
MS. KREITZER responded that this language is current regulation.
In further response to Representative Miller, she offered to
provide the specific citation.
3:45:03 PM
REPRESENTATIVE SADDLER referred to page 1, line 11, to the
reference to "country" and related his understanding that BVE
expressed concern that allowing someone licensed in another
country to volunteer services may result in a lower standard of
care.
MS. KREITZER responded that the language is the bill drafter's
convention, but the sponsor did not intend to include other
countries. She said the language was left in the bill for
discussion purposes since the BVE and ASVMA has expressed some
interest in reciprocity with Canadian veterinarians.
3:46:33 PM
REPRESENTATIVE SADDLER referred to page 2, line 19 to
"nonmonetary donations or other nonmonetary consideration." He
said the language seemed broad. He asked whether a cap or
reasonable expenses should be considered.
MS. KREITZER referred to page 2, lines 16-19 to the definition
of "uncompensated practice." She said it does not include
practice for which the person receives only reimbursement for
actual expenses incurred. This language was designed to
encourage more pro bono clinics in Alaska. She suggested
perhaps someone would provide a pro bono clinic if they received
reimbursement for aviation (AV) gas and materials were donated.
She explained that nonmonetary donations or other nonmonetary
considerations are broad enough to cover coffee, lodging, and
other things. She related her understanding that some angst
exists. She recalled a scenario previously discussed even
suggested offering a bear hunt for compensation; however that
would entail purchasing tags and means someone would need to
take time out for a hunt. She reiterated the sponsor's goal to
encourage people to go to the Bush and provide veterinarian
services. She reported that the bill drafter pointed out there
is a difference between nonmonetary donations or nonmonetary
consideration, as well. She admitted she thought she saw the
line between the two but the concept was still vague in her
mind.
REPRESENTATIVE SADDLER said that the translation between money
and services is pretty direct. He asked how far the travel
expenses would extend and whether it would include travel from
places as far away as Miami or Belgium.
3:49:47 PM
MS. KREITZER answered no, but admitted there is no limit in the
bill. She was unsure why a limit would be necessary. She
identified veterinarian services in rural Alaska as a long-term
problem. She highlighted that the clinics in question are pro
bono clinics and the people receiving the services are not being
charged for them. She cautioned that this bill does not
reference low-cost clinics, which are offered by some
veterinarians or groups. The sponsor did not want to limit the
creative types of things that people might consider. She also
recalled her experiences in attracting people to serve at a
clinic in Cold Bay as difficult.
3:50:57 PM
REPRESENTATIVE SADDLER asked for an estimate of the value of
travel and services from Anchorage to the Bush to offer a pro
bono clinic.
MS. KREITZER said she did not know. She suggested a practicing
veterinarian may be able to provide an estimate. She cautioned
against limiting travel costs. She provided an example in the
community of Cold Bay, in which the USCG turned over housing to
the community to attract a practitioner. She related things she
did to provide food, including donating crab and halibut for
his/her freezer, buying groceries at Costco, and holding
potlucks. She suggested that placing a value on the commodities
would detract the communities from finding creative solutions
for nonmonetary donations.
3:52:59 PM
CHAIR OLSON referred to the language on page 3, which appears to
mirror the medical statute, except gross negligence or
[repeated] negligent conduct has been added [lines 23-24]. He
asked for the intent of this language.
MS. KREITZER offered that the sponsor did not want gross
negligence or gross conduct to be linked or be motivated by an
economic complaint. She offered to continue to review the
language.
3:54:08 PM
DON HABEGER, Director, Division of Corporations, Business, and
Professional Licensing (DCBPL), Department of Commerce,
Community, & Economic Development (DCCED), introduced himself.
CHAIR OLSON asked for a report on any activity that has
generated investigations in the department.
MR. HABEGER suggested [the bill] may be a response to an
investigation that the division reviewed, but did not complete
since the licensee surrendered his or her license and did not
undergo the process.
3:55:50 PM
CHAIR OLSON asked who would absorb the costs of an
investigation.
MR. HABEGER replied costs for any investigation are distributed
back to the licensees. He referred to AS 08.010.065, which
mandates the division to essentially examine any costs and
distribute cost to licensees during their biennial license
renewal.
CHAIR OLSON asked for the number of licensees.
MS. KREITZER, in response to a question, answered that there are
300 veterinarians licensed in Alaska.
3:57:34 PM
CHAIR OLSON asked whether a veterinarian needs a firm license,
in addition to their professional license in order to practice
in Alaska.
MR. HABEGER advised that if a veterinarian has a corporation,
the corporation would register with the state, and the
individual would also need a business license. In further
response to Chair Olson, he agreed it would pertain to all sole
practitioners.
MS. KREITZER asked to correct the total number of veterinarian
licenses and offered that there are 350 current licensees. In
response to a question, Ms. Kreitzer agreed that the
veterinarians many not necessarily be practicing veterinarians.
3:59:21 PM
REPRESENTATIVE THOMPSON related his understanding that there are
numerous unemployed veterinarians in the state. He asked
whether the division has any knowledge of this.
MR. HABEGER answered that the division does not track that
information and limits its tracking to licenses and the
licensure process.
MS. KREITZER added that she has been made aware at least one
veterinarian in Anchorage has closed his or her door. She said
she does not know how that bears on veterinarians that wish to
do pro bono work.
4:00:40 PM
REPRESENTATIVE SADDLER recalled that some veterinarians practice
outside the purview of the VBE. He asked Ms. Kreitzer to expand
on this.
MS. KREITZER responded that some out of state veterinarians do
not come under the purview of the BVE so as long as these
professionals do not call themselves a veterinarian. She
clarified that a licensed veterinarian from another state can
perform veterinary care without compensation - although
compensation is not defined in current statute - but the
veterinarian may not use title "veterinarian." In response to a
question by Chair Olson, Ms. Kreitzer elaborated that a
veterinarian many not use the initials that normally follow a
veterinarian's title.
4:01:54 PM
REPRESENTATIVE SADDLER related a scenario in which a
veterinarian licensed in Washington comes to Alaska but doesn't
collect for veterinary services. He questioned whether the
veterinarian could practice veterinary medicine and not be
subject to sanctions or oversight by the BVE.
MS. KREITZER related her understanding from reading the statute
and legal opinion from legislative legal that the veterinarian
could do so.
REPRESENTATIVE SADDLER asked how prevalent that type of activity
is in Alaska.
MS. KREITZER said she was not sure how prevalent it is given the
way the statutes are currently written.
4:02:59 PM
CHAIR OLSON asked for an estimate on how many people HB 251
would impact.
MS. KREITZER responded that the second tier of work she has done
was to identify impacts in villages. She offered her belief
that one veterinarian served 72 villages, but that veterinarian
is no longer practicing in Alaska. She presumed many villages
would seek help and surmised that since rural Alaska has
sporadic veterinary services, with long waits in between visits,
the progress that was made may have been lost.
4:04:14 PM
CHAIR OLSON asked for clarification on the zero fiscal note.
MR. HABEGER acknowledged that the division has submitted a zero
fiscal note since the division thinks it can absorb costs with
existing staff.
4:05:00 PM
JAMES DELKER, Veterinarian, stated that he is the Past President
of the Alaska State Veterinary Medical Association (AKVMA),
currently serves as a board member. He related that he
discussed his concerns with Ms. Kreitzer and some common ground
exists, but some disagreement also exists. He said he
represents concerns of the AKVMA, whose membership consists of
70 percent of licensed veterinary professionals in Alaska. He
related his understanding that this bill presents an emotional
issue with respect to providing veterinarian care to rural
communities. He emphasized that the AMVA is also concerned
about the veterinary care in rural Alaska. The AKVMA's
executive committee has followed this issue and HB 251,
sponsored by Representative Dick. He said the AKVMA supports
the sponsor's efforts to increase availability of veterinary
care in rural communities in Alaska.
DR. DELKER highlighted that the AKVMA has significant concerns
with the bill as currently drafted. First, the BVE was formed
to protect Alaskans, but HB 251 effectively strips the BVE of
any oversight or recourse especially for those individuals who
want to practice gratis veterinary medicine in the state.
Second, the bill also proposes to give equivalent rights and
privileges to veterinarians from other countries, where
standards of training and health care standards are far below
what would be considered acceptable here. Third, the bill
removes the rights of Alaskans to report harmful activities to
animals simply because they do not own the animals affected.
Additionally, while the intent of the bill would be to enhance
veterinary services in Alaska, the AMVA believes the bill as
currently written fails to protect Alaskans, and would lower the
standard of veterinary medical care statewide.
4:07:37 PM
DR. DELKER acknowledged that field medicine often involves less
than ideal settings. He deferred to other veterinarians who are
online to better address the issue. He acknowledged that Bush
medicine is different from what one would expect in a hospital
structure; however, veterinarians are still expected to provide
competent veterinary services within a basic standard of care
and using the best of their ability given the circumstances.
Under current statute, only veterinarians performing grossly
substandard medicine would be investigated by the BVE or be
prosecuted under criminal animal abuse statutes. He repeated
that the BVE would only investigate veterinarians performing
grossly substandard medicine. He also acknowledged that current
statutes do not prohibit veterinarians from providing gratis
veterinary medicine or offering free veterinary medicine in
Alaska. In his experience, he has yet to find anyone who would
complain about someone providing low-cost care or free
veterinary care to truly remote Bush communities.
4:09:10 PM
DR. DELKER asked to touch on specific points of the bill. He
referred to Section 1, with respect to persons practicing
without compensation. He said that veterinarians licensed in
the U.S. must obtain an AKVMA accredited degree, but other
countries' programs may not necessarily be equivalent to an
AKVMA degree. He suggested that in certain developing nations,
vast differences in standards and teaching standards exist and
this language does not guarantee the person is competent to
practice veterinary services in the U.S. no matter what the cost
of services he/she provides. He referred to subsection (b),
which would remove the BVE from any oversight of uncompensated
veterinarians. He interpreted this to mean uncompensated
veterinarians would not be subject to the laws and regulations
that pertain to the veterinary practice since the BVE only
regulates licensed veterinarians. He expressed concern that
uncompensated veterinarians, not licensed in Alaska, would not
be subject to the laws and regulations pertaining to the
standards of practice of veterinarian medicine, such as pharmacy
dispensing or medical records. He pointed out that without
requiring temporary licensing, the BVE would not have any record
of who is practicing veterinary medicine in Alaska. He surmised
that uncompensated veterinarians not licensed in Alaska would
not have to provide their qualifications unless a civil or
criminal case was filed against them.
DR. DELKER turned to subsection (c), which references
compensation. He said it seemed reasonable that actual expenses
incurred should include cost of travel, lodging, medical
supplies, but allowing uncompensated veterinarians to receive
"other nonmonetary consideration" seems ambiguous and open to
abuse. He suggested this also creates the potential for tax
evasion and the form of other nonmonetary donations could far
exceed the expense of any veterinary services provided. He
offered his belief that this language should provide clear
definitions or some limit to nonmonetary compensation. He
questioned whether this subsection is even necessary given
conversations he has held with BVE members, who point out that
current regulations do not prohibit veterinarians from receiving
shelter, a warm bed, or complimentary meals.
4:11:27 PM
DR. DELKER turned to Section 2, to the surrender and
reinstatement of veterinarian licenses. He was unsure of the
necessity of this proposed change. Currently, a veterinarian
can surrender his/her license and leave the state without being
questioned. If a veterinarian plans to return, the veterinarian
would pay the biennial fee and maintain continuing education
(CE) requirements and his/her license would remain active so
long as the veterinarian is not subject to an investigation or
prosecution in another state. He offered that he was unsure of
the purpose of the section. In other states a veterinarian can
pay a lesser fee for an inactive license. He noted that he
holds an inactive license in Minnesota and can reactivate it at
any time he wishes to return to Minnesota to resume his
veterinary practice. He offered a willingness to work with the
sponsor on this section on the intent and suggested the BVE
could help draft proposed regulations.
4:12:17 PM
DR. DELKER turned to Section 3, which relates to professional
incompetence and related his understanding this section was
adopted from the human medicine statutes; however, the language
does not mirror the medical statutes, but places a much higher
burden of proof as compared to the human medical statutes. He
was unsure of the reasoning for this. He offered his belief
that some of the proposed changes are somewhat vague and
dangerous. He was unsure that practicing unconventional and
experimental medicine without liability is a good idea. He
asked who would define unconventional or experimental medicine,
noting the vague reference is potentially prone to abuse by
veterinarians who could cite this language as an excuse for
providing negligent medicine. He related that the AKVMA
believes all practitioners should provide care within a minimum
safe standard regardless of the location of the veterinary
practice.
4:13:19 PM
DR. DELKER referred to Section 4, with respect to complaints,
investigations, and hearings. He said the AKVMA does not
believe it is ethical or legal to deprive citizens the right to
report misconduct by a professional. Additionally, this section
seems to provide an effective statute of limitations - a six
month window to report malpractice. He described a situation in
which a client presented him with an animal about nine months
after it had undergone an incorrectly performed surgery. Under
this bill, the owner would not have the right or responsibility
to report the person, nor would he as a professional
veterinarian have the right to report deficient veterinary care
due to the statute of limitations in this section. He related a
scenario, in which a person from another country could provide
uncompensated services, but may have caused serious harm to an
animal. He highlighted that under the language in Section 4, if
the owner or caretaker does not complain the action would be
considered acceptable, which he found inappropriate. He
questioned whether an owner in rural Alaska would have the
resources to track down a professional who has since returned to
his/her country or another state. He further asked what legal
remedies an Alaskan resident would have in this type of
situation. He acknowledged the intent of HB 251 is good, but he
did not see how the bill protected Alaskans.
4:15:02 PM
DR. DELKER summarized that the AKVMA applauds the sponsor's
efforts to increase the veterinary care in Bush communities. He
offered his belief that to do so is complex and would involve
numerous socio-economic obstacles. The AKVMA is not aware of a
single veterinarian in the state who would obstruct a
professional willing to go into truly rural communities and
provide veterinary care at no cost. However, that care must
meet basic standards and not harm those being helped.
Regardless of compensation, all veterinarians must be held to
the same basic standards of care. The AKVMA does not believe HB
251, as written, protects rural communities from substandard
care. The AKVMA supports the intent of the bill but cannot
support it as written. He said the AKVMA will support any bill
that will improve access to proper veterinary care, but only if
such legislation does not lower the standards of veterinary
health care in the state.
4:16:25 PM
REPRESENTATIVE SADDLER recalled his earlier testimony that
present regulations do not prohibit offering veterinarians
shelter, warm bed, and complimentary meals.
DR. DELKER responded that those comments were based on the
conversations he previously held with the BVE, but he did not
recall the specific reference. He reiterated his belief nothing
currently prohibits this activity. In further response to
Representative Saddler, he thought Dr. Eastman so advised him,
although he was uncertain.
4:17:48 PM
VICKY THOMAS, representing herself, said she is a past
environmental manager for the Native Village of Fort Yukon. She
testified in favor of HB 251. She offered his belief that
without this bill there will continue to be a dangerous lack of
veterinary care in the villages. She related as past manager of
the tribe of Fort Yukon, she has observed firsthand the public
health risk to this and other villages.
4:18:58 PM
LIZ HOFFMAN, Veterinarian, Christian Veterinary Mission, stated
she is affiliated with an organization, the Christian Veterinary
Mission. She said she lived and worked as a veterinarian in
Alaska for 24 years and was a resident from 1980-2004. She
explained that her organization received a request from Hooper
Bay to offer a clinic. This community advised her they had not
had any veterinary services for 11 years. Residents expressed
concern in the village about animal populations, too many dogs,
rabies, and dog bites. The resident explained that police would
often forewarn residents they would shoot any dogs not tied up.
Her organization's goal is to provide services, generally at no
cost, in hopes that repeated visits to communities may encourage
others to go into training as veterinarian technicians or as
veterinarians. She reported that she did not maintain her
Alaska license after she left; however, she did take a licensed
Alaska veterinarian with her to clinics. She would like to
reinstate her license; however, it is very expensive to do so
and she would need to retake the veterinary examination. She
tallied the cost at $900. She would be happy to purchase a
temporary license, but was advised by the department that she
did not qualify for a temporary license since the services she
planned to offer did not qualify as a special event. She
reiterated the barrier as the expense to reinstate her license.
She explained that her organization does not want to compete
with veterinarians within the state, nor would they offer
services in a town in which veterinary services are already
being provided, but would limit their veterinary care to remote
villages. She concluded that she would like the Christian
Veterinary Mission to be allowed to provide services more easily
within the legal framework of the state.
4:22:13 PM
BOB SEPT, Veterinarian, Bering Sea Animal Clinic, provided a
brief history, such that he came to Alaska in 1978, obtained his
veterinarian license, and worked in remote communities. He said
he has operated a clinic in Bethel since 1981 and provides
regular care for up to a week at a time in rural Alaska. He
related that he travels to Aniak, has a Bush clinic in King
Salmon, and Naknek, and has also traveled to Egegik. He
reported that he practices within the state rules, maintains his
CE, and finds it very easy to provide high-level care in the
Bush. He acknowledged that rural Alaska services are costly,
and he sometimes must bring all of his equipment and assistants
along. This effort has allowed him to provide reasonable
veterinary care at a reasonable cost since 1981. He offered his
belief that the crux of this matter is that veterinarians do not
have any issues with pro bono work so long as the veterinarian
is licensed and under the purview of the board. He suggested to
do otherwise would not protect animals and people in these
communities. He reiterated that maintaining his veterinarian
license is reasonable. He further reiterated that he was not
aware of any veterinarian with issues with respect to pro bono
work so long as the veterinarian is licensed [in Alaska]. He
further emphasized that the veterinarians should operate under
the same rules, regulations, and standards of care as all
veterinarians who currently practice in the state.
4:24:46 PM
REPRESENTATIVE SADDLER asked for an estimate of the percentage
of veterinary work that is exclusively to spay, neuter, and
administer vaccinations.
DR. SEPT responded about 60 percent. He suggested one problem
is that people ship in animals in to the clinic. He estimated
the demand for these services as being fairly high. He reported
that he tries to offer spay and neuter services monthly or
quarterly.
REPRESENTATIVE SADDLER inquired as to whether he could suggest
any compromise that would allow pro bono spay and neuter clinics
with less oversight.
DR. DELKER answered no. He offered his belief that people think
the procedure is a simple one until their animal dies. He
pointed out that the animal must undergo anesthesia, the
veterinarian must have proper instrumentation, and use a
reasonable facility. He opined that it would not be good to
lessen the standard of care. He was puzzled why a pro bono
person could not obtain his/her license, since he did not find
it is difficult to obtain and maintain a veterinary license in
Alaska.
MS. KREITZER clarified that the bill is clear that a
veterinarian must be licensed in Alaska or by another state in
order to provide pro bono work. She acknowledged the current
bill includes other countries, too, but it is likely that
language will be removed.
DR. DELKER offered his belief that veterinarians should be
licensed in the state so the BVE has purview over the licensee.
4:27:40 PM
DENALI LOVELY, Veterinarian, asked to speak against HB 251. She
works in North Pole and currently serves as the president-elect
for the Alaska State Veterinary Medical Association (AKVMA).
She was born and raised in Fairbanks and attended veterinary
school out of state, but came back to practice in Alaska. She
acknowledged she is very aware of needs of veterinary services
in Bush communities. She has worked in these communities as a
biology technician and has also received telephone calls
requesting veterinary advice. She said she supports rural needs
since they are badly needed; however she does not support the
bill in its entirety since the bill would limit the rights of
Alaskans to hold professionals accountable. She referred to
Section 4, noting that the impacts of actions by veterinarians
go well beyond family members. She also reported that
veterinarians vaccinate to prevent disease and are responsible
for the herd health of food animals. Under HB 251, only a
person responsible for the care of an animal may file a
complaint. Additionally, under the bill if a food animal was
given antibiotics illegally or with inappropriate withdrawal
times people cannot complain about antibiotic residue in the
animal's meat. She advised that an improperly stored rabies
vaccine could be ineffective, but would affect human public
health issues if a person contracted rabies. She emphasized
that veterinarians are held accountable to all animals in the
state and this bill does not hold veterinarians to the proper
level. The purpose of professional licensing boards is to
safeguard the health, safety, and welfare of Alaskans. This
bill would remove this by imposing restrictions of citizens to
file complaints against a member to the respective professional
board.
4:30:31 PM
REPRESENTATIVE SADDLER asked whether any rural needs were un-
served needs.
DR. LOVELY answered yes.
REPRESENTATIVE SADDLER inquired as to her suggestions as the
incoming president of the AKMVA to address these needs.
DR. LOVELY wondered why Native corporations have not hired
veterinarians in rural areas they represent. She agreed it is
expense to provide care since the costs to travel to rural
Alaska are high. She reiterated that it is expensive to
practice in rural Alaska and hard to get compensated for the
work. She suggested that having a veterinarian employed by the
state or a Native corporation would be a great way to provide
access and address the lack of care. Under current law,
nonprofits can provide services, but the community must rely on
organizers of any clinic event to ensure that the person is
licensed. She acknowledged that those licensed in other
countries may make mistakes since their accreditation
requirements may be less than in the U.S. She further
acknowledged the potential for those credentials to be lapsed or
non-existent. She suggested the state or Native corporations
may be able to provide the services.
4:32:56 PM
REPRESENTATIVE SADDLER asked whether any expectations exist for
veterinarians to perform pro bono work in rural Alaska.
DR. LOVELY answered no. She related her own practice as a busy
practice plus she also has family and other responsibilities.
She said she does not have the time due to the aforementioned
constraints. She related her understanding the military has
provided some veterinary work in rural Alaska.
4:34:17 PM
DOUG BOWERS, stated he is a 37-year resident of Alaska. He has
been a dog musher since 1977. He offered his belief that this
issue comes down to competition and pressure, which is why
veterinarians stop conducting clinics in rural Alaska. He
recalled a veterinarian who provided pro bono Bush care at low
or no cost. He also recalled his childhood in Pennsylvania, and
remembered veterinarians often practiced out of their pickups.
These veterinarians took care of horses, cows, and other
animals. With respect to standards of care, the regulations
discuss the degree of skill by average members in communities in
which veterinarian practices. He suggested the regulatory
language leaves a lot of room for interpretation. He said that
terms such as average are hard to define, but also relate to the
setting. He pointed out some veterinarians are skilled and some
are not. He emphasized that the state needs to create an
environment that is conducive to having veterinarians provide
rural services without fear of reprisal from other
veterinarians.
MR. BOWERS suggested the problem arises due to a lack of clarity
in the standards. He suggested if complaints brought are
frivolous, the complainant should be held accountable. He said
some of the concern local veterinarians have is due to perceived
financial harm. He highlighted that rules do not address
competition so it is perfectly legal for a veterinarian to build
a practice by offering lower-cost veterinary service. He
encouraged veterinarians to examine their own practices. He
offered his belief the BVE does not have the authority to
regulate commerce, specifically any competition between
veterinarians. He related that it is within the scope of the
BVE to make changes necessary for consistent veterinary care and
he hopes as the bill moves forward, these same goals can be
addressed. He further suggested one way to encourage additional
pro bono work in the Bush is to reduce license fees or provide
equipment and supplies for veterinary services. He wondered if
perhaps some surplus federal medicines may be available or may
be languishing in clinics that could be diverted to rural areas.
He surmised the veterinary medicines are not much different than
health care medicines for humans.
4:38:36 PM
STEVEN MERSCH, Veterinarian, said he thought the topics have
been covered. He related his understanding that pro bono work
would not require Alaska licensure.
CHAIR OLSON answered yes, that is correct.
DR. MERSCH inquired how drugs are controlled for practice in
rural communities by pro bono veterinarians.
CHAIR OLSON said he did not know.
DR. MERSCH asked if someone is injured, who will cover workers
compensation, and if the sponsor must cover it.
CHAIR OLSON answered that workers' compensation is assessed only
on payroll.
4:40:36 PM
DR. MERSCH said he agreed with Dr. Delker, that numerous holes
exist in the bill as currently written. He agreed with Doctor
Sept that that the state has responsibilities to provide a
professional standard of care.
4:41:04 PM
HAYDEN E. NEVILL, Veterinarian, stated that he supports the
concept of providing more veterinary services in Bush
communities in Alaska. He offered his belief many veterinarians
are willing to provide pro bono work if their travel and
supplies are paid for to conduct clinics in rural Alaska. He
emphasized that the barrier to care is not some legal problem,
but is due to a lack of supplies and travel costs. He asked to
go on the record to offer his services several months a year to
provide care. He agreed that one cannot tell the quality of a
veterinarian by examining a degree; however, the BVE has the
ability to review credentials. He expressed concern to delete
the BVE oversight. He offered his belief that passing HB 251
would drastically change the veterinary standard of care in the
state. While he did not suggest the same veterinary standard of
care in the bush, he specifically wanted to ensure any rabies
vaccine used is active, that the drugs given to food animals are
safe for humans to eat, and to control how veterinarian dispense
dangerous or controlled drugs so these drugs don't fall into the
hands of children. He also wanted to ensure pet owners are
informed in the event their pet is receiving experimental
treatment. This bill would allow any of those aforementioned
items to happen. Thus, this bill would limit the ability to
protect Alaskans. He characterized the bill as dangerous to
public health and unfair to Alaskans. He concluded by
suggesting that the committee kill this bill and instead should
work with Alaska veterinarians to develop a real plan for rural
veterinary care - a forward thinking plan that gets things
accomplished.
4:44:09 PM
SARAH LOVE, Veterinarian, stated that she is the only small
animal internal medicine specialist in Alaska who practices in
rural and urban Alaska. She pointed out she is also a dog
musher and a rural EMT. She has traveled to more than 20
Alaskan villages as an educator or a veterinarian. She agreed
there is a huge lack of veterinarian care in rural Alaska. She
suggested that this needs to be addressed to also address public
health. She acknowledged earlier testimony and the excellent
points made by veterinarians today. She commended people who
provide rural veterinarian health care. She said she opposes HB
251. She did not think that a halibut trip would pay her
mortgage. She agreed that state funding or funding from Native
corporations would be helpful to fulfill the needs of Native
villages, but pointed out that not all villages are Native
villages. She emphasized that she opposes the bill and thinks
it limits the rights of Alaskans.
4:46:16 PM
MYRA WILSON, Veterinarian, Anchorage Animal Care and Control,
stated that she has been the secretary of the AKMVA for eight
years. She said did not want to repeat points made, but
acknowledged the good testimony provided today. She has been
licensed in Alaska since 1981. She recalled hearing people
discuss public health. She said she often works with the state
veterinarian and epidemiologist. She stated that rabies
vaccines were mentioned earlier and noted that the regulations
require a licensed veterinarian to administer rabies
vaccinations. Therefore, people who are not licensed, but are
administering vaccines would invalidate these vaccines.
Further, rabies vaccines administration by anyone not licensed
in Alaska as proposed under this bill would also not be
considered valid. She highlighted staying current in Alaska
helps veterinarian professionals have a familiarity with
emerging diseases, such as salmonella, which a person just
coming to the state may not understand. She also expressed
concern that veterinarians not adhering to Alaska's standards of
practice would not be required to maintain records so those
records would not be available to clients. She said such
veterinarians would not need to adhere to regulations, label
prescription, or provide medical records, which she
characterized as an injustice to citizens of Alaska. She
commented on local pro bono work. She suggested that at least
6-7 clinics spay and neuter animals arriving at the Anchorage
Animal and Control. She noted that the organization has
received animals locally, the Matanuska-Susitna area, and Kenai.
She said that veterinarians are willing to help if their
expenses are covered. Lastly, she suggested two remedies:
temporary licensure, which she did not think HB 251 addressed
adequately, but believed the AKMVA would be willing to place on
their agenda or discuss at their next annual meeting. She did
not think that the problem would be addressed overnight. She
reiterated that many interested parties can work to address ways
to help serve these underserved areas in Alaska.
4:51:10 PM
TIM HUNT, Veterinarian, stated that he is licensed in Michigan
and Alaska. He said he has worked during the Iditarod and has
seen many dogs, including non-sled dogs. He related that he is
constantly approached to help out due to the lack of care. He
agreed that the problem must be addressed to get veterinarian
care to rural communities. He offered his belief that many
veterinarians have worked admirably, such as Dr. Sept and Dr.
Lovely. He suggested that the state needs to take this to a
higher level and not rely just on military veterinarians to
visit communities one or two days a year. He acknowledged that
this is not a new problem. He was unsure if this bill is the
correct approach, but he stressed that something needs to be one
on some level, as the perception in the Lower 48 is that no one
really is stepping up to the plate.
4:52:42 PM
DR. JON BASLER, Veterinarian, stated that he has been in
practice in Alaska since 1985. He worked in Anchorage the first
three years, and was paid by the North Slope Borough for three
years from 1987-1990 to provide veterinarian services to all
communities within the North Slope Borough. He acknowledged
this has concept has been mentioned several times, the NSB has
deep pockets. He pointed out that animals are often last on the
list, but some responsibility from Native, Regional, or Village
corporations to try to hire veterinarians to serve rural Alaska.
He offered that salaries were paid by the NSB, but the
veterinarians basically provided pro bono work to local
residents since the care to local residents was essentially at
no charge. He did not want to repeat testimony, but agreed
with Dr. Wilson that it seemed like one of the sticklers is
removing all oversight since most veterinarians in Alaska do not
object to pro bono work performed. He identified the main
thrust is to identify and facilitate groups, such as national
organizations who often provide the mission-type work that much
of rural Alaska entails. He acknowledged that local
veterinarian are not required to perform pro bono services, but
he surmised that nearly everyone practicing in Alaska does pro
bono work since they often have clients who cannot afford
services.
4:56:00 PM
PAIGE HEYWOOD, Veterinarian, stated that she is a small animal
practitioner. She testified in opposition to HB 251. She
concurred with the majority of the points made. She offered her
belief that Alaska veterinarians can and are willing to provide
care to rural communities if travel, lodging, and supplies are
covered. She offered that she often speaks on the phone to
villagers and communicating with EMTs on how to provide first
care to animals that are not able to immediately be seen by a
veterinarian, which is pro bono work. She expressed concerns
with the bill sections that limit complaints against
veterinarians to client complaints since clients are not always
aware of poor practices, such as poorly labeled medications, and
misuse of medication, or use of expired vaccines. She also
related that some people do not have the knowledge or resources
of how to file or pursue complaints. She concluded that
veterinarians should be held accountable to their clients and
their peers.
4:58:15 PM
MORGAN PETERMAN, Veterinarian; Veterinary Skills Director,
Humane Society of Veterinary Medical Association (HSVMA), stated
that the HSVMA is a national veterinarian medical association
with a focus on animal health and welfare. One of HSVMA's
missions is to provide veterinary medical care to animals in
need in remote areas of the U.S. She stated that during 2011,
HSVMA's rural area veterinary services (RAVS) provided high
quality care to over 8,600 animals lacking essential services.
She stated that HSVMA supports HB 251 and its goal of addressing
the lack of veterinary services to remote populations in Alaska.
Additionally, the HSVMA recognizes the difficulty in addressing
these needs given the current veterinary licensing laws, which
limit those who can serve remote populations to veterinarians
licensed in Alaska. She related that the lack of care is not
only an issue for the well-being of the animals, but poses
significant health concerns for the remote communities. She
explained that her organization has worked to address similar
issues on American Indian reservations in the Lower 48. The
RAVS tries to provide high quality free care and education on
many of the reservations with the goal to reduce infections,
providing population control through sterilization surgeries,
limiting stray animals, and decreasing dog bites and the need
for rabies treatment in humans. She emphasized that RAVS is an
excellent example of how an above standard quality of care can
be practiced in an atypical setting. The organization does not
believe the standard of care should be compromised, it is
critical to recognize the requirements to practice quality
veterinary medicine and have an open mind in assessing rural
situations since they may meet these requirements in creative,
yet safe and effective ways. She said she hopes the bill
addresses these needs by allowing veterinary practitioners with
up to date and those who hold licenses in the U.S. in good
standing to be permitted to volunteer their services under the
laws set forth by the BVE and the state. These services should
be allowed in areas of documented needs, where veterinary care
is geographically or financially unavailable to the population
receiving the service. In closing, she said she hopes the
legislature will support the goals of HB 251 and hope the
legislation will result in increased veterinary care for
underserved animal populations in Alaska.
5:01:19 PM
ANGIE FITCH stated she is a consumer and supports HB 251. She
said she is concerned with the lack of veterinary care in
villages. She offered her support for HB 251 since without the
bill, there will continue to be a lack of care in the villages.
It is cost prohibitive for villages to request a veterinarian
come to the area. This bill would provide an alternative. In
terms of the standard of care that is compromised under the
current situation under the BVE. This bill would bring much
needed veterinarian care to areas in rural Alaska that do not
have the care.
[HB 251 was held over.]
5:04:10 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
5:04 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SSHB251 Supporting Documents-Assorted Emails-Letter 2-12012.pdf |
HL&C 2/20/2012 3:15:00 PM |
HB 251 |
| SSHB251 Supporting Documents-Letter Humane Society VMA 1-24-12.pdf |
HL&C 2/20/2012 3:15:00 PM |
HB 251 |
| SSHB251 Supporting Documents-12AAC 68.048.pdf |
HL&C 2/20/2012 3:15:00 PM |
HB 251 |
| HB251 Supporting Documents-Testimony by Annette Kreitzer before HL&C 2-20-12.pdf |
HL&C 2/20/2012 3:15:00 PM |
HB 251 |