Agriculture, Forestry & Economic Development - Senate

Today we do not have a form. Now we have more of first we with before we get to the center field we we will have a center stone president will force you would go then the table. DO one from state park here. From your own your own day. You would enter the ship for the record you're recognized Matt stone Senate district to it feels good outlaw I've often found myself Mona model. That it'll be what it'll be I think this is gonna be a simple non current non controversial bill the purpose of this bill this is to change the Department of Parks heritage tourism the State Parks Division I thank you record Senate bill two fifty one yes I'm sorry Senate bill to be the one it is to tackle changed only that is correct what is it anyone have a question on is. The one here speak for against this bill. You closing your bill I'll close for the bill moved to pass have second all in favor say aye opposed the Bill pass thank you. Silvertone. You go Bills all right Sir do. We have an amendment passed out of committee if you look on your The folder your amendment is there to until I let you speak for your first lesson in Bruxelles. For the record you're recognized Bills. Okay. Yeah. Ricky Hill Senate district eleven. Okay your okay you should have an amendment in your hands basically Lee is saying we strike lines thirty one and thirty two and we had the veterinarian should be licensed in this state. Found out that the of the reminder that we must have risen residents in the state of Arkansas is unconstitutional so we deleted that. If would explain to me that limits competition anyone have a question on the amendment. I have a. What players committee on the amendment. Move do pass second all in favor say aye. Member okay limits adopted so you're recognized to present your bill as amended thank you Mr chair. That you see on this is a pretty pretty simple non controversial bill because I'd like to refer to it as some of you may look at different. The we're just adding one thing it basically is already a law we're saying the. This means that a veterinarian has recently seen in personally acquainted with the keeping and care of the animal by virtue of an examination. This is part of this new whether in person or by telemedicine of the animal by medically appropriate and timely business to the premises with animals can't. And also if the if a veterinarian is using telemedicine the veterinarian shall be licensed in the state of Arkansas. In the veterinarian complies with all capital federal laws and regulations. Hello information will say today then we kind of got repetitive repetitive from the other day when they represent a different bill Arkansas is under state of emergency for veterinarian services. Veterinarian telemedicine is defined as the act of practicing veterinary medicines from a distance a veterinarian is practicing make telemedicine if they are not if they diagnose the condition recommended treatment are provided prescription without the patient being physically present in the clinic for an in person examination instead of meeting in person the veterinarian and client can make via phone call text online chat email video conferencing program such as a this would totally be up to the vet to decide how they will do it if they want to do it or not veterinarian do not have participate in this. We're here that we're overlooking that no one's been really talking about the tellement Neri. Telehealth software that's available. Many telemedicine requires a vast amount of record keeping in veterinarian client communication capabilities therefore telehealth software companies are beginning design software specifically for veterinarian telemedicine. The typical veterinary. Practice management system may contain an electronic health record system remote patient monitoring. Customer relationship management and you prescribing functionality. The veterinarian telehealth market is expected increase in extreme growth over the next eight years the market is expected to grow at a rate of seventeen point six nine percent it is expected to reach a market size of five hundred ten million by twenty thirty. And that's only with seven state using it. Okay. Telemedicine's legal issue. Is it legal for veterinarian provide telemedicine services as long as there's an established veterinarian client relationship. Yes yes in most circumstances federal law leave it up to the states to define what it be CPR yes and how does established with the exception of one federal law requires that BCP are to be in person. There are three major components of that. When using medication for feed. It must be in person. When used off label drug use it must be in person. And we're compounding drugs it must be in person those are three of the exemptions for that. You may wonder were some of this information came from Department bag. What you does each state regard Hamby CPR there are three different views among states regarding the CPR and how it may be established. The first view is to establish a VCP are the bit must have examined are physically examine that'll. Therefore they cannot create a BCP are through telemedicine when they do that. Are the second view the vet must either have seen or be acquainted with the animal four ZPG BCP are to be established therefore cannot create a B. C. P. R. through telemedicine the third view is have passed laws this is a B. CPR can establish service through telemedicine there are seven states that are currently doing this so we're not new to this. No matter what we hear and just for a one No the last three years every state in the United States has been using telemedicine to establish of the CPR of the code guidelines for emergency it's been going on throughout the country so this is not new no that areas did not have to do that if I didn't do it is dirt choice to do. The seven states right now we're talking about looking Virginia Oklahoma DO Jersey Michigan I hope in Hawaii in Florida even have the the CPR. Right now. We have fourteen vets per her down people's they've Arkansas which rounds out to roughly B. four hundred thirty four now there are some out of state veterinarians that are last in the State of Arkansas which is not accounted for this. We have one point seven seven million cattle. Under sixty eight thousand courses. Million nine hundred ninety seven thousand dollars in eight or ten thousand kids with four hundred thirty four bit near the state of Arkansas that's a lot of animals. Arkansas is the highest paying state for veterinarians at a hundred and forty six point seven percent of the attic every salary across all occupations. And we wonder why. We don't want to change it's time to get veterinarian science up to the twenty first century why are you doing this for humans. In the old saying yes well your animal can't talk well neither can a baby. Anyway you look at that baby can't talk who do you depend on it's easy to miss the parent who depend on with an animal. The owner. In the veterinary will have the right to say I can determine what's going on here you need to come into my office I can't make a good call or the vet nearing conside hi this is what I think it is a try this now be available tomorrow for you. When you look at it we have fifty three thousand square miles in Arkansas roughly at a hundred twenty two miles permit. Who needs television everyone in the east of the eastern part of the state they economically challenged part of the state the southern part of the state in the southwest part of the state if you're in central Arkansas northwest Arkansas you're in good shape you don't have any issue you've got plenty of ignorance. What does it take to establish. The CPR. Federally. A veterinarian must assume the responsibility for making medical judgments regarding the health of the animal and the need for medical treatment and the client owner has agreed to follow those instructions of the veterinary. Your sufficient knowledge of the animal by the veterinarian to initiate and at least general preliminary diagnosis of the condition of the animal. And the person veterinarian is readily available for follow up. In case adverse reactions and failures of the regiment of therapy. That's what it takes right there. But that'll take any questions. Their duties. Thank you senator. like many of you I've I've received a lot of. Calls and emails and texts about but this bill I've got a few questions if I can read then I think you address some of today's thank you at your to answer some of those but some clarification was asked around When if we if we pass this does does a telephone call. Count as a telemedicine or VCP are under this language under this plan okay that will actually set up by rules exactly how to find a house to find in the in the industry I'm a read I read to you again. Instead of meeting in person the veterinarian a class meat be a phone call text online chat email video Compton program such as an but our rules when I go to set that up could define telemedicine okay there there was a concern around if if telephone call a non visual inspection is approved is allowed there's a concern that there is even a patient involved because what it sounds like is is that would would would hurt the definition of an examination or into our our point before about how animals can't speak can't communicate and so that would that would be hard to prove in a telephone calls is that the Texan and emails I've gotten second to that about the how we do this with humans versus how we deal with with that you know because humans can speak babies can't That narrative communicate to me that the typical response from an animal is is not to communicate instructor retract when there's a medical need and so to not express a purchase symptoms except you're aware as a baby not be able to to speak but could express pain in different ways that are visible so there's concerns there but but let last question cannot can address that because of I'm used for example last night when I went to the house we had a horse that was calling. And collecting of their intestines template that holds that are shaking his head in Poland when he was telling me how he felt so yeah they they can communicate with their owners the owner has to be able to communicate back to the veterinary with animals telling them. Makes sense makes sense. On On the federal side I had some veterinarians say that All this speak bluntly House communicate to me and and you went down this road is helpful in maybe in this question help mate maybe some repeating what you said but the question was why are we doing this if it's against federal law today it almost of what is the purpose of this bill and I think you start explain that and so with the concept of that question it it sounded to me that. This is against federal law but maybe it maybe I'm wrong on that so help me understand okay it It is in state or out of state to be CPR K. up and how that is established. Federal law says with three areas that up you must go by federal guidelines any time federal guidelines that way whatever the state does with the state does the relative and those those three guidelines or if you're using Medicaid food which is for the food chain. The KP not food medicated feed off label drug use. And the compounding of drugs that the veterinarian must see those animals in person president have a relationship with west will be from you have a large cattle operation he's from here's what's going on because he's been out there under those circumstances he must see them because it's federal law. Is that what we're doing here will not affect that whatsoever. Okay that's helpful thank you Mr. Any other questions. Good thank you thank you we've got to sure we've signed up to speak of. On the bill and against the bill the roof all. If you would like your name for the record and you're recognized good morning my name's Bruce Holland I represent the American veterinary medical association You service center Caldwell here in the Senate was chairman of this committee and was a former director executive director of Arkansas livestock and poultry commission. Also cattlemen and that one time I had to write it eight hundred head of of commercial cattle and been working with veterinarians and veterinary medicine all my life I understand from the cattle perspective got a few points that I'd like to make today and I've written down so I'll be succinct and will take up too much of the committee's time. We believe that this this bill will ultimately lead to misdiagnosis unnecessary suffering and death is of pets as well as farm animals telemedicine can be a very important part of veterinary medicine after after a veterinary client patient relationship has been established. None of our border states allow prescriptive authority without an in person veterinary client relationship first established that it that it's all states including Oklahoma Texas Missouri Tennessee Louisiana all of them there is a provision in Oklahoma's law where they you can call a veterinarian in an emergency situation but they do not have prescriptive authority and I think that's important because I think one of the challenges that this bill has is we create a situation where people could abuse the privilege veterinarians in other states as in particular of sending medications to Arkansas that shouldn't be I can give you an example of that if I got a I've had this happen on my farm per California starts growing inter head okay. Well I don't have the facility this rented pastor and like I don't really have a way to catcher right now and so I can call a veterinarian and he can prescribe me some some beaut that I can put in my dart gun and give that cal Darton put her down well that same drug is being abused today with fentanyl if the I was talking to veterinarian over here earlier today. It gives them a zombie effect in it in but it's being abused and this is not the only veterinary medical drug this being abused there was a situation a couple years ago in Florida where they tried to pass a similar bill in my name that bill the puppy pill mill Bill because they were afraid of over prescription of not only drugs like I spoke of their but of antibiotics and creating the antibiotic resistance that we're going to see if you over prescribe antibiotics in cattle chickens horses goats whatever that animal might be. So when if an animal is made that misdiagnosed or condition goes on identified you could cause unnecessary suffering and potentially death when an in person bid visit could have simply treated and cured the condition there's also the danger that a misdiagnosis could lead the human transition of an animal disease avian influenza which is easily misdiagnosed and has been found in Arkansas this year could easily spread to other animals as well as humans driving influenza is on arctic disease it can easily be passed from a chicken to hold to a human depending on what variety it is as we as you know we get a flu shot every year maybe it's H. one into the third vaccinations for this year some of them. You know they got a good chance of hitting it and as they predict these things. But if that's one that's easily passed between species then we can have a real problem and these. If you diagnose that over the phone with someone's backyard poultry and that starts spreading across the country. You are based been to the store recently and sing with egg prices are today that's because of avian influenza has affected so many birds when I was director of livestock and poultry commission we had a break of avian influenza up enough in a flock in Boone County. The protocol is to draw seven mile circle around that facility and check every backyard flock within that seven mile circle if you find others can you draw another into you get a controlled area and you can start you from passing that those birds and control it. That poultry incident in twenty fifteen I think they had to euthanize about twenty thousand birds. We process twenty six will be back up. Back then when I was a director the term whatever the number was we processed about twenty six million birds a week it could be devastating to the economy of Arkansas if the disease like that were to be misdiagnosed because someone out of state. Said okay that's probably new castle disease or mycoplasma or something else and cents and biotics to treat that. I think that's important to consider when we're when we're looking at a bill like this. And animals and to the other point about the comparison to human medicine animals react very differently than humans when they become sick and obviously they are non verbal and cannot communicate their symptoms in human medicine the American academy of pediatrics state that Tellem medicine should not be provided to children under the age of two years except when the provider has established an in person relationship with that patient. And I think that's you know animals is is Center diesel brought up earlier. They go into survival mode they don't always. Exhibiting what's hurting them we can't. Just look at him until I certainly can't if it's a dog or cat I know a lot about cattle but I don't know a lot about other species but I know that these symptoms can be easily misdiagnosed. The veterinarian who came and spoke on this bill back before it was hurting Committee from Texas a and M. who is the authority nationwide on telemedicine gave the example that someone called one time and their cat was having trouble in the little box said Mike and I know my cat I've seen my cat everyday for the last fifteen years the cats constipated news need something to take care of that. When that could easily be a sign of a blockage in the urinary tract which could if you gave them the required medicine for. Constipation it could kill that animal so just simple things like that. Telemedicine has its place in veterinary medicine if I call my vet today and say I've got a steer out here this bloated and I'm having trouble getting that down where exactly should I put my needle in that cal side to let that are off if that veterinarian knows me and knows my understanding of my heard and it's been out to my farm in those my understanding is going to tell me how to do the. We're going to take care of that problem. But the. Bad actor out there who's maybe going to try to prescribe pills are all this. We're gonna have a lot of problems with misdiagnosis so with that I'd be happy to answer any questions here. Committee on have questions for. Or seek mates for Senator all. Represent the issues Davis thank you so if the. If it was just establishing the relationship in person then you guys are okay with telemedicine beyond that it's just the way it yes the relationship is a status that that relationship must be a step there so many things. If a veterinarian goes out to my farm and he sees I've got backyard poultry and some goats and maybe some guineas whatever run around there they're going to observe what kind of trees are growing in the yard Mr crabapple tree growing over here are there acres on fresh ground over here where's the water source are they drinking out of a muddy ponder they get fresh water every day those are the things that that veterinarian can look around and and then he can have that visit with that client out there on the farm and understand their practices what they're feeding how they're doing their animal care those are the important things that need to be established with that visit you wouldn't if your child was an emergency you would call a doctor that you never talked to before and say I got this going on and they don't understand. That patient that's why it's important to establish a better client relationships do you feel like and. Veterinarians are having a hard time getting out to establish that relationship I mean so I mean I we know that the argument is there's a shortage and are we are actually able to take care of these animals I think that's something that could be detrimental to Arkansas when a veterinarian is getting his degree in coming back to open a practice if the seven to compete now with out of state veterinarians. Then then that becomes even more of a problem for Arkansas. M. as their way to establish and sentences they have to be licensed in the state we can't mandate that they reside in the state and is there allowance through the promulgation of rules that they like. But you guys like to dictate mmhm who can be licensed in the state like it can you but I'm asking I guess is can you control how many out of state people are actually licensed in the state don't think that the bill goes into that depth and say how many can be twenty or two hundred or or how many and I would assume that if you can provide the necessary documents to the state burner medical board you could get a license in the state my wife's a physician she just got licensed in California the other day so you know there's things like that okay last thank you that helped you. Anyone else. The thank you Committee. Okay next to the. Jordan a fever Board. If you would come to the table. Again. If you would please your Mike is on introduce yourself for the record and you're recognized shores good morning my name's Jordan fire born I am the government affairs director for Merck in here to testify in opposition to the bill per share your time this morning you know many of the points that I'll make have been already you know statement disponible who more kids but would you for the record yeah health happens and work Merck it is a pharmaceutical company we manufacture and market a number of and animal health products as well so I have a large veterinary care portfolio. Right so our main concern with this bill is a related to the the establishment of the veterinary client patient relationship and of the establishment appropriately meeting in person for many of the same reasons that you just heard we're concerned about misdiagnosis inappropriate prescribing of public health consequences economic consequences that may come from missing you know a diagnosis overprescribing at cetera we are not opposed to telemedicine or the use of telemedicine so long as the relationship is established appropriately meeting in person the the virtual or that veterinary client patient relationship is really the backbone of the industry we want to make sure that those relationships are maintained in a safe and effective way so are our main concern is around the establishment of that relationship in person. I believe you have my written comments in front of you but I'm happy to answer any questions you may have. Everyone of a copy of the letter this presented. The mental go over that the. The. Thanks for does make the community a how would you describe the be The total number of visits or the shortage conversation from your perspective you believe there's enough earnings to believe there's a significant shortage you think there's an issue there what what what's your perspective on that I'm not sure I can speak specifically to the exact situation Arkansas as it relates to access or veterinary shortage what I would say is I believe this this comment was made by the previous testify or this may not necessarily help access it may actually hurt it a veterinarian so we're getting there you know degree and want to practice in the state of Arkansas are having to compete with folks who don't live in the State or practicing via telemedicine I think there are probably other ways to address an underlying access issue that don't include opening this up and maybe putting the health of animals and I honestly public health in jeopardy by allowing for that virtual relationship to be established so I don't know if I fully answered your question but hopefully maybe from an a national perspective then or would maybe not just Arkansas what you have a better perspective across the country well I think you heard earlier that there are still a minority of states to allow for the tell the virtual establishment this relationship I think telemedicine is used in veterinary care across the country so long as that relationship is established in person our concerns are addressed it's it's not that we're opposed to you the utilization. Dress access as an issue it's just that we want to make sure that that first visit as established in person that veterinarian has a good understanding of the client the patients patient so that there is not you know misdiagnosis or things like that that would have huge consequences. Davis thank you M. S. that I did I understand correctly that and states were doing this during COVID establishing and these relationships the act like video or telephone again I don't know that I can speak specifically to everything that was happening during COVID but I do know as part of the public health emergency certainly there telemedicine was used obviously I think the circumstances that existed that allowed for that to happen pretty unique I don't know that that should necessarily be the standard moving forward right we're not always going to be and that such that type of situation hopefully however if we do established you know to allow for the establishment of these relationships virtually everyone of the potential consequences is another huge public health issue. Avian flu as was mentioned hand foot mouth I mean we could be headed down a road where we would have a huge emergency in terms of food supply or public health we want to avoid that yeah so I just M. I want to understand better because and this is a tough bill and so. I guess I want to know maybe two things and if you can't answer if there's anyone else that could help answer is one do we have any data on what that look like during COVID like in terms of outcomes and for animals when we allowed setting at and patient relationships this way and if it was like negatively impact of this is like any data we have from that and I guess my second question just because I am trying to understand on like safety and and food supply and change it if it's. I guess I want to understand like it will that truly be impacted yes it's not legal federally and to do any of the like medicated feed M. R. compounding or off label drug use if that all has to be done in person and will that. Take care of the problem that you guys are talking about with the flu and stuff like I just want to understand and is that protected federally so it won't really impact that and or is that outside of the scope where we be allowing it and then what does the data look like where we have allowed these relationships be set up through telemedicine sure so to your first question I think all differ I think someone else would be the most appropriate person to answer that question in terms of the data and what it did look like during covid to your second question about federal protection my again I'm not a veterinarian but my understanding is that there are a number of conditions that probably present as something really routine that could be something else so I don't know necessarily that the protections around medicated feed off label drugs I don't think that would capture everything that you're mentioning again I'm sure that there is a veterinarian or someone here that could that could answer that question more specifically. Is it okay if we have someone come up I mean if everyone's done with license with this witness but at the appropriate time given just one clarification it this letter from you this letter is from up our associate vice president right I'm government affairs director so that's right correctly thank you. You want. Thank you very much thank you okay of. Sir David Tollett you ask your question again see who might can come up and answer. The. Thank you okay would you like me to ask again okay. M. so two things I guess what the time limit senator for the record please. I'm not a Baker and I represent the Arkansas than or medical association Davis recognized okay thank you and so I guess my question is do we have any data that shows what the impact was on animals during have it when we allowed relationships to be set at three video inspect the real soon but we don't have that today with this okay and so probably lead looking as we go down the road for you yeah I would be interested in address them the true impact and and then in terms of like medicated feed and stuff like that things that were saying are going to create and you have safety issues in our food supply chain. The. There might. Cumbrae doctor allows up with nickel a lot of. From the nurse to closure of over. I tried resume tried wrestling thing before you begin Sturch please have them and in addition to for the right one is doctor Michael lines from Searcy. A man practicing general medicine and Searcy and Batesville FOR forty two years in a mental search the school board for thirty years still general medicine veterinary medicine not determines that general veterinary practice I'm sorry. I'll try to cover a few things that we want from this. The restrictions now. Owner who can give certain medications federally or turning by FDA. It's a little different it is for human medicine as state side who can have prescriptive authority but they decide how much to be used and their medicines if its off label and that is very common in with animals to do what to call off label it out for a medicine may be the state for cal be specific but it also works on of a goat or pig or something else but is not labeled that way like you get that the pharmacy so it has to be altered somewhat dosage method of of of the application oral. Intravenous whatever and the off label cannot to. has been struck by a veterinarian based on an personal the CPR established personally same thing is true for the feed direct. And same thing also for a source. Okay in addition to that you have FTA the controls controlled substances and that has to be done by a licensed veterinarian has to be done after establish a perfectly CPR and it has. That's pretty. The control okay so those are all things as I understand bill here those are all things that for initial visit a new patient telemedicine. You couldn't do those things the doctor the vendor could what then it can prescribe in that case is only with drugs and that's something that maybe for your dog is a certain size or whatever that is package that way as I understand it and you know say medicine might be of use for cat but if it's not labeled that way then you could do the same thing We do have a telemedicine for veterans and in Arkansas what you establish that relationship then you can make these diagnoses telemedicine in you try these things we talked about but you got to have that in person established the CPR and that's kind of been helps that's the mental part of veterinary medicine and that's what make sure that you do things that you have some relation I'll give you an example for store that tell me in the last three days. She had patient Calder. Don't tell miss last and someone she had just been stabbed relationship with and so my dog not doing well one of the what is the condition but I don't recall that but she said okay I'll know what to do for that and how much you know what. Two hundred twenty pounds. She checked her records because she established as the CPR person her dog last visit weighed eighty pounds. Okay and she said there isn't a discrepancy or you want me to bring the dog and that is the way the dog is eighty three pounds she estimated hundred twenty. Which is you governor does of the the medication prescribed for this for a hundred twenty pound dog to ninety pound dog could calls producers complication for that animal that's why that relationship just one example of many others that's what that relationship is important to to do those things so The industry built around that if it's part of the safeguards as part of what keeps everything flowing and working correctly Status that through technology can have its issues critically of and I'm just giving my opinion but with telephone all you can't see the animal so even if the person on the other end is telling you correctly what the animals doing you still can't visualize the extent of that held the queue that might be there some things you can do you know telephonically of first is the a good picture Azam told not not lead you to a diagnosed. What makes a veterinarian veterinarian or what makes doctor doctor is the ability thanks a lot of trying to diagnose Ackerley. That establish from there you go the prognosis. Maybe surgery may be our prescription all those are based on the diagnosis and having that relationship with that animal in that that client to know. Hello animals cared for what problems maybe it's had before be able to look at it get responses that's all intervals to being able to treat that animal successfully Sherwood misdiagnosis can cause a lot of problems the hundred twenty pound of it might result in death or or emergency one calendar if it's we've not very long ago had mail that Kelsey's country of. It shut down. Hold thanks you couldn't transport cattle applicant cleared up if something like that is missed in loud roll then it becomes worse Most of this is you might be interested in and is that over seventy percent telemedicine visits for animals end up in a referral to the live it the colleague. Restriction we talked about I can't create and in those walks of the relaxation yes we've had telemedicine of the last three years the covered that relaxation has been taken off the FDA I believe it was twenty first of this month the last week so it was taken off they're getting stricter they're becoming stricter out of body experience at that prescription for the antibiotics starting June that you can get it fixed store today because of antibiotic resistance and we understand it So those are kind of the basis for a hope of a few questions of talk. Thank you for sure but That are being tried and tried again. Yeah I guess laws can join in please these pro yeah I guess I guess one question maybe you guys don't have the data to answer which is just what what does the data show doing this for three years like was actually harming animals like you know just what is it shall but I guess the other question I have is in terms of I'm just talking about safety within the food supply chain like if we're medicating animals we haven't seen it gets in the fade like M. so my question I guess is is that protected in the part where it says work that this will comply with all federal laws so does that protect some of those safety concerns or are there still things outside of the scope that you feel I could be a detriment to our food supply chain or whatever the cases okay once again under Michael lines. To your question about COVID and what happened during the in that hit so fast would never dealt with anything like that at all so we were all just doing what was recommended by the CDC in the state and the AVMA and everything trying to keep our heads above water tread water keep our doors open and keep food on our table. So we did the. Curbside thing and that worked out fairly well and we wore masks and gowns and gloves and and let the patients in the room and different things to protect the humans. so nature questions we didn't keep any records on yeah. So this committee in COVID bill of law and I guess I've done telemedicine all my forty two years old and realized that the legislature phone and answering a question but nine times out of ten it was a client that I knew that I'd seen their vote receive their Porsche C. McAdam admin out to the farm bill Abbas of those of the CPR. That we had. Of my fear okay back to your other question on if the anything you have these three of The. The med medications the off label stuff from the compounded those are good measures to help that but that still doesn't safeguard enough I don't think so let's say senator former senator Holland I'm his veterinarian for his large cattle form and we have done work for you for thirty years. He calls me up and says. I'm gonna get out here that I think she's she's in a she's a pastor where there's a pear tree and I think she swallowed a pair because she's acting like she's choking Lynch can't breathe ball and you know I I can't get her in and you know I know you can't get out here for a couple hours what what can I do well. Senator Bruce if if she's choking you can reach actually reached down her throat with a speculum and if it's a pair you may be able to reach its full and now even if you can't reach it you can sometimes take a vacuum cleaner and stick the nozzle down innards the paired pulling out that'll. All right so he does that he finds repair. And then she gets worse and worse and she dies and we necropsy All times Jeez rabies. Will he stuck his arm Denters wrote his son stuck his arm down our throat he may have a granddaughter that's seven years old it's got a real skinny arm as though she could reach it because arm skinnier seven year old stuck there you may have five or six people exposed to rabies off that one. Phone call or that one I mean he could have even sent me a video of what cal was doing. It looks like she's choking me. But looks just like rabies so we're talking about misdiagnosis which I prefer to call it missed in my SS B. E. D. misdiagnosis. You couldn't fit the missed diagnoses that made over forty two years on this table that's because. I do the best exam that I can. Nose to tail. I ask years throw. Musculoskeletal. List of the heart listen chest listen eleven the local lymph nodes the bank Filipinos in the back of the leg public the abdomen can't tell you how many veterans have found either reform body or tumor about help aiding in abdomen. You keep helping and have been on the phone. Are you gonna put off some things that need to be taken care of by pretending that you're establishing of the CPR when you haven't. But what you're saying about the the food the food chain. Federal kind of takes care that. But. Foreign animal diseases and very very contagious animal diseases like Senator Bruce is saying of avian and influenza. African so I have swine fever came as close as Porter Rico early ten or fifteen years ago it's worldwide but we if it's a foreign animal disease HM United States. If somehow will swine happen to come on a boat some refugees here an infected swineherd in Miami. Africans were very rude that would cut down it was shut down every swine operation in the nation I'm just the state the nation. They had it in England about fifteen years ago that the deep populate every single bovine in England. So the. So not diseases and rock rabies and the reportable diseases ornaments that uses I mean they're out there is not really a matter of if they're going to hit its kind of wind. And they trained us to look for those forums these I mean the receivers out there granted but in the back of our mind you know we've got off it. Accum looks funny we'll call somebody. Somebody told me one time that the bank tellers they don't teach them how to recognize counterfeit bills they make them look at enough real bills to when something comes along book. Looks funny what is it looks like it does look like the bill and for the last fifteen months so it's kind of like that it back to the misdiagnoses yeah small animals large animals. In my records I put either impressions. Comma. Busto esto. Upon mass public law. For. Tentative diagnosis. Samarqand thank. Because what you put down diagnosis. List something on hold your feet to the fire. And so you want to if you didn't make if you've got impressions in there you have committed yourself list can be hard to give either an impression for a tentative diagnosis or even a differential diagnosis of a picture or even a video on the phone. Another example on on on need to keep this brief the state. The client. The that I know. Calls me said I got a. I have Mister Malo is a bad wound on the side of his neck circuit city picture and this is a person I've been doing work for for years and years and years. Just send me a photograph for photographs different angles the wound on the neck looks like to me from the photographs that it's a really deep. Staphylococcal is skin infection call for oculus. Okay he lives over McCurry let's say which is thirty nine miles from us. And I know we. So it's okay I'll call runny Hefner overt SNH pharmacy in makori. And prescribe some cephalexin for twenty one days. And also some hippie clans which is what M. diesel scripter hands with for the going to surgery. To give the give the cephalexin tablets capsules and usually Health plans and scrub it really good warm water once a day for ten days and then call me back in seven days and tell me what looks like an even sent me a picture in seven days let me know what it looks like. Our children send me a picture ID and call. By staff to busy to make a call back which are supposed to. Anyway we lose contact for say four weeks then he. Comes into my clinic with the deceased Same job that we looked at and said you know what happened. We do not topsy only discussed blast on my coaches which is a fungal disease that is very prevalent in Mississippi River valley including the Arkansas Tennessee I mean Arkansas Louisiana. And can affect humans will he said the sixteen year old daughter out there barehanded scrubbing it wound every day she's the one who got more time to be able to do it. She comes up with a call for reproductive nasty call. She's got some little stores and training areas on our hands and everything. So we that we use in the tissue off and it's blast though. Dead dogs dead with nothing we do now we could have such four weeks ago. But we send Chayanne to the hospital and they determine from X. rays she either has a. A tumor on or be yeah remember that okay blast so hi all it could be blessed opener on either way they get over chest take a biopsy to kind of jump along about like that widget cheese. And Bourgeon Langat NO money. So he didn't pay me for anything that I've done. Then the total telemedicine anything else and. Chayanne gets well but she's got Hill told of a hospital bill and they find out that you know I got malpractice insurance. So they turn it all on me. The answer to the thing about the code we don't really we don't have records of Maggie might be able to do something because different practices did different banks but for the most part the thing slow down at the early part when people really need to get him scene they were they were saying and one other thing is there are Maggie tower either eight hundred fourteen BVM living in the state of Arkansas. There are eleven hundred licensed deviance in Arkansas I mean DVM that have an Arkansas license some of them are out of state. The mistake. So. Whether there's a shortage or not. If you could make a living. Doing large animal in certain parts of the state you have people there. But if you work sixteen hours a day seven days a week and forget that you got a wife and kids. You might be able to. Sure does. Sure days. Thank you Mr I I think I'm boiling down my decision making process down to a. An oversimplification of a question and I I would love Sir here when you close if you could think about this as well if you would but I don't want to give you a chance to be too as well what's the biggest risk misdiagnosis or or animals that are and not getting care and that are that are dying. or being hurt first pain and suffering because we're not able to get there fast enough could you help me understand that those two Rhys and your perspective. Hi the biggest risk is the animal not getting the proper care because he's bad sick he needs to have a veterinarian touching smelling. Listen in tomb and trying to make it is close to the actual right diagnosis is you can get. And remember the diagnosis a lot of times it's not just one thing. They gonna blast and. G. R. E. blast owner loans and you're already a in their gut. Be sick but you got to try to figure out what's what and how many different things or going on to make you sick. So I think they're the biggest risk is to the animal not not getting. Actor care. Soon enough care. And As something that's well I maybe a follow so it will be well Senate testimony we heard before was it's a handful seven or eight other states are head of us on this I have no idea testimony we heard and and I'm not hearing of. Significant telemedicine issues related to misdiagnosis food chain issues and not maybe I'm just not I'm missing the store's missin that could be It so I'm trying to balance that risk versus the risk of the other side of what I haven't talked about today's our stories of farmers not able to get that nearing out there to stab the relationship and so I I just wanna give kind of both kind of the size of a chance to help me understand that that crux there. Luvvie blunt. One of the reasons that I quit making farm coast one gentleman who had a small dairy was because he owed me twelve hundred dollars and he never paid me he wasn't making payments he was trying to make payments. I let it go let it go let it go lost all that money but it came a time when I could not afford to go out to his farm for two hours entries can now and not get paid. Tools yeah there's some producers and parts of the state that do have I guess a trouble getting doctors. When I got first got on practice in Batesville Arkansas nineteen eighty one we made form calls. The path keep see Sydney evening shade Melbourne a city. Newark. We go on a forty five mile form call one way. Easy. Take a half a day so we were available back then but there were enough forms and calls to make that you could actually make a fair living. At that. So. Doctors are willing to go to drive that far if the get paid for their draft time and their professional services once we get there. Okay. Yeah a lot of civil though about this bill. Else that was passed status the V. C. P. R. over the phone or motion of. In prescribed those drugs that are on live their own lives. The very commonly off label drugs. Bible for one species of species it does so you really have limited response on all this is just the. Small slice of the whole picture so you may actually spend time trying to be this telemedicine find out that the doctor the line. Oklahoma City. Right out they would describe me what you need and seventy plus percent of time they're going to perform back to regular veterinary class. And you still have to go we've lost a. The sometimes it's not always convenient to get to the Some animals larger cargo hold. The Bill problems of people. You don't have to put all this together somebody that are not perfect answer. But you Library will waste time and money is still in the. All the other. Thank. What. thank you thank. We have one more to the side of the. And I'll follow the doctor how can I read your name would. Renee lavergne thank you in a veterinarian come may it'll be thirty years. Excuse me. Thirty three years I'm sorry you're recognized for ambassador thank you Mr chairman members Committee thank you for your time but. As we saw last time with the H. bill H. B.. Eleven eighty two Senator hills very passion about this and and I'm also very passion about this and didn't get a chance to speak two weeks ago and I appreciate your time. I've been passed but I was past president of the Arkansas veterinary medical association been practicing for thirty three years my wife and I have a small animal practice in Little Rock I do have race horses I have a few cattle. Backyard NO no operation some chickens and goats donkeys And I do appreciate Senator Hill backed up to eleven eighty two because we need to go into that and see what we did with that can tied into what this bill does And I'm gonna speak to you from a small animal practice. Saturday's asked about the damage will you know there are a lot of uh. Corporate practices now and all the corporate practices were gave a new years off so Monday January second. The copper practices were closed. My wife saw a patient who was seen by telemedicine. Radiograph was taken. Didn't touch the animal and said okay you know. Take this GI medicine and be fine. The lady didn't think anything it was it just one right right my wife diagnosed it and I'm in surgery and she says I think I got instruction for you a great party had four surgeries that day and I'm not speedy Gonzales I try to do my best for every patient sure enough it was. And this one had a. My wife picked it up on the gas pattern. My wife pal Payton said sums up here. And so I opened it up and and there was an obstruction that was lost and stomach and then part of it went further down I was a dog toy that patients alive today because that. Under the client didn't trust what she heard. I'm gonna back up to the house bill eleven eighty two and I'm really here to clarify we're not addressing it be Monday so I'm gonna I'll give I'll give you have a little window narrowing to thank you to the that together okay it'll tied together in the end so there were some misunderstandings I think that were brought up with that bill Senator love asked the question he had. Emails that can you do this with a two year online degree and representative Vaught didn't understand I don't think looked over to Megan Harrison and she said no you can't get the veterinary technologist in a two year but you can become a certified veterinary technician with a two year degree what that does with this bill so. and then the house ag committee they talked a veterinarian came and testified she has she and her husband had to veterinary clinics in one town by the third and said I would like to be at my third clinic and my certified veterinary technician take care animals that we have an established client patient relationship with. So the big danger with that so to answer your question yes you can get. A two year online Sir to become a certified veterinary technician and see patients while the veterinarians out. What this brings to what it ties in with this bill is imagine an emergency clinic. Where there's no veterinarian there there's a certified veterinary technician who got it to your online degree. And they see a patient when your constituents coming of veterinary clinic and say veterinarian may expect to see a veterinarian with this bill and that bill. You can have emergency patients. Being seen. Tell medically. By a veterinarian who's never seen it before and will never see him again. And that is a disservice to the public. Some of the certified veterinary technicians are not ready for it and the veterinarian who's who you know for whatever reason can't staff the clinic with veterinarians that becomes a danger with telemedicine establishing the client patient relationship. Question Trumann. The questions can I can I in with just one quote from my Senator. My Senator said. I'm opposed to this. It's well intentioned folks. With miss guided solutions. And senator hill was angry when he said the veterinarians oppose us on everything even the vet tech Bill cannot clarify this one thing. The veterinary association I was on the board then we went investigating got the veterinary tech school at A. S. U. B. B. we interviewed three or four we got that what we were supposed to was the heritage college that came in and popped up in Little Rock by the way make Harrington wrote the curriculum for that they never got accreditation they dissolved and there were student I hired a girl name shy and not the same Cheyenne who had thirty thousand dollars in debt and could not get her certified veterinary technician program well that all combined with we're doing harm to the veterinary protection profession by allowing this these two bills together and you'll have veterinary shingles with veterinary technicians running it and it's just not what people expect. Okay thank you. Thank you due to your close your bill. If you have questions yes may we call and Secretary ward to the table. We're toward Victor ward. As at. What is your cell sector were would you state your name for the record please yes Sir west ward secretary of the department called for Arkansas go ahead Senator thanks thank you I I know you can't speak for against the bill I'm certainly not asking the table to take position or anything like that but just to sort of get more feedback and from you know the department and what do you feel like you're seeing in terms of like the need to have large that's across the state I'm just generally speaking and then what do you here at the department and just in regards to this debate yes ma'am I think that's a an excellent question and I think that's a where where this and other bills are coming from you know we we here you know we interact with industry a lot especially the agriculture industry in the large animal food animal production and and we hear constantly within the Department the need for a more large animal food animal veterinarians and several I thank them for sure this this bill as well as other bills are tempting to address that I thank I think that's what's your stem done and start of the conversation with a issue in lines about starting about school I think there's there's recognition of the need that exists agriculture is our state's largest industry animal agriculture's of significant significant portion of that whether it's poultry or or cattle or swine or dairy you know there's a significant impact there Sir so certainly there's a need your and I think from the Department standpoint I think we're we're looking for any ways to to help address that we have a major medical examining board within the department you know what I thank you my read this this is not me saying I'm for or against but I think I think what this might my read of this bill would personally is that uh is the tries to give an option Sir or if if it's merry can prevention doesn't have enough information they can say that they're not establishing that relationship if they do and they feel comfortable it's that's their own professional judgment to do that but again that's not saying I'm for again this is just you know I think we're we're looking for option. It's to be helpful to industry and we lose those services certainly has a an impact on our state's arson Mr. You're more thank you for the I was same thank you comments. Secretary thank you for for being here come to the table If you would just sort of speak to obviously there's there's bad actors in every field we know this and that's why we have rules and regulation and that's why the the veterinary board exists and you exist to help monitor this In the last estimate we heard we heard that basically shingles were Mr popping up of. But the expression was going out and doing these things do you foresee that being the case in the board allowing that to take place and part of agriculture. Allowing those things to happen to put folks practicing beyond what they're capable and license to do. I don't personally you know I I think you know I think that's that's why they were. There's there's the rich medical examining board in the rules that are approved by by the legislature are in place to make sure that it's a purchase in the the best and most beneficial way possible so I think there's certainly there's there's ways that the legislature and and approving rule making authority S. as those are presented that if it's if it's not in line with the intent of the legislature that those can be. It back and readdress to to to carry out the intent of the legislature on how this move forward. Remarkable. Hello. So do you think there's enough teeth in place with the board I mean I've I've heard just and talking some vets generally that. Alright that's really opposed either these bills That they have concerns just generally speaking from the board's perspective that maybe there's not enough teeth to hold accountable by the actors do you you think there's those things are in place to any more should the US department look further into that. I can certainly follow up with you you know I I think that their or their disciplinary measures in place through the board there's a complaint process there's way to hold bad actors accountable I could certainly follow up with you if that needs to be re addressed and looked at as you're better ways of doing that but concerns over the. Thank you. read closer you will yes Sir. I'll start out by saying only address some of the issues that were raised why when my closing statement by some of the others that presented. I'll be the first one to say that date was mentioned that they'd be saying shingles on every door throughout I will personally say if that starts out on a bill to stop. We we can take care that I don't think it's gonna be an issue whatsoever if it does I'll I'll write a bill to stop personally you've got more on that. The only start out with Bruce whenever he made some comments about you know suffer suffering animals I hear how how their suffering things going on to a misdiagnosis as is calling them to suffer I personally feel that those suffering or those in the economically challenged part of the state that does not have a veterinarian those are the animals that suffering is not those that are in an area. The in Northwest Arkansas or here in central Arkansas if those areas that are underserved by veterinarians we even heard doctor allows testify that the. Lacing his office didn't return phone calls for diagnosis simply because they were too busy. How do we stop that business we have to find a cure ways to do it you take this and allow the vet techs that were passed out a few weeks ago this allows a veterinarian to work them to be hands own they can call back they can take pictures they can show everything's going on out there the last that bit tech may make a call on sales this will aid that tech having a veterinarian to be able to do this with them I think it's a plus to have that put together on this deal. And we must eighty influence mother issues out here that can take place and be misdiagnosed you know until we get wild hogs and ducks in my reading burgeoning control we're gonna have if the issues that matter what we're facing and if Bruce during the rest can control that and I'm all for veterinarians only in face to face personal there's no way they can control wild animals. So what does this tell of income income maybe a taking pictures made this veterinarian has some knowledge what's going on don't go back a step farther I'm not just talking that use our cell phones right now there's apps out there they're updated the software that I mentioned earlier that's available. For the field this is a changing industry and we can either change with the industry we can get left behind and right now we're being left behind. So we've got to change and to some of Senator Davis is questions that she had while ago this bill in no way affects anything that interfered with federal law the food system change the compounding the drugs the Offaly's this bill does not affect that whatsoever that's a federal law does not change it. So with that out with that being said. You must have a shortage of Indians out here veterinarians that we have are stressed. They are overworked they have family time as like doctor allows me to comment while ago yeah you could do some the stuff if you only work sixteen eighteen twenty hours a day. This could alleviate some of that and we have an obligation to the state of Arkansas couple and try to take care of our state of emergency we have within hearings will this solve the problem no it does not solve the problem this helps alleviate one issue hopefully it can help some animal suffering in East Arkansas or some economically challenged families that can't afford to drive and have them worked on with they can make it a do a face to face face time and get get a diagnosis for them and what they might be able to do. We owe this to the livestock producers we owe this to the animals we don't know this to be a farmer we had mark coming here that's big pharma that has yet the drastic lengths they're willing to to go on this bill to bring big pharma into Arkansas to try to fight us on the S. I don't know why they're that worried because. Come June Bennett how the script have all the script ability anyways can be taken off the shelves even the over the counter stuff we have right now is going straight to the veterinarians must be by script so they have control of it and the thing that we are all forgetting is the veterinarian has a choice a choice to do this a choice to not do it plus the vendor has another choice if he does do it have the X. common sense with your knowledge these big names we have there are some of the smartest people in the world lost more than a lot of medical doctors we have. Because what they have deal with them then we can't talk to them we have to figure things out these guys and ladies have to be able to say you need to bring the animal infirmity check it out that's not too hard to do that is their responsibility to say if they wanted telemedicine make your own decision stand firm if you're going to do it and families to come in make a call and do it. That being said I will go one step for that we haven't touched on. Currently in the US there's two lawsuits right now they're taking place. In the both of them are in state where there you must see in person the animal must be seen in person. Telemedicine not allowed to be utilized in any way whatsoever. And with this being said the society for ethical treatment of animals. Is one of the groups that spring these charges against a state. The other one. Is. The family doctor forget the name of it. Two current lawsuits exist over telemedicine restrictions by states in which only of the CPR can be established by in clinic visits reversing the first and fourteenth amendments the so that the society of prevention of cruelty to animals and the National Institute of family and life advocates so a court is fixing this side dish part of it with actual legitimate or not it is actually fixing to be heading to the Supreme Court so we can actually sit here and fight this all we want to. But this is coming this is a way allow technology to twenty first century and veterinarian need to get over being scared of competition that's the key word that drives all this competition that's everything you hear I don't want to veterinarian from out of state doing this I don't even if not a state doing that but we can't stop that because Interstate Commerce so would be a scare competition. That's what drives our economy in each and everyone of us knows that competition drives success maybe have competition everyone makes more money everyone gets better service which is the thing we're lacking right now is service or animal care in the state of Arkansas especially in the delta and south Arkansas and I ask you for a good vote for those animals and those people who are in economically challenged that need this thank you very much. Thank you later the committee. What do pass. Or is amended to fifteen. Conclusion of the Okay of we have a under motion and second for do pass as amended all in favor say aye All opposed no. Call for room. Just for clarification on the on the roll call what is it similar procedures we do and in session the S. Renault or the president. Pardon chance to change at the end it does make sure I understand procedures is very similar. The asset has one one path yeah no there's no changing voter anything of that nature one past yep. Senator Wallace yes hi yes. Senator Davis. Senator Davis. Senator Leding. I Senator Gilmore. I. Senator dis. I. Senator love. Senator love. No. Senator stone the no. The Bill pass The vote stakes five thank you Sir I'd like to expunge. You bring back agreement with bill humor. Returned.