2011 FVMA Advocate Issue 4

F V M A ADVOCATE Issue 4 - 2011

Proposed U.S. Prescription Mandate House Bill 1406 May See Movement in Senate page 14

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PRESIDENT’S MESSAGE 7 131 Lake Ellenor Drive Orlando, Florida 32809 Phone – (407) 851‑3862 Toll Free – (800) 992‑3862 Fax – (407) 240‑3710 info@fvma.org www.fvma.org

OFFICERS Dr. James A. Kanzler President Dr. John Bass President-Elect Dr. Richard B. Williams Treasurer Dr. Jan Hasse Past President Mr. Philip J. Hinkle Executive Director

DISTRICT REPRESENTATIVES Dr. Charles P. Hall District 1 - Big Bend Dr. Richard C. Sutliff District 2 - Northeast Dr. Jerry L. Rayburn District 3 - Central Dr. Donald H. Morgan District 4 - Tampa Bay Dr. Mark D. Dew District 5 - Treasure Coast Dr. Ronald W. Todd Jr. District 6 - South Florida Dr. Richard M. Carpenter District 7 - Southwest Dr. Michael Epperson District 8 - Northwest Dr. Christine M. Storts District 9 - Space Coast Dr. Ernest C. Godfrey AVMA Delegate Dr. Stephen Shores AVMA Alternate Delegate Dr. Corey Miller FAEP Representative to the FVMA Executive Board Ex Officio Dr. Glen F. Hoffsis, Dean College of Veterinary Medicine

FVMA STAFF Brenda Eggert Brader Communications & Public Relations Director Sandra P. Brooks Accounting/Membership Director Amber Coon Executive Administrative Assistant Ralph E. Huber Industry Relations Director Erin Pratt Meeting & Events Coordinator Beni Jean Price Financial/Membership Coordinator Kevin R. White Multimedia Art & Design Director

2 | FVMA ADVOCATE

The FVMA Industry Advisory Council met in September at the Florida Hotel in Orlando. I was privileged to join the members who represent pharmaceutical companies, manufacturers and service providers allied with veterinary medicine.

The council is designed to be a sounding board for issues which impact the relationship between industry and vet‑ erinarians. We need their products in order to care for our patients, and they need us to utilize their goods and services so they can continue to develop and improve those products.

Those of us who own practices understand that there is more to this re‑ lationship than just business. Our distributer representatives and technical specialists are an invaluable source of advice and education. They can be an integral part of your practice.

When I started my practice on a shoestring more than 30 years ago, “sales‑ men,” as we called them then, offered lines of credit and special pricing.

They also provided advice about what I needed and what I did not need to get my practice going. More importantly, they contributed enthusiasm and encouragement.

Maybe I have been especially fortunate, but the folks who call on me at my office have been capable, sincere and knowledgeable. They always seem to have my best interests in mind as well as what’s best for my patients and clients.

They invariably become friends who I enjoy seeing on a regular basis.

Outside of our direct relationship, our IAC members also support our pro‑ fession by funding continuing education and marketing our services. They are major sponsors of FVMA activities as well. We are extremely fortunate to have so many good people and companies supporting our profession.

To give ourselves some credit, there has to be a reason so many people stay in this industry. I have heard more than once, that veterinarians are easy to deal with. We are generally accessible, open to advice and most of us pay our bills promptly and responsibly.

So, this symbiotic relationship has been very successful. Let’s hope this continues. We need to do our part and remain accessible, be open to their sug‑ gestions and give their products honest consideration. It can only improve our ability to offer the best care to our patients.

James A. Kanzler, DVM FVMA President

IN THIS ISSUE

14

3 | Longtime Department Chair Dr. Colin Burrows Retires

6 | FVMA Annual Awards Call for Nominations 8 | Cyanotoxins and the Health Impacts on Pets, Livestock, and Wildlife

14 | Proposed U.S. Prescription Mandate House Bill 1406 May See Movement in Senate

16 | One Health 18 | Florida Pill Mill Legislation 22 | The FVMA’s Industry Advisory Council –

A Harmonious and Important Partnership

27 | Classified Advertisements

Longtime Department Chair Dr. Colin Burrows Retires

A

fter more than 30 years at the UF College of Veterinary Medicine where he migrated from clinics to administration, expanded and fine tuned clinical services and relationships with practi‑ tioners and industry representatives alike, Dr. Colin Burrows has finally bid the college farewell.

His retirement from the chairmanship of the college’s department of small animal clinical sci‑ ences was effective July 1, exactly eight months after the official grand opening of the new Small Animal Hospital he helped to develop and oversee.

“Right up until the very end, Colin was work‑ ing and making sure things were getting done that needed to get done,” said the college’s dean, Dr. Glen Hoffsis, during a party held June 25 in Burrows’s honor in conjunction with the traditional reception held after the college’s annual Referring Veterinarian

Appreciation Day. “A lot of people would have coasted, but not him.”

Burrows’s family, including his son, Alex; daugh‑ ter-in-law Elaiza, and his wife, Joyce, were present at the party, along with many friends and colleagues from all over the state and beyond.

“This is ‘Mr. Veterinary Medicine’,” said Dr. Doug Mader, a renown zoological medicine specialist and immediate past president of the North American Veterinary Conference. “All over the world, people know him.”

Burrows has been invited to speak in more than 50 countries and said he had learned a lot from his many friends in veterinary medicine around the globe. He has won numerous awards as well from key profes‑ sional groups and has been specifically recognized by his peers for his contributions to international veterinary medicine. continued on p. 4 www.fvma.org | 3

Although Burrows intends to remain very active on the veterinary scene, both through his continuing and longtime role as executive director of the NAVC and in his new appointment as vice president of the World Small Animal Veterinary Association, he leaves the college with mixed emotions.

“I’m lucky I’m not going into a vacuum, as I have the NAVC and the WSAVA to keep me busy,” he said.

“I’ve always said, you don’t retire ‘from,’ you retire ‘to.’ But it’s a strange feeling.”

A graduate of the Royal Veterinary College at the University of London, Burrows received his Ph.D. from the University of Pennsylvania and as a clini‑

cian, specialized in canine and feline gastrointestinal, hepatic and pancreatic disease. Although he left clinic duty behind for the most part when he began his position as department chair at UF in 1996, Burrows always stayed abreast of the latest information in his field, sharing articles of interest he would find in professional journals with faculty colleagues.

But when he arrived at UF in 1980, he never thought he’d stay as long as he did.

“Back then they called UF ‘Penn South and Davis East’ because almost half of the original clinical faculty had been recruited from Penn and Davis,” Burrows recalled, adding that at the time, UF was a new school, finding its way.

He looked forward to coming to UF to work with his old pal and mentor from the University of Pennsylvania, Dr. Al Merritt, an equine gastroen‑ terologist now retired from UF’s faculty, and his friend Richard Halliwell, who was then department chairman. Years later, in 1996, Burrows accepted that position, following the death of Dr. Mark Bloomberg.

As chairman, Burrows oversaw both department and small animal hospital operations, since up until last year, the chairman’s duties also included serving as chief of staff of the small animal hospital.

Burrows’s contributions to college life are too many to list, but include creating and strengthening the Visiting Practitioner Program, through which veterinary practitioners spend time at the college learning more about areas of interest to them; the re‑ ferral liaison positions, which strengthen communi‑ cation and relationships with the referral community; the client advocate program, through which commu‑ 4 | FVMA ADVOCATE

nity volunteers provide assistance to hospital clients; the Referring Veterinarian Appreciation Day; and the shelter medicine program, which provides a key link to the local animal shelter and provides students with valuable clinical experience performing spay and neuter surgeries in the Merial clerkship. That program has now expanded to perform statewide outreach and with inroads into forensic medicine with support from Maddie’s Fund.

Many international students, residents and prac‑ titioners were also given opportunities to learn and contribute to life at UF, thanks to Burrows’ s support and wide network of connections.

“That is one of the things I’ve really learned over the years, and through NAVC as well; it’s all about relationships and communication with industry and with referring veterinarians,” Burrows said. “I’ve had a sixth sense for the importance of that over the years that has been developed over time. PR and marketing are different, but related. I learned the importance of marketing the college and hospital over the years.”

Burrows said he was proud of the clinical services developed under his aegis in cardiology, oncology, emergency medicine and critical care, and of the acupuncture and rehabilitation service. All of these programs continue to grow, many due to support from donors and friends who have strengthened their bonds with the college through Burrows’ s involve‑ ment. His industry contacts also included represen‑ tatives of the Florida Association of Kennel Clubs, a group which has provided scholarship support to the college. Speaking of scholarships, Hoffsis an‑ nounced that a student scholarship has been created in Burrows’ s honor with almost $80,000 donated thus far.

“The opening of the new hospital last fall certainly helped us turn around the declining caseload that was driven by the economy,” Burrows said. “The associated publicity made more people aware of our existence than before and I think the excitement surrounding the grand opening gave us a big lift.

Opening a comprehensive 24-hour emergency service also helped.

But despite the fancy new building and the excite‑ ment it engendered, in the end Burrows said that’s not what, for him, it’s all about.

“It’s not bricks and mortar that makes a great place,” he said. “It’s the people who work there.”

Editor’s note: To make a contribution to the Colin F. Burrows student scholarship, contact Karen Legato, senior director of development and alumni affairs, at (352) 294-4256 or email her at legatok@ufl.edu.

Article courtesy of Sarah Carey, Director of Public Relations, University of Florida College of Veterinary Medicine.

DR. LEONARD FOX / OWNER ANIMAL HOSPITAL OF WEST PORT ST. LUCIE VETERINARY HOSPITAL PORT ST. LUCIE, FL SINCE 2008 7 EMPLOYEES

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By BRENDA EGGERT BRADER Communications and Public Relations Director

E

ach year, the Florida Veterinary Medical Association conducts an Awards Ceremony to honor out‑ standing members and individuals whose service has contributed significantly to ad‑ vancing veterinary medicine or the status of the profession. The awards and the ultimate presentation hold considerable significance within the organization. It is an honoring of their peers and colleagues in recognition of their careers, achieve‑ ments and contributions.

Nominations for the various awards may be made by any FVMA member or local veterinary medical association or society. Each nomination is considered and selected by the FVMA Awards Committee that is chaired, each year, by the immediate past-president. Chair this year is Dr. Jan Hasse.

All award winners will be invited to attend the annual Awards Ceremony held during the FVMA’s 83rd Annual Conference in Tampa on Friday, May 4, 2012.

The categories for awards bestowed by the Association and for which nominations are needed are as follows: Gold Star Awards – To be awarded to members who have contributed much of their time and energy to the Association and/or local association for the advance‑ 6 | FVMA ADVOCATE

ment of Veterinary Medicine and the pro‑ fession. In any given year, no more than two percent of the total membership may be awarded a Gold Star. To be eligible for this award, the nominee must have been an active member of the association for at least the past three years.

Veterinarian of the Year – To be awarded to a member for distinguished and unselfish dedicated service to the Association for the advancement of Veterinary Medicine and the profession.

To be eligible for this award, a nominee must have been an active member of the Association for at least the past 10 years.

Lifetime Achievement Award – To be awarded to senior active or retired members who have made outstanding contributions to the association and the Veterinary Medicine. To be eligible for this award, a nominee must have been an active or retired member of the Association for the last 30 consecutive years and must be at least 65 years old. In exceptional cases, the service requirement may be reduced to 25 years.

Distinguished Service Award – This award is given for exceptional achieve‑ ments and contributions by a member towards the advancement of Veterinary Medicine and the Profession. To qualify, a member must demonstrate that he/she has been fully dedicated to Veterinary

Medicine and given time and energy beyond reasonable expectations. To be eli‑ gible for this award, a nominee must have been an active member of the Association for at least the past 15 years.

Citizen of the Year – This award is to be awarded to any non-veterinarian who has made an outstanding contribution to the advancement of the Association and Veterinary Medicine.

Pet Hero – There will be one in‑ ductee selected for one of the following categories: 1. HERO – Pets who have unself‑ ishly saved or preserved human life (non-professional).

2. COMPANION – Pets who have provided a benefit and contributed to the quality of life and their human companions.

3. PROFESSIONAL – Specialty train‑ ing as a physically challenged person’s assistance animal or used in law enforcement.

Certified Veterinary Technician and Team Member of the Year – These two awards recognize the many outstanding contributions made by Certified Veterinary Technicians (CVT) or any other special team member to the overall success of the veterinary practice operated or staffed by an FVMA-member veterinarian. The criteria for nomination requires that the individual be a full-time employee of an FVMA-member practice for a minimum of three years and demon‑ strate the following: • CARING – Provides animal health care services in a compassionate and clinically appropriate manner.

• COMMITMENT – Works in sup‑ port of the employing veterinarian to achieve a high level of client satisfac‑ tion and established annual perfor‑ mance goals of the veterinary practice.

• LEADERSHIP – Assumes a leadership role in creating and maintaining an efficient and highly motivated animal health care services delivery team among all employees.

• EDUCATION – Regularly strives to further develop his/her knowledge and skills by participating in continu‑ ing education seminars, formal study at a junior college or university or by understanding self directed study through journals, online programs, etc.

Nominations may be placed in the following manner:

A separate form must be completed for each nomination.

Forms may be found at www.

FVMA.org website. The form(s) needs to be selected, printed, filled out and faxed or mailed to the FVMA Awards Committee, Dr. Jan Hasse, Chairman, by Jan. 13, 2012.

The committee will announce the 2012 award recipients on March 23, 2012. Address, fax number and complete instructions are provided on each form. Past years’ award recipients may be viewed on the FVMA website.

FVMA members and member associations are reminded to submit their nominations by Friday, Jan. 13, 2012. Questions on the nomination procedure should be directed to Brenda Eggert Brader, Communications and Public Relations Director, at bbrader@ FVMA.org or call (800) 992-3862. www.fvma.org | 7

Cyanotoxins and the Health Impacts on Pets, Livestock, and Wildlife Becky Lazensky, MPH; Andrew Reich, MS, MSPH; Dr. Stanek, DVM; and Dr. Blackmore, DVM, PhD

Survey The Florida Department of Health (FL-DOH) Aquatic Toxins Disease Prevention Program is conducting a short survey of veterinarians to assess how often cyanobacteria-related illnesses occur in pets, livestock, and wildlife. The goal is to increase awareness of cyanobacteria-related illness in do‑ mestic animals, collect data on past cyanobacteria illness reports, and assess whether domestic animals are a good surrogate for cyanobacterial exposures in humans.

The results of this survey will be used to plan future activities aimed at both increasing case report‑ ing and for developing response efforts such as water testing, posting signs in impacted areas, and further educating pet and livestock owners and veterinarians on the harmful effects of cyanotoxins. You may assist in these efforts by participating in a brief 5-10 minute internet survey, by clicking on the following link: http://www.surveymonkey.com/s/6M3ZGRC. If you have any questions about the survey or cyanobacte‑ ria-related illnesses, you may contact Becky Lazensky, MPH, at (352) 955-1900.

To report any illness from an exposure to harmful algal blooms in animals or people, the toll-free Aquatic Toxins Hotline of the Florida Poison Information Center is available 24/7 at 1-888-232-8635.

8 | FVMA ADVOCATE

Background With more than 7,700 lakes, 27 springs, 1,197 miles of coastline, and 11,000 miles of rivers, streams and waterways, there are numerous opportunities for humans and animals to have contact with Florida waters1. Typically, these interactions occur without consequence, but it is important to acknowledge the ongoing risks presented by cyanobacteria, commonly referred to as pond scum or blue-green algae. Florida lakes, rivers, ponds, streams, canals, ditches, lagoons, and marine waters can all host cyanobacteria blooms.

Some cyanobacteria species produce dermatotox‑ ins, hepatotoxins, neurotoxins, endotoxins, and cytotoxins6.

Cyanobacteria and the Environment

Cyanobacteria are members of the monera king‑ dom, which contain some of the most ancient life forms on the planet, with fossils dating back 3.5 bil‑ lion years2. They have withstood some of the earth’s most drastic weather conditions, including high tem‑ peratures and acidic environments. These chlorophyll containing prokaryotic bacteria form either single or multi-cellular colonies. By self-producing energy through photosynthesis, they contribute a large sum of fixed nitrogen to the planet. Cyanobacteria have characteristics of both plants and bacteria with cell division and structure similar to bacteria, and

photosynthetic properties comparable to plants and algae2. Recently, they were reclassified as bacteria and removed from the eukarya (algae) domain.

Cyanobacteria can produce an array of toxins.

More than 46 species are known toxin-producing strains; more than 60% of blooms sampled in past studies were found to contain at least one toxic species3. Toxins include known hepatotoxins, with Microcystis being the most common cyanobacteria associated with liver disease in human and live‑ stock 3. Statewide, microcystin, anatoxin-A, and cylindrospermopsin can also be found and each has been previously isolated in Florida surface waters4.

Although it is difficult to predict when cyanobacteria blooms will occur, researchers report a combination of variables which impact bloom formation includ‑ ing “light, temperature, percent oxygen saturation, nutrient availability and depletion, wind patterns, internal lake mixing, growth stage and zooplankton predation2.”

Marine toxins are also associated with negative health effects in both human and animals. Karenia brevis, the marine dinoflagellate which causes redtide blooms, produces a neurotoxic brevetoxin able to trigger a wide-range of health symptoms. In 2003 a red-tide bloom in Little Gasparilla Island prompted the veterinary treatment of 8 dogs following a beach exposure11. Symptoms such as seizures and gastroin‑ testinal illness were reported.

Microcystis Aeruginosa Cell – Photo Courtesy of Dr. Jake Kann. Source: http://www.klamathwaterquality. com/images/Microcytis_cell_close_up.html

Anabaena Cell – Photo Courtesy of Lang, Krupp, and Koller Source: http://genome.jgi-psf.org/anava/anava.home.html

Florida’s climate and water systems create many opportunities for cyanobacteria blooms to occur and persist in the environment. The state’s year-round warm water temperatures are conducive to cyanobac‑ teria growth and bloom formation. Late summer and early fall are the seasons when cyanobacteria blooms are more common, although Florida’s climate allows some blooms to persist beyond this typical season.

Shoreline areas are more likely to be impacted by cyanobacteria and are often the areas where more people and animals are likely to spend time while in the water. Toxin water concentrations do not cor‑ respond neatly with the amount of algae that can be visually detected, resulting in difficulty in assessing the level of cyanotoxins present by visual assessments alone. Additionally, identifying a cyanobacteria bloom is challenging because blooms can be pres‑ ent with a range of colors including brown, red, and green shades6. Surface scum can result from a variety of sources, including cyanobacteria, which further limits the ability discern the nature and composition of the bloom by visual assessment alone.

Historical Significance

Cyanobacteria-related illnesses have been re‑ ported globally, with all continents affected. Written accounts of cyanobacteria-related illnesses date back 49–37 million years ago from the Middle Eocene epoch8, establishing the historical significance of algal blooms. Mass mortality events in the literature involving birds, livestock, and dogs suggest that a range of animals are susceptible to cyanotoxin poisoning. One well-documented poisoning event reported in 1878 and attributed to cyanobacteria resulted in sheep, horse, and dog fatalities near Lake Alexandrina, a freshwater lake at the mouth of the Murray River in Northern Australia4.

www.fvma.org | 9

Recent events include the deaths of three dogs who consumed water at a beach near Dauphin Lake in 19964. Anabaena was isolated from water samples4.

Anabaena was also identified in water samples fol‑ lowing 16 cattle and 1 dog fatalities associated with a creek in Manitoba during the same year4. In 2009, the California North Coast Regional Water Quality Control Board issued a press-release after a dog died following exposure to a cyanobacteria bloom5.

A total of 11 dog fatalities were investigated by the California Department of Public Health from 2001 to August 2009. For a more comprehensive summary of the documented animal mortalities associated with cyanobacteria, see table 4.1 at: http://www.who.int/ water_sanitation_health/resourcesquality/toxcyanc‑ hap4.pdf3.

Preventing Cyanobacteria Blooms

Although the literature affirms the long history of cyanobacteria blooms, it also suggests increasing cyanobacteria events in recent years. Eutrophication or the process of adding nutrients to water can occur when nitrogen and phosphorus find their way into surface water from agricultural applications and home fertilizer use6. “Run-off” has been shown to increase the frequency and duration of cyanobac‑ teria blooms. To reduce the chance a cyanobacteria bloom will occur, homeowners should prevent lawn clippings and debris from entering storm drains, maintain vegetation barriers around their yard to filter water, reduce excess fertilizer usage, and use phosphorus-free fertilizers and dish detergents whenever possible6. Herbicides and algaecide can lyse cell walls, causing the release of cyanobacteria cell contents. Therefore the use of these products to treat surface water should also be minimized.

Health Effects

Exposure to cyanotoxins can cause severe and even life-threatening illness in pets, livestock, and wildlife. If cyanotoxins are present in water they can cause illness in pets and people when contaminated water is ingested or through dermal contact when swimming. Cyanotoxins can affect the nervous and gastrointestinal systems, the liver, and serve as tumor promoters.

Animals that swim in water with “pond scum” present may experience symptoms ranging from in‑ creased salivation, loss of appetite, skin rashes, ataxia, weakness, vomiting, diarrhea, numbness/tingling, difficulty breathing, cardiovascular abnormalities, convulsions, loss of consciousness, and death, often with little time for intervention. Increased salivation can begin within 15-20 minutes following exposure,

10 | FVMA ADVOCATE

and should be monitored as a sign of neurotoxin exposure2. Cylindrospermopsin produced hepatotox‑ ins have been associated with tissue necrosis and liver failure in animals4. Nodularins have been identified as tumor promoters and hepatotoxins4.

Table 1: Symptoms Associated with Cyanotoxin Exposure in Animals

TOXIN

SYMPTOMS

Microcystis

Jaundice, shock, abdominal pain/distention, weakness, nausea/vomiting, severe thirst, rapid/weak pulse, and death.2

Saxitoxin/ neosaxitoxin

Weakness, staggering, loss of muscle coordination, difficulty in swallowing, labored respiration, muscle paralysis, and death2.

Anatoxin-a

Muscle tremors, rigidity, lethargy, respiratory distress, convulsions, and death13.

Anatoxin-a(s)

Salivation, urination, lacrimation, defecation, tremors, dyspnea, convulsions, and death13.

Nodularin

Lethargy, vomiting, loss of appetite, and death15.

Cyanotoxin ingestion can occur when animals drink water containing cyanotoxins, when they clean or lick their fur, or when they consume algal mats.

Pets that did swim in water with an algae bloom should be immediately washed before they have a chance to lick their fur. Because of their relatively smaller size and body weight, some animals can suffer greater adverse health effects after ingesting, inhaling, or having dermal contact with cyanotoxins.

Some toxins such as microcystins may persist in the water for weeks after a bloom has disappeared, there‑ fore it is good practice to keep people and pets out of the water during and after a bloom2. There is no way to know if a cyanobacteria bloom is toxic without testing a sample in a laboratory, although some field test strips offer a promising tool.

RECOMMENDATIONS

washed with clean water quickly before they have a chance to lick their fur.

Pets, domestic livestock, and wildlife should not swim in or drink water where an algal bloom, discolored water, or foam is present. Remember, algal blooms can be present in shades of bright green, brown, red, orange, purple, and yellow or other colors. Sometimes algal blooms are reported to resemble spilled paint in the water due to their bright colors.

;; Treatment for cyanobacteria-related illnesses in pets is supportive with activated charcoal gavage cited as a potential treatment for gastrointestinal illness and/or other symptoms7.

;; Pet owners should report any severe illness to their veterinarian immediately.

;; Biomarker testing is available to analyze blood or urine specimens from live animals or tissue samples from deceased animals.

;; Pets that have been exposed to a bloom should be

;; Cyanotoxins are excreted from the body rapidly; pets that survive the first few days of their illness typically recover fully.

References 1. State of Florida: (Figure includes lakes greater than 10 acres and first magnitude springs) http://www.stateofflorida.com/Portal/ DesktopDefault.aspx?tabid=95 2. Washington State Department of Health: http://www.doh.wa.gov/ ehp/algae/default.htm • http://www.doh.wa.gov/ehp/algae/toxinsym.htm 3. World Health Organization: http://www.who.int/water_sanitation_health/resourcesquality/toxcyanchap4.pdf • http://www.who.int/ water_sanitation_health/bathing/srwe1-chap8.pdf 4. Florida Department of Health Aquatic Toxins Disease Prevention Program: http://www.doh.state.fl.us/environment/medicine/aquatic/ cyanobacteria.htm • http://www.doh.state.fl.us/environment/medicine/ aquatic/pdfs/Cyanobacteria_200208_Pgs037-073.pdf 5. California Department of Public Health: http://www.cdph.ca.gov/ healthinfo/environhealth/water/pages/bluegreenalgae.aspx • http:// www.cdph.ca.gov/HealthInfo/environhealth/water/Documents/BGA/ RegionalBoardBGAPressRelease-08-2009.pdf 6. Wisconsin Department of Natural Resources: http://dnr.wi.gov/ lakes/bluegreenalgae/ 7. Oregon Department of Health: http://oregonvma.org/care-health/ blue-green-algae-hazard-dogs • http://oregonvma.org/files/WaterSafety-for-Dogs.pdf

8. Environmental Protection Agency: http://www.epa.gov/cyano_ habs_symposium/monograph/Ch28.pdf 9. University of Berkeley: http://www.ucmp.berkeley.edu/bacteria/ cyanolh.html 10. Centers for Disease Control and Prevention (CDC): http://www. cdc.gov/hab/cyanobacteria/default.htm 11. Fish and Wildlife Research Institute Technical Reports. Resource Guide for Public Health Response to Harmful Algal Blooms in Florida. Available at: http://www.myfloridaeh.com/medicine/aquatic/ resourceguidepublichealth.pdf 12. University of Maryland Center for Environmental Science: http:// ian.umces.edu/pdfs/ian_brochure_265.pdf 13. Environmental Protection Agency: http://www.epa.state.oh.us/ portals/35/inland_lakes/OhioVeterinaryAssociationArticle40910%20. pdf 14. World Health Organization. Toxic Cyanobacteria in Water: A guide to their public health consequences, monitoring and manage‑ ment: http://www.who.int/water_sanitation_health/resourcesquality/ toxicyanbact/en/ 15. Environmental Protection Agency: http://www.epa.gov/cyano_ habs_symposium/monograph/Ch28.pdf

www.fvma.org | 11

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FEATURE

Proposed U.S. Prescription Mandate House Bill 1406 May See Movement in Senate

By BRENDA EGGERT BRADER Communications and Public Relations Director

The proposed House bill requires a veterinarian to: • Write a prescription whether or not he/she will dispense the product; • Provide a written disclosure notifying clients that they may fill the prescriptions at the veterinary clinic or at an off-site pharmacy; • Verify a prescription electronically or by other means consistent with applicable state law. This means a requirement for veterinarians to verify prescriptions electronically, regardless of the licensure or accreditation status of the online pharmacy.

14 | FVMA ADVOCATE

T

HE ORIGINAL HOUSE BILL CONTINUES to be in the House subcommittee, but efforts are under way to introduce similar legislation in the Senate.

“As yet, there is not a lead to sponsor the Senate bill,” Dr. Morgan said, “But the issue is out there and there will be Senate legislation by the end of the year. Wal-Mart has been pushing it on the Senate side. The ASPCA wrote a letter in support of the bill in July 2010, but we have not heard from them since.

“We also have heard that Wal-Mart is planning to hold an educational briefing on the issue for the Hill (congressional) staff,” Dr. Morgan said. “Now it is an animal welfare issue.”

BACKGROUND

The bill or resolution was assigned to a congressional committee on April 6, sponsored by Rep. Jim Matheson (D-Utah). The House Committee on Energy and Commerce referred it to the Subcommittee on Health, where it has remained.

This is the first set in the legislative process. Introduced bills and resolutions first go to committee that deliberate, investigate and review them before they go to general debate.

The majority of bills and resolutions never make it out of committee.

On Sept. 26, the AVMA sent a Call to Action to its mem‑ bers in response to the legislation. The Florida Veterinary Medical Association sent an email to its membership at that time because Wal-Mart launched an aggressive campaign of support aimed at their customers, urging them to take action and call on Congress to require mandatory prescrip‑ tion writing by passing the Fairness to Pet Owners Act of 2011.

THE PROPOSED HOUSE BILL REQUIRES A VETERINARIAN TO:

• Write a prescription whether or not he/she will dispense the product; • Provide a written disclosure notifying clients that they may fill the prescriptions at the veterinary clinic or at an off-site pharmacy; • Verify a prescription electronically or by other means consistent with applicable state law. This means a requirement for veterinarians to verify prescriptions electronically, regardless of the licensure or accreditation status of the online pharmacy.

IN ADDITION, THE VETERINARIAN MAY NOT DO THE FOLLOWING:

• Require the purchase of the drug from the prescriber or from another person; • Charge a client a fee for writing a prescription as part of (or in addition to) the fee for examination and evaluation of a pet; or • Require a client to sign, or supply a client with, a waiver or liability disclaimer should the prescription be inaccu‑ rately filled by an off-site pharmacy.

CALL YOUR CONGRESSIONAL LEGISLATORS

The AVMA is now urging veterinarians to call their congressional legislators from Florida to encourage them to NOT support any legislation that would mandate veterinar‑

The AVMA, as well as the FVMA, have always been supportive of a client’s right to choose where he/she has their prescription filled, and clients already have the flexibility to fill a prescription at their veterinary clinic or off-site at a pharmacy of their choice. ians to write out prescriptions – something veterinarians already do.

“We are hearing reports from congressional offices that their constituents are calling in support of the House bill,” Dr. Morgan said.

The AVMA cautions veterinarians to not become frus‑ trated or embarrassed if their legislator, when contacted, is not familiar with the issue. Not all legislators are aware of the issue.

“It is out there and your telephone call may be the first time your legislator has heard of the issue,” Dr. Morgan said.

“But because of your contact, he (or she) will recall your con‑ versation when that legislation does come before him.”

The AVMA, as well as the FVMA, have always been sup‑ portive of a client’s right to choose where he/she has their prescription filled, and clients already have the flexibility to fill a prescription at their veterinary clinic or off-site at a pharmacy of their choice.

The AVMA urges members to stress the following reasons to their U.S. Representatives and Senators for requesting the bill’s dismissal: • The AVMA believes this bill is redundant and will cause undue regulatory and administrative burdens on veterinary practices. It is burdensome and unnecessary to require a written prescription be provided, as well as written notification that the prescription may be filled elsewhere. This would be required even if the client wants to have the prescription filled at the veterinary clinic.

• The provision requiring verification of prescriptions, regardless of whether the pharmacy is accredited or li‑ censed, places the veterinarian in both a legal and ethical dilemma. At the same time, it puts consumers at risk.

• HR 1406 encroaches on state jurisdiction; state pharmacy and veterinary practice laws that already govern compli‑ ance by veterinarians.

The FVMA, with the AVMA, believes that veterinarians are uniquely trained to provide the best professional guid‑ ance and education to pet owners when dispensing prescrip‑ tion products.

Over the next month, the AVMA Governmental Relations Division Staff will be contacting state veterinary medical associations and other key stakeholders to join a coalition in opposition of the legislation.

“We will be sending a letter to members of Congress outlining the coalition’s concerns,” Dr. Morgan said. “We strongly urge every state VMA and other associations to send a letter to their state’s federal congressional delegation in the House and Senate in opposition of this legislation.” www.fvma.org | 15

By BRENDA EGGERT BRADER Communications and Public Relations Director

One Health

16  |  FVMA ADVOCATE

One Health is a relatively new term, but the actual concept has been around since ancient times.

One Health is the recognition that human health is impacted by the animals, plants and humans interacting within the environment.

Because animals suffer from many of the same chronic diseases as heart disease, cancer, diabetes, asthma and arthritis as humans, sometimes a disease entity is recognized in animals long before it is rec‑ ognized in humans, according to a 2008 article in the American Veterinary Medical Association publication, JAVMA. The Florida Medical Association House of Delegates formed a resolution in July citing collabora‑ tion among human medicine, veterinary medicine and the environmental sciences (One Health).

Among the several decree points cited in the AMA Resolution, main points include: The health of people, animals and the environment are interrelated.

That important psychosocial effects of the human-animal bond exist and the majority of households include at least one animal.

Infectious diseases are recognized including bioterrorist agents, and zoonoses diseases affecting both people and animals.

By their very nature, the fields of human medicine, veterinary medicine, and the environmental sciences are complementary and synergistic in confronting, controlling and preventing zoonotic diseases from infecting across species.

Many chronic health problems, such as cancer, diabetes and obesity, are shared by people and their companion animals.

Environmental health hazards may be shared by people and animals including toxicants, allergens and psychosocial issues.

An initiative called “One Health” exists to improve the lives of all species through the integration of human medicine, veterinary medicine and the environmental sciences.

One Health aims to promote and implement close and meaningful collaboration/communication among human medicine, veterinary medicine and environmental sciences professionals with goals of improving the public’s health and the efficacy of disease.

“This (One Health Concept) has been revived a number of times, and in a wave, if you will, surfaces again, hopefully to last this time” said Dr. Carina Blackmore, Florida State Public Health Veterinarian who works with animal diseases from a human health perspective. “I think bioterrorism attacks and some of the natural disasters that we have had, have brought people together outside the traditional areas of zoonotic disease prevention where this concept is obvious. People recognize the value of the collabora‑ tive efforts and this is the opportunity to formalize those relationships in training and education of the larger groups in practice, as well.”

Dr. Blackmore cites the 2009 outbreak of the novel H1N1 flu virus where “we realized rather quickly, that it was not an isolated event that people in California got sick from the new virus. The event was traced through an outbreak in Mexico and back to the United States. Also, despite being of animal origin, the H1N1 wasn’t as much a livestock disease as a human issue that occasionally spilled over to animals.

The outbreak helped the USDA recognize the need to further increase their capacity to deal with problems other than the traditional program diseases they have worked on for a long time like tuberculosis; and they have since modified their strategic plan to ac‑ commodate work on emerging One Health diseases.

They realized they needed to enhance their ability to respond to the unexpected.”

Not a formalized group in Florida, Dr. Blackmore says that it would be a good idea to “strengthen the formal (One Health) among the three medical professional groups in the state, the FVMA, FMA and the health department. The AVMA and the American Medical Association (AMA) are members of a One Health national commission where they are represented together with public health and wildlife experts. In an example for the obvious need for the associations to work together, she relates the issue of pain medication abused as drugs.

“Some of those drugs are also available to vet‑ erinarians,” Dr. Blackmore said. “Any restrictions to the human side may also impede access to the veterinarians.

“We need to work together to solve the issues,” Dr. Blackmore said. “I am hoping that we will continue to improve. I believe we have to work on identifying areas that overlap and identify gaps and where we can work on covering those gaps. We need to work with other specialists to solve problems. In Florida alone, One Health issues include non-native plants and animals, the availability of clean fresh water and other impacts of future population growth on the environ‑ ment, animals and people.”

For further information about One Health, please visit web pages: onehealthinitiative.com; onehealth initiative.com/newsletter, and AVMA.org/onehealth.

www.fvma.org | 17

Florida Pill Mill Legislation

By BRENDA EGGERT BRADER Communications and Public Relations Director

he FVMA has been receiving several telephone calls during the past few weeks from members regarding the recent Florida Pill Mill legislation.

In summary, counterfeit-proof drug prescription blanks must be used by li‑ censed health-care practitioners who pre‑ scribe controlled substances in the state of Florida, which was effective July 1, 2011.

Florida veterinarians are NOT included in this law signed by Gov. Rick Scott.

As of July 6, 2011, Dr. Frank Farmer, Florida surgeon general, had temporarily suspended the part of the legislation that requires physicians to use new counter‑ feit-proof prescription pads. This emer‑ gency order was made because pharma‑ cies, at that time, had been refusing to fill otherwise legitimate scripts. That deadline was extended for 60 days concluding on Aug. 29, 2011.

The provision in the law is targeted pri‑ marily at pill mills (pain-management clin‑ ics) and the dispensing of drugs classified by the Federal Drug Enforcement Agency as Schedule II, III or IV of section 893.03 F.S., meaning they have some accepted medical use, but high potential for abuse.

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“The new law was not designed to have an impact on the practice of veterinary medicine,” said Edwin A. Bayo, attor‑ ney representing the Florida Veterinary Medical Association. “For example, the new requirement for using tamper-proof prescription pads is found in Section 456.42(2), F.S. and is only applicable to a ‘health-care practitioner’ as defined in Chapter 456. That definition is found at Section 456.001(4) and it only includes human health-care practitioners, not veterinarians.

“Unfortunately, veterinarians will have to do one of two things: • Argue the law on a case-by-case basis or • Get tamper-proof prescription pads

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HBOT delivers maximum oxygen, greatly benefiting damaged, swollen and inflamed tissues. Treat crush, burn and spinal cord trauma with exceptional effectiveness, as well as many types of challenging cases such as sepsis, pancreatitis, radiation necrosis, wounds and stroke.

“My recommendation is that veterinar‑ ians obtain tamper-proof pads and that (each written prescription for a controlled substance) ‘has the quantity of the drug prescribed in both textual and numerical formats’ and ‘dated with the abbreviated month written out on the face of the pre‑ scription,’” Bayo said.

Those stipulations, cited by Bayo, are stated in the new Florida law. In addi‑ tion, the law cites that prescription-pad approved vendors must submit a monthly report to the Department of Health that, at a minimum, documents the number of prescription pads sold and identifies the purchasers.

“Once again, even though veterinar‑ ians are not included (pharmacies should still honor veterinarians’ non-counterfeit prescription pads), ensuring that any prescription issued by a veterinarian for a controlled substance looks like what the law now requires for every other prescrip‑ tion, is a good idea,” Bayo said.

“There are no limits to stocking and ordering these drugs in a veterinary practice, but veterinarians need to know

that drug wholesalers are now required to ‘credential’ their customers and have a better understanding of their clinical practices and legitimate need for con‑ trolled substances, which may mean, that drug wholesalers may send out question‑ naires or make phone calls or otherwise seek to gather more information about things such as the number of veterinar‑ ians in the practice, the average number of surgeries performed and other similar information.” Bayo said. “Once again, the law does not mandate wholesalers to do this for veterinarians, but I suspect that some wholesalers will decide they need to do this for everybody.”

Counterfeit-Proof Pads Security features on the counterfeitproof pads include background color blue or green and resists reproduction, printed on watermarked paper, must resist era‑ sures and alterations, and the word “void” or “illegal” must appear on any photocopy or other reproduction of the blank.

The counterfeit-resistant prescription blank must contain the following infor‑ mation: The preprinted name, address and category of professional licensure of the prescribing practitioner, and a space for prescribing practitioner’s Federal Drug Enforcement Administration number for controlled substances.

DOH website

A list of Department of Health coun‑ terfeit-proof prescription pads or blanksapproved vendors, DOH vendor reporting and frequently asked questions are found on a DOH website at http://www.doh.state. fl.us/mqa/counterfeit-proof.html and the FVMA website at www.FVMA.org.

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www.fvma.org | 21

The FVMA’s Industry Advisory Council – A Harmonious and Important Partnership

T

By BRENDA EGGERT BRADER Communications and Public Relations Director

he FVMA has a harmonious and extremely impor‑ tant working partnership with its Industry Advisory Council. The IAC, made up of manufacturers and dis‑ tributors of animal health-care products and compa‑ nies offering other business support services to FVMA members, is a valuable resource and maintains formal lines of communi‑ cation in assisting in the veterinary profession’s organizational objectives in Florida.

Through that partnership, the IAC presents suggestions and valuable information working with the veterinary industry through the FVMA. Meeting with the FVMA staff at least three times a year, those meetings offer the two groups the opportunity to confer and share information. Although the meetings are not mandatory, the two groups are able to discuss ideas regarding the annual conference regional meetings, legislative issues and Florida veterinary and industry issues in general.

Formed in 1999, the IAC acts as a conduit for information exchange, continuing education program support and other administrative resources. The IAC has become an effective part‑ ner with the FVMA in bringing together, in a formal manner, an open means of highlighting discussion between participat‑ ing companies, as well as the FVMA’s leadership, staff and membership.

Within the last 12 years since the IAC’s formation, the suc‑ cessful partnership has improved the awareness that the veteri‑ nary industry has a commitment to work with its state associa‑ tion in order to achieve legislative, educational, business practice, office staff development and public awareness goals of mutual interest.

The IAC members also are valuable to the FVMA in that, as a group, they provide a formal mechanism for the veterinary industry to have participation and input during the planning stages for programs and activities being planned by the FVMA that they may wish to support.

Financial Support

The IAC has been a strong financial backbone for the FVMA’s ability to host and present its many extensive continuing educa‑ 22 | FVMA ADVOCATE

tion programs and conference held annually. The IAC industry members offer several financial sponsorships that lay the ground work for the FVMA to invite cutting-edge veterinary industry professionals who offer their expertise in continuing education lectures. It is through this same working relationship, that the FVMA is able to afford and promote several small animal and equine wet labs at the events presented throughout the year, have the speakers and all equipment preparations paid for and to pro‑ vide those wet labs and lectures in the ultimate facilities.

The veterinary profession benefits from these top-notch speakers at the conferences and special events that all result in new knowledge the veterinarians and technicians can take back to their veterinary practice teams for instant use thereby improv‑ ing and enhancing each individual practice or veterinary-related business.

Additional Support

With the merger of the Florida Association of Equine Practitioners with the FVMA, the IAC has another opportunity to offer additional support to the continuing education events and conferences sponsored by the FAEP. With the addition of another organization, the IAC participants’ financial support for sponsorships and the like are a tremendous help, but the benefits to the IAC members include one-on-one contact with another great number of veterinary contacts.

The IAC contributes to the Membership Recruitment and Retention Campaign held annually by the FVMA through offer‑ ing free products to new and renewing members. This program provides the opportunity for IAC members to visit the veterinar‑ ians on a one-to-one basis organized so the veterinarian may obtain his/her free products.

The IAC’s goal continues to be to enhance industry’s working relationships between the veterinary community and industry.

That relationship has resulted in major improvements to the FVMA conference, regional meetings, membership growth of the FVMA and overall quality between veterinary practices and industry.

Special Thanks To Our 2011 Industry Advisory Council Members 1800Endoscope.com

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www.fvma.org | 23

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New Listing in the Eastern Panhandle- Well established solo Dr. small animal grossing $690,000. Newly remodeled freestanding 2900 sq. ft. office on 3 acres.

NEW! Daytona Beach Area Well-established solo, SA prx in clean leased facility. Well equipped and open only 4.5 days per week. Virtual tour video available. Prx $390K (FL50A)

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Central Florida Solo dr prx gross $635K. $114 avg trx chg!

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CLASSIFIED ADVERTISEMENTS ASSOCIATES WANTED

Experienced veterinarian wanted to practice 2- 2 1/2 days a week

in a two veterinarian practice in Ruskin, Fl. If interested please fax resume to 813‑645‑3336 or email to drhalott@aol.com. (Exp. Issue 4/11:6435)

RELIEF VETERINARIANS

Seeking part time or relief veterinary work in Central Florida. Have extensive experience of approximately 20 years in both individual practices and emergency work. I am compassionate and caring both with the animals and their owners. I have worked well with staffs of all previous employers.

Contact Ruthann Conklin at 321-926-3677,or cell 1-805-272-5333 or E-mail

ruthanndvm@sbcglobal.net or in writing at 172 Clear Lake Circle, Sanford, FL 32773. (Exp. Issue 4/11:17836)

Central Florida veterinarian located in Sanford, Fl. seeks employment for house calls for euthanasia of pets.

I am compassionate and caring. I also have extensive experience in critical care and would consider home hospice care or end of life transitional care on an on call basis.

Contact Ruthann Conklin at 321-926-3677,cell 1-805-272-5333 or E-mail

ruthanndvm@sbcglobal.net, or at 172 Clear Lake Circle, Sanford, FL 32773.

(Exp. Issue 4/11:17836)

Small animal Veterinarian with 40+ years experience would like relief work on the East central coast of Florida. Recently sold my practice. W. Joe Fuller, 321‑544‑2507. (Exp. Issue 4/11:892)

Relief or part-time veterinarian available in the Tampa area 30 years of experience as a practice owner. Enjoy surgery and working with people, small animal only. Call Dr. Joe Priest at 813‑230‑5998. (Exp. Issue 6/11:1289)

MISCELLANEOUS FOR SALE

Equipment for Sale: Storz Endoskope Camera for Sale. Asking $4,000 OBO. Original cost of camera was over $10,000.00 Model #: 692301 20. Please call (561) 723-0025 (Exp. Issue 4/11:3023)

Heska supplies for sale: SPC6 (1 box) dated April 2012, Chemistry

controls July 2013, Lyse Sol’n August 2012, Diff Sol’n (2) August 2013 & Sept 2013. Will discount 20% from invoice/taxes and ship. Call 904-731-8410 or e-mail cjedvm@sbcglobal.net. (Exp. 5/11:14489)

Classified ads for FVMA members cost $45 for up to 40 words with additional words assessed at 25¢ per word. For non-members, the rate is $65 for up to 40 words with additional words assessed at 25¢ per word. All ads must be submitted in writing preferably by email for verification of word count and payment is necessary in advance of publication. Email your classified ad to info@fvma.org. For more information about FVMA advertising please call 800-992-3862 for an insertion order. Now all Advocate Classified Ads are also published on the FVMA website www.fvma.org under “Classified Ads.”

Experienced hard working DVM for relief work in Hobe Sound area. Proficient in general surgery. Call Todd Rieke @ 651-485-4778 or drtrieke@hotmail.com (Exp. Issue 2/12:17508)

PART TIME/RELIEF VET AVAILABLE -35 yrs. experience, interest ACP(IVAS 2000) and integrative medicine, good surgical skills, Mid Gulf Coast/consider travel, available Dec 2011-April 2012; (517) 803-7737; MLIFE109@yahoo.com; Dr Michael Lifsey. (Exp. Issue 4/11:10738)

Experienced small animal Veterinarian - Founded three hos-

pitals, excellent client communication, compassionate care and respect for your staff are of the utmost importance, anywhere in Florida R.A. Swiezy, DVM – 772‑418‑1939. (Exp. Issue 5/11:557)

Veterinary Relief Service: Tampa Bay, Orlando, and surrounding areas. Short/long term positions accepted. Internship trained and in

practice for 10 years. References available on request. Small animal, some avian, aquatics, and exotics. Enjoy working with staff and clients. Contact Martha Keller, DVM at (813) 434-3070 or drkeller@faavs.net (Exp. Issue 4/11:9212)

Experienced small animal veterinarian willing to serve Central Orlando, Daytona, Altamonte, Casselberry, Longwood,

Winter Springs and Oviedo areas. Other locations are negotiable. Excellent client communication, compassionate care and respect for your staff are of the utmost importance. Call Tiffany Lewis at 321‑332‑4949 or email: tlewisdvm@gmail.com. (Exp. Issue 5/11:10579)

VETERINARY RELIEF SERVICE: CENTRAL FLORIDA. 56 years

veterinary experience; 30 as practice owner, 26 as relief service. J. D. Lynch, DVM – 407‑620‑2697. (Exp. Issue 5/11:1124) Relief or Contract Veterinary Services: Mature veterinarian with several years of practice experience in a variety of practice situations available in Collier, Lee, Charlotte, and Sarasota Counties. Contact Gene A. Rinderknecht, D.V.M at rindydvm@msn.com or my mobile phone 561-707-8126. (Exp. Issue 5/11:3009)

PS Broker, Inc. Veterinary Practices for Sale Florida: Bay County–Price Reduced! 2,600sf SA w/RE. 3-exam rooms. FL50.

Broward County- SA w/RE. 3-exam rooms. FL56.

Cocoa-2,100sf SA w/RE. 2-exam rooms. FL31.

Gulf County-New Listing! SA, Freestanding leasehold facility. Newly established. FL59.

Martin County–2,950sf SA w/RE. 3-exam rooms. FL57.

Volusia County-2,800sf SA w/RE. 4-exam rooms. FL58.

Delaware: Sussex County-New Listing! 3,600sf Equine w/RE. Easily expand into SA. RE & Practice $430K! DE1.

New Jersey: Monmouth County–Multi-doctor SA w/RE. 3-exam rooms. NJ3.

Morris County—New Listing! AAHA multi-doctor SA. 4exam rooms & computerized. NJ7.

North Carolina: Buncombe County-3,000sf clinic w/RE. 3-exam rooms. NC7.

Houston, Texas: New Listing! Freestanding SA on +/-1 acre. 3-exam rooms w/room to expand. TX3.

Bookmark our website to view new listings!

AVAILABLE FOR RELIEF OR PART-TIME WORK (2-3 days per week),

(’69 University of PA) SMALL ANIMAL MEDICINE & SURGERY Former multi-doctor practice owner (38+ yrs. Exp.) Reliable, professional with excellent communication skills. Jupiter and CLOSE surrounding cities; Weekends are okay. Contact: David M. Green, VMD, Home: (561) 747-4300 Cell: (305) 613-4405 (Exp. 5/11:300)

WWW.PSBROKER.COM Tel: 800.636.4740 INFO@PSBROKER.COM

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Florida Veterinary Medical Association 7131 Lake Ellenor Drive Orlando, FL 32809

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Experience We’ve got it.

• Selling and valuating veterinary practices since 1977 • • More credentialed business appraisers than any other firm • • Recognized authors and international lecturers • • Serve on industry and VMA advisory boards • • Charter members of VetPartners • • Serve on the Veterinary Valuation Resource Council (VVRC) of VetPartners •

national reach

regional expertise

www.simmonsinc.com

Founder of

1-800-333-1984

practice sales • practice appraisals • buyer agency • sales facilitation • exit strategy