A major battle is brewing over a pair of measures that, assuming they get on the November ballot, seek to modify the way health care is delivered to animals in Colorado.

On the one hand, the group that is pushing for the ballot measures is pitching the changes as a potential solution to the state’s shortage of veterinary care, while also expanding access in rural communities.

Critics counter that the measures would undo a carefully crafted law aimed at facilitating tele-health and the changes would permit individuals who are not licensed to practice medicine to deliver veterinary care to animals. In both scenarios, critics said, animals are at risk. 

Already, veterinarians can be found on both sides of the policy fight.  

Ballot initiative 144

The first initiative seeks to overturn some of the provisions in this session’s House Bill 24-1048, which puts into statute a long-standing requirement that veterinarians must conduct an in-office visit with a pet before offering telemedicine services in the future.

If approved by voters, Initiative 144 would remove that requirement, allowing a veterinarian to establish care either through an in-person visit or via telemedicine. 

Dumb Friends League President and CEO Apryl Steele, a veterinarian, claimed that HB 1048 won’t lead to expanded access to care. 

On the contrary, Steele said, “when 40% of visits are resolved over telehealth, and when people physically can’t get in because they live in veterinary deserts or they’re in rural areas of Colorado and they need help for their pets, to deny them the ability to get this care is not being appropriate for the animals’ needs or the people’s needs.”

Steele offered several arguments in favor of eliminating the in-person requirement.    

First, she said, Gov. Jared Polis signed, during the pandemic, an executive order permitting the same regime as the one outlined in the ballot measure. Steele also claimed that, during the period the executive order was in place, “there were no increases in complaints attributed to telehealth.”

Steele added that, in some cases, telehealth can be a “better way” to evaluate a pet’s condition, as opposed to an in-person visit. 

“For lameness and limping, vets can actually see the animal walk in their normal environment, which is actually better than what you can do in a clinic, because they never walk normally in a clinic,” she said. “For behavior issues, they can watch the behavior situation, see if there’s a trigger and notice things that an owner can’t notice.”

While an in-office visit may sometimes be necessary after a virtual evaluation, allowing the initial appointment to be conducted via telehealth saves a trip to the vet for many of the pet owners, she said.  

“With telehealth, the initial steps would all be the same,” Steele maintained. “If the animal didn’t improve, then they would say, ‘Hey, you need to go be seen. This is not a typical situation and we need to do further diagnostics.’ So, those things still would follow that same pattern.”

‘A skin infection could be anything’

Rep. Karen McCormick, a veterinarian who opposes the initiative, argued that while veterinarians are currently able to give “tele-advice” without a prior in-person appointment, an initial physical check-up is crucial for establishing a relationship with pet owners and accurately assessing an animal’s condition.  

Elsewhere, she argued that Colorado should embraces telehealth — but as a supplement, not a replacement, to caring for animals in person. Otherwise, she said, that puts animals at risk. 

“If you have that baseline, you have a foundation and at least you have information on this animal and you met this owner. You trust them, they trust you,” said the lawmaker sponsored HB 1048.  

McCormick emphasized that some issues are too difficult to diagnose virtually, even if they are technically allowed to be. 

“A skin infection could be anything from a parasite infection to a bacterial infection or a yeast infection. They all look the same,” she said. “You cannot tell by a video or picture what you’re dealing with. In the past, if somebody would send a picture in, the honest thing to do would be to say, ‘If this has never been diagnosed before and we have no medical history on this animal, we need to see that animal because we may be sending the completely wrong medicine.'”

McCormick also said federal law requires veterinarians to see an animal in person before prescribing medications not labeled for animal use. 

“So, it wouldn’t matter what Colorado does, that veterinarian would still be confined to a subset of medications that they would be able to prescribe to an animal, and that potentially can cheat the animal and cheat the owner,” she said. “I’m just sending you antibiotics that are for animal use only and following the label exactly the way the FDA says I need to do — because that’s all that would be available to me.”

The lawmaker added: “Many of the medications for skin infections that we use in animals are (labeled for) humans. I wouldn’t be allowed to send that to you, and I wouldn’t have any idea if it was a yeast infection anyway because I wouldn’t have done the diagnostics that I needed to do.”

Ballot initiative 145

Initiative 145 creates the position of “veterinary professional associate.”

Under the measure, the new position would require a Master’s degree in “veterinary clinical care,” a new program, or its “equivalent.”

Supporters like Steele are pitching it as similar to a physician’s assistant or nurse practitioner, arguing that veterinary professional associates would have more training and duties than veterinary technicians, who hold either an associate’s or bachelor’s degree, but less than doctors of veterinary medicine, who typically complete at least eight years of schooling. 

According to Steele, the average veterinary technician lasts about seven years in the profession before they move on to another career, often in human medicine. This trend is primarily driven by limited opportunities for advancement and low pay, she said. Unlike the extensive six-plus additional years of schooling required for a veterinary tech to become a doctor of veterinary medicine, transitioning to a veterinary professional associate role would only require two additional years of education.

Colorado State University is on track to become the first school in the nation to offer a Master’s in veterinary clinical care, which will be a five-semester program. Lincoln Memorial University in Tennessee offers a similar program for two-and-a-half semesters.

McCormick also opposes Initiative 145, saying it further complicates things. 

“Adding a new profession to this mix does not necessarily help the system,” she said. “Part of this issue is that adding a Master’s level person in here when we still desperately need veterinarians and veterinary technicians does not actually get to the root of the problem. We need more veterinarians and we need more vet techs.”

McCormick’s proposed solution is to expand the responsibilities of veterinary technicians, who she argues, are trained to do much more than their current duties within a practice. She sponsored this session’s House Bill 1047, which expands the scope of practice for veterinary technicians to include procedures, such as dental extractions, suturing incisions, and reproductive ultrasounds. 

With an increased scope of work would come higher pay, McCormick added, incentivizing veterinary technicians to remain in the profession longer instead of having to seek higher-paying jobs elsewhere. This shift would also allow veterinarians to focus on duties only they are qualified to perform, such as surgeries and prescribing medication.

“Over time that veterinary technician is contributing more and more to the engine of the practice,” McCormick said. “We’re getting more people in, and guess what? That veterinary technician is earning more for the team, and they’re earning more for themselves. So, as a business owner, I see tremendous opportunity here for veterinary technicians to contribute more for practices to thrive and more people to be seen.”

The Colorado Veterinary Medical Association, which represents more than 2,700 veterinarians and veterinary professionals across Colorado, last year said it does not support the creation of a “mid-level” veterinary professional.

The group said the proposed new profession would encounter numerous barriers to integration and utilization, and that it would be more efficient to further develop the role of veterinary technicians, who are “underutilized.”

The group said among the regulatory hurdles the proposed mid-level profession faces is that the FDA only allows licensed veterinarians to prescribe.

“This means that unlike human medicine, a mid-level professional would be unable to prescribe independently,” the group said.

Both measures must receive just under 125,000 signatures by the end of July to qualify for the November ballot.