The Academy of Veterinary Homeopathy (AVH) is suing the American Association of Veterinary State Boards (AAVSB) for breach of contract and fraud concerning the board's decision to deny continuing education credits for classes at the group's 2009 conference in Savannah, Ga.
highlights a simmering controversy in the veterinary profession on the legitimacy of complementary and alternative modalities that cross the line from conventional medicine to include acupuncture, chiropractic medicine, homeopathy and herbal or botanical medicine.
The case also spotlights concerns that the AAVSB's Registry of Approved Continuing Education — a national evaluator of CE providers commonly known as RACE — is unfair and politically driven.
Dr. Sidney H. Storozum, an attorney and veterinarian practicing homeopathy, filed the lawsuit in January in the circuit court of Amherst County, Va. According to court documents, the AVH seeks $10,000 in compensatory damages and $60,000 in punitive damages from the AAVSB.
The AAVSB filed a 26-page response
denying any wrongdoing, as well as several motions, some of which are intended to derail the case. While one has succeeded — Storozum has been removed as legal counsel due to his direct involvement in the lawsuit; he is replaced by attorney James Stringfield in Monroe, Va. — several others, including a motion to dismiss, likely won't be heard until September.
AAVSB Executive Director Robyn Kendrick is not commenting on the lawsuit, though she stresses that the decision to deny RACE approval of the AVH convention's CE was not rooted in prejudice against complementary and alternative medicine. Rather, the organization as a whole is focused on improving quality assurance within all of its programs. AAVSB attorney, Michael Montgomery in Richmond, Va., could not be reached to discuss the matter.
The AAVSB is a 501(c)(3) that represents 57 licensing boards regulating veterinary medicine in the United States, four Canadian provinces, Puerto Rico and the U.S. Virgin Islands.
RACE was established more than a decade ago under the AAVSB to develop uniform standards
for CE and centralize the approval process for state regulatory boards faced with the daunting task of vetting the merits of thousands of CE programs annually offered to veterinarians. Nearly every state regulatory board requires veterinarians to complete a certain amount of CE for license renewal, and many look to RACE for guidance on what courses to accept.
As a result, RACE and the AAVSB wield significant power in the CE arena. RACE uses paid consultants to advise a committee of six volunteer veterinarians appointed by the AAVSB to evaluate applications for CE credit. The RACE committee makes recommendations to the AAVSB Board of Directors, which is the ultimate decision-making authority.
Critics argue RACE committee members and their paid consultants have no knowledge of homeopathic veterinary medicine, therefore they can't properly evaluate the merits of such CE courses. It wasn't until after the 2009 conference that the AVH was notified that RACE did not extend its approval of the convention's CE, the lawsuit states.
That means the courses many AVH conference participants paid to attend in 2009 did not go toward the credits required needed to renew their licenses. The denial came as a shock to AVH leaders because RACE had granted CE recognition for nine of the organization's previous conferences.
What changed? Revised RACE standards released in late 2009 include a requirement that all scientific information used in RACE program applications in support of any animal-care recommendation must conform to “the medically accepted and scientifically supported standards of experimental design, data collection and analysis.”
This line of thinking worked to preclude homeopathic courses that were not based on what RACE committee members considered to be clear, evidence-based science. It narrowed the road to acceptance, critics say, giving weight to published science rather than experts in homeopathy.
Moreover, the 2009 rewrite was issued after the AVH convention. Storozum and others believe that CE approval met previous RACE standards that required CE courses to "build upon or refresh participants in the standards for practice and courses as found in the curriculum of accredited colleges and schools of veterinary medicine."
"That was the standard we were deemed to have met for nine consecutive years, and then suddenly it was decided that we did not," Storozum explains. "It was the sudden turnaround on the interpretation of this requirement that is at the heart of the lawsuit. We were not under the late 2009 standards revision at the time we applied for our 2009 conference."
The AVH is the only plaintiff in the lawsuit, but several other professional groups for veterinary practitioners of complementary and alternative medicine claim to have had similar experiences with RACE officials and the organization's processes. Last year, the brewing conflict prompted the American Holistic Veterinary Medical Association (AHVMA) to draft sample letters protesting RACE denial of CE credits for complementary and alternative medical courses, so that the group's members could send them to their respective state boards.
In part, the four-page form letter reads: "RACE is clearly running the risk of becoming irrelevant to the state boards, at least until the advisers include more well-informed and educated CAVM (complementary and alternative veterinary medicine) practitioners."
In an attempt to negotiate, attorney Storozum said he's represented seven different complementary and alternative veterinary groups in discussions with AAVSB and RACE until reaching a dead end in late 2010.
Unable to craft a compromise, members of the AHVMA incorporated a new CE accrediting organization called the Registry of Alternative and Integrative Veterinary Medical Education (RAIVE). Launched in April, RAIVE's advisory board will evaluate courses that teach complementary and alternative veterinary medicine for CE approval. According to the group's website, the board consists of 19 experts with advanced degrees and training in conventional specialties or biological science as well as integrative therapies. This summer, licensing boards in states such as Nebraska, New Jersey, Massachusetts and Washington mulled whether to accept RAIVE as an approved reviewer of CE programs, though it's unclear if any regulatory body has made a final decision.
While the certification model is similar to that of the AAVSB and RACE, RAIVE ensures that applications will be reviewed by two or three members of the committee trained in the specific area being evaluated. Letters have been sent to state regulatory boards, soliciting their acceptance of RAIVE as an evaluator of CE providers in the complementary and alternative veterinary medical arena.
Circumventing RACE via RAIVE is expected to fend off troubles like those experienced by the AVH, whose leaders allege that the group had been approved by RACE as a CE provider as late as March 2009, and had applied for the October 2009 conference three months in advance. The lawsuit alleges that the RACE committee delayed ruling on the group's application until January 2010, three months after the conference had been held.
According to the AAVSB website, after the new standards were adopted in June 2009, there was a period of communication with provider organizations before they went into effect in September 2009. Storozum maintains AVH was left in the dark while RACE considered their application; the process that previously had taken three to four weeks lasted nearly six months.
This forced attendees and AVH leaders to scramble to gain CE recognition from individual state boards. Nine of 12 boards petitioned ultimately recognized the 2009 conference, but the event suffered, Storozum said. With RACE approval up in the air, less than 50 veterinarians attended the AVH conference. That's less than half of the conference's normal attendance, he said.
Much of mainstream veterinary medicine simply does not subscribe to the merits of modalities such as acupuncture and homeopathic medicine, Storozum said. Some veterinarians expressing their views on the Veterinary Information Network
, an online community for the profession, firmly believe that the barriers barring complementary and alternative CE from earning RACE approval are rooted in discrimination.
Not so, counters Dr. David Ylander, AAVSB president. Ylander, himself a practitioner of veterinary acupuncture, states that the changes to RACE standards were meant to tighten the approval process across the board.
“The RACE standards for all CE went through a revision process in 2008,” Ylander explained. ”The board approved the changes in June 2009. Those standards are applicable to all applications for CE.”
The impetus for changing the standards came from state regulators, he said. “The state boards and regulatory boards were asking that, when programs or providers were coming to AAVSB and RACE for approval, that things just weren't being rubber-stamped."
CE courses rooted in more traditional veterinary medical modalities have been rejected by RACE as well, he said.
About half of the CE applications for courses on complementary and alternative medicine received since the standards change have been approved, Ylander said. But Storozum and others maintain that the 2009 standards are designed to exclude any modality not already taught in an accredited veterinary medical program.
“The debate over what is a valid form of veterinary medicine is not a debate that belongs with AAVSB/RACE,” Storozum said. “That discussion belongs with groups like the AVMA. That should have nothing to do with evaluating the merits of a program of continuing education.”
The American Veterinary Medical Association, or AVMA, convened the Task Force on Complementary and Alternative Therapies in 1996 and 1999. The group crafted Guidelines for Complementary and Alternative Veterinary Medicine
, adopted by the AVMA Executive Board in 2001.
Of the lawsuit, Storozum added: "We’re open to the possibility of a settlement if RACE will take a step back. It should never have come to this.”
Ylander concurs: “Everything is always open to review. There are many good suggestions that the Board of Directors will look at and have the RACE committee review, too.”
He advises veterinarians with concerns about RACE to contact their respective state regulatory boards because "all the licensing boards are members of AAVSB. The licensing boards are the entities that vote at the AAVSB annual meetings."
Jennifer Fiala contributed to this report.