New Motions Filed: Massage Hearing Postponed
Oh, dear readers, we thought in this issue, we would be reporting to you the judgement rendered in the final hearing of the July 1, 2008 lawsuit brought by massage therapist H. Mercedes Clemens and the Institute for Justice (IJ) against the Maryland State Board of Chiropractic Examiners in which the plaintiff’s allege that the State is violating Mercedes’ constitutional rights.
But no, the final hearing has been postponed and then postponed, and is now scheduled for July 30.
In the June issue we reported that Montgomery County Circuit Court Judge David A. Boynton gave the the Chiropractic Board a chance to rethink their cease and desist order, but after the Board’s monthly May meeting, they declined to do so.
So, on June 3, Mercedes and her team filed a motion for a summary judgement, which would not only set aside the Board’s cease and desist letter, but would also expressly state that the Board has no jurisdiction over animal massage.
On June 5, the Board filed a motion to dismiss the original case, supposedly because they rescinded the cease and desist (but The Equiery has not found evidence that the order was rescinded and is relying on hearsay; as of press, the court documents had not yet been made available to the public).
Regardless of whether or not the order was rescinded, the plaintiffs still want a summary judgement in order to ensure that the Board does not later issue to either Mercedes or any other animal massage therapist another cease and desist order.
On June 12, Mercedes and IJ filed another motion, this time to consolidate all three motions (their original lawsuit, their request for summary judgement and the Board’s motion to dismiss).
On June 17, the Board filed motion opposing consolidation. Filed a motion opposing the consolidation? Well, apparently the courts thought the motions should be consolidated, and have now scheduled all three to be heard on July 30.
This is in response to non-veterinary trained (lay) persons providing dental care to horses, and to The Equiery’s question of “What’s in a Name: Dental Technician or Dentist?” (January 2009).
A veterinary technician or a dental technician plays a supportive roll similar to that of a nurse to a doctor. A “dentist” by definition is a person formally trained and licensed to perform dentistry. In the case here, dentistry is part of veterinary medicine. Is it just a play on words? No, it does really matter. Words mean things. Especially since neither “dental technician” nor “dentist” is an appropriate term to be used by unlicensed, non-medically trained (lay) people.
As a horse owner, the question I have is, why is the horse the only animal we allow and accept non-medially trained (lay) people to provide medical services, such as dentistry? Dentists or dental technicians, in all other realms, have to be college or university-trained graduates, tested, licensed, etc., to provide medical services. This includes cats and dogs. So why are horses treated differently? Aren’t horses just as important?
At the heart of the matter is [the fact that] these lay people are given the same opportunity and (with work) could become veterinary technicians or – for that matter – veterinarians, [just] like anyone else. They just need to make the efforts, plus the personal and financial commitments to go to a recognized school for veterinarians or veterinary technicians, as the rest of the medical field personnel had to do. They then could be called “professionals” and use the terms dentist or dental technician because they would actually be [those professionals].
Why do these lay dental people think they cannot do the proper medical training, testing and licensing, with regards to our horses? Why do they have this special privilege? Should the laws of Maryland allow it?
– Anthony Salazar, Rockville
Editor’s Comments to Mr. Salazar and Equiery readers: Mr. Salazar’s question, “Should the laws of Maryland allow it?” is answered in prior issues of The Equiery and on www.equiery.com. The current debate began as a result of Maryland’s law requiring that, except for a few procedures, equine dentistry be performed only by licensed veterinarians.
I have had many occasions to use both licensed veterinarians and so-called equine dentists to work on many horses’ teeth over the years. Usually the vet charges less money than an EQDT, so that to me is not an issue. I have seen the results in my horses: The vets tend to do a very thorough job, as well as some lay people.
But I have also had some serious issues resulting from the use of lay dentists that really did not know what they were doing. I agree that it is up to the owners to treat their animals as they see fit; however, I do not believe that these EQDTs should use the term “dental technician,” as that implies to people that they are trained at an accredited veterinary school or university. I believe that is highly misleading to the general public. I think they should use different terminology, as most of these “lay dentists” have not had any anatomy and physiology courses at an accredited university. Possibly use a term that is very easy for the general public to understand the difference. So for a “dentist” to go to a two-week program and then be certified as an “equine dental technician” is very misleading. I would like to see them have to have more study hours. I strongly advise anyone to investigate [this] thoroughly for themselves.
– Nichole Reinke, Misty Manor Farm, Marriottsville
Beyond Maryland’s Borders
We have been quite amazed to receive letters from throughout the country regarding Maryland’s veterinary practice laws. Apparently, The Equiery and equiery.com is developing a national readership tracking this issue. Here is a sampling from our mailbag.
Missouri Vet: Who’s Arrogant? Vets or Non-Vets?
I would like to respond to the article which you published by Dr. Casey on the subject of non-veterinary equine dental practitioners, and also in reference to other, similar stances by veterinary boards in many states besides Maryland. Most of my comments will be toward the equine dentistry aspects, since I have limited my veterinary practice to that part of horse health for over the last decade.
The statements that we see about equine dentistry/massage therapy/etc. always having been considered a part of veterinary medicine are not quite true, as is the case with most of the claims made by the veterinarians who comment on these issues. In fact, the American Veterinary Medical Association came out with the “Model Practice Act” in the late 1980s or early ‘90s and only then included, basically, anything dealing with the health of animals, as being “part of veterinary medicine.” The insinuation is that the “primary care provider” is the veterinarian who periodically sees the animals, rather than the person who sees the animal on a daily basis and provides the stuff of survival constantly (little things like water, food, etc.) and also monitors the health of the animal by observing [its] behavior and physical condition thousands of times more often than the veterinarian. Obviously a false claim from the veterinary camp.
While it would be great if, in fact, we veterinarians did possess thorough knowledge of all of the fields claimed by the practice acts, the actual case is that we do not—no one can be expert in all fields, although the veterinary practice acts attempt to regulate them. Oh, yes, some veterinarians are excellent equine dental practitioners, and some may even have some capabilities in massage therapy and/or chiropractic, grooming, farriery, etc., but most do not.
And there are some excellent non-veterinary equine dental practitioners. Notably, they are the ones primarily responsible for resurrecting our interest in the area of horse health care dealing with teeth. Probably most notable is Dale Jeffrey, who began looking into equine dental care in the early 1980s and had the audacity to begin trying to help horses with dental issues after discovering that veterinarians willing or in fact capable of providing help with that part of horse health care could not be found. His efforts riled the local veterinarians, who brought his actions to the attention of the authorities and eventually resulted in legal cases which led to the defeat of the non-vet in the state of Nebraska.
The reality of the conflict can be related by the old statement: “There are three sides to every story: my side, your side, and the truth.” We have a few veterinarians that are good at horse dentistry, a few non-veterinarians also, and now that the veterinarians have seen the features and benefits of thorough equine dental care, they are beginning to look at it realistically, although some will continue to emphasize “education” as the most important factor in evaluating a practitioner’s abilities. They are referring, of course, to “formal education” rather than practical experience, which is always the best teacher. The veterinarians arguing against the non-vets often mention the extreme importance of years of college, studying everything from embryology of the pig through pharmacology for ostriches, while seldom admitting that they did not receive exposure to equine dental issues, neither theoretical nor applied.
While a few veterinary colleges are beginning lately to offer good exposure to equine dentistry, they often utilize the services of some excellent non-veterinary equine dental practitioners, though they will not admit such in their printed or online information. This fact says a lot about the status of the vet vs. non-vet issue.
I have seen that the most important aspects of equine dentistry are learned from those who have done the most of it, especially if they have done it with an open mind and continually considered what is best for the horse. I believe that we currently have more non-veterinarians that fit into that classification than vets at this point in time, and with the decreasing percentage of graduating veterinarians heading for horse practice, that is not likely to change. The better, smarter vets in general practice, desirous of providing the best care for their equine patients, will employ (or at least refer horse owners to) individuals that can provide the best service, whether that be a local non-veterinary equine dental practitioner or a veterinarian.
But, then, I do have to admit my bias: I am more in favor of horses than of veterinary state boards or large veterinary associations that claim as their creed the advancement of the well-being of the horse, while conducting themselves in ways that decrease the availability of sources of care for these noble creatures.
The most worrisome thing to me is that the horse owners are still sitting on their hands, not letting the bureaucrats know that they really want to retain their right to choose who works on their horses. Perhaps your efforts will help with getting them to speak up effectively.
– Tom Allen,DVM,IAED Certified, Patterson, MO
A message from a massage therapist in Texas.
Like Mercedes, I have a very similar issue with a conference with the Texas State Board of Veterinary Examiners. I have been accused of practicing unlicensed veterinary medicine with massage therapy. The Institute of Justice heard of this and will be present at the “hearing.”
– Charlotte Morris, LMT, CEST, Texas
NY Court Rules for Lay Dentists
According to the Daily Racing Form, on January 15, the New York State Appellate Court upheld the Nassau Country Supreme Court’s ruling that equine dentists need not be licensed vets. Interestingly, it was not New York’s version of the Maryland Board of Veterinary Medical Examiners that issued the “cease and desist” order; it was the New York State Racing and Wagering Board, which ruled off all lay dentists as being insufficiently certified. Thirty-year lay dentist Chris Brown challenged the case and won. The Racing Board now has the option to appeal to the State Supreme Court.
The Equiery inadvertently referred to Bruno Favre casually as an “equine dentist,” while Favre and his wife Leslie were scrupulous about using the term “equine dental technician” in their commentary and not the more informal “equine dentist.”
An examination of the websites for both the International Association of Equine Dentistry and the American School of Equine Dentistry shows that, although the term “dentistry” is used with frequency, individuals practicing dentistry are referred to as either “equine dental vets” or “equine dental technicians.”
While The Equiery certainly appreciates the impact of words and terms, we would be interested in hearing from our readers whether the distinction between “dentist” and “dental technician,” in referring to non-veterinarians, is meaningful to them.
Pretty Mad – Harmony Little, Harmony’s Equine Dentistry (Germantown)
I would just like to say that after reading the article by Dr. Casey in the November 2008 issue of The Equiery about equine dentistry, I was pretty mad, to be blunt honest. I could use other words. I’m an equine dentist myself in this area and I also went to Dr. Hyde’s school, American School of Equine Dentistry. I could not believe the stuff that vet was saying. So, after reading Mrs. Leslie Favre’s argument back on the subject, I’m now so happy.
I read Dr. Casey’s article over and over again in disbelief. I know there are plenty of vets out there that do like to do horses’ teeth themselves, but there are also a lot of vets that don’t like working on horses teeth. I have a few vets myself that refer their dental clients to me. I work with a number of different vets that meet me for appointments to sedate horses for me. I don’t think it is fair to say all equine dentist are bad because Dr. Casey witnesses one equine dentist that he didn’t agree with the job that was being done.
Why, as a equine dentist, should I be condemned because of a poor job done by another dentist? And if that dentist was doing something that Dr. Casey felt was dangerous, why didn’t Dr. Casey jump in and stop him?
I do think there are bad equine dentists out there, but there are also bad farriers, bad vets, bad massage therapists—in any profession there is going to be someone who doesn’t do the job the best.
I feel it is the horse owner’s responsibility to make sure the person (dentist, farrier or even a vet) working on his or her animal has the experience to know how to do the job correctly. I just wanted to say “thank you” for running Mrs. Leslie Favre’s response. It was definitely needed.
Thanks for your time.
Dentistry is Medicine – S. Lynn Renner (Severn)
I have read the articles and responses regarding the discussion of the “Vet Law Challenge” and would like to weigh in. “Equine dentists” present and deceive the public by implying they are medically trained when they are not. More importantly many claim to be “certified” or “masters” and say they have earned 200 credit hours. How misleading!
I have a Bachelors of Business Administration (BBA) degree and a Masters of Business Administration (MBA) degree. It took me six years to obtain these degrees and 150 college credit hours from an accredited University. I have been on the faculty of both a college and a university. I know it takes a lot more years for some of the brightest, most accomplished people to receive PhD’s, Medical degrees, Dental degrees, and Veterinary degrees. These “equine” lay people claim they have obtained 200 credit hours in a two week program. Please, how absurd to pass this off as comprehensive training. Furthermore, these aren’t even credit hours because these “equine dental schools” and “organizations” are not accredited by any authority; not any state board of higher education, nor the American Veterinary Medical Association, or the American Association of Equine Practitioners. These “equine dentist” or their “schools” are not even recognized for licensure by the Department of Health Profession or the State Board of Veterinary Medicine.
“Equine dentists” say they have been “practicing dentistry” for years. Then they are not only misleading the public into believing they are something they are not, but providing medical care when they shouldn’t. They shouldn’t be practicing anything they are not degreed and licensed in. They shouldn’t use titles that deceive the horse owner.
Webster’s 9th New Collegiate Dictionary defined dentistry as “the art or profession of a dentist,” and if defines dentists as “one who is skilled in and licensed to practice the prevention, diagnosis and treatment of diseases, injuries and malformations of the teeth, jaws and mouth…” Obviously, dentistry is medicine and meant to be performed by medically trained people who have passed an accredited program.
Basically, the “equine dentist” are telling us that anyone can go to any type of unaccredited program or school, say we are certified, and provide medical services. This type of activity is illegal in human medicine as well as canine and feline veterinary medicine. Why do we allow it with our equine friends?
I personally wouldn’t go to or take my children to a human doctor or dentist practicing without a medical degree. I certainly would not let these so called “equine dentists’ treat my horse. So getting straight to the point, all responsible horse owners should make themselves well informed before letting someone float their horse’s teeth. The “equine dentist” can hang their shingles out all they want but they are not qualified to perform dentistry. If they want to perform dentistry then they should go to an accredited school of veterinary medicine.
In Defense of Both Vets and Lay Practitioners -Chesa Profaci Dickinson (Chestertown)
There seems to be great debate over equine auxiliary care: massage, chiropractors and, most recently, dentists. The arguments are heated, but so far the only voices heard are those of the professionals. Perhaps it is time for horse owners to weigh in on the issue. After all, in any service or medical debate, the customer or patient should come first – and the patients are our horses.
To me, the care of a horse’s mouth is about having a happy, healthy horse and a safe relationship, either on the ground or in the saddle or sulky -— and [it’s] about saving money on feed. As the owner of seven Thoroughbreds and a pony, I have had both veterinarians and lay dentists work on my horses. Dentistry, like any other technical skill including blacksmithing, has a scientific basis. However, then there is the actual execution of the skill—and this is where the “art” comes in.
The underlying premise of any procedure is to first do no harm, whether the work is performed by a professional or a lay person. Both may understand the terms, but solid practice also figures into the equation.
Anyone who has watched a horse’s teeth being floated knows that dentistry is hard physical work. It requires the conditioning of shoulders, arms and wrists. Oftentimes, the dentist has to put his or her back into it, even get on bended knee to float a pony or mini. Conditioning comes with practice; practice makes perfect, so it makes sense that whoever tends to your horses should regularly practice the dentistry trade, be he or she a vet or a layman.
Then there is the advent of dental power tools like grinders to consider. These tools are oriented toward the practitioner, not the horse. Power tools eliminate much of manual labor but usually necessitate medication. Perhaps the sudden zeal within the veterinary association to take over the dentistry profession is due in part to the development of sophisticated power tools, making dentistry easier, quicker and hence more lucrative to practitioners.
If this is the case, then the debate is really over medication. Sedating the horse can lessen the trauma of the experience, not to mention decrease the abuse the dentist, veterinarian and owner receives bouncing around the stall or aisle trying to hold or calm the horse. While everyone knows that only veterinarians can professionally administer medications, most horse owners are practiced in giving their animals an IM tranquilizer for transport, training or even performance, so a vet isn’t always necessary. (Nor is tranquilizing always necessary when working manually in a horse’s mouth if the horse is well-mannered and the dentist has good horse sense or karma.)
In conclusion, this is not an “us or them” scenario. I read somewhere that a veterinarian might successfully be able to handle a caseload of 2,000 to 2,500 horses a year. (This is assuming use of power tools and medication.) According to the American Horse Council’s 2005 study, there are 153,000 horses in the state of Maryland. That tells me that there is plenty of work to go around -— especially if I am not keen on having my horses medicated.
As horse owners, we have the right to manage our own animal’s heath care, and we want only skilled people practicing dentistry, be they vets or lay people.
After all, this is still America, the land of opportunity and freedom of choice!
I appreciate your continued coverage of important equine issues.
The Vet Board Can And Should—But Won’t—Regulate & Approve Non-Vets to Treat Animals – Steven J. Strunk, PT (Rockville)
The author is the chair of the Maryland Animal Physical Therapy Task Force: Maryland State Board of Physical Therapy Examiners. Created by the Maryland State Board of Physical Therapy Examiners, the regulatory and licensing board for the profession of physical therapy, the mission of the Maryland Animal Physical Therapy Task Force is to “assure access to the highest quality of care, performed by qualified licensed health care professionals, for physical therapy and rehabilitative services for animals.”
Readers of The Equiery who have been following the developments in “Vet Law Challenged” about the lawsuit filed by H. Mercedes Clemens, NCTMB, LMT, EBW, may be left with questions regarding several aspects of this issue. For example: What are the laws? [Editor’s Note: please visit www.equiery.com to read the law.] Does the current veterinary medicine practice act constitute a monopoly over all treatment of animals? How have treatments been developed for animals that have not been part of traditional veterinary medicine?
Are animals endangered by treatments provided by those who are not licensed veterinarians? Is the public served or protected by the current situation? And most importantly, what is the best way forward? This commentary will attempt to clarify these issues for the consideration of Equiery readers.
Chris H. Runde, DVM, President, State Board of Veterinary Medical Examiners (SBVME) accurately represents the broad scope written into the veterinary practice act. “Treatment of any nature”* of an animal is subject to being misconstrued as the practice of veterinary medicine, regardless if the treatment is not part of standard veterinary medical education or practice.
Anyone who is not a licensed veterinarian [and] who provides any treatment for an animal stands accused of the practice of veterinary medicine without a license. On its face, this does reflect a monopoly. However, as noted previously, exemptions do exist in the veterinary practice act for treatment of animals by non-veterinarians. In fact, a precedent exists for licensed acupuncturists to practice their discipline with animals.
Animal care has tremendously improved and been expanded by interdisciplinary collaborative efforts over decades. Dr. Runde writes that, “In recent years, short courses, workshops and seminars on chiropractic techniques for animals have enjoyed a surge in popularity.”
It is well known that veterinarians and their staff are receiving this sort of education and training taught by professionals in acupuncture, chiropractic, massage/body work, physical therapy and other alternative, complementary, or conventional interventions. Recently discussed advances in animal dentistry have also been developed in this manner. In fact, this sort of interaction between veterinary and human medical fields has led to advancements in both. Indeed, all such beneficial treatments have been the product of collegial relations between veterinarians and those in other fields who have adapted and applied their disciplines to animals out of a caring desire to improve animal health and well being.
However, while veterinary medicine has benefited from the fruits of these collaborative efforts, with rare exceptions those who are not veterinarians—yet who have been instrumental in developing these practices for animals—have been restricted from providing these services by regulation.
Dr. Runde reports that, concurrent with the surge in courses in animal chiropractic, there has been an increase in the number of complaints to the Board of Chiropractic concerning manipulation on animals. Combined with his statement that the mission of the SBVME is to protect animal health and welfare, he gives the impression that animals are being injured by this practice.
Without a description of the nature of these complaints, it is impossible to directly comment on Dr. Runde’s inference. What is not known here, in addition to the question [of whether] any actual harm to animals is alleged, is whether these manipulations were performed by licensed chiropractors, veterinarians or their staff, other licensed professionals or lay people.
What is known is that upon investigation, no complaints had been registered with either the Acupuncture Board or SBVME regarding the acupuncture treatment of animals by certified licensed acupuncturists. Coincidentally, just as no harm to animals was demonstrated over 11 years ago when acupuncturists were served their “cease and desist” from the treatment of animals by the SBVME, no harm was done to horses treated by Ms. Clemens. In spite of the fact that Ms. Clemens’ clients were [apparently] satisfied with her services, as they had filed no complaints with either the Chiropractic or Veterinary boards, she was arbitrarily served a “cease and desist” based on regulatory technicalities.
The current situation is not conducive to protecting animal health and welfare, the public seeking services they desire and find helpful for their animals, or practitioners who happen not to be veterinarians. It appears that veterinary medicine, while enjoying the expansion of animal treatments beyond the traditional scope of veterinary medical education and practice, is reluctant to enter the 21st century.
Instead of following the interdisciplinary team approach model in human health care, where one may take advantage of many services offered safely, effectively and efficiently by those who are not medical doctors, veterinary medicine would prefer to remain a monolithic anachronism.
The public and their animals would be best served and protected by having access to treatments that are not part of traditional veterinary medical education or practice, provided by those who are regulated in these fields and can demonstrate proficiency in applying these disciplines to non human species. Obviously, one can seek such services from veterinarians or their staff under current regulations. However, even if one can find a veterinary practice offering such treatments, no regulatory standards exist for veterinarians or their staff to provide acupuncture, chiropractic, massage/body work, physical therapy, dentistry, etc.
The model provided by the precedent set for licensed acupuncturists works well. They must meet stringent education and practice standards to qualify to treat animals. The public and their animals are well protected by this sort of regulation. It has proven to be safe and beneficial, with no threat to the animals, acupuncturists, veterinary medicine or the public.
The SBVME has the authority to promulgate regulations for those who are not licensed veterinarians to provide treatment for animals under Agriculture Article 2-304(e). However, in the 11 years since this clause was added, the SBVME has failed to utilize this authority. In the case of physical therapy for animals, the SBVME has refused to do so in ways that would not conflict with or contradict well-established existing regulations for the physical therapy treatment of humans that have been time-tested and proven.
The way forward is clear. Either the SBVME uses the authority granted them in Agriculture Article 2-304(e) fairly, without compromising existing regulatory standards, or the state legislature must act (as was done in the case of acupuncture for animals in 1997) to ensure that clients, their animals and all professionals offering animal services are protected by regulation.
I join Ms. Clemens in urging those concerned to contact their state district representatives and senators to get them to act on this detrimental situation.
* Mr. Strunk is referencing the statement issued by the Chairman of the State Board of Veterinary Medical Examiners, Chris Runde, D.V.M. on July 9, 2008:”The SBVME, whose mission is to protect animal health and welfare, has the statutory authority to regulate the “practice of veterinary medicine,” which “includes the practice by any person who…diagnoses, advises, administers [an]… appliance, application, or treatment of any nature, for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of an animal.” Agriculture Article, § 2-301(f). If a person engaging in equine massage is “practicing veterinary medicine,” as defined, the person must be a licensed veterinarian. Agriculture Article § 2-313(1).”
Why an Equine Dentist Does Not Have to be a Vet by Leslie Favre
Leslie Favre is married to Davidsonville equine dental technician Bruno Favre, for whom English is a second language. These are his thoughts.
I am writing in response to the letter by Dr. James Casey (November 2008) regarding Equine Dental Technicians (EqDTs). My husband, Bruno Favre, has been practicing as an EqDT for 10 years. He is a proud graduate of the American School of Equine Dentistry. Despite what Dr. Casey says about this program, it is a comprehensive 200-credit hour program put together by a veterinarian and it far surpasses the 10 hours of course work, according to the VA-MD Regional College of Veterinary Medicine, that any vet gets in the normal course of his education.
My husband is also a member of the International Association of Equine Dentistry, which was founded by both EqDTs and veterinarians from all over the world. According to its website, the purpose of the IAED is “to promote the advancement of equine dentistry throughout the world amongst veterinarians and non-veterinary dental technicians.” The IAED meets several times per year to share ideas, new techniques and provide continuing education to equine dental professionals, vets and EqDTs together. They also offer certification programs and examinations.
Though Dr. Casey holds little respect for these two organizations and those who belong to them, I am sure your readers are intelligent enough to realize that is his opinion and that there are many veterinarians who do respect these organizations and what they are trying to do to maintain and improve the quality of dental care our horses receive.
Historically, equine dentistry has been a very labor-intensive job that vets were simply not interested in doing and welcomed a good EqDT to provide that service to horses. Most vets are just too busy doing what they were trained to do, diagnose and treat horses. Now that there are power tools and the job is less labor-intensive and more lucrative, Dr. Casey wants to become specialized, which is fine; but he should not attack the EqDTs who have taken care of horses for decades. Dr. Casey claims that equine dental care has become so technical and advanced that only a veterinarian should do the work and that he is only looking out for the horse’s welfare. If that is the case, shouldn’t Dr. Casey also be buying a set of blacksmith tools? Haven’t the same advances been made in the care and maintenance of equine hooves?
I personally do not understand why a veterinarian would want to concentrate his practice on the general maintenance of equine teeth. I can only assume they are not very busy in their other “specialties.” Horse owners who are also veterinarians hire EqDTs to do their horses’ teeth. Why? Hopefully one will write in and answer that question for us. But, I believe it is because an EqDT does many horses every day. They have the strength and tools to do the job. The vet may even acknowledge that the EqDT is probably going to do a better job because it is his or her specialty.
The practices my husband has learned from the American School of Equine Dentistry, along with numerous other EqDTs who have shared their knowledge with him, have served him and his equine clients well. Dr. Casey says cutting canine teeth with a cutter is dangerous but neglects to comment that there are problems reducing canine teeth with power tools, such as bringing too much heat to the tooth or grabbing the tongue with the burr (the grinding mechanism of the power tool). Many EqDTs and vets cut canine teeth every day without any problems. Dr. Casey is also against bit seats, when, in fact, most professionals in the field acknowledge the necessity of them.
The bottom line, to me, is that the horses are being well taken care of and it isn’t the clients who are writing in and complaining. My husband, like many other EqDTs, has taken care of thousands of horses’ teeth for hundreds of owners – many of which he has been doing for a decade. If he comes across a problem that he himself cannot fix, he refers his client back to the veterinarian and/or a certified master equine dentist or dental technician.
I urge your readers to believe that the EqDTs who have taken good care of your horses for years are very knowledgeable and capable of continuing to provide excellent, safe and affordable care to your horses. We are all here for the well being of our horses and should work in a friendly cooperation with one another.
In the July issue of The Equiery, we reported that a lawsuit had been filed against the Maryland State Boards of Veterinary Medical Examiners (Vet Board) and Chiropractic Examiners (Chiropractic Board) by a licensed human and certified equine massage therapist who had received several cease and desist letters from the Chiropractic Board, using a memo from the Vet Board as justification. On November 13, the Circuit Court granted the Vet Boards motion to dismiss while denying the Chiropractic Board’s motion to dismiss.
The lawsuit has launched a conversation in The Equiery about Maryland’s Vet Practice Act and whether or not it needs to be changed. Other massage therapists and equine dentists have weighed in, as well as horse owners. To read all the articles and letters published to date, please visit equiery.com and click on “Vet Law Challenged.”
Although many “alternative health care practitioners” (in addition to massage, those non-vets practicing such alternative therapies such as laser and magnetic therapies and homeopathic alternatives) are affected by the Vet Practice Act (depending upon whether one reads the law narrowly or broadly), the conversation in The Equiery seems to have become centered on equine dentistry. The Vet Practice Act does make some allowances for non-vets to provide some equine dental services. To learn more, please visit www.equiery.com and click on “Vet Law Challenged.”
We would also like to remind our readers that this section of The Equiery, “News & Views” contains just that: personal points of view. If you have a viewpoint on a current issue, please e-mail your letter to firstname.lastname@example.org.
Maryland State Board of Chiropractic Examiners
Maryland State Board of Veterinary Medicine Examiners
Institute for Justice
American Association of Equine Practitioners
International Association of Equine Dentistry
American School of Equine Dentistry
Equine Dentistry Should be Restricted to Vets (November 2008 The Equiery – News and Views)
– The author of the following commentary, James M. Casey, D.V.M., M.S., is an equine vet who is based in Laurel and who specialized in dentistry, sports medicine and surgery. These are the views of Dr. Casey a not of The Equiery. The Equiery remains neutral on the issue.
Both the American Veterinary Medical Association (AVMA) and the American Association of Equine Practitioners (AAEP) have always considered and defined dentistry as veterinary medicine. Today we have an increased awareness of equine dental problems. Veterinary medicine concerning equine dentistry is going through rapid improvements in dental techniques with vastly improved equipment and instruments. Also, in veterinary equine dentistry we have ever advancing diagnostic aids and better understanding of equine dental anatomy, physiology and pathology.
As a result of these many advances in veterinary medicine, there is a lot more to your horse’s dental care than just floating their teeth. Horses’ modern day dental care is vastly better than what it was even a few years ago. So the question comes, who should provide your horse’s dental care?
Having education, training and experience as a veterinarian, and through my experience as having once been a professional jockey, have exercised, ridden and trained over the years several thousand horses, I have seen good, poor and even detrimental dental care of horses. In my opinion, a veterinarian who has built onto [his or her] veterinary education with advance knowledge and skills in equine dentistry and also has the modernized equipment to perform the task(s), would be my choice for my horse’s dental care. A veterinarian with advanced training in equine dentistry can readily identify and address abnormalities of horse’s teeth far beyond the scope of the “lay horse dentist.”
There are some lay people that proclaim themselves to be a “horse dentist.” As a professional horseman and with what I see in my veterinary practice, only a very small minority of these so called and self proclaimed “horse dentists” do an adequate to good job of the basic floating of horse’s teeth. The vast majority of these self proclaimed “horse dentists,” in my experience, do extremely poor, often neglectful and at times out right fraudulent work.
The terms “dentist” and “performing dentistry” to most people refer to some one with at least eight years of higher (college) education. In the human field of dentistry, this would be someone with a Doctor of Dental Science (D.D.S.) or a Dental Medical Doctor (D.M.D.) degree.
Veterinarians usually have eight or more years of college and professional training. The self-proclaimed “horse dentist” does not have this training or education. Some say that veterinarians get little training in equine dentistry while in veterinary school. There isn’t any truth in that statement. Furthermore, today more than ever, equine medicine and veterinary dentistry are under going changes in [the] schools of veterinary medicine. Special elective courses in equine dentistry are more often offered. The AAEP even has programs with experienced equine practitioners going into veterinary schools and teaching equine dentistry.
What is misunderstood by the non-veterinarians is how a veterinarian’s education is structured. First, one must gain entrance into a school of veterinary medicine, which is not easy. Most [entrants] have at least a bachelor’s degree, usually in a science, and must excel in courses such as biology, chemistry, physics and advanced mathematics. Once in veterinary school, [a] doctoral graduate level of intense, detailed study is done in Anatomy, Physiology, Histology, Embryology, Pathology, Toxicology and nearly every “-ology” dealing with animals you can think of. Then veterinary education moves into diagnosis, treatments, surgery and so on. One who graduates with a Doctor of Veterinary Medicine degree has a base or platform of education and knowledge to build upon.
A Doctor of Veterinary Medicine degree is NOT where a veterinarians’ education ends. After graduation from veterinary school, one often goes to work with experienced veterinary practitioners. Many complete externships, internships and residencies. Many more veterinarians. after graduating from veterinary school, complete additional study and research leading to a Master of Veterinary Science or PhD (doctorate) degrees. After graduating from veterinary school, a number of veterinarians acquire intense training in a specific area and become board certified in various areas of veterinary medicine.
Then there is continuing education for veterinarians. The requirements vary from state to state. Usually, I complete 80 to 90 hours of continuing education a year and have completed over 150 hours of continuing education in a single year. Of course, most veterinarians subscribe to and read a number of professional veterinary journals to further our educations and keep current.
Equine dentistry, equine dental techniques and equine dental science are advancing rapidly. The AAEP has state-of-the-art continuing education on equine dentistry at all [its] national meetings and the AAEP has devoted an entire focus meeting to equine dentistry in recent years. Many state organizations (Florida Association of Equine Practitioners, etc) have meetings on equine dentistry. These meetings of advanced continuing education are well attended by veterinarians. Unfortunately, few non-veterinarians attend these meetings.
In deed, part of the veterinary oath is a commitment to life long continuing education. The self proclaimed “horse dentist” often has no formal training or [has] attended an unaccredited program for a couple of weeks.
Poor training and lack of the most basic knowledge in equine dental anatomy, physiology and pathology is dangerous and can be harmful to your horse. For example, I once observed a non veterinarian (a “lay dentist”) floating a horse’s teeth [gets] out what appeared to be a bolt cutter device and cut off the horse’s canine teeth. A horror right in front of my eyes! Cutting the canine teeth of a horse in this manner can fracture the teeth, open the pulp chamber (soft area) within the tooth and cause premature loss of the horse’s teeth. This dangerous procedure could potential cause infection of the bone and soft tissue in the horse’s jaw. I cautioned this person on the dangers of cutting equine teeth with a bolt cutter device. This “horse dentist” told me he was a graduate of the American Academy of Equine Dentistry, and this was how he was taught to address overgrown canine teeth in horses. Furthermore, he was employed by a non-veterinarian, a self described “certified equine dentist” of the International Association of Equine Dentistry. He told me that his employer had demonstrated and instructed him to cut off horses’ canine teeth in this manor.
Radical bit seats were another detrimental thing to the horse’s teeth that this “lay horse dentist” was doing. This is reducing or grinding away 30% or more of the first cheek teeth. This “lay dentist” told me he was educated by the “Academy of Equine Dentistry” to perform these radical bit seats and that it is also considered standard practice by his employer, again the self described, non-veterinarian “certified equine dentist” of the International Association of Equine Dentistry. I pointed out to this “lay horse dentist” that horses’ teeth are not a block of wood to be chipped and carved up; they are living structures. Reducing teeth or grinding more than 3 – 4 mm (less than ¼ inch) of tooth material at a time risks opening the pulp chamber, is very dangerous to the horse’s dental and overall health.
Additional things I often find in my veterinary practice are large caudal hooks, overgrowths and other abnormalities left uncorrected by these self described “horse dentists.” Without proper technique, knowledge, modernized instrumentation, diagnostic equipment, availability of sedation and anesthetics when needed, it is impossible to gain access to even apply a full-mouth speculum and visually and digitally examine every structure in the vast majority of horses’ mouths without endangering the horse, the handler and yourself.
Since both the AVMA, AAEP and State Veterinary Practice Acts define dentistry as veterinary medicine, to use the term “equine dentist” and to be performing equine dentistry should be reserved for those who are veterinarians.
The group who calls themselves the International Association of Equine Dentistry is made up of both veterinarians and non-veterinarians. The majority of this group are non-veterinarians. This group started out calling themselves the International Association of Equine Dental Technicians (IAEDT). Then they were trying to draw the analogy to a human dentist’s dental technician. However, they did NOT have degrees from an accredited college in dental (equine) technology and usually [are] not employed by a veterinarian. Human dental technicians are employed by and work for human dentists. You can not compare an equine lay dental education (four weeks max–no prerequisites not even a high school diploma) to a dental hygienist. To become a dental hygienist in United States, you must graduate from a dental hygiene program, with either an associate’s degree (most common), a certificate, a bachelor’s degree or a master’s degree from a dental hygienist school that is accredited by the American Dental Association (ADA). All dental hygienists in the United States must be licensed by the state in which they practice, after completing a minimum of two years of school.
Now the organization calls itself the International Association of Equine Dentistry (IAED) and not only do the members proclaim to be “equine dentists,” but now call themselves “certified equine dentists” and “certified master equine dentists.” Keep in mind the non-veterinarian members, the majority of this group, do not have a doctoral-level education and haven’t spent a day in veterinary school.
If a group formed and called themselves the International Association of Lasik Eye Surgery (IALES) and proclaimed themselves to be Master Lasik Eye Surgeons, NOT having a medical doctoral degree, NOT having years of internship and residency in ophthalmology, would you allow some one from this group of self proclaimed “Master Lasik Eye Surgeons” to operate on your eyes? I don’t think so.
A Reason For Vet Practice Acts
The reason we have practice acts is not to protect the veterinary profession but to protect the public, and [they were] demanded by the public. Most practice acts define dentistry as veterinary medicine. In most states, only veterinarians can legally perform dentistry on animals. In some states, such as New York, a human dentist can only work on animal’s teeth when under the supervision of a veterinarian.
The Maryland Veterinary Practice Act defines equine dentistry as veterinary medicine. However, it does have a clause permitting the floating of equine teeth by non-veterinarians. This clause in the Maryland Veterinary Practice Act was placed in the law many decades ago. It is my understanding the clause was placed in the practice act chiefly for an individual who was employed by and worked for a group of veterinarians, and NOT for someone proclaiming to be an equine dentist and/or working on their own.
In those days equine dentistry had not changed much for 100 or more years. We did not have the knowledge, instrumentation, diagnostic capabilities, sedation and anesthetics, and the many other advances we have today.
Lynn Caldwell, D.V.M., the chair of the AAEP Dentistry Committee, cautioned that wording in Veterinary Practice Acts [requires] great care to avoid unintended consequences. It is not likely that when the exception was placed in the Maryland Veterinary Practice Act decades ago, it could have foreseen the advances in veterinary medicine, surgery and dentistry of today, where we can drill and fill equine teeth, perform root canal surgery, have effective motorized instrumentation, portable digital x-rays in the field and so on. If these advances had been foreseen the exception may not have entered the Maryland Veterinary Practice Act.
Who should provide my horse’s dental care? From my veterinary stand point, the ultimate consumer (you and your horse) are the ones at risk. Another part of the Veterinary Oath states “The health of my patients, the best interest of owners, and the welfare of my fellow man, will be my primary considerations.” Here is the big dilemma: there are some very well educated, skilled veterinarians available to perform dentistry on your horse and a few non-veterinarians capable of doing basic care (floating teeth). Then there are a number of poorly educated individuals doing you and your horse a disservice.
I urge horse owners and trainers to regard equine dentistry as a professional service and an important part of horses’ healthcare. The services of a qualified veterinarian [who is] also licensed to perform surgical procedures and to administer medication is invaluable.
Some things you need to look for in a good equine veterinary dentist are:
Are they looking at what they are doing?
They should be using portable surgical grade light (not a flash light), a padded stand, a full mouth speculum, and a veterinary assistant to steady the horse’s head. All equine dental procedures are best performed when you can see what you are doing. This work does not need to be done blindly.
Clean and Sanitary
All dental instruments, the speculum (device that holds the horse’s mouth open), buckets, etc are all cleaned and washed with an antimicrobial disinfectant (I use Nolvasan Scrub and Solution) between each and every horse. No exceptions!
Equipped to do the job
They should be well equipped with good instrumentation, both motorized and non-motorized. I have over 100 different instruments that I use and probably could use more.
Examination noting pathology and record keeping
A complete examination with the use of surgical grade lighting, a dental mirror, and other appropriate instruments should be done. A record indicating all teeth in your horse’s mouth, noting location and significance of all abnormalities, what work needs to be done, and time of follow up examinations should also be included.
Sedation and Anesthesia
This should be done when indicated and needed. An array of medications is available to assist us when we perform dentistry. These medications make your horse more comfortable. When the horse is sedated, it allows us to do a better job in a safer way.
They should have access to diagnostic imaging equipment, such as x-rays, preferably digital x-rays. This allows us to uncover and manage a host of equine dental abnormalities.
When any invasive procedure such as wolf teeth extraction is performed, it should be done with sterile instruments under sterile techniques.
(To view the article about the lawsuit which originally raised this issue, click here)
Over the years now I have been told lots of times that I either hadn’t “kept up with the times” (that’s okay, neither have the horses that I know of) or that I simply didn’t know what I was doing. As long as the horse knew what I was doing, and they seemed to, I figured I would live with those opinions from people, most of whom have been on this planet for less time than I have worked with horses.
Now, however, I find that what I have done, what almost all of my contemporaries have done in fact, is not only wrong, it is illegal. Yep, illegal, at least as far as the Maryland State Board of Veterinary Medical Examiners and the Maryland Board of Chiropractic Examiners is concerned. I can’t afford a chiropractor and don’t worry too much about what they think about me anyway, but, gee, I have always thought highly of almost every vet I ever met. And yet, here I am, in noncompliance with their rules and regulations.
If I am not allowed to massage horses for money, was I acting illegally all those years that I worked as a groom? I know that nowadays folks mainly tie up a horse and bathe them, but back in the bad old days, we groomed them every day. If a good all over grooming is not a form of massage, I’ll eat one of those big old horse brushes.
Here, in print is #5 of the State Board of Veterinary Medical Examiners’ regulations for what is legal: (5) A person administering to the ills and injuries of his own animals if they otherwise comply with all laws, rules and regulations relative to the use of medicines and biologics;
So where does that leave grooms? They certainly aren’t working on their own animals. They are working on other people’s animals, and for money, too. A groom normally administers to the regular ills and injuries of the animals owned by his employers. If he did not he wouldn’t be much of a groom.
Does this mean that a groom can’t deal with gravel with the blacksmith? No more hooves covered with duct tape without a vet standing over us each and every time we wrap that hoof up? Are there vets enough to go around for this sort of supervision?
What person can afford to have a vet on hand to supervise a groom in dealing with every small boo-boo that a horse can get in a normal day’s turnout in the pasture?
I can hear it now.
“Yes, yes, it IS an emergency! The horse that I groom has a one half inch cut on his gaskin and I need a vet here to wash it out and apply a bit of ointment. And, yes, you have better have him plan to come out and deal with this for the next three or four days. This horse never has healed all that quickly from anything! Oh, and by the way, I leave at five on the dot. This is not a very nice horse so the vet better drop everything and get on over here if he wants to live through this!” Yeah, right!
But, come to think of it, if the vet has to deal with everything anyway, according to the SBVME, why should the groom hang around? Grooms get paid by the week and their days go on forever. It would seem to me that one expert on the case ought to be enough. Get the vet to leave a fully written explanation of what he has done and go on out to a movie, right? Wrong!
If it comes to this pass the first person who will complain will be the owner who has to pay the vet bills and the second person who will complain will be the long-suffering vets who never get enough sleep anyway. Most vets depend upon good grooms to have sense enough to know what they can handle and what needs the vet’s expertise.
That groom/vet relationship has been going on for a long, long time. If the SBVME tries to get in the middle of that I’ll bet they will hear about it from a lot people much closer to them than the equine massage practitioners and the Institute for Justice.
After the September issue of The Equiery hit the streets, I—as the editor and publisher—was questioned about my decision to publish an anonymous letter from a veterinarian; the letter commented on the lawsuit recently filed by Mercedes Clemens against the Maryland Boards of Chiropractic Examiners and Veterinary Medical Examiners.
As regular readers of The Equiery know, we have closely followed the lawsuit filed by Mercedes Clemens against these two Boards. At issue is whether or not the Boards are imposing unnecessary regulations that imping on Clemens’ ability to make a living, thereby violating her rights under the Maryland State Constitution. The Equiery has received and published several commentaries supporting her efforts or detailing the writers’ personal experiences with the Vet Practice Laws. Almost all letters published are critical of Maryland’s Vet Practice Act.
Privately and off the record, several veterinarians have set forth coherent and logical reasons for the laws as they currently stand. Additionally, several veterinarians have noted that, in their opinion, the issue is not really about the Maryland Vet Practice Act, but about the Chiropractic Board’s regulations. The anonymous letter published in the September 2008 issue explores this is some detail.
For reasons that are perhaps typical of the breed (veterinarians being among the more scholarly and conservative of equine professionals), no veterinarian had, as of press time for the September issue, been willing to go on the record. The Equiery has been promised—and will no doubt some day receive—a letter from one or more vets who are willing to go on record outlining the benefits of the Vet Practice Act as it currently stands. Of course, since they are a scholarly breed, it may take these vets the same length of time it took them to get through vet school to get the letter written.
In the meantime, The Equiery was stuck. On the one hand, the magazine was getting criticized for running only one side of the issue, and but on the other side, no one was willing to go on the record and outline the coherent points that they were willing to share with us privately.
In the interests of providing some sort of balance, I made the decision to print a commentary without attribution. I was subsequently called to task for it, noting that it was not “fair,” because those challenging the Maryland Vet Practice Act had done so publicly, allowing their criticisms to be attributed to them by name. They had “stuck their necks out,” and it was not fair for The Equiery to publish an opposing viewpoint anonymously.
However, we at The Equiery also have a responsibility to our readers, and a responsibility to attempt – as best we can – to present to our readers “both sides” of any given issue. Thus, in an attempt to be fair to our readers, I made the decision to run the anonymous letter in an effort to present “the other side” of the issue. Although the decision may not have been fair to those who have written in opposition of the Maryland Vet Practice Act, I believe the decision to be fair to our readers, as the letter provided other aspects to consider. (It should be noted that the letter was neither a defense of nor criticism of the Vet Practice Act, but rather an argument outlining that the Chiropractic Board’s regulations currently contain provisions to allow licensed massage therapists to practice on animals.)
Since then, we have received, and will publish in a future “News & View” (The Equiery’s “op/ed” page)—a commentary from Dr. James Casey, DVM, a Maryland veterinarian who specializes in dentistry.
And we continue to encourage anyone who has an opinion on this subject, or any Maryland related equine industry issue, to share their opinions and thoughts with our readers.
Vet Law Challenged – Round Three (September 2008 The Equiery – “News and Views”)
The Equiery first reported on massage therapist Mercedes Clemens’ lawsuit challenging the constitutionality of Maryland’s Vet Practice Act in the July issue. Earlier this year, the Maryland Board of Chiropractic Examiners (“Chiropractic Board”) issued Clemens, a licensed human massage therapist and a certified equine massage therapist, a “cease and desist order,” noting that a license from the Chiropractic Board (which regulates human massage therapists) prohibits her from practicing on animals.
The Chiropractic Board included a memo from the Maryland State Board of Veterinary Medical Examiners that states, in part, “There is no exclusion under [the Vet Practice Act] to allow for … massage therapy, physical therapy or other manual techniques on animals. Consequently, an individual who is not a licensed veterinarian who performs any of these procedures on an animal would be considered to be practicing veterinary medicine without a license.”
The Chiropractic Board’s letter said that if Clemens did not immediately cease practicing on animals, the Chiropractic Board would revoke her license to practice on humans.
Clemens ceased her equine massage practice and subsequently, through the Institute for Justice, filed a lawsuit against both Boards for violation of her constitutional rights.
In July, the Vet Board attempted to distance itself from the Chiropractic Board by issuing a statement stating that it had no problem with Clemens’ massage practice, implying that the Chiropractic Board had not only acted alone, but had acted inappropriately in using its [the Vet Board’s] memo.
Since then, the Associated Press has picked up the story, with news outlets from USA Today to CNN Radio to the Australian Broadcasting Company running articles or interviewing Clemens. In addition, an AOL poll pulled in thousands of participants.
In August, the Chiropractic and Vet Board filed a Joint Motion to Dismiss based on improper venue. The Institute for Justice filed the suit in Montgomery County Circuit Court, and the Motion to Dismiss notes that the “domiciles” of the two Boards are Baltimore City (for the Chiropractic Board) and Anne Arundel County (for the Vet Board), and that therefore, Montgomery County is an inappropriate venue (see equiery.com for a copy of the motion).
Does the Maryland Vet Practice Act Need to be Changed? A Mechanism For Licensed Massage Therapists Already Exists – submitted by a Maryland Vet
The letter that Clemens received was based upon a human health regulation, not the Veterinary Practice Act, and [the fact that]she was not told that she could not do massage on horses, but rather that she could not do massage on horses while retaining her license to do massage on people.
According to the Annotated Code of Maryland, Article – Health Occupations, §1–211:
A person who is licensed, certified, or otherwise authorized to practice a health occupation under this article may not practice the health occupation on an animal unless the person: (1) Is a licensed pharmacist practicing pharmacy under Title 12 of this article; (2) Is a licensed acupuncturist practicing in accordance with § 2-301(g)(11) of the Agriculture Article; or (3) Provides care to an animal in accordance with § 2-304(e) of the Agriculture Article.
These rules govern the conduct of human health care professionals, not lay people working on animals—and altering the Practice Act would have no effect on this situation.
In item (3) of the above section, provisions are given for exceptions, if done within the following framework (§ 2-304(e) of the Agriculture Article):
(e) (1) The Board may authorize the practice of a health occupation on an animal by a health care practitioner licensed, certified, or otherwise authorized under the Health Occupations Article.
(2) If the Board authorizes the practice of a health occupation on an animal under paragraph (1) of this subsection, the Board may:
(i) Impose requirements for education, training, and supervision by a veterinary practitioner; and
(ii) Require the registration of each health care practitioner authorized to practice a health occupation on an animal in accordance with this subsection.
This provision seems as though it could be a reasonable mechanism to allow people like Mercedes Clemens who are already licensed in a human health profession to work on animals using existing law.
My Story – Courtney Molino (ESMT, CMT) is a certified equine sports massage therapist and owner of the Maryland-based “Hands On Horses” practice. To read her letter in full, click here.
I am trained in equine anatomy, massage techniques, gait analysis, muscle function and common musculoskeletal disorders. I studied equine science and anatomy at Virginia Tech before pursuing my equine massage certification in 2004. I believe I bring a much-needed alternative service to my clients of all riding disciplines and levels, from competitive athletes and pleasure horses to aging equines and those recuperating from illness or injury.
I have always been careful to ensure that my clients realize that massage therapy does not equate with veterinary medicine. In fact, I very clearly state the following on my website and in all promotional materials. In no way are massage services meant to be construed as the diagnosis or treatment of injury or disease, but rather as an aid to promote and improve the animal’s overall wellness. A massage program is not a substitute for medical treatment, and it is always recommended to consult your veterinarian prior to beginning a massage program.
However, my disclaimer apparently was not clear enough to the Maryland State Board of Veterinary Medical Examiners, who sent me a letter in January 2008, stating that I may be in violation of the Maryland Veterinary Practice Act and therefore practicing veterinary medicine without a license. Specifically, the Board was taking exception to certain phrases I used on my website, such as being trained to “identify muscle spasms,” “alleviate sore backs, stiffness and lameness” and “relieve pain.” According to the Board, only licensed veterinarians are legally qualified to do these things.
The Board requested that I “cease and desist immediately from activities constituting the practice of veterinary medicine.” They further informed me that I should give a “thorough and thoughtful revision” to my website and promotional materials to “avoid giving the appearance” that I was practicing veterinary medicine. I was surprised, to say the least, as I honestly believed I was only offering massage services to my equine clients.
The Vet Board was “particularly concerned about the barn call aspect of the business, which is without the benefit of direct veterinary supervision.” I agree a good massage practitioner is able to work with the veterinarian as part of a comprehensive healthcare team, but it is unreasonable to expect the veterinarian to serve as a “direct, standing-over-your shoulder, watching every move” supervisor. In fact, many of my clients come from veterinary referrals, and most of the veterinarians I have talked with express no desire to massage horses. Their expertise is best utilized elsewhere.
And, apparently, since there is no exclusion under the Practice Act for “certified massage therapists,” the state of Maryland “views a certified equine massage therapist no differently than any individual having no training whatsoever.” Because the state does not “regulate or license massage therapists for animals” nor certify “equine/canine massage therapists,” then those of us who have spent vast amount of time and money learning this trade apparently are bad people who must be reeled in and banished from the animal world! I’m sure my fellow qualified practitioners who, like me, have dedicated themselves by expending the time and resources to learn the skills of this trade would disagree.
Luckily for me, I was able to continue serving my equine clientele by making the terminology changes the Vet Board suggested.
As horse owners, we have the right to self-determine the type of care our horses receive, as long as the care (or lack of care) does not constitute animal abuse. This includes having access to trained professionals who successfully demonstrate their ability to promote overall wellness and keep the entire equine body in peak physical condition. Holistic and alternative services for our horses should be available to all of us and provided by individuals qualified to provide those services, [which does not necessarily mean] four-plus years in medical school.
As the profession of equine massage continues to grow, it is a given that we will all suffer from growing pains. However, there is a better way to handle this. With the recent outpouring of animal massage certifications schools, some better than others, it is imperative and the responsibility of horse owners to do their homework to ensure only trained professionals work on their animals. It is critical for practitioners to supplement the knowledge gained in massage school with continuing education, and for the practitioners and public to demand this level of expertise. None of us should ever stop learning!
While we all wait for the outcome of the current lawsuit brought against the Board of Veterinary Medical Examiners and the Board of Chiropractic Examiners, you can make a difference. Contact the Maryland State Board of Veterinary Medical Examiners (Laura Downes, Executive Director, 410-841-5862, email@example.com) and let them know that you want free access to the healthcare practitioners of your choice. Contact Christopher J. Kelter, M.P.A., Deputy Director/Massage Therapy Program Manager of the Chiropractic Board at 410-764-4738. Let the Boards know that you, as the primary advocate for your horse, want and will demand access to trained professionals of alternative services as you determine yourself!
There is strength in numbers. It is up to all of us to make a difference!
Call to Boycott Chiropractors – Elizabeth Rowland, owner of the Maryland-based Half Halt Press, publisher of equestrian-related books and manuals
I am writing regarding the unwarranted interference of Maryland Board of Chiropractic Examiners, in collusion with the Maryland Board of Veterinarians, that affects my rights and abilities to select the best care options for my horses—-specifically equine massage therapy. I am the OWNER of said horses, not the Chiropractic Board, and to have my options blocked by a group who in all likelihood doesn’t even know which end of a horse eats is simply outrageous.
Horse people, almost by definition, have back problems and use chiropractors with some frequency. Until that is, they come to know that chiropractors are blocking them from receiving the equine massage therapy they may desire for their horses. Let’s see, what do you think will happen? Who will be blamed? Can you spell B-O-Y-C-O-T-T? What will your chiropractors think of their own board if it causes such problems for them?
I, for one, will not set foot in my chiropractor’s door until they back off, and I will do my level best to make sure every horse person in Maryland is aware of this situation.
What do you think? E-mail your thoughts to firstname.lastname@example.org.
In the July issue of The Equiery, we reported that on June 10, massage therapist Mercedes Clemens filed a lawsuit against the Maryland State Board of Veterinary Medical Examiners (“Vet Board”) and the Maryland Board of Chiropractic Examiners (“Chiropractic Board”) for violation of her constitutional rights. Last winter, this Gaithersburg resident received a “cease and desist” letter from the Board of Chiropractic Examiners. A follow-up letter from the Chiropractic Board, reaffirming its position, included a generic notice from the Vet Board.
On July 9, the members of the Vet Board issued a statement (see below) apparently saying that it didn’t really mean that non-vets couldn’t do massage, that this is all just a big misunderstanding and that the Board would be happy to talk it over with Ms. Clemens. Is this really just a misunderstanding? In addition to the Vet Board’s July 9 statement, we are including as illustration the original generic memo (see illustration on right). To read Maryland’s Vet Law in full or to review court documents related to the case, please click here
In response to our original article in the July issue, The Equiery has been receiving numerous phone calls and e-mails from therapists and equine health care workers. Some are willing to share their stories with our readers, but others – out of fear that legal action will be taken against them – are not willing to go on record, as they are still practicing, just “off the radar.” We want our readers to form their own opinions on this controversial subject, and so we will endeavor to let our readers, including the chairman of the Vet Board, speak for themselves. As they provide us with their stories, letters and/or other materials, we will make these available to our readers through both our print and digital publications.
Vet Board Chairman Responds to Lawsuit
Chris H. Runde D.V.M., is chairman of the Maryland State Board of Veterinary Medical Examiners.
Annapolis, MD (July 9, 2008) –
– On June 17, 2008, the Maryland State Board of Veterinary Medical Examiners (“SBVME”) received a copy of the lawsuit filed by Ms. H. Mercedes Clemens against the SBVME and the Maryland Board of Chiropractic Examiners. Ms. Clemens alleges that both the SBVME and the Board of Chiropractic Examiners have, through their regulatory authority, prevented Ms. Clemens from practicing equine massage in Maryland. The SBVME unequivocally has never interfered with Ms. Clemens’ right to practice massage on horses in Maryland and views this lawsuit against the SBVME as premature.
The SBVME does not regulate equine massage by nonveterinarians if the massage is intended solely for the purpose of helping the animal relax or generally feel better. The SVBME, however, has indicated in communication with the Chiropractic Board that a person engaging in equine massage may be in violation of the Veterinary Practices Act if the massage services offered are for the purpose of diagnosing and treating a specific ailment or injury of a horse. The SBVME, whose mission is to protect animal health and welfare, has the statutory authority to regulate the “practice of veterinary medicine,” which “includes the practice by any person who … diagnoses, advises, administers [an] … appliance, application or treatment of any nature, for the prevention, cure or relief of a wound, fracture, bodily injury or disease of an animal.”— Agriculture Article, § 2-301(f). If a person engaging in equine massage is “practicing veterinary medicine,” as defined, the person must be a licensed veterinarian. —Agriculture Article § 2-313(1).
Ms. Clemens’ lawsuit, however, does not contain a single allegation that she is offering—or advertising— her massage services for the purposes of treating or diagnosing disease or injury of horses. Thus, SBMVE regulatory oversight is not an issue at this time.
Unfortunately, the SBVME is not aware of any effort by Ms. Clemens, or her attorneys, to discuss her situation directly with the SBVME. As chairman, I would have been happy to meet with her in an effort to make the SBVME’s position clear and explain to her that she is not prohibited from massaging horses for the purposes she describes in her lawsuit.
Will She Drop the Law Suit?
Should Mercedes Clemens drop the lawsuit? The Institute of Justice, which is handling the case, immediately responded with a press release of its own (see equiery.com), in which it stated that it was pleased to
see that the Vet Board was “backpedaling” on its earlier position.
Here at The Equiery, we wanted to know what Ms. Clemens’ personal position was. And so we asked her.
Equiery: The Vet Board has now gone on the record as saying that it never asked you, specifically, to cease and desist your equine massage practice, and that it really has no problem with your equine massage practice. According to the Vet Board, it does not now, nor has it ever found you in violation of the Vet Practice act. Does this change your plans at all for the lawsuit?
Mercedes Clemens: Simply put, there will be no change to our lawsuit until there is a change to the law. The undated memo from Maryland Vet Board President Chris Runde was addressed to ALL Maryland licensed massage therapists, which is what I am. Runde unequivocally stated in the memo:
“There is no exclusion under this law to allow for…massage therapy… or other manual techniques on animals. Consequently, an individual who is not a licensed veterinarian who performs any of these procedures on an animal would be considered to be practicing veterinary medicine without a license.”
The memo makes no mention of exceptions to the statement, such as massage for “general relaxation” or for making an animal “feel better.” If that was the Vet Board’s view at the time, it should have been included in that memo. So no, the Vet Board’s recent statement backpedaling from their earlier position does not change our plans to proceed with the lawsuit against both the Vet Board and Chiropractic Board (which issued the “cease and desist” order). The Vet Board claims that it has “never interfered” with my equine massage practice. Their earlier statement is unequivocal—massage and other manual techniques are considered to be the practice of veterinary medicine. No exceptions. It is a document that the Chiropractic Board used as justification to shut down my animal massage business. That is pretty clear interference.
There are no exemptions in the veterinary practice act for licensed massage therapists or for massage and other manual techniques performed by non-veterinarians. Yet there remain exemptions in the act for more invasive procedures, such as equine dentistry, farriery, acupuncture and livestock management techniques.
Licensed massage therapists are not being treated equally under the law. There is no guarantee that the Vet Board’s current stated position will be the same one they hold a year from now. And the Chiropractic
Board, which relied on the Vet Board’s earlier statements to shut me down, hasn’t backed down from its position at all. So until the law is changed, I, along with other licensed massage therapists in Maryland, will remain under threat of losing our businesses.
The Vet Practice Act Needs To Change
David Butts is a certified equine dental technician, owner of the Libertytown-based equine dental practice The Horse’s Mouth, and vice president of the International Association of Equine Dentists.
The plaintiff’s position against the Vet Board is very legitimate from a working member of society’s viewpoint—particularly when that member is educated, certified and licensed.
It is my opinion that vet boards across America are less interested in the welfare of our animals and their owners than they are in their own bankrolls. The [American Association of Equine Practitioners, the American Veterinary Medical Association, the American Bar Association and the American Medical Association] are professional unions: They educate their members, but their major concern seems to be the economic welfare of their members, not the health of the animals/ people their members treat. Yes, it’s costly to go to vet school. But these folks are supposed to care about our horses and their health. They are not supposed to monopolize that care for economic reasons.
Most vets admit that their vet school education included barely one to three hours of time spent on horse dental matters. I doubt any vet would take his children to the family doctor to have dental care. So why, then, would a vet believe he or she is more qualified to work on horse’s teeth than an educated and certified equine dentist? The same can be said for an equine massage therapist or anyone educated, certified or licensed in a particular aspect of horse health care.
With fewer vet school graduates interested in working on horses, the current equine practitioner is already stretched thin. This situation will only worsen as the horse population continues to grow. Other individuals who are educated, certified and licensed in their horse health specialties will be needed to maintain horse health and free up vets to do the things only they have been trained to do, such as reproductive work, surgery, etc. The bottom line should be how a team of properly educated and certified individuals can best maintain the health of our horses, not greediness over the money spent on horse health care.
The Maryland Veterinary Practice Law needs to be changed.
(August 11, 2008)
Massage Lawsiut Hits National News
On Monday, August 11, the Associated Press (a newsfeed service for all media) issued a news release on the massage therapy lawsuit against the Maryland State Chiropractic Board. Look for interviews on ABC Channel 7 (link), CNN Radio (link), WBAL (link), and WTOP (link). To participate in the American Online poll click here.
(July 11, 2008)
Institute for Justice Replies to Vet Board Statement – by Bob Ewing (Institue for Justice)
ARLINGTON, VA (July 11, 2008) —In a statement released today, the Maryland State Board of Veterinary Medical Examiners backpedaled on its earlier position that only licensed veterinarians may perform animal massage in the state of Maryland. However, until the law is changed or struck down, animal massage therapists still cannot practice their craft freely.
The Veterinary Board’s statement was released in response to a lawsuit filed on June 10, 2008, by the Institute for Justice on behalf of Mercedes Clemens, a Maryland entrepreneur with a thriving massage practice in Rockville that, until recently, offered both human and animal massage. In addition to being a licensed massage therapist for people, Mercedes has more than 30 years of practical experience as a horse owner and rider, has been privately certified in equine massage, and has even taught animal massage to others.
“We are encouraged by the Veterinary Board’s statement, but until Maryland law is changed, entrepreneurs like Mercedes still cannot practice their craft without threats of prosecution,” said IJ Staff Attorney Paul Sherman. “We will continue to fight until Mercedes’ right to practice her chosen occupation is fully vindicated.”
In February 2008, the Maryland Board of Chiropractic Examiners—which licenses massage therapists—threatened Mercedes with criminal sanctions and the loss of her license to massage people unless she stops practicing animal massage and takes down the parts of her website offering the service. Included with a letter from the Chiropractic Board was a letter from the Veterinary Board in which the Board’s President, Chris H. Runde, stated that Maryland’s veterinary practice act encompassed “massage therapy . . . [and] other manual techniques on animals.” The letter also stated that, “an individual who is not a licensed veterinarian who performs any of these procedures on an animal would be considered to be practicing veterinary medicine without a license.”
But after Mercedes Clemens brought a lawsuit challenging the veterinary monopoly on animal massage, the Veterinary Board backpedaled. According to the Veterinary Board’s newly released statement, “[Ms. Clemens] is not prohibited from massaging horses for the purposes she describes in her lawsuit.”
“The Veterinary Board’s change in position simply acknowledges the obvious: limiting animal massage to licensed veterinarians makes no more sense than limiting human massage to medical doctors,” said IJ Senior Attorney Scott Bullock. “Animal massage is a skill that requires some hands-on training and common sense around animals but not four years of veterinary school at a cost of $150,000.”
Founded in 1991, the Virginia-based Institute for Justice has represented entrepreneurs nationwide who successfully fought arbitrary and unnecessary regulations. These cases include the landmark legal battle to open the interstate shipment of wine in which the U.S. Supreme Court struck down discriminatory state shipping laws that hampered small wineries as well as their consumers.
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(July 9, 2008)
Vet Board Responds to Lawsuit – statement by Maryland State Board of Veterinary Medical Examiners’ Chair, Chris H. Runde, D.V.M.
ANNAPOLIS, MD (July 9, 2008) – On June 17, 2008, the Maryland State Board of Veterinary Medical Examiners (“SBVME”) received a copy of the lawsuit filed by Ms. H. Mercedes Clemens against the SBVME and the Maryland Board of Chiropractic Examiners. Ms. Clemens alleges that both the SBVME and the Board of Chiropractic Examiners have, through their regulatory authority, prevented Ms. Clemens from practicing equine massage in Maryland. The SBVME unequivocally has never interfered with Ms. Clemens right to practice massage on horses in Maryland and views this lawsuit against the SBVME as premature.
The SBVME does not regulate equine massage by non-veterinarians if the massage is intended solely for the purpose of helping the animal relax or generally feel better. The SVBME, however, has indicated in communication with the Chiropractic Board that a person engaging in equine massage may be in violation of the Veterinary Practices Act if the massage services offered are for the purpose of diagnosing and treating a specific ailment or injury of a horse. The SBVME, whose mission is to protect animal health and welfare, has the statutory authority to regulate the “practice of veterinary medicine,” which “includes the practice by any person who…diagnoses, advises, administers [an] … appliance, application, or treatment of any nature, for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of an animal.” Agriculture Article, § 2-301(f). If a person engaging in equine massage is “practicing veterinary medicine,” as defined, the person must be a licensed veterinarian. Agriculture Article § 2-313(1).
Ms. Clemens’ lawsuit, however, does not contain a single allegation that she is offering—or advertising—her massage services for the purposes of treating or diagnosing disease or injury of horses. Thus, SBMVE regulatory oversight is not an issue at this time.
Unfortunately, the SBVME is not aware of any effort by Ms. Clemens, or her attorneys, to discuss her situation directly with the SBVME. As chairman, I would have been happy to meet with her in an effort to make the SBVME’s position clear and explain to her that she is not prohibited from massaging horses for the purposes she describes in her lawsuit.
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(July 1, 2008)
Massage Therapist Sues Vet Board – News and Views, The Equiery July print issue
Mercedes Clemens of Gaithersburg is not the first massage therapist to receive a cease and desist letter with threats of fines and more, but if she succeeds in court, she could very well be the last to receive such a letter.
It has become apparent to the staff of The Equiery that over the years, equine dentists and other non-veterinary animal wellness professionals have chafed under Maryland’s strict Code of Veterinary Practice, which essentially prohibits anyone from practicing any sort of animal physical wellness or therapy unless under the “direct” supervision of a licensed vet.
Under this code, certain health care professionals—such as farriers, individuals caring for their own horses, vet techs and acupuncturists—are exempt. Some dentistry is exempt, some not. Acupuncturists must be licensed to practice on animals by the State Board of Acupuncture as well as meeting other strict criteria within the Vet Code. Currently, the Maryland State Board of Chiropractic Examiners licenses massage therapists who work on humans. Mercedes Clemens notes in a June 10 press release and on her website that she is a licensed human massage therapist under the State Board, is privately certified in equine massage and is a Certified Equine Body Worker®. Unlike acupuncture, there is currently no license requirement for animal massage under the governing human board equivalent.
According to the website for the Institute for Justice (which is representing Clemens), as recently as September of 2003, the Maryland State Board of Veterinary Medical Examiners was on record as stating that it did not consider animal massage to be the practice of veterinary medicine, and therefore subject to regulation by the board, as long as massage therapists were careful to limit the claims they made about the benefits of massage. Clemens was scrupulous in ensuring that she made no false claims, and her website clearly states: “Massage and/or bodywork is used along with conventional and complementary health care as well as proper training techniques to enable a horse to perform at an optimum level. Massage or bodywork is NEVER a substitute or replacement for proper veterinary care. Horses should only receive massage and/or bodywork with veterinary consultation and approval. I am trained to work as part of a comprehensive health care team.”
In the last five years, however, the Vet Board appears to have reversed itself, and is now working in conjunction with the State Board of Chiropractic Examiners to shut down animal massage therapists (more on how they are working together will appear in the next issue). According to Clemens, “Both Boards [the Vet Board and the Maryland Board of Chiropractic Examiners] made their positions absolutely clear. I was informed by the Chiropractic board that if I continued my animal massage practice, I would face immediate revocation of my license to practice massage therapy on humans. The Veterinary board stated that licensed human massage therapists who practiced animal massage would be considered to be practicing veterinary medicine and would face criminal prosecution.”
This is not the first incidence of The State Board of Veterinary Medical Examiners sending cease and desist letters to “alternative” care professionals, including dentists; both The Equiery and the Maryland Horse Council have been contacted by health care practitioners who have received such letters. In the case of massage therapists, we have learned that they are often able to quickly resume practice by deleting a word or two from their marketing and including some sort of disclaimer (those therapists have been invited to share their stories in future issues).
Over the years, the MHC and other organizations have been asked to lobby to modify the regulations, a lengthy and often grueling process. Other than the accupunturists, who lobbied for their own modifications to the law, Maryland’s other complementary and alternative equine health care professionals are still working to organize themselves so they can present a cohesive proposal and one voice.
Clemens has decided to take a different approach: Rather than attempting to amend the law, she is suing the State Board of Veterinary Medical Examiners and the Board of Chiropractic Examiners for violation of her constitutional rights. “The Maryland Constitution protects my right to earn an honest living free from unreasonable regulations,” she explains. “That’s why I’ve joined with the Institute for Justice, a national public interest law firm with a history of defending economic liberty, [and why] we filed a lawsuit through the Montgomery County Circuit Court in Rockville, challenging Maryland veterinarians’ unconstitutional monopoly on animal massage.”
Will Clemens’ suit succeed in overturning Maryland vet law? Or is this a beginning of a dialogue that will ultimately amend the law?
Mercedes Clemens is a co-founder of The Equiery and was its art director for 15 years before retiring to practice massage.