Agriculture, Forestry & Economic Development - Senate

On college meeting to order Uh years she's a quorum before we start I have we we can add a. The mess up at our last meeting in all of the AG of related lobbyists and supporters of the different industries were standing outside and the leading you to come in and introduce himself and so I want to say I will start with you back to back if you would to tell as to who you are and who you represent please. Bill Arkansas. Arkansas respiration. All the segments in aspects of. Pascua represent Arkansas cannabis industry association both of a in. Murdock rules with the Arkansas. Association. All. Right to go ahead and what writing or what you're. Concepts and I represent the Arkansas medical association also. I believe you you just here for the fun you're trying to buy a pony arch. Okay let's start over. just returning. You. A more clever with Arkansas farm. Your local council of Arkansas representative performers. Arkansas that is. The governor's office. We work with the office sessions. And serve we we spoke before their organization meeting to tell people that AG is the head of a radi of of the industry that we represent is not just row crop so anyway let have you all here sorry we missed it missed opportunity to meet you before but today is a little unusual Senate bill is not want to present the bill today but we do have people from out of state to from Ohio and Texas it had to make arrangements to come in to testify against Bill we're going to hear the testimony were not will take a vote the. I'm going to ask you committee gave security the shelter we were told about real put on record of. Play an insurer work and but anyway. welcome STURCH. There's so yes Sir but the again we're going to hear the the testimony if you all have any questions please ask we're not we'll take a vote today which is a little bit out of the ordinary but but the fact that the that they had spent the of money in there for years and time and effort to get here I felt it was only fair to allow them to speak so the. Right if you'll notice your you'll sit in with word or. It doesn't matter so we'll we'll for issue only more informal that correct. I'm an open. If all. The doctor again if you were to come within the table turn your microphone. introduce yourself for the record we we are recording and and live streaming so we don't want to hide anything from anyone to again it's a little unusual for the fact we're not presenting the bill but again we do wanna hear testimony. The doctor if you record of station name for the record you're recognized yes Sir and Dr Paul Jenkins of veterinarian in Bologna group here in Arkansas until issue please don't hold it against me practice down there a couple years and then came back to central Arkansas to practice and been there since two thousand four I want to very much thank the committee for us today session are special circumstances will have an opportunity had to experts scheduled to come in and so like Ronnie said I'm here on behalf of the Arkansas than your Medical Association and do legislative lobbying with them we are against Senate bill five because it strips the required veterinary client patient relationship from telemedicine in our father that is V. CPR probably as we discuss what we are not against is telemedicine and all of us use telemedicine in various ways but we are against the the CPR being stripped from it. We feel like it's a threat to proper animal care in Arkansas in that animals may not get urgent or timely care with some type of in person visit. we've you know been told that it could be a money grab for veterinarians or another way for veterinarians to to charge a fee but we know that sixty to eighty percent of the time that it telemedicine council occurs or is performed that in in office our own form visit actually comes out of that so there ends up needing to be some type of of physical exam or interaction with that animal as it's written any fees that are collected on a telemedicine council. Could go out of state and not benefit our state tax base I'll give you two examples one is let's speak theoretically for an same bindings for second their companies out there that are corporate that have already formed and say someone has a small animal that company may have a veterinarian employed in another state but be licensed in Arkansas that be located in the other state and that company employees veterinarian owns the telemedicine platform if you will that probably would come in the form of an app. And they on the pharmacy and so their goal is to sell a product in continue to sell that product none of which would benefit our state another example large animal medicine you might theoretically have a veterinarian to Morasca lasses in Arkansas doing telemedicine consultations on a group of food producing animals here in the state and never have had to lay eyes on. And Furthermore if if this goes through if our young veterinarian looking to come to this state to set up a practice it's going to turn me was having this competition already going on he could create pill mills for chronically affected animals that really need follow up care and are not getting it better just continue to be sold those prescriptions from the the company as indicated earlier we feel like it could increase the possibility controlled substances being over prescribed and then ultimately abused in the in the world. he could further add to antibiotic resistance if antibiotics were prescribed and they really weren't needed once again that's the power of the physical exam on being able to determine in with some diagnostics as well where that antibiotic even needed to be prescribed. then you medicine is you many different to human medicine in that our patients are non verbal communicators and we base what we do off of the history but more importantly a physical exam and diagnostics if they're needed. And lastly I would make you aware there for instance is we're the federal law is going to supersede state law regarding the V. C. P. R.. And the first one is where a VFD is written and that's called a veterinary feed directive so if animal producer has a group of say cal's that we've identified an infection in I can ride a new prescription it's a federal document and have a female and Exane a body ache into the feed to help help benefit or treat that condition. the next one is for a third rate race sources being treated that's created by the horseracing integrity and safety authority. the next one thirdly would be if drugs are being use extra liability so you know maybe the condition that you're treating is not what that that drug is intended for but you can use it extralite believed to to treat so necessary and then the last one would be if biologics are being used for example in Arkansas poultry's big we've identified in a flock a unique infection in that group of birds we can have a vaccine made your use of working with an outside company that is specific to that flock and only be used in that flaw. So I appreciate you all listen to me I'll take any questions that you may have. When you want of course. Good production concerning you. Lord. Corporations. Well if you would to turn Michael on. And the introduce yourself and you're recognized. Howdy I'm Dr Lori teller and I am the president of the American veterinary medical association and I am you also the critical associate professor of telehealth at Texas a and M. for twenty eight years I did work in private practice. Providing veterinary care for companion animals before being recruited by taxes in and to specifically developed the telemedicine program there as well as to teach students in their primary care rotation which is in the last year of veterinary school when they're in their clinics Texas a and M. as the only veterinary school to currently have a full time position dedicated to this role. So first I want you to understand the difference between telehealth and telemedicine because we we do this and veterinary medicine it's a little bit different than human medicine. Telehealth is the over arching term that encompasses all use of technology to remotely gather and deliver health information advice education and care and tele triage of determining if something is an emergency is also considered a part of telehealth. Telemedicine is a subset of telehealth they're refers solely to the provision of healthcare services through the use of telecommunications technology and telemedicine involves the use of electronic communications and software to provide clinical services to patients without an in person visit so in veterinary telemedicine we do require an established veterinarian client patient relationship so just to kind of summarize all that all telemedicine is telehealth but not all telehealth is telemedicine. So there is an incredible amount of care that can be provided via telehealth outside of an existing B. CPR this includes tele triage Sir determining if something's an emergency and the animal needs to be seen immediately or if it's something that can wait to you can be in contact with your own veterinarian so there's also tell advice an example would be that would be somebody is a first time puppy owner and they just need to learn how to house train their puppy you don't have to have an established the CPR you can do that through a telehealth platform with your veterinarian whatever it it may be. There are other things that should only be done within of the CPR that would be making an actual diagnosis or differential diagnosis for a Pat making a prognosis or determining specific recommendations to treat a patient. Ongoing research has continued to show that antibiotics for more frequently prescribed via telemedicine visits than in person visits and with the increasing concerns around resistance to antibiotics it is that much more important that it be CPR be established with an in person exam to lessen the incidences of these occurrences and those of you that may be in food animal or where that the FDA is pulling any remaining anti biotics off of the shelf at food supply feed stores things like that so the only way any large animal producers going to have access to these meds is through an established the CPR. Great care is also required when comparing the practice of veterinary telemedicine to human telemedicine this includes not only how care is provided but also how drugs themselves are regulated physicians have great latitude to use medications and an off label manner however the FDA has very specific regulations for veterinarians to prescribe drugs in a manner for which they are not labeled and I'm married to a physician my father is a physician so I really have a good understanding of the differences and similarities between the two and there's some pretty significant differences between what my husband and my father can do versus what I can do as far as providing medical care. That energy medicine is often compared to human pediatrics as Dr Jenkins said because neither animals nor infants can speak and so you think that there are these telemedicine people what they're saying get online with My Baby right help me however when you actually read the guidelines from the American academy of pediatrics telemedicine guidelines there were also adopted by the American telemedicine association the very clearly state that telemedicine services should not and that is bold in the guidelines should not be provided to children under two years of age except when the provider as the previously established in person relationship with the patient or when the patient centered medical home has referred them for a subspecialty council. So a patient centered medical home is where a patient gets primary healthcare services it also creates and maintains the provider patient relationship or what we would have is if the CPR and coordinates and integrates care with specialist or other care providers needed by the patients so that way your primary doctor or veterinarian is coordinating any care that you may need with others and you're not fragmenting what that care about site. This is very different than direct to consumer telemedicine were prescribing is done outside the traditional doctor patient relationship and with direct to consumer telemedicine there's an increased risk for inappropriate prescribing and drug interactions and the main goal is to sell product not to determine what is the best possible treatment for the patient on the human healthcare side the FDA has recently taken an increasing number of enforcement actions against DTC or direct to consumer telemedicine companies these actions have ranged from warning letters to criminal indictments this is all within the past four years. These these this reiterates the fact that the FDA has broad regulatory and enforcement authority over telemedicine related activities and serve Arkansas allows for the creation of an electronic you CPR which conflicts with the federal the CPR veterinarians will be at risk of violating federal prescribing laws and as the amount of research has grown on the human side it's actually become increasingly clear the human medicine is moving towards a hybrid model where patients are encouraged to have an in person visit with a physician then use telemedicine as appropriate for follow up visits management of chronic conditions consulates with specialized as per coordinated by your doctor or veterinarian and tele triage when needed this is very similar to the position that the American veterinary medical association supports for the provision of veterinary care for our patients. And I just want to say because I know Arkansas is mostly a rural state as is a significant portion of taxes so a significant portion of my clinical duties at Texas a and M. includes decreasing the barriers to veterinary care that may exist for our clients and rural areas or with limited funds so telehealth is huge it can be used to help provide care to some of these patients but I have yet to see one patient that I could have helped with telemedicine alone each patient has required an initial in person visit to address acute medical issues as well as determined the next best steps to provide appropriate care the in person visit also allows the veterinarian the opportunity to determine how well an owner can recognize and interpret the animals clinical signs and minimizes the risk for a misdiagnosis also the same population of people that has trouble accessing veterinary care frequently also has challenges with broadband access and wi digital literacy so telemedicine is a tremendous and I do this I live and breathe this I jumped to enhance veterinary care for our patients when it its use within an established in person be CPR but it's really not necessarily the wisest investment for someone who has limited funds. Even the access to veterinary care coalition states that managing veterinary cases with incremental care so step by step based on their phones requires frequent communication with the animal owners and regular re evaluation through in person clinical exams telemedicine visits in between these exams can help ensure client compliance with the veterinarian's recommendations and trouble shoot minor problems before they become more complicated and expensive to manage. So in summary telehealth can be helpful to all animal owners who need general advice for teller G. R. services and inventor in medicine neither of those require and establish the CPR for more specific care telemedicine is best utilized following an in person examination of the patient and establishment of the CPR. And all entertain any questions. Do you recognized. Thank you Mr thank you Dr Kellermann today You said you were brought in for it to an M. four specifically this area it this seems to be me a relatively new development in medical space as technology advances. You give us a little bit of background of how long have we been doing this Sir not only on humans with humans but also in soul veterinarians will tell you they've been doing telemedicine since the telephone was invented but it in the more modern terms telemedicine really started taking off in the veterinary space. Seven eight years ago on the human side they're they're probably twenty years further down this road COVID of course drove this home there were clients who connect comment didn't want to come in there were various restrictions depending on what state you live down on. If you could basically leave your home so telemedicine and telehealth services really took off with COVID we saw the number of veterinary telehealth visits increase from single digits to about thirty eight percent sense various waivers have lifted people are essentially return to normal lifestyles we've seen telemedicine visits drop back down into the single digit numbers so it's going to be a steady state and a lot that we learn particularly there is a particularly in veterinary medicine is that we really do need that that in person exam or visit and that has a large animal that may be a farm visit our barn visit something like that as well but it it makes a tremendous difference. Sure do let me make a statement on the human side of it on from the technology and everything that to come about we passed legislation in my first term which was ten years ago so the humans other than telephone speaking on phone for telemedicine of the fortune diagnose of from remote areas you're saying in Arkansas basically started about ten years ago. I have remote to access rule hospitals have access to the UAMS and larger facilities I remember a. The legislation being passed back then to allow a lot of that region. And so that you I. mass would be like a patient centered medical homes you have the central facility and doctors even rural doctors tend to be on staff for the budget basically technology for for a name date of the city and in the next very loud that you aim is looking at something and McGee Arkansas. The which was really is fairly new. Other questions. Tucker would appreciate you coming in here take this and take your time. The maximum in Oxford general John let him tell his background for the most of your income to the a lot yes thank you. Thank you very much for this opportunity your Mike is on if you would enter the state your name for the record and you're recognized my name is Dr Fred Gingrich cattle veterinarian and I was in private practice for twenty one years in California and Ohio and in two thousand seventeen I became executive director of the American Association of bovine practitioners which is the largest cattle veterinary association in the US and we have a over five thousand members primarily in the US and Canada but also in about thirty two countries internationally so really appreciate the opportunity and my comments are really going to be on how SP five can impact both cattle producers and cattle veterinarians because that's kind of my space so I'm just going to stick to my my species for the most part of my comments but I appreciate that eighty P. our organization we develop guidelines and position statements to advocate for our members and also to provide our members with information and support on a broad variety of cattle health topics and these are publicly available on our website but the one that probably pertains to SP five is our guidelines entitled establishing and maintaining the veterinarian client patient relationship and bovine practice and it states quote regular site visits are an essential component to providing veterinary oversight however this can be supplemented through laboratory data evaluation records evaluation telephonic and electronic communication the timeliness of the site visit should be determined by the veterinarian of record based on the type and size of the operation. So cattle veterinarians utilize telehealth and other types of services to supplement the previously established the CPR through electronic means and as Dr teller previously mentioned when you asked the question about how long have we been doing this we've been doing this a long time through records evaluation we have veterinarians that place computers on feed yards and get the data downloaded to their system every single day that's been going on for years and years and so a lot of our telehealth is on a consultation basis for looking at the herd is the patient but we have been doing that for a number of years what I would like to focus on to some of the risks with allowing the establishment of the CPR through electronic means and that's what I'm here to talk about today so the first is risks tech cattle health our patients or both the heard an individual animal treatment for many diseases affecting cattle are administered by farm labor or owners not by the veterinarian and they use protocols and training that have been provided by the veterinarian within an existing the CPR and those protocols are developed and we consider the needs of the client the size of the operation and the diseases they may encounter their facilities as well as their abilities so those protocols are very tailored to a specific farm operation within that the CPR and attempting to diagnose an animal condition with out a previously established the CPR does put that animal at risk of a misdiagnosis but also since most of the diseases we treating cattle are contagious pathogens it puts an entire herd at risk which we don't want to see and so that is one risk to animal health another big risk that we are more and more concerned about today is the risk of foreign animal disease introduction in that devastating effects that would have on our entire nation national economy the recent COVID nineteen pandemic has taught us about the. Impacts of the introduction of a novel disease pathogen veterinarian to visit farms on a regular basis on the front line of defense against the spread of a foreign animal disease the big one we're worried about in cattle is foot and mouth disease one of the most critical steps in preventing the spread of this highly contagious disease is a quick diagnosis and then implementing stop movement order orders working with state and federal animal health officials. Risk to veterinarians. As my colleagues previously stated we must follow both state and federal regulations that are different from those from our human counterparts an important example is how pharmaceuticals are regulated in this country. The regulation of human drugs by the FDA is focused on their label and human healthcare professionals have broad discretion in how they use those drugs in contrast when it comes to veterinary medicine especially food animal medicine the FDA regulates the label and its use by the veterinarians and also has the authority to define how of the CPR is established for certain uses of human or animal drugs in or animal drugs or human drugs that we use in animals and the federal government is very strict about how it regulates veterinarians drug use and the reason they do that is because they're over arching charges project protecting food safety and using antimicrobial and other medications in food animals has implications and that's why we have these regulations. Keeping that in mind veterinarians must often use drugs in ways that different from their label when treating animals including cattle and the reason is because very few FDA drugs are have all label indications and so when we look at cattle the most common labeling indications would be pink eye for right uterus infection mastitis and ammonia so that's five diseases cattle get more than five diseases and so if we're treating something that is not on the label that's extralegal drug use and we have to follow those federal regulations. And that is established in what's called the animal medicine old drug use clarification act we call it in due to which was established in nineteen ninety four. Another regulation that we must follow is treating which my colleague Dr Jack it's mentioned was treating animals by in feed use of antimicrobials that's a very common thing and one very specific example I wanted to share with you is a disease is very common in the southeast US that's called anaplasmosis okay it's a vector borne diseases spread by blood parasites or sharing needles and things like that because the cattle industry about three hundred million dollars a year in the US and in Arkansas there was a recent study published in about beef cattle in Arkansas the fifth largest ag commodity in the state where they took blood samples from cattle in Arkansas and found fifty nine percent of the cattle in Arkansas we're still positive for anaplasmosis so that's more than half the cattle have this disease how do we treat and control that diseases to in feed use of antimicrobial so it's not an effective vaccine there's not very good control measures those animals need to have this treatment to control the spread of the disease within the herd in order for a veterinarian to do that they have to follow the federal guidelines for writing of VFD which requires an in person visit and actually that law states that that prescription is valid for six months which would infer that that veterinary needs to visit that form at least every six months and so that's just a very specific example for the state about how we need to make sure that that is utilized within an established V. CPR. And as my colleague also mention the USDA also regulates veterinary biologicals or vaccines autochthonous vaccines we do make those for cattle as well again that requires that in person visit and the timeliness of that does it should be determined by that veterinarian and I think another risk that we can talk about when we're caught talking about consumers and the public is the producers themselves how is this a risk to producers if we look at another stab study that we recently published in our journal. Hi from a Mississippi State University they look to fourteen thousand cal calf producers across the US and that study revealed that two thirds of the respondents stated that veterinarians are influential in management decisions for their farm and that they use a veterinarian for a variety of services. There are certainly areas of the country where veterinarians are in short supply in Arkansas forty two such locations were identified by the USDA last year we'll have twenty two eighty P. members in the entire state of Arkansas so there's certainly a workforce shortage we're talking about cattle that Marian's in this state. Unfortunately allowing a PC but P. R. to be established through telemedicine increases the risk of the shortage situation in our opinion why is this much of the work that we do requires an in person visit such as emergency services reproductive services actually able drug use and prescribing medications for use in feed there is a risk that consulting firms that have access to establishing of the CPR through telemedicine even out of state veterinarians who apply for an Arkansas license many of our members have multiple state licenses. If that is allowed it may put pressure on those local veterinarians were they are no longer available in the community to deliver those critical healthcare needs to the cattle in that community. A veterinarian can no longer remain economically viable in the community due to this then they are not going to be able to provide those services allowing the use of telemedicine within a previously established the CPR can help addresses workforce challenges I think we need to communicate with our members about how they can do this for their clients. But allowing it to be established increases that risk of furthering those workforce challenges that we all are experiencing in rural America right now. In closing were opposed to allowing the establishment of the CPR through electronic means do these identified risk but we're very supportive of its use to improve our effectiveness effectiveness delivering care to Katelyn rule communities while protecting animal health welfare and productivity thank you. Committee members questions. From the testimony of that we've heard docking which basically. The opposition comes from allowing tele medicine without and previous relationship. Correct yeah we're very supportive of you know and I think most cattle veterinarians probably utilize telehealth services in some capacity yeah just a simple phone call evaluating records et cetera for their clients that is difficult to do without an existing client as well as like I said it increases these risks better hearing could be following state law and unknowingly violating federal law and I think the other thing is that when we look at the consequences of violating that federal law they're pretty severe if if a veterinarian road of VFD for herd of animals at outside of of the CPR unless it because the food residue okay the detected that antibiotic the FDA did an investigation they would because that was illegal on a federal level that feed would be declared adulterated could not be fed but the animals that received it would also be considered adulterated and could not enter the human food chain and those situations have happened and the veterinary like I said unless they were very familiar with the federal law they could unknowingly make that mistake. Okay. Davis. Thank you Mr chair I'm in the states I know there's a handful of other states that are already doing this so do you have and has been going on long enough for you guys have any data on if it's increase shortages or like what that looks like for and veterinarians who treat cattle. so when you say there are states that are allowing this could you I'm not sure if you mean allowing the establishment of a B. CPR through telemedicine because there's no states that I'm aware of that allow okay I thought I saw list yesterday that had some states so maybe not for veterinary medicine. There's okay Arkansas letters I just want. Yeah okay Havel is there any data showing that yet I am interested to know that like if there's a strength. Okay so it's not been going on long enough okay and it's important also to recognise it during the pandemic the FDA said that they would exhibit or implement regulatory discretion if veterinarians established of the CPR electronically during the pandemic okay then it's probably been about six weeks ago or so where they put a notice out all veterinarian to so they were withdrawing that and they would begin enforcement of the CPR is established electronically for actually will use or the writing of the FT's okay five eight what would you come to the table please that no that's fine this could bring pull your chair right would you for sure okay two of the five states are considering retracting the electronic the CPR. And going back to an in person exam that's currently being reviewed okay okay thank you and then you had a question about the the work force issues worsening is that what was yes because I mean if one of the concerns I understand what you're saying that if there's already a shortage well it just make the shortage even greater if people are you know doing this and there's not as much of a demand for ad veterinarians that are already here so it states that are doing this already in this way it but I I'm understanding maybe it's not even been going all along and I have to tell what the impact of that will be right and I think if you look at shortage areas where we have major shortage areas it's where those communities cannot economically there's not enough work in that community for a veterinarian to make a living and and with the increasing debt that students are facing et cetera. Our opinion is is that allowing the establishment of the VCP are remotely will push even further economic pressure on those communities and then the only thing the veterinarian is asked to do is get called out for an emergency at two o'clock in the morning and you just can't have a good life or make a good living doing. That makes sense thank you. Love. Thank you Mr know what with the two reasons for the two states and then what were the reasons why they were. Similar concerns to what we've been talking about a lot related to prescribing antimicrobial resistance one is Michigan the other one is New York and which also has a bit for all areas while so a lot of it's related to the prescribing inappropriate prescribing of medications and it does put pressure is doctor Gingrich said on. Revenue staying in the state as well. Following up on the the chairman's comments in regards to of the initial visit. But also you all want to see the revaluation done annually is that is that what you're saying. Mmhm so there's not as far as the visit goes yes so what are guidelines stated state is that timeliness we call that timeliness that's the language that's in most state practice acts and federal law we believe that that is best left to the veterinarian of record and why is that I had clients large dairies where that visit was every single week I had small cow calf operators where they had ten mama cows and we just prayed checked once a year and that was plenty of time okay there was nothing to do there every week I and so that's why it it's very difficult to put that in any type of regulation because of those nuances okay all right thank you sure let me give an example the have to me personally back in June I have five horses at my house lightning struck and killed two of the the insurance adjuster wanted to venture into look at I'm to confirm lightning struck and killed and the the nearest vet that I had when was two hours away and but I did have a relationship with the particular vested factors of it which is bill passed and but we didn't have the political means to or legal means for him to advised me the on it and so that's why we need telemedicine now the other issues I had a relationship with him that's what they or. Pushing for issue to have the a in person relationship at least once. You know the so what what basically what what this bill once it is an in state veterinary wants to establish relationships electronically but by doing that you can have it from from Oklahoma Missouri New Jersey the Hawaii Alaska to establish a relationship electronically and do business in Arkansas and if we do that then the local that that we have would would have list. Customer base but doing that and and that this is part of the the issue now again when you come in with the USDA regulations on medication you have five states have done it to your rescinded it so it's you you it's a deeper of look the veterinarian joint on what we're doing instead of on people on telemedicine folder if if you know you'll you'll have to decide for yourself on that would but others need for telemedicine after the the crux of whether you for this bill or against this bill would be if whether you have a though at least one time personal relationship that the. And or whether you're gonna let the any that call you say hi just junk you veterinarian the like a revision will. To to further go on your question so. Typical standard of care is considered every twelve months most states do not define it California does for example Texas does not and it's goes to what Dr king or said it's based on the veterinarians judgment for veterinary feed directive sets every six months so you can even go a year or so when it comes to that law and that's federal that's every six months but otherwise if I have a a diabetic cat I'm gonna wanna see that cap more frequently than every year but that doesn't mean I have to see it in person every week I can I can do in between visits with with telemedicine. Thank you. Mr SerDes. Thank you get help me with this one so farmers in my district have have had this sentiment and how would you respond to this this type of of comments I don't want people coming up to my farm. I know on a lot of issues yeah they've been the third fourth generation farmers cattle farmers I I feel like I know the situation I just any prescription so speed to get a remedy quickly is is a concern and and so how would you respond to some of those sentiments when it with that I mean that's all that I that I think that's a great at that's a great question and I think veterinarians already have done that you know as I said in my practice. when I started I drove around all over the place just treating animals okay and then I decided it's a lot more efficient for me to teach you how to do the very simple stuff you know a list of those five diseases. I didn't go out and treat pink II you disinfection mastitis pneumonia didn't do that that's what protocols are for and training and then the farmers have their prescription they have inventory etcetera etcetera most of my parents had more medications than I had because they stay informed toward them to treat their own animals and then they called me when the animal maybe didn't respond to the treatment or maybe they had an outbreak what's going on here you know I've had way too many of these that's where the veterinarians Wallace so I agree with you completely you're right farmers are many of them are capable of treating the most common symptoms that we see in cattle okay and that's where those protocols and working within that the CPR work great there's not enough of us to treat the number of animals we have completely agree with you but. You can also look at. Where does veterinary oversight play into antimicrobial stewardship because you know what are we doing in food animals that could be impacting human health that's a concern for everyone that eats meat and drinks milk and so what I would say on that is is that there is ample evidence that veterinary oversight is a very critical component to ensuring antimicrobial stewardship often times when I got called out in the person said white in this animal responded this antibiotic it's because they didn't have the disease if you thought that that okay and a very specific example of veterinary oversight in relation to and microbial stewardship is about five years ago when the FDA put in the VFD regulations which moved all those things under veterinary oversight you can look at the amount of animal antibiotics sold in the U. S. declined by about thirty percent okay and the only difference was veterinary oversight healthcare did not suffer for animals improved because we figured out how to prevent those diseases outside a using an appropriate so I think. Your point is great I agree with you completely but a veterinarian is still crucial to ensure that the protocols are right the treatments are done appropriately following up making sure we don't have outbreaks insider that makes sense which means if the veterinarian because the property once a year. And the pharmacy has service they almost always have that medication already it's just the veterinarian saying yes this is the appropriate use for that but that the FDA's removing them from the shelf so the farmers not gonna be able to get the prescription without the veterinarian. Thank. In order. The. Okay thank you all for coming projects to the. Runny of something in a field for We've asked come come to the table with. My the my kiddo like Senator so I'm Robert Baker and I represent better medical association over here I just wanna let you know that we appreciate the time that you've allowed us today I understand a little different to normal would also let you know that these the two people who spoke here three people are or will be around for a long if you have personal questions or individual questions you'd like to ask they'll be here to visit with you and just in fable tenth maybe or a recap of. We have we passed you passed the law two years ago for a veterinary telemedicine. Rules promulgated they were rolled in last summer and at that point there was an emotional discussion came up in a committee about the fact that when you did telemedicine for humans you took out the professional relationship to preexisting relationship and it was left in their clothes still in the law. Provider for animal care of those emotions discussion the committee that day about why within something for animals we will refer people. We will straight here today there's a very big that there is a significant difference between animal care animal telemedicine in human telemedicine in part of that is the food chain part of that is the complication of very species part of that is the you know the fact some these patients can't come in very regularly these are all differences. That warms the. Keeping the pre existing relationship between veterinarians and clients and just as a way of again a feeble recap on my part but we're gonna be around for awhile we'd be glad to try to answer any questions you may have we appreciate you allowances time thank you. A before your committee we've been invited as a committee to come into or the a marijuana growing facility in pine bluff and to go out to the red oak steak house to eat. Of who we can do that is a committee and take a gift so if you all give me some dates that you might be available to set it up if you The have someone special you will take to the supposedly best steakhouse in Arkansas renewed and there will the set it up make arrangements the staff was also included at school we always check your staff when we when we go to eat if you could take time to meet the the people that have introduced himself here of the a lot of different industry representative to or