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California lawmakers are considering a bill that would allow registered veterinary technicians to perform cat castrations.

California veterinary regulators are opposing a bill that would allow registered veterinary technicians to neuter male cats, a sign of expanding resistance to the controversial proposal as it moves toward its first big test in the Legislature.

AB 2133 would allow RVTs who have obtained training in cat neuter surgery to castrate cats following written protocols established by a supervising veterinarian who must be on the premises when the procedure is done. The California Veterinary Medical Board (VMB) would be in charge of approving the training curriculum.

The VMB's vote on April 17 against the bill is not binding on legislators, but it represented the bill's first public vetting by the regulators who would be charged with enforcing its provisions. The measure is now before the Assembly Committee on Appropriations, which it needs to clear in order to be considered by the full Assembly. The bill must pass that chamber by May 24 in order to progress to the Senate.

If the bill becomes law, California would be the only state to allow RVTs to neuter cats, according to the American Veterinary Medical Association.

Supporters say the change would enable more castrations to be done, thereby reducing overpopulation and euthanasia of cats. It could also increase access to veterinary care and reduce the price of care if veterinarians choose to pass lower costs through to clients. They also maintain that providing new opportunities to RVTs would help practices attract and retain staff in these positions.

Critics argue that only veterinary school prepares practitioners for surgery and its possible complications. The proposal, they say, also raises the question of whether supervising veterinarians would be liable for problems resulting from the surgery. And they disagree that authorizing RVTs to perform castrations would have a significant impact on cat overpopulation or access to care.

Bill sponsor Judie Mancuso criticized the regulatory board's opposition. "They came with their preconceived notions and opinions," she told the VIN News Service. "I felt that their open minds were left somewhere outside the door."

Mancuso is the founder, CEO and president of Social Compassion in Legislation, an animal advocacy organization focusing on public policy. She said the group came up with the proposal to expand the RVT scope of practice after brainstorming solutions to cat overpopulation and ways to give veterinarians more time to do procedures that require more expertise.

Mancuso, who served on the veterinary board as a public representative from 2010 to 2018, said bill supporters will try to address concerns the board raised in hopes of making the legislation acceptable to the regulators. 

Veterinary board concerns

The veterinary board's opposition was nearly unanimous. Five of the six board members voted to oppose. An abstention came from Dr. Maria Preciosa S. Solacito, board vice president and senior veterinarian at the County of Los Angeles Department of Animal Care and Control.

Kristi Pawlowski, the board's sole veterinary technician, was among those opposing the bill. She said the way to address RVTs' job satisfaction is to allow them to do the range of work they are already trained and certified to do.

"I believe the majority of hospitals underutilize RVTs, which is why most are still underpaid and leaving the profession," she said, warning that enabling them to perform castrations could, counterintuitively, make the situation worse. "To be clear, when this surgery goes wrong, the tragedy will only ensure more RVTs leave the field," Pawlowski said.

Board member Dr. Jaymie Noland, a professor of animal science at California Polytechnic State University, described the bill as an incremental step toward creating a midlevel position, like a physician assistant or nurse practitioner in human medicine.

She said the profession has been talking for years about adding another layer of practitioner. If it's to be done, she said, it should be done with intention. "Let's actually sit down and say, ‘OK, we're going to have a different level where it's similar to a physician's assistant, and the professional person is trained from the get-go to integrate surgery with anesthesia with physical exam.' "

Board member Dianne Prado, an attorney, said a solution to the need for more neuters might be found in another bill — one making its way through the Senate.

That legislation would create a certification program at California's two veterinary schools to train veterinarians in high-quality, high-volume spay and neuter surgery techniques. It is supported by both the California Veterinary Medical Association, a trade group that opposes the effort to allow RVTs to castrate cats, and Mancuso's group.

The Senate bill "is something that is going to help create a curriculum that actually helps both neutering and spaying," Prado said, adding with a laugh, "So, we can talk about more than balls."

Practitioners raise questions

More than two dozen animal rescue and welfare organizations are listed as supporters of AB 2133.

The CVMA and American Veterinary Medical Association have been leading opposition to the measure. There also appears to be plenty of concern among the rank and file.

A VIN News article published in February about the bill elicited mostly opposition from the nearly 60 veterinarians who posted comments to a message board of the Veterinary Information Network, an online community for the profession and parent of VIN News. Only three veterinarians in the discussion voiced support for the bill.

Many practitioners underlined the point that surgery is something veterinarians exclusively are prepared to do. They voiced repeated concerns that technicians would not be able to handle complications with potentially serious consequences. And they frequently used the term "slippery slope" to express worries that allowing RVTs to neuter cats was just the first veterinarian responsibility that would be handed over to those without veterinary degrees.

Several also worried about veterinarian liability if a cat neuter resulted in a major complication or death. The bill does not specifically address liability. Nancy Erhlich, the regulatory legislative advocate for the California RVT Association and a supporter of the bill, said during a legislative committee hearing that she presumes that the veterinarian who allows an RVT to neuter a cat would be liable in the event of a complication, just as they are for other tasks RVTs do within a practice.

"RVTs have been doing lots of things — extracting teeth and suturing, for example — and no one was terribly concerned about the liability for those things," she said.

Bonnie Lutz, an attorney and past president of the American Veterinary Medical Law Association, said during the VMB hearing that very few RVTs have any kind of liability insurance.

"If something goes south and the RVT [draws] a complaint to the board, or a small claims action, they will either be flying solo without any insurance to cover anything, or they will have to hire an attorney and pay the attorney themselves," Lutz said.

She added that the supervising veterinarian also would probably be sued and face a board complaint. "That will mean that for any given case, you'll be dealing with two different claims. That's a lot of money."

Mancuso stressed to VIN News that no veterinarian would be required under the bill to allow RVTs to neuter cats. "If every vet said they don't want to do this, nothing would change," said Mancuso. "There are no obligations for veterinarians with this bill — only opportunities."

‘Not a technically demanding procedure'

By many accounts, castrations are typically quick, simple procedures that rarely result in complications. Even veterinarians who are generally opposed to the measure agree that veterinary technicians could learn the procedure and neuter cats safely in most cases.

"It's not a technically demanding procedure to learn/perform," conceded Dr. Miranda Spindel, a veterinarian in Fort Collins, Colorado, in an interview by email. "There are complications that can occur. The bill is written to require direct supervision, so if something were to go wrong, theoretically, a veterinarian would be available to help immediately."

Spindel, who also serves as a VIN shelter medicine consultant, said she nevertheless opposes the measure because she doesn't think it will significantly alleviate veterinarians' workloads or remedy cat overpopulation.

Jana Gale Connell, an RVT in Sonora, California, told VIN News that during more than 35 years in her clinical career, she rarely saw a complication during a cat neuter surgery. Other procedures that technicians do routinely, she maintained, are far riskier.

"The most dangerous thing about any surgery is anesthesia — making sure [patients] are breathing. But that is what vet techs are there for," she said. She added that the veterinarian she worked for would have been "more than thrilled" to allow her to castrate cats had they been legal.

Dr. Rick Hill, owner of a veterinary hospital in Happy Valley, Oregon, said in an interview that he neutered his own cat when he was 15 years old after being trained by the owner of a kennel where he worked. Thirty years later, he said he'd have no problem if veterinary technicians were trained to do the procedure.

"I have a really good tech," he said. "She could easily do the neuter and would be interested in learning how. I don't see the pitfalls. I like the choice."

Speaking to concerns about safety and liability, Hill said everything veterinary professionals do involves risk.

"Under [bill opponents'] train of thought, vets should be giving every injection and every rabies vaccine because God forbid the animal has an anaphylactic shock reaction," he said. "There is more risk of injury or adverse complications from cystocentesis or recovering from anesthesia, which are the responsibility of technicians." (Cystocentesis is a procedure by which urine is drawn from the bladder using a sterile needle and syringe.)

Dr. Joseph Griffioen, who runs a family veterinary practice in Belmond, Iowa, agreed that castrating cats isn't difficult but noted that complications can and do happen. "One time, years ago, I damaged a urethra and had to do a urethrostomy," he said. 

Purported benefits questioned

As for claims that allowing RVTs to neuter cats will alleviate time pressure on veterinarians, some are dubious.

"These are inexpensive and efficient procedures," said Spindel, the shelter medicine consultant. "I don't know of any shelters that have a cat neuter backlog, and I don't think we have a pet overpopulation issue because of a lack of veterinarians performing spays and neuters."

RVT Jaime Larson, director of animal services for the Sacramento SPCA, agreed.

"I don't know how much time it would actually save a vet to have RVTs do all the neuters and vets do all the other things," she said, speaking for herself and not for the SPCA. "The procedure itself takes about a minute and a half. It would not free up that much time. A vet still has to be on-premises and take oversight of the procedure, so I don't know that the return on investment would be as impactful."

Larson argued that giving technicians more to do could be counterproductive, given existing strains on the profession.

"The problem and challenge is ultimately that we have just as much of an RVT shortage as we do a vet shortage," she said. "If we keep stacking heightened responsibilities on RVTs, we will not have enough people around to function as RVTs."

Given what they contend is the relative lack of benefits of allowing technicians to castrate cats, bill opponents question why the legislation was brought forward in the first place.

"If it doesn't really add to the operational efficiency of shelter medicine, let alone practice medicine, and it's such a quick procedure, you wonder what the real motivation is," Griffioen said.

"It seems to establish a bridgehead to where if vet techs can do this surgery, why can't they do that surgery? It establishes a bad precedent. You lose that clear line between the roles."

Many veterinarians have expressed similar concerns, suggesting that veterinary practice chains would stand to benefit financially if RVTs, who are paid less, were allowed to do more of the work traditionally reserved for veterinarians.

Worth further conversation

In closing remarks at the VMB meeting, Solacito, the board member who abstained, said: "The conversations that we've had are very limited. And I think that because the intention is really good, maybe it is worth just at least having further conversations."

Should the board opt to discuss the bill further, its next opportunity would be at its next meeting, in late July.

If the bill passes out of the Assembly, the last day the Senate could act on it is Aug. 31.

Update: The bill authorizing veterinary schools to train and certify veterinarians in high-volume spay and neuter techniques passed the state Legislature and was signed by the governor on Sept. 26.