Updates on Colorado Proposition 129

A name change, following the money, and supporters respond to criticism

Dear Readers,

Last week, I wrote about the push to create a Veterinary Professional Associate (VPA), or a midlevel practitioner, in Colorado. This is a fast-moving story and I have a number of updates for you in this edition. If you missed the original coverage, check out that post here:

Proposed Initiative #145 Becomes Proposition 129

Just to make things confusing, since proposed ballot initiative #145 got enough signatures to qualify for the November 5th election, it has been renamed Proposition #129. I wanted to clarify for accuracy and for any readers who live in Colorado and may be voting on it. The non-partisan election education website Ballotpedia has a great synopsis on Prop 129 including the full the text of the legislation, a plain English summary, arguments for and against, and details about campaign financing for both sides. Here is the TL;DR on what a yes or no vote means:

Follow the Money

All Pets Deserve Vet Care is a registered Political Action Committee (PAC) that is funding the push for Prop 129. According to Ballotpedia, they have received $1.36 million dollars in donations. The top donors were the Dumb Friends League—a non-profit animal shelter based in Denver, Colorado—and the ASPCA:

You can also see who has donated to the opposition PAC Keep Our Pets Safe, which raised less money at under $1 million, and the lion’s share came from the AVMA, with a much smaller amount from the Colorado VMA.

The non-profit, non-partisan organization Transparency USA tracks campaign finance expenses in dozens of states, including Colorado. Through their website, we can see what entities were paid by All Pets Deserve Vet Care. Their single largest expenditure was almost $300,000 to a company called Ground Organizing for Latinos:

What is that group? Ground Organizing (formerly named Ground Organizing for Latinos) is a business and officially licensed petition entity in Colorado that specializes in getting candidates and initiatives on the ballot. According to their website, their services include:

• Collecting signatures

• Door-to-door campaigning

• Phone-banking and texting efforts

• Mail distribution of campaign materials

Corazon Printing LLC is (unsurprisingly) a local printing company and Tierney Lawrence LLC is a law firm. I could not find any information about Switchboard Strategies LLC online—ah, the wonders of shell companies and dark money in American politics 🤬

They are not exactly transparent that donations go to PACs and lobbying firms

To be clear, all of this appears to be legal. However, I doubt that many people who donate to the Dumb Friends League or ASPCA to help homeless animals know that these organizations are spending huge amounts of that money on lobbying.

Bill Sponsor Responds to Criticism

The Dumb Friends League has seen the blowback coming from veterinary organizations opposed to Prop 129, and President and CEO Dr. Apryl Steele (a veterinarian) recently posted this defensive response, calling criticism of the VPA “[i]ntentional misinformation.” I would encourage everyone to read her statement in full so they hear both sides of the story. I dispute a number of her claims, and will highlight a few below.

“Historically, the AVMA and state VMAs have made veterinary policy decisions that often come from a place of arrogance.  How do we celebrate the social, emotional, and physical health benefits of pet ownership while also saying that people who cannot afford veterinary care should not own a pet?”

I don’t think the majority of veterinarians out there would say “people who cannot afford veterinary care should not own a pet,” but most of us realize that someone has to pay the bills: medical equipment, facilities, and drugs all cost a lot of money, to say nothing of paying veterinary technicians and DVMs (who would still be needed even with VPAs). In the US, safety net programs like Medicaid and the 1986 Emergency Medical Treatment & Labor Act (EMTALA) guarantee at least some baseline level of care to everyone, regardless of ability to pay. However, this is only possible because of taxpayer-subsidized payments to doctors and hospitals, and these systems are chronically under financial strain.

While universal veterinary care is a nice idea in the abstract, without substantial state and federal funding, it is a pipe dream. The vast majority of veterinary hospitals in North America are private entities, and not everyone has the luxury of operating on tax-exempt donations like the Dumb Friends League does. Furthermore, as I wrote last week, I strongly dispute that VPAs will significantly reduce costs for owners, and virtually all are likely to work in the private sector, rather than for shelters.

“AVMA’s President, Dr. Sandra Faeh, was quoted recently in a press release saying, "The proposed training for this position is completely inadequate and will lead to missed or delayed diagnosis...leading to more suffering for the animal and increased cost for the client." This is blatantly false and based on a willful lack of knowledge. The Master’s in Veterinary Clinical Care degree program under review at Colorado State University’s College of Veterinary Medicine and Biological Science is a 65-credit hour program focused only on cats and dogs. Future graduates of this program would be able to serve in shelter medicine regardless of the success of this legislation, but if this proposition is passed they could make a bigger impact and truly move the needle on helping animals across our state.”

It is hard to believe someone can argue with a straight face that a three-semester, 65-credit program—conducted mostly online—is remotely sufficient training to diagnose, prescribe drugs or perform abdominal surgery. For comparison, the University of Colorado Physician’s Assistant program is *132* credits over three years, nearly all of which is on-site lectures, labs, and clinical rotations. Surgical PA’s must go through additional clinical training after their degree program (many do a 12-month residency), and they still are not allowed to perform surgery independently; they primarily assist the MD/DO surgeon with tasks like retracting, handing instruments, placing chest tubes and IVs, suturing, etc.

Side note: I am not sure what to make of her claim that VPAs could still “serve” in animal shelters if this legislation fails 🤔 However, it would seem to undercut the necessity of Prop 129, which her organization is spending heavily to advance.

“What about surgical training or dentistry? When you compare the proposed VPA curriculum, including surgical labs, with DVM preclinical surgical training in small animals, the required pre-clinical surgical training for a VPA is 108 hours as compared to 105 hours for the DVM program. To assert that a VPA would be unprepared for surgical procedures is to say that DVMs are similarly unprepared.”

I don’t know where she is getting those numbers; presumably they are from CSU, although that is not explicitly stated. The amount of pre-clinical and clinical surgery training DVM students get varies widely depending on the school, but those estimates strike me as quite low. 105-108 hours is just under three weeks, and I definitely had more than that at WesternU, and the other vet schools I have been affiliated with such as Virginia Tech and Auburn have entire semester-long courses dedicated to the theory and principles of surgery.

That is almost besides the point, because what really matters is actual hands-on surgery experience. During my time at vet school, I had…

• Frequent surgical skills labs throughout years 1 and 2

• A 2-week junior surgery rotation that took place at a shelter where I performed spay and neuter surgeries every day (under supervision of course)

• A 4-week senior surgery rotation at a specialty hospital where I assisted with advanced procedures, performed minor procedures like lumpectomies under supervision, helped with bandages, exams, and paperwork

That is hundreds of hours of direct, hands-on surgery training after the pre-clinical coursework and to be honest, I was still a pretty crummy surgeon! (Hence why I went into pathology 😅) Surgery is a difficult skill that takes years to master, which is why the American College of Veterinary Surgeons is so opposed to this effort.

“It is offensive to say that someone with this level of training, while supervised by a DVM, would create suffering for animals while millions of pet owners report not being able to access veterinary care to provide any relief to injured and sick animals. Many of these pet owners are desperate for help but cannot obtain appointments, live in a veterinary desert, or cannot afford care.”

The level of VPA training described in this letter and other outlets strikes me as wholly inadequate to deal with time-sensitive complications like sudden hemorrhage in the abdomen during a spay. In those situations, you may only have a few minutes or even seconds to find and ligate the bleeding vessel or the patient could experience severe consequences, including death. I understand that many people cannot afford routine pet care, but what is worse? A pet who goes un-spayed because of cost (which is actually the norm in most countries outside the US) or a pet who dies because someone with minimal training was performing the surgery?

“Will creating a VPA lead to more cost-sensitive options for veterinary care?

Yes. Animal Health Economics has completed three business models that will soon be published. These show significant business opportunities when VPAs are utilized, resulting in revenue that can augment technician salaries and be deployed to offer lower-cost care. Funding for subsidized veterinary hospitals is outpacing the ability of animal welfare groups to hire veterinarians, roles that a VPA could successfully fill. Finally, without a VPA, there is little hope that low-cost veterinary options will become more available.”

This is basically the “Source? trust me bro” answer. Even though the effort resulting in Prop 129 has been years in the making and election day is a little over a month away, we are expected to just take their word for it that business case white papers no one has seen validate the idea that this will reduce pet care costs??? In my experience, cost savings usually fund better profit margins rather than lower the absolute price to consumers.

“Who is funding the ballot measure in Colorado?

To date, the investment in obtaining enough signatures to get on the ballot in Colorado has been $1.3 million. This has been funded primarily by animal welfare organizations, including the Dumb Friends League, the ASPCA, and NOCO Humane. Many invested citizens of Colorado have also contributed. No corporate funding has been accepted by these non-profit organizations and subsequently invested in this initiative. One gift of $10K was donated to the Vet Care Coalition directly from a corporation. The claim that corporate veterinary medicine is funding this work is false.”

From what I could find on Ballotpedia and Transparency USA, this is not inaccurate, but the phrase “…and subsequently invested in this initiative” is doing a LOT of heavy lifting here: We all know that money is fungible, and $1 given to an organization and earmarked for purpose X can free up general funds for purpose Y. So even if it is literally true that no corporate donations went to the All Pets Deserve Vet Care PAC, there is simply no way short of a detailed audit to prove or disprove whether large company donations indirectly supported these organizations.

Q&A with CO Rep. Dr. Karen McCormick

For more information about Prop 129, AVMA News recently posted a Q&A with Dr. McCormick, the state representative and veterinarian who has been opposing and raising awareness about this issue. There is a lot of great stuff in the interview, including more details about her concerns with the proposal, and talking about legislation Colorado already passed to improve access to vet care through telemedicine and expanding the scope of practice for veterinary technicians. Check it out, it’s well worth your time.

Make Sure to Register to Vote!!!

Finally, the stakes of this initiative show how important it is to make your voice heard at the ballot box this November. You can check your registration status, sign up to vote, and get the latest information on where and when voting happens in your state/precinct at the non-partisan website Vote.org. You can research candidates and issues at Ballotpedia.