May 2, 2022
There is a general belief that arbitration favors employers and large businesses. However, an important change in the law, backed by bipartisan support, has advanced employee rights significantly by increasing their access to courts for certain claims. Specifically, the new law affects an employer’s ability to enforce an arbitration agreement and handle sexual harassment/assault claims privately through arbitration.
On March 3, 2022, President Biden signed the Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act of 2021 (the “Act”) into law. This law, which amends the Federal Arbitration Act, prohibits forced arbitration of sexual harassment and sexual assault claims.
Under the new statute, a litigant who brings a sexual harassment or sexual assault case will not be bound by an arbitration agreement or a waiver of a collective or class action that they entered into before the dispute arose. Specifically, the Act provides:
at the election of the person alleging conduct constituting a sexual harassment dispute or sexual assault dispute, or the named representative of a class or in a collective action alleging such conduct, no predispute arbitration agreement or predispute joint-action waiver shall be valid or enforceable with respect to a case which is filed under Federal, Tribal, or State law and relates to the sexual assault dispute or the sexual harassment dispute.
Many have commented on the overall purpose of the Amendment. For example, one senator said that the law will ensure that the voices of sexual assault and sexual harassment survivors voices will not be silenced. The senator also noted that the law is narrow in scope and application and should not be the catalyst for destroying pre-dispute arbitration agreements in all employment matters.
This piece summarizes some of the key take aways from the Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act:
The Alleged Victim Can Still Arbitrate: The person alleging sexual harassment or assault may still choose to enforce an arbitration agreement. However, it must be their choice, not the employers. Similarly, the parties may still agree to enter into an arbitration agreement after a dispute involving sexual harassment or sexual assault arises, and either party may enforce such an agreement without being blocked by the Act.
The Definition of Sexual Harassment: The Act defines “sexual harassment” as any conduct that is alleged to constitute sexual harassment as defined by federal, tribal, or state law. Under New York, New Jersey, and federal law, this includes all forms of gender-based or sexual harassment, whether or not it involves any sexual element. The Act also applies to allegations of sexual assault, which it defined as those involving an alleged non-consensual sexual act or sexual contact.
Application of Federal Law by a Court: Whether the Act applies must be decided under federal law, and must be decided by a court regardless of whether the arbitration agreement at issue states that such a determination must be made by an arbitrator.
Claims Affected: The Act applies to all disputes or claims involving sexual assault or harassment that arise on or after March 3, 2022, the date on which the law was enacted. This means that the Act will invalidate existing arbitration agreements (even those in pre-existing employment agreements) that otherwise would have required such claims to be brought in arbitration rather than in court.
Discrimination Claims Can Still be Arbitrated: The Act only applies to sexual harassment and sexual assault claims, not discrimination claims based on any other category, or discrimination based on sex. Similarly, the Act does not apply to harassment claims based on other protected categories, such as race or disability. Employers may still choose whether they want other forms of harassment to be subject to mandatory arbitration.
What Should You Do? If you have entered into an employment agreement that is effective prior to March 3, 2022, you should review it and determine (1) whether it contains an arbitration provision; (2) whether the arbitration provision expressly excludes any claims (specifically sexual harassment and sexual assault); (3) review the agreement with an attorney with whom you should discuss preparation of an amendment that will reflect the change in law.
April 12, 2022Peter Tanella, Esq., Chair of the National Veterinary Law Group at Mandelbaum Barrett and Partner Dennis Alessi, Esq. have co-authored an article in the April/May issue of Today's Veterinary Business titled "Fair Share." The article is featured in Mr. Tanella's regular column called "Legal Lingo" and discusses how granting equity interest in a hospital is a great way to beef up employee compensation and enhance loyalty.
April 7, 2022National Veterinary Law Group at Mandelbaum Barrett Chair, Peter Tanella. Esq. and Partner Dennis Alessi, Esq. will be giving two presentations at the VHMA (Veterinary Hospital Managers Association) 2022 Virtual Legal Symposium on April 7th, 2022 from 1pm to 4:15pm ET.
March 23, 2022
The key question here is: “do I need a partnership agreement if I am going into business with my veterinary partner?” Many veterinary business partners who form a legal entity under which they will operate their practice decide not to adopt a partnership agreement to save on expenses early in the life of their practice. Here, the term “partnership agreement” is being used generally to refer to an agreement between the owners of a veterinary business. Excited by the prospects of a new business and all the opportunities they foresee, the partners also believe there is no time to waste; they are convinced that negotiating a partnership agreement will slow their momentum and create unnecessary legal obstacles. Like many people they think “what could possibly go wrong if we operate our company without a partnership agreement?” The right answer: “Lots of things could go wrong” and this one decision could lead to significant financial consequences, not to mention the mental stress of a dispute among partners. To illustrate the conflicts that veterinary business partners can encounter, consider the following hypothetical:
A deeply shared interest in providing high-quality veterinary medicine along with compassionate service was the catalyst for a veterinary practice partnership between Jared and Eli. The business weathered a rocky start but appeared to be making progress toward sustainable growth. Unfortunately, by that point, Jared and Eli’s relationship had deteriorated. They were clashing often, especially over questions of contribution and control. Jared felt that he was doing all the real work, while Eli criticized his partner for mismanaging finances and decisions pertaining to employees. An outside friend weighed in on the situation and helped Jared see that he had made a lot of mistakes that cost the business money and good employees. Jared acknowledged his mistakes and decided he wanted out of the business. He contacted a colleague he had kept in touch with since veterinary school and started negotiating a purchase price for his shares in the practice. When Eli learned this, he felt angry and betrayed, and the hostility between the two further festered. Unfortunately, the situation depicted here is far from rare. The disputes depicted between Jared and Eli arose primarily because they did not have a clear partnership agreement in advance.
By adopting a well-drafted and custom-tailored partnership agreement, partners can avoid many potentially painful consequences. For example, in the above hypothetical, a partnership agreement would have served to define the rights and responsibilities of each owner. Further, addressing important issues in a partnership agreement means that the owners can set and manage each other’s expectations and avoid future disputes. With this understanding of what can go wrong, let’s dive into a few basics, and some of the key terms that should be addressed in a partnership agreement between veterinary business partners.
If the business is a limited liability company (LLC), or in some states, a professional limited liability company (PLLC), the agreement between owners is called an “operating agreement.” If the business is a corporation (Inc., Corp., PA or PC), the ownership agreement is referred to as a “shareholders’ agreement.” The following key topics and questions must be answered and addressed in a partnership agreement:
Ownership and Voting Rights:
1. What percentage of ownership will each owner hold?
2. Will all the owners have the same voting rights?
3. What voting percentage is required to approve an act by the company?
4. Will any decisions require unanimous consent of the owners?
Management of the Company:
1. Who will serve as the officer(s)/manager(s) of the company?
2. Will the officer(s)/manager(s) be paid separately for managing the company?
3. What are the responsibilities of the officer(s)/manager(s)?
4. What services will each owner provide the company?
5. If the owners cannot agree on an important decision, will they bring in a neutral decision maker, or mediate/arbitrate the dispute?
1. Who will manage the company’s finances?
2. Will the owners be required to make additional capital contributions or loans to the company?
3. When will distributions be paid to the owners and who will determine the amount of those distributions?
Restrictions on Transfer/Sale:
1. What happens if an owner leaves the company voluntarily or involuntarily? (e.g. death, disability, termination or employment, criminal behavior)
2. If the majority of owners vote for a sale of the business, can minority owners be forced to sell on the terms agreed to by the majority?
3. In the event of a sale, how will the purchase price for an owner’s interest be determined?
4. Will owners be restricted from transferring or encumbering their equity? If so, how?
1. Will owners be permitted to own an interest in another company or veterinary practice?
2. What restrictions will apply if an owner leaves the company (non-competition, non-solicitation, confidentiality)?
3. What time and geographic restrictions will apply?
1. How does the legal entity protect its owners from liability?
2. Will the company indemnify the officers/members and owners for defense costs and/or damages should a lawsuit or claim arise?
3. Are there any exceptions to the indemnity and limited liability the company will provide (e.g., breach of fiduciary duties)?
1. How often will the owners and leadership of the company meet?
2. What should be accomplished at these meetings?
3. How should these meetings and the decisions made be memorialized?
1. If the company ever needs to be dissolved e.g., after a sale, what procedure must the owners follow?
2. Must all owners consent to the dissolution? What are the consent requirements?
3. Who is entitled to payment, and in what priority, if the company is dissolved?
Another important consideration in deciding whether to prepare a partnership agreement is that absent a written and binding agreement, a company will be governed by the default statutes and regulations in the state where the company was formed. Although many state’s rules are comprehensive, they may not adequately address the rights and obligations of the partners under many different and relevant scenarios. By way of example, state rules may not discuss what happens when the company needs more capital, or whether an owner is prohibited from competing with his/her other veterinary business. Because each veterinary practice is unique, and the relationships between partners varies greatly, accepting the one-size-fits-all approach of state laws can be dangerous. For this and many more reasons, a well-structured partnership agreement prepared by counsel, which sets forth the parties’ intentions and provides for agreed rights and protections is the most valuable option. The National Veterinary Law Group at Mandelbaum Barrett is here to answer any questions you may have.
March 16, 2022
With integrative veterinary care becoming increasingly common, many veterinarians are utilizing dietary supplements and prescribing them to their patients for a variety of different reasons. Naturally, many veterinary practices may want to streamline the treatment process by selling dietary supplements and other over-the-counter (“OTC”) products directly to their patients. While this seems like a routine progression, it is important for veterinarians and veterinary practice owners to understand how these products are regulated, in order to ensure they maintain compliance in marketing and selling products from their practice.
Integrative Veterinary Care
Integrative veterinary care includes the use of complementary therapies and treatment options, in addition to conventional veterinary medicine, in order to offer a more comprehensive approach to treatment. Much like humans, all animals are different, and there are a variety of factors that can be used to help determine the best treatment options for each veterinary patient. Perhaps the most common treatment option for animals outside of traditional medicine is the use of dietary supplements and other diet-related approaches. Dietary supplements in particular may be prescribed by veterinarians for a number of different reasons, with uses ranging from treatment or prevention of a particular condition to general health and wellbeing. Examples of commonly used dietary supplements for animals include:
· Milk Thistle
· Fish Oil
However, despite the wide range of potential uses in veterinary practice, dietary supplements for animals lack the same comprehensive regulation as their human counterparts. As explored below, the lack of regulations specifically addressing dietary supplements for animals creates a unique “gray area” in determining how they should be regulated at the federal level. As a result, depending on their intended use, dietary supplements for animals may be regulated as either food or drugs, each regulated quite differently.
The Federal Food, Drug, and Cosmetic Act (“FD&C Act”) is the primary food and drug law in the United States, giving the Food and Drug Administration (“FDA”) authority to regulate and oversee the safety of food, drugs, medical devices, and cosmetics. The FDA is responsible for ensuring the safety of food products and drugs for both humans and animals. This includes regulating safety and efficacy, as well as how food and drug products are manufactured and labeled.
The FD&C Act defines “drug” to include in relevant part, “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals” and “articles [other than food] intended to affect the structure or function of the body of man or other animals.” Conversely, the FD&C Act defines “food” as “articles used for food or drink for man or other animals...and articles used for components of any such article,” which courts have interpreted to mean products used primarily for nutrition, taste, or aroma, or components of that product. Noticeably absent from the FD&C Act was a clear answer or guidance on whether dietary supplements were to fall under the category of food or drugs. As a result, dietary supplements generally fell under the definition of food and were regulated as such. However, because dietary supplements were also subject to labeling requirements, as more health claims were made about supplements, they were pushed towards falling under the FDA’s definition of a drug.
In 1994, the Dietary Supplement Health and Education Act (“DSHEA”) was passed, amending the FD&C Act to create an additional category and regulatory framework for dietary supplements. Shortly thereafter, the FDA made a clear determination that DSHEA did not apply to products for use in animals. Therefore, unlike dietary supplements for humans, products marketed as dietary supplements for animals would not fall under a separate category of FDA regulation and would be regulated as animal food or animal drugs, depending on their intended use. Because the distinction between regulation as animal food or drugs hinges in part on the products intended use, this issue becomes incredibly important to veterinarians who prescribe and/or sell certain nutritional products and dietary supplements directly to their patients. This is because for certain products or supplements, whether they should be regulated as a food or drug can be decided in part on how and/or why the veterinarian prescribes and communicates their intended use.
The “Gray Area”
One clear issue before the adoption of DSHEA was that as the supplement industry continued to grow, more health claims were being made about various supplements, and it was becoming increasingly difficult to classify a product as either a food or drug. The very fact that additional legislation was created to specifically address regulation of dietary supplements makes it abundantly clear that there was a gap in the regulation that needed to be filled. While DSHEA recognized and filled this “gap” for human products, the FDA’s determination in 1996 that DSHEA does not apply to animal products has left a significant gray area and only fostered more confusion surrounding the regulation of dietary supplements for animals.
After making the determination that DSHEA did not apply to animal products, the FDA published guidance in the Federal Register explaining some of the underlying reasons behind the agency’s decision. One of the primary issues the FDA highlighted was the lack of available information on the safe use of dietary supplements in animals compared to humans. The FDA observed that many substances that fell under the definition of dietary supplements for humans, such as herbs and other botanicals, had a history of use in humans that could be used to establish reasonably safe levels. The same history of use did not exist for animals. Similarly, the FDA also noted that unlike humans, each animal species requires different nutrients, absorbs and metabolizes nutrients differently, and can exhibit different toxic reactions to food and its components, thus making it even more difficult to compile adequate information. While the reasoning provided by the FDA helped demystify the decision, it did little to address the gray area that was left behind.
Where are we now?
Today, over twenty years since the FDA determined DSHEA was inapplicable to animal products, the same gray area exists in the regulation of dietary supplements for animals. As integrative veterinary care becomes more prevalent throughout the industry, many veterinary practices are continuing to expand their range of services to include more holistic therapies and treatment options, many of which include the use of dietary supplements, botanicals, and other nutritional products. In addition to the enigmatic classification of food versus drug, each of these categories may include products that can be prescribed for a variety of reasons, further complicating the analysis. For example, while a veterinarian may suggest a supplement to one patient for their general health and wellness, the same veterinarian may prescribe the same supplement to a different patient in order to treat a specific condition or ailment such as joint pain or gastrointestinal issues. As this example demonstrates, based on the regulatory framework discussed above, the same product could theoretically fall into the regulatory definition of a food or drug, depending on its intended use.
Why is this important?
While these regulatory concerns are often shouldered mainly by the manufacturers of the products, it can become an issue for veterinary practices that sell pre-packaged dietary supplements directly to patients or compound their own blend of supplements to package and sell to patients. While this entire concept seems like a very niche issue, it can potentially affect other areas of a veterinary practice, such as how holistic treatment options and dietary supplement use are marketed to patients, as well as compliance concerns related to proper licensure to sell over-the-counter products directly to patients either in person or online.
The Business Angle
Understanding how a specific veterinary practice treats patients through holistic treatment methods that include the use of dietary supplements, as well as whether the practice sells or intends to sell such products directly to patients, are important considerations in assessing the risk of a potential acquisition. While this article has highlighted some of the ambiguities in federal regulation of dietary supplements for animals, there are still a variety of state-level regulatory considerations that can vary considerably from state to state. Whether you are a current veterinary practice owner that sells dietary supplements and/or over the counter products, or are in the market to acquire a practice that does, it is always important to review the veterinary board regulations of the state in which the practice is located in order to ensure the practice has all required licenses and is in compliance with any other regulatory requirements for the marketing, use, and sale of dietary supplements for animals. The attorneys at the National Veterinary Law Group at Mandelbaum Barrett are available to answer any questions you may have.
 21 U.S.C.A. § 321(g)(1).
 21 U.S.C.A. § 321(f).
 Pub.L. No. 103–417, 108 Stat. 4325 (1994).
 Federal Register, Vol. 61, No. 78, April 22, 1996.
March 3, 2022Peter Tanella, Esq., Chair of the National Veterinary Law Group at Mandelbaum Barrett is thrilled to be this week's guest speaker on the Harbor Business Experience Podcast with Robert J. Trimble DVM.
March 1, 2022
1) Marijuana Use by Employees: While the federal government is not going to legalize recreational marijuana, states and local jurisdictions continue to propose and pass legislation that addresses decriminalization of marijuana, recognition of medical marijuana use and legalization of recreational marijuana. Currently 34 states permit medical use of cannabis products, and 18 states and the Washington D.C. permit recreational use of marijuana. The laws in some of these states prohibit employers from taking adverse action against an employee.
What does this mean for your Practice? Regarding recreational marijuana you can still prohibit employees from being under the influence while working. With respect to medical marijuana, you must engage in the “interactive process” and determine if a “reasonable accommodation” can be provided to an employee whose medical condition requires that they be under the influence during working hours. Your practice should review its substance abuse policy to ensure that it complies with your state and local laws, and you should identify a local lab that can perform the testing required to determine if an employee is under the influence while at work.
2) Paid Leave: Although the paid leave requirements of the federal government’s covid relief legislation has sunset, many states, counties, and cities have enacted or are considering enacting paid leave laws. Additionally, the Build Back Better Act would provide each worker with four weeks of paid family/sick leave. Some of these laws will require paid sick leave, others will provide for paid family leave. Given that these laws can vary from state to state and even city to city it is important that you review your Practice’s paid and unpaid leave policies to ensure that you are following the requirements for each practice location.
3) Pay Equity: This is no longer just a question of equal pay for equal work. In fact, in some states the standard has been revised to provide equal compensation, including benefits, for substantially similar work. Additionally, some states have enacted legislation that prohibits a prospective employer from inquiring about a candidate’s salary history. The Biden Administration has made this issue a priority and we anticipate some additional action from the Executive Brach. We recommend that you review the salaries and benefits being provided to all employees to ensure that there is consistency within each employee group.
4) Worker Classification: The U.S. Department of Labor recently withdrew the prior administration’s final rule designed to simplify the classification of workers as independent contractors, leaving open the possibility that the agency might be looking to propose a new rule. Such a rule could expand the number of workers considered to be employees under the Fair Labor Standards Act. Additionally, some states have made the misclassification of an employee a crime.
We also expect continued focus on exempt v. non-exempt status. Failure to pay even a minimal amount of overtime can result in the Practice being responsible for the back wages, a penalty, treble damages, and attorney fees. Practices are required to comply with multiple federal and state laws and agency guidance when determining worker status, applying wage and hour and tax laws and eligibility for fringe benefits. If you have a question about whether an employee is exempt you should seek the advice of an experienced employment law attorney before designating the employee as ineligible for overtime. Brent Pohlman, a Partner in the Employment Law practice group at Mandelbaum Barrett is ready to help with these questions.
February 18, 2022
For over two years Americans have continuously grappled with the unprecedented economic and social uncertainties brought about by the COVID-19 pandemic. While each individual was forced to face their own unique trials and challenges, many sought to cope with the ongoing isolation in a similar fashion: pets and companionship. Since the start of the pandemic, more than 23 million American households have welcomed new pets into their homes, nearly 1 in every 5 nationwide. As a result, American pet ownership has reached an all-time high, with household ownership rates exceeding 70% for the first time in U.S. history. This extraordinary surge in animal ownership has been accompanied by a significant uptick in pet-related spending. In 2020 alone, total pet spending in the U.S. reached nearly $84 billion, a 6.8% increase from the previous year, with expenditures on pet food, training, supplies, veterinary expenses, and more all experiencing considerable increases.
The remote nature of the pandemic had Americans not only spending more time with their pets, but more money on them as well. However, as Americans continue to navigate their way through the pandemic and toward a return to “normalcy”, social and professional obligations which have been absent from American life since early 2020 have begun to weigh heavily on recently adopted pets, as well as the bank accounts of their owners. A steady return to life in person has led many pet owners to seek out businesses, friends, and family members to care for their pets during working hours to ensure that they are not left alone throughout the day. The financial and logistical difficulties of pet ownership post-pandemic have left millions of Americans in precarious position, with some, unfortunately, electing to forgo their commitment to their pandemic companion in exchange for additional flexibilities. Pet ownership is a responsibility millions of Americans navigated for decades prior to the COVID-19 pandemic, and while the post-pandemic world certainly presents a plethora of obstacles to new pet owners, an ever-evolving pet-care industry is suited to assist. Below are examples of a few ways the legal field is helping to ease and improve pet ownership:
An Evolving Veterinary Landscape
Just as American pet ownership rates have seen a substantial increase since the start of the pandemic, so too have nationwide revenues in veterinary medicine. In 2020 alone, the veterinary industry saw an increase in national spending of more than 14%. The national average salary of veterinarians also saw a substantial increase of more than 5%, a stark contrast to many other professions over that period. Thus, the state of veterinary medicine is quite excellent, despite recent industry-wide obstacles such as clinical staffing shortages and COVID-related facility access limitations.
What does the state of the veterinary industry mean for pet owners? As the veterinary industry continues to grow, so too does level of service pet owners will experience. Across the country veterinary practices are being purchased, sold, and merged at record-breaking rates. These transactions often result in a more efficient and resourceful veterinary practice suited to better serve the individual and their pet. The parties playing the role of the buyer in many of these transactions tend to be larger companies with plentiful resources. After the transaction has been completed, the resulting veterinary clinic is often larger, more resource abundant, allowing veterinarians to focus on treatment of patients while management responsibilities are handled at the higher level. The beneficiary of this industry trend is not only the veterinarian, but the American consumer and pet itself, who will steady begin to experience a veterinary field better suited to meet the demands of the post-pandemic, pet-heavy market.
Increasing Landlord Lenience
Pet-related restrictions in the rental real estate markets have limited many new owners’ living mobility in a significant way. Pet-friendly housing can prove scarce in many areas of the country, an issue which the Humane Society has estimated to lead to nearly 500,000 pet surrenders each year. Even when many rental housing providers claim “pet friendly,” further restrictions on weight, breed, and age of the animal can result in the exclusion of the majority of otherwise eligible owners. The recent surge of American pet ownership has only further exacerbated this dilemma, with pet-friendliness ranking in the top 3 of rental amenity searches since 2020. The good news is that recent trends in the rental market are moving in favor of our four-legged friends. The Human Animal Bond Research Institute recently found that 83% of real estate owners reported pet-friendly vacancies are filled faster, and that residents in pet-friendly housing tend to remain 21% longer than those in housing that does not allow pets. “Individual apartment landlords are more agreeable to allowing tenants to have pets just to get tenants to rent their apartments,” said one prominent New York real estate agent.
While pet-friendly housing is trending in favor of pet-owners, renters should still expect their pets to affect the renting/leasing process in considerable ways. Indeed, a pet is likely to become part of leasing agreement, as many landlords will request a higher monthly multiple in security deposits from prospective renters accompanied by pets. While one to one and one-half monthly rent is typical in most residential leases, pet-owners should not be surprised by two, or in some cases even three times monthly rent is requested in security deposit at signing. Additionally, lease addendum permitting pets are also quite common. These are addition terms which attach to a lease agreement, and typically include a list of specific pets permitted in the rented space, pet vaccination requirements, liability provisions, and other rules and restrictions relating the pet’s occupancy of the property. These pet addendums are worth examining thoroughly, as owners will want to ensure that information contained therein is accurate and not overly cumbersome to the pet’s living situation.
February 18, 2022
It may be your first time buying or selling a veterinary practice. During this process, you will undoubtedly stumble upon terms that are unfamiliar to you and admittedly confusing. While learning all the terminology and legal jargon of the mergers and acquisitions industry should not be your goal, it is important that you understand the meaning of some key terms that will help you confidently navigate the course of buying or selling a veterinary practice.
Below we have compiled a number of key terms which will likely rear their head at some point in the acquisition process. We have condensed the meaning of these terms and organized them in a way that should follow the natural progression of a veterinary practice transaction. However, please be mindful that transactions are driven by the parties and their unique needs. Therefore, this is not an exhaustive glossary of words or issues that arise, but rather a sampling of terms practice owners and buyers will likely encounter during the sale.
A Non-Disclosure Agreement (“NDA”): This is typically the first agreement that is signed as it serves to keep sensitive information disclosed by the seller to the buyer confidential. Proprietary data, such as the practice’s financials, client/patient list, supplier information, and employee information can be crucial to a potential buyer in assessing the acquisition. However, if this information fell into a competitor’s hands, it could be detrimental to the seller. With an NDA in place, sellers can feel more comfortable sharing information with a prospective buyer. Nevertheless, it is important to have a signed NDA in place before handing over any sensitive information.
Letter of Intent: This is a preliminary document (also known as an “LOI”) which sets out the key terms of a proposed business transaction. An LOI is usually non-binding, which means the parties are not obligated to complete the proposed transaction. The purpose of an LOI is to ensure that the parties agree on important terms such as purchase price, payment terms, employment terms following the sale, due diligence, and closing contingencies before investing further resources negotiating the deal. Signing an LOI signals the parties’ willingness to negotiate exclusively for a set period as the parties work to finalize the deal.
Asset Sale: An asset sale is the most common way to sell a veterinary practice. It involves a seller agreeing to sell all or certain assets, and in some cases the practice’s liabilities to a buyer. Assets will include, but not be limited to equipment, goodwill, intellectual property, inventory, patient/client lists, and accounts receivable. However, in this sale, the seller will retain its corporate entity and the buyer must either (1) purchase the assets in his or her individual capacity (not recommended), (2) use a pre-existing entity, or (3) form their own entity for the purchase (the preferred method). During the transaction, the parties will negotiate an asset purchase agreement (the “APA”), which is the primary transaction document that sets out the key terms of the sale. The APA will include the purchase price, payment terms for the practice, the representations and warranties of the seller and the buyer, a detailed description of the assets being purchased, a list of other documents and information to be delivered at the closing, as well as other key terms such as representations of the selling veterinarian about the pre-closing operation of the practice, restrictive covenants, transition obligations, closing contingencies, and indemnification obligations.
Due Diligence: A buyer’s careful assessment of the benefits and liabilities of a proposed acquisition, which entails inquiring into all relevant aspects of the past, present and future of the target practice. Due diligence occurs after a LOI is signed and may be limited to an agreed-upon period or may continue through the closing date. By way of example, due diligence can include running lien and judgment searches on the practice (and the individual owner(s)), which can reveal unpaid taxes, debts, or legal judgments; financial due diligence, which includes a deep dive into the seller’s financial statements; and legal diligence, which includes an exhaustive review of seller’s contracts, governmental permits, professional licenses, insurance coverage, employee data, litigation, corporate formation documents and ownership, employee benefits, along with a host of other issues. A good legal team will mentally prepare both parties for this phase of the transaction, as it often leads to “deal fatigue.” This is because due diligence is tedious, may feel repetitive, and often seems to last a long time. This response is normal and expected. However, in the end a thorough due diligence process is in both parties’ best interests. A buyer does not want to overpay for the practice or inherit an unexpected liability or problem, and the seller does not want to indemnify the buyer for violations or inaccuracies in the representations and warranties the seller makes when selling the practice.
Rollover Equity: This term refers to an ownership interest in a practice purchaser’s entity (or affiliate) given to the seller of a practice as part of a sale consideration. This allows a buyer to pay seller less cash up front, and ensures a selling veterinarian has some skin in the game. Accepting rollover equity is riskier than taking cash at closing, but can be rewarding if the buyer is successful. In some circumstances, rollover equity may also be advantageous from a tax perspective.
Covenant Not to Compete: This is a contractual term in the APA (and owner employment agreement (if applicable)) that restricts the seller’s right to engage in competitive activity in a specific geographic area and for a specific length of time. For example, a veterinarian that is selling a small animal practice will generally be required to agree to a non-compete provision prohibiting the veterinarian from practicing near their former practice for several years (typically 3-5 years) following the sale of the practice, unless the veterinarian is working for the buyer. In most states, non-competes must be reasonable in time and geographic area to be enforceable.
Closing Contingencies: These are conditions that must be satisfied before a transaction can be completed. Generally, a buyer will insist that key employees agree to continue working for the purchaser (this may include the owner of the selling practice); that due diligence be satisfactorily completed; that the buyer have an agreed-upon lease with the practice’s landlord or have successfully negotiated an agreement to purchase the property where the practice is located; and that all the debts and liens on the practice’s assets be paid off and terminated at or prior to the closing.
Hopefully these key terms will help you gain a better understanding of what to expect when buying or selling a veterinary practice. If you are comfortable with these terms, you will be better equipped to take the required steps to ensure your transaction proceeds efficiently and successfully. The National Veterinary Law Group at Mandelbaum Barrett is here to answer any questions you may have.
February 16, 2022"Common in veterinary practice transactions, restrictive covenants are designed to prevent the seller from soliciting clients and competing with the buyer after the sale. Through such restrictions, buyers aim to protect themselves and ensure that the acquired business does not lose value due to the seller's re-entering the market. To fulfill those objectives, a purchase agreement's restrictive covenants should be negotiated, clearly stated, endure for a reasonable period (for example, two to five years) and be practical in geographic scope."
February 16, 2022Peter Tanella, Esq., Chair of the National Veterinary Law Group at Mandelbaum Barrett, and attorneys Melody Lins, Esq. and Justin Wade, Esq. will be attending the Western Veterinary Conference (WVC) in Las Vegas from March 6th to 9th, 2022. They are looking forward to connecting with industry friends and colleagues and will be at Booth 1351.
February 8, 2022"Empathy and communication go a long way when heading off litigation. Unfortunately, a New Jersey case shows what can happen in their absence."
October 27, 2021
For many veterinary practice owners, aspirations of selling your practice may be tempered by the unknowns of the acquisition process. Even when the circumstances of a potential sale are ideal, unfamiliarity with the market and sale procedures can lead to hesitancy. While timidity toward the unknown is certainly justifiable, owners should not let it stop them from becoming a participant in the rapidly growing market for veterinary practice acquisitions. While each veterinary practice sale is unique in its own right, there are also a number of procedural commonalities that appear in nearly every deal. Getting familiar with these steps and procedures may help shed some light on the selling process and relieve the effects of the acquisition unknowns:
Deciding to Sell: Behind every veterinary practice sale is the practice owner’s “Why”. The end goal for a successful veterinary practice owner is to one day sell their practice for a lucrative price and start their next chapter. For some, that next phase is complete retirement. For others, it might mean stepping away from a managerial role to focus solely on medicine, carving out more free personal time or sharing the responsibilities with a partner. Whatever the motivation may be, every sale of a practice begins with an owner’s decision to sell.
Valuing the Practice: An owner must have a general understanding of the monetary value of their practice prior to initiating the sales process. This valuation establishes reasonable expectations of return prior to entering the acquisition market and sets a pricing standard for potential buyers. Several key factors that are helpful in determining your practice’s value include the practice itself, equipment, and current and potential revenue. Potential buyers will also consider gross revenue, profit and loss statements, net operating income, EBITDA (earnings before interest, taxes, depreciation, and amortization), profit margins, a good location, room to expand, a long-lasting, efficient staff, a practice owner who will stick around and great client retention.
Finding a Buyer: There are many ways in which a practice owner may come across a suitable buyer. In some cases, the buyer may be a partner or associate veterinarian in the practice. In others you may have considered selling to a corporate consolidator. Selling to a corporate consolidator can be an excellent way for some owners to get their equity out now, with the ability to still work as a DVM for a few years after the sale. Three things that just about every corporate consolidator is looking for in a practice – high gross revenue, profitability and location. Knowing your options when it comes to selling your practice is a must. Consider engaging an experienced practice broker who can help you form the best plan for you and the best plan for your practice.
Negotiate the Deal: Once a suitable buyer has been located, it is time to determine the terms of sale. What does the purchase price look like? Will the owner receive all cash at closing? How long will the owner have to work after the sale? Are there any ownership opportunities for my associates? Should I sell or hold the real estate? What will the terms of my lease look like? There are many moving parts that need to be negotiated before the transaction can be consummated.
Letter of Intent: The letter of intent (LOI) is the preliminary agreement of the acquisition process which contains such salient terms as the purchase price, how the purchase price will be paid at closing, when the deal will close, the owner’s opportunity to reinvest in the buyer, the owner’s post-closing employment terms, and the terms involving the real estate. While the LOI is not a legally binding contract, it is typically used to establish both the essential terms of the transaction and the commitment of the parties to move toward a successful closing.
Due Diligence: This is the process of “looking under the hood” of the practice; the buyer will conduct an extremely detailed accounting of the assets, records, inventory, and financial standing of the veterinary practice. By conducting due diligence, the buyer is ensuring that the practice to be purchased is worth the price to be paid. For this process, the parties will want to involve industry specific accountants and legal counsel, as the closing of the deal and the purchase price to be paid is naturally contingent upon buyer’s satisfaction of the due diligence outcome.
Contracting Stage: The “Purchase Agreement” is one of the most important pieces of the entire transaction. This agreement, prepared and negotiated through each party’s respective legal counsel, will encompass the essence of the acquisition and obligations of both buyer and seller in successfully closing the transaction.
Pre-Closing Contingencies: Between the execution of the LOI and the agreed-upon closing date, both the buyer and the seller will be contractually obligated to perform a number of actions prior to the closing. These obligations may include the obtaining financing, disclosure of all practice operations, execution of employment documents and various certificates, etc. Each party’s respective legal team will be significantly involved in facilitating the drafting of documents and ensuring the satisfaction of deadlines and contingencies during this period.
Closing: The “Closing Date” is the day that the veterinary practice transaction is solidified; the seller is paid the purchase price, the buyer acquires ownership to the practice, and transaction is complete! Keep in mind that with modern technologies, a successful closing is typically accomplished electronically – gone are the days of the in person closing. The closing date marks the end of the acquisition process, and a new beginning for each party, especially for the owner who moves one step closer towards retirement.
If you have questions about Veterinary Law, please contact Peter Tanella.
October 27, 2021
President’s Executive Order
The enforceability of non-competition agreements (NCAs) has been a hot topic in many industries since President Biden issued his July 9, 2021 Executive Order. The Executive Order does not bar or even limit NCAs. Rather it is a directive to the Federal Trade Commission to analyze the issues surrounding NCAs and promulgate rules. Although the media has framed this section of the Executive Order as seeking to ban non-competition agreements in employment contracts, the plain language of the Order makes clear that the Administration at this time is seeking to target what it feels are “unfair” uses of NCAs that “unfairly” limit worker mobility.
Regardless of whether the FTC has the authority to do so we anticipate that it will promulgate rules relating to NCAs within the next 12 months. We expect that the FTC will prohibit NCAs for lower wage earners, as defined by the FLSA, and will require that an NCA be presented prior to the acceptance of an offer of employment or promotion. When these regulations are issued there will be litigation over whether the FTC has acted outside the scope of its authority.
This is not just an issue at the Federal level. A few states have already adopted legislation either prohibiting NCAs or limiting their scope. Many other states have recently introduced legislation, that although not successful, demonstrates that this is an issue of concern to state legislatures. It is more likely changes in the laws governing NCAs will come from the States as opposed to Congress or Federal administrative agencies.
Creating Enforceable NCAs
You have hired a new associate. You spend countless hours training and mentoring the associate. You expend resources to market the associate to the community you serve, only for the associate to leave for a competitor, or start up his/her own practice in direct competition with you. That story does not have to happen. In most states a Practice has the right and ability to protect its legitimate business interests through NCAs.
1. Know Your State’s Law: California, North Dakota, Oklahoma, and have enacted legislation effectively bans NCAs in most circumstances, and Washington D.C.’s law will go into effect in 2022. Other states have implemented laws that prohibit NCAs for low wage employees or require that the employee be provided with some level of compensation during the restrictive period. Some states have implemented requirements regulating when a NCA can be issued to an employee. However, most states still will still enforce an NCA that contains reasonable terms.
2. Cleary Define the Services Your Practice Provides: If your practice provides emergency services, mobile services, home visitation services, or another specialty be sure to identify those specialties in both the employment agreement and restrictive covenant. If the agreement only states that the associate will provide general veterinary services to companion animals and that employee then seeks employment with a specialty practice a court may find that the two practices are not in competition and may not enforce the NCA.
3. Identify The Prohibited Activities: Specifically articulate the activities the associate is prohibited from engaging in, and the classes of individuals or entities the associate is prohibited from soliciting.
4. Imposing a Reasonable Geographic Scope: This is going to vary based on the location of your practice. A reasonable geographic scope in an urban area will be different than in a suburban or rural area. This will also vary depending on the type of practice. The reasonable scope for general veterinary practice will be less than one for a specialty practice.
5. Imposing a Reasonable Duration: Generally 1- 2 years is considered reasonable. However, if an associate does not work out within the initial 60-90 day period of employment a Court is not likely to impose a 1-2 year NCA.
A reasonable NCA will apply only to employees who are in a position to compete with the Practice. This means veterinarians, practice managers, operations and financial officers. It should be provided to the employee at the time of hire, when given a promotion, or a bonus. An NCA with a tech or assistant is not likely to be enforceable. The NCA should identify what key services that employee provides to your practice, and what the employee is being prohibited from doing. The time and geographic restrictions should be reasonable in nature when considering where the Practice is located and the type of Practice.
Finally, it is important to remember that non-solicitation agreements (NSAs) can be just as useful as NCAs in protecting your Practice’s business interests and NSAs are not subject to the regulation and judicial scrutiny that NCAs are.
If you have questions about Veterinary Law, please contact Peter Tanella.
October 22, 2021
October 20, 2021
An analysis of the plaintiff’s lawsuit
August 17, 2021
At certain points in time, there have been unique windows of opportunity, where market factors have driven veterinary practice valuations upward. For example, in 2012, America approached a fiscal cliff, due in large part to George W. Bush’s expiring tax cuts. If Congress and President Obama failed to act, which it appeared they might, it would have led to the largest tax increase in more than six decades. As this played out, many veterinarians raced to close their transactions, fearful of an increase in the capital gains rate.
In the end, Congress and President Obama reached a last-minute compromise that avoided most of the issues that veterinarians feared were inevitable – and the M&A market came back to earth.
If you fast forward to recent times, one trend driving transaction activity in the marketplace is the consolidation that’s occurring throughout the profession. We are now seeing the rapid emergence of private equity-backed consolidators, which are becoming a greater percentage of the overall marketplace. As a result, practice values and sale prices have been driven higher because of the different valuation concepts used by private equity compared to traditional veterinarian to veterinarian transactions.
Throwing gas on this already bright fire is the COVID-19 pandemic, which has caused many veterinarians who were contemplating their future to rapidly accelerate their timetable for transition. Simply put, many older veterinarians have been impacted by the stress of the pandemic, and when they’ve been presented with one of the lofty offers floating around the market these days, decided that they did not want the burden of running their practices anymore.
On top of this, we see a third factor emerging, which should lead to an unprecedented volume in M&A activity in the profession. Since the beginning of the COVID-19 pandemic, the federal government has been printing money at an unprecedented pace, including the $2.2 trillion CARES Act passed in March 2020, a $900 billion relief bill passed by the Trump Administration late last year, and President Biden’s $1.9 trillion American Rescue Act, passed in March of this year. On top of that, the Senate passed a $1.2 trillion infrastructure bill in August, and one day later a larger $3.5 trillion budget resolution.
When you add up these extraordinary pieces of legislation, you get a potential total of over $9.7 trillion of newly printed money by the federal government – in just over a year. Regardless of your politics, this spending will plunge the country deeper into debt, and there appears to be no plan to pay for any of it other than President Biden’s plan to dramatically raise taxes. Moreover, the intensity of political debate is fierce, as politicians fight for, and against, such a complete overhaul of the tax system.
If you’re contemplating a practice transition, it’s important to recognize that a material increase in the capital gains rate is a likely outcome from this debate, and that change will have significant adverse tax consequences if you sell a practice after December 31, 2021 (the President’s plan calls for making this increase retroactive in 2021, but most experts do not believe he has the support for such a drastic measure).
The current proposal calls for any person or family with a combined income of $1 million or more to potentially pay 39.6% tax on any capital gain or ordinary income, plus the Obamacare tax, resulting in an enormous tax of over 40%. Many in the tax profession believe it might be difficult for the President to gain the support of every single Democrat, which he will need in order to pass this huge tax increase, however the same experts are confident that there will be an across-the-board increase in the long-term capital gains rate from 20% to something in the neighborhood of 30%. While nobody has a crystal ball, when you reflect on the recent spending, and the fact that the country was already massively in debt, I think we can all agree that our taxes cannot stay the same.
Taken together, this perfect storm of conditions should lead to unprecedented veterinary M&A activity in the final quarter of 2021.
My advice to you is this: If you’re thinking about listing your practice, or considering a transition, you must start the process immediately. And for those of you looking to grow through acquisitions, I recommend you speak with your banker, line up capital, and be ready to strike at an opportunity with a motivated seller who is racing against the tax clock.
August 4, 2021A handbook is an important resource that every veterinary practice should have, whether it has five, 25, or 50 employees. That’s because the key to healthy relationships between employers and employees is clear and consistent communication. Most workplace dissatisfaction, tension, and even litigation results from employees not knowing what’s expected of them, what they are entitled to, or the appearance of practices and polices being inconsistently applied. A handbook provides employees with the following:
June 22, 2021The purchase or sale of a veterinary practice can be an overwhelming journey. Even seasoned clinicians will encounter numerous potholes — emotional, financial and legal issues — on the road to closing what in many cases can be a multimillion-dollar transaction. Here are eight gaffes that frequently occur in the veterinary world and suggestions for overcoming them.
February 24, 2021
The FDA began issuing COVID-19 vaccines in December. With distribution determined by “phase” classifications, many members of the veterinary industry have been left wondering when their vaccines will be made available.
Vaccination distribution plans have been primarily left at the discretion of state governments, thus resulting in some differences from one state to the next. That said, Phase 1A has generally included frontline healthcare workers, as well as residents and staff of long-term care facilities. Upon the substantial completion of Phase 1A, some states have begun transitioning to Phase 1B, which generally includes first responders, individuals over the age of 65, and individuals with underlying health conditions. The parameters of Phase 1C is still largely unclear in many states, but it is generally expected to encompass select groups of “essential workers,” including childhood education workers, public transit workers, postal workers and more. Vaccination of the general population is not expected until Phase 2 (or, in some states, Phase 3).
While veterinarians are typically recognized as “healthcare providers” by their respective states, they have scarcely been included in Phase 1A of vaccine distribution – with California and Oregon being notable exceptions. The CDC has recently recommended including “veterinary services” in Phase 1B of vaccine distribution, with states such as Illinois and Pennsylvania following this federal guidance. Other states, however, have not granted this level of priority; for instance, South Carolina and New Mexico have designated veterinarians as Phase 1C eligible, while Massachusetts will not make vaccination available to veterinarians and support staff until it is available to the general population in its respective Phase 3.
Many states such as New York, New Jersey, Florida, and more, have yet to determine which priority status will be granted to veterinarians and support staff, if priority status is provided at all. The prevailing trend seems to be that veterinary medicine will receive Phase 1B or Phase 1C classification in most states. However, it is important to remain up to date on the vaccination distribution plan of your respective state, as such plans have been subject to frequent update and revision.
May 15, 2020
On March 24, 2020, the U.S. Food and Drug Administration (FDA) suspended temporarily the enforcement of certain regulations governing veterinarian-client-patient relationships (VCPRs), a move that helps veterinarians examine and treat animals using telemedicine, while limiting human interaction and the potential spread of COVID-19. This is welcome news if you’re considering telemedicine for your practice, but you also need to review the specific VCPR requirements that may exist in your state; as well as telemedicine licensing considerations if you’re treating patients across state lines.
After you’ve done that, there are a number of technology options available, including TeleVet, Medici, GuardianVets, AirVet, BabelBark and VetCareShare. Here are a few common features, and the potential benefits they provide:
Remote exams and evaluations
Telemedicine platforms make it easier to offer certain services remotely, such as medical progress exams and follow-up evaluations of existing conditions. For instance, a vet could remotely offer post-operative surgical consults; and evaluations of skin disorders, wound healing, ear infections or bladder infections.
File and screen sharing
The telemedicine platforms offered by these companies include features that have been widely adopted during COVID-19, including image and video sharing, and document transfers. In addition, some allow vets to share lab results or x-rays with a voice recording that explains the results to the animal’s owner. Many of these platforms also help veterinary practices store and maintain medical records, including pictures, data, client/provider communications, and recorded consultations.
Remote monitoring of patients
Some platforms also include around the clock ability to monitor a patient’s well-being. For example, telemedicine platforms have been used to supplement and support veterinary staff by providing a hotline that can triage patients’ medical needs remotely. Further, to ensure continuity of care, some platforms can send veterinary practices the details of the call and outcomes, which can be helpful with after-hours cases and overflow.
Patient monitoring applications
Another benefit of some platforms is a patient monitoring application, which enables the service provider and the client to share health metrics such as weight, diet, nutrition, medication compliance, activity or exercise. This feature expands the data in a veterinary practice’s medical records because clients can make contemporaneous updates, such as a recording of a pet’s food, or notes about prescriptions purchased elsewhere, all of which can help if correlated health issues arise later.
May 15, 2020
Stay at home orders and social distancing may be the current norm, but eventually businesses will re-open and gradually come back to life. In the rush to return to normal, veterinary practices must carefully plot the safest and smoothest path forward. In this article, we address many of the issues veterinary practice owners need to be mindful of as they re-integrate their workforce, including employment rules, guidance for managing the care of household animals that reside with a person with COVID-19, and best practices for implementing curbside service and/or telemedicine.
What kind of medical information can veterinary practice employers ask their employees?
Employers covered by the Americans with Disabilities Act (“ADA”) may ask employees who report feeling ill at work, or who call in sick, questions about their symptoms to determine if they have or may have COVID-19. Currently these symptoms include, for example, fever, chills, cough, shortness of breath, or sore throat. These inquiries are not disability-related and are thus permitted under the ADA. Similarly, an employer can send home an employee who has reported to work with COVID-19 or symptoms associated with it. Further, because the CDC and state/local health authorities have acknowledged community spread of COVID-19, employers may also measure employees' body temperature as an additional measure to protect the practice. However, as with all medical information, employers must maintain all information about employee symptoms and illness as a confidential medical record in compliance with the ADA.
May a veterinary practice employer compel its employees to take a vaccine during a pandemic?
No. An employee may be entitled to an exemption from a mandatory vaccination requirement based on an ADA disability that prevents him from taking the influenza vaccine. This would be a reasonable accommodation barring undue hardship (significant difficulty or expense). Similarly, under Title VII of the Civil Rights Act of 1964, once an employer receives notice that an employee’s sincerely held religious belief, practice, or observance prevents him from taking the influenza vaccine, the employer must provide a reasonable accommodation unless it would pose an undue hardship as defined by Title VII. Although there is no currently known vaccine available for COVID-19, ADA-covered employers should consider simply encouraging employees to get the vaccine rather than requiring them to take it.
May a veterinary practice employer require employees who have been away from the workplace during a pandemic to provide a doctor’s note certifying fitness to return to work?
Yes. Such inquiries are permitted under the ADA either because they would not be disability-related or, if the pandemic influenza were truly severe, they would be justified under the ADA standards for disability-related inquiries of employees. As a practical matter, however, doctors and other health care professionals may be too busy during and immediately after a pandemic outbreak to provide fitness-for-duty documentation. Therefore, new approaches may be necessary, such as reliance on local clinics to provide a form, a stamp, or an e-mail to certify that an individual does not have the pandemic virus.
What guidance exists for veterinary practices that manage the care of household animals that reside with a person with COVID-19?
In addition to other prevention measures, people with COVID-19 should be advised to limit interaction with household animals. Specifically, while a person infected with COVID-19 is symptomatic, they should maintain separation from household animals as they would with other household members, and avoid direct contact with pets, including petting, snuggling, being kissed or licked, sleeping in the same location, and sharing food. If possible, a household member should be designated to care for pets in the home and should follow standard handwashing practices before and after interacting with the household animal. If a person with COVID-19 must care for pets, they should ensure they wash their hands before and after caring for pets. If an owner is sick with COVID-19, a family member or friend from outside the household may bring the animal to a veterinary hospital or clinic. Telemedicine may also be appropriate to provide consultation with a veterinarian if the owner is a COVID-19 case and is unable to find an alternative caretaker to bring the pet to the hospital.
Veterinarians and their staff should review and adhere to their biosafety and biosecurity protocols for infectious diseases to ensure the safety of their patients. Further, they should familiarize themselves with the concepts in NASPHV Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel. This document outlines routine infection prevention practices designed to minimize transmission of zoonotic pathogens from animals to veterinary personnel. These infection prevention and control guidelines should be consistently implemented in veterinary practices and hospitals, regardless of ongoing outbreaks of infectious diseases, but are especially important during an outbreak of an emerging infectious disease such as COVID-19. Further, a state public health veterinarian should be contacted by animal health professionals or veterinarians that have discovered a household animal with a new, concerning illness that has had close contact or resides with a person with COVID-19.
How should veterinary practice managers change their protocols to continue providing excellent service while keeping people and animals as safe as possible?
Social distancing has proven to be an effective way to mitigate the spread of COVID-19. Therefore, many veterinary practices and hospitals have changed their workflow completely to offer curbside service. If your practice has not implemented telemedicine or curbside services yet, this may be the best way to ease back into life after COVID-19. Many practices made the decision early on to stop elective procedures and ancillary services (e.g. grooming, boarding) and currently are providing only outpatient services and emergency surgeries. With a few exceptions, namely euthanasia appointments, clients are being asked to remain in their cars and are not permitted in the building.
March 12, 2020
A Management Services Organization Adds a Layer of Structural Complexity to a Veterinary Practice but Offers Non-Veterinarians and Even Family Members the Opportunity to Reap the Financial Rewards
Veterinarians, investors and executives who want to form a management services organization (MSO) often do so without fully exploring the reasons. One revolutionary change in the veterinary industry over the last decade was heightened interest in MSOs, which resulted in a lot of newer market entrants, including, but not limited to, private equity.
Category: Partnership Agreements
October 6, 2019
Avoiding Malpractice Liability: A Guideline for Veterinary Practices
October 5, 2019
Surviving the Corporatization of Veterinary Medicine as an Independent Practice
While the veterinary industry remains comparatively fragmented to other parts of health care, the area has seen substantial consolidation over the last five years. The consolidation has largely been led by Mars, Inc., who are considered by many to be the lone strategic buyer in the industry. But, as more private equity firms begin to explore sales of their investments in veterinary hospital groups, new strategic buyers attempting to capture economies of scale could emerge. In this coming shift, how can a veterinary practice owner continue to grow their practice, or, if the time is right, obtain the best value for their practice?
Private Equity has been a persistent investor in the veterinary industry because of the lack of strategic buyers, the attractive private pay revenue stream, and the largely recession proof market for veterinary services. Over the past 5 years the industry has seen two stages. First, the Ares purchase of National Veterinary Associates for 13x EBITDA in mid-2014 until the Morgan Stanley investment in Pathway Partners. The second stage began with Mars Inc.’s purchase of VCA at a multiple of 18x EBITDA in late 2017 is continuing today. The current climate of large valuations are seen when larger groups can capture economies of scale, roughly at 20 clinics. However, the purchase price for smaller groups and add-on investments has also crept up to about 8x-10x EBIDTA from 6x.
Currently, the expectation is that the private equity firms will remain active in the space for another 6-8 years at which point the market is expected to have become more consolidated. This shift will occur as investments reach the end of their timeline and begin to sell to established corporate groups like Mars or new strategic buyer entrants.
A practice owner in this environment can find it stressful to grow their business with the economic pressure that can come from corporate groups or feel anxious that they are not getting the best possible price for the business they have worked so hard to build.
First, remember that what makes a veterinary practice successful has not changed in the current environment. Veterinary practice owners should continue to do what some large corporations cannot: practice better medicine and offer better and more personalized client services! But in order to continue to grow and be attractive to clients and potential buyers, practice owners should learn from the corporate model and focus on the business side of revenue and improving efficiencies.
A few areas that practice owners can learn from the big corporations are:
Corporations spend a lot of time marketing and it really matters. Spend time developing a marketing plan and thinking about strategic partners in the community.
Team and Client Education
Corporations do a great job and invest a lot of effort into making sure their teams are on the same page. Practice owners should develop training manuals for their employees on a variety of topics. Furthermore, corporations often have resources online to educate clients on major issues.
Talent Acquisition and Retention
Big corporations have the advantage when it comes from providing benefits to new and existing hires. Practice owners should educate themselves on benefit offerings and make the investment in the wellbeing of their associates and staff.
Lastly, practice owners shouldn’t shy away from investing in the physical appearance of the practice. While corporations might be able to invest more money into renovations, smaller investments into the facilities of the practice can pay large dividends down the road.
In the climate of corporate competition, remember to focus on what made your practice successful in the first place. The independent veterinary practice will continue to survive, but the corporate structure is here to stay.
For more information, please contact Peter Tanella at 973.243.7915 or firstname.lastname@example.org.
October 4, 2019
Maximizing your “Paw”-Fits: Structuring Your Veterinary Practice the Right Way
Choosing the right business structure for a veterinary practice is a vital decision that can have significant consequences for the future of your practice. If a veterinarian selects the wrong structure, it can cost their business a significant amount of money. Choosing a correct business structure for a veterinary practice is a fundamental decision that will impact your business daily and should be guided by an attorney. The main factors to consider when structuring your business are: (1) the financial issues and tax consequences; (2) limited liability; and (3) flexibility versus formality. Selecting a business structure is one of the most important decisions you will make for your practice. In selecting the right entity, substantial tax, legal, and accounting expertise is recommended. It is advantageous to start your business on a good foot, and while it may look daunting to hire expert consultants at the beginning of your endeavor, it is a valuable investment for your future success. The proper structure of your veterinary practice will allow you to reap all the possible benefits and increase your chances at a successful practice. However, it is recommended for veterinarians to stay active in the process in order to ensure that the expert’s proposals reflect the needs and goals of your practice.
Tax benefits are a primary driver when choosing a proper legal structure for a veterinary practice. Two key aspects include: taxation on income/profits and taxation on the sale/transformation of a practice.
Limited liability is another significant consideration when deciding between business entities. The majority of independent veterinary practitioners around the country have traditionally operated as a partnership or sole proprietorship. However, there is a growing trend towards incorporating a practice and/or forming LLC’s as a vehicle for running the business because the structures various benefits. This business structure combines features of a corporation and has elements of a partnership and/or sole proprietorship. Limited liability companies can be tactical from a tax standpoint. Single member LLCs can be taxed either as a ‘C’ Corp or sole proprietorship. Multi-member LLC’s can elect to be taxed as either a ‘C’ Corp or partnership. However, this can be dependent on the state, as not every state allows for veterinarians to form an LLC (for example, California). There are many benefits for the LLC Sub ‘S’ structure. These types of entities are treated the same as any other corporation under state law. Although under federal law, ‘S’ corps do not receive federal tax.
For certain veterinary practices, it can be advantageous to be the only owner and in complete control of the practice. There would be no requirement for seeking approval and or consent of any partners, members, or officers. With a sole proprietorship, there are also minimum to no reporting requirements. Sole proprietorships do not need to file an annual report with the state or federal government. However, under a sole proprietorship, a veterinarian will be held personally liable for all general debts and liabilities of the practice. Moreover, in a partnership, each partner is jointly and severally liable for the debts and obligations of the business. In comparison to sole proprietorships and partnerships, the significant advantage of a corporation or LLC is that the owners of the business (the shareholders/and or members) enjoy the benefits of limited liability.
There is one big exception; however, in that a veterinarian is always liable for his/her own professional negligence and negligence of other employees. Insurance is the only avenue to mitigate this kind of liability, and it a necessity in veterinary practices.
Benefits of Flexibility and Adhering to Formalities
Certain entities also provide more flexibility and can be less of a burden than others. Veterinarians often ignore these formalities, which can be a serious mistake. In certain instances, courts have looked past the liability shield and have held owners personally liable for failing to observe the formalities of separating their personal affairs from their veterinary practice.
July 1, 2019
In early January, Governor Phil Murphy and Democratic leaders of the Legislature struck a deal that would raise the minimum wage to $15.00 per hour in New Jersey. On Monday, February 4, Governor Murphy followed through on his campaign promise, signing the legislation that will increase the state’s minimum wage over the next few years. This deal places New Jersey among the most progressive states in the nation, joining California, New York, and Massachusetts, in phasing into a $15 hourly wage.
While the wage increases are seen to be beneficial for employees, numerous small to medium-sized businesses are apprehensive about the reforms and impact on company revenues. The good news is that the impending changes provide an opportunity for New Jersey employers to audit their pay practices and ensure that they are in compliance with all wage and hour laws. Below summarizes the potential impact of the new ordinance and provides some tips for adjusting to the wage increases:
I. Increases will continue through 2024
The new minimum wage ordinance will not occur immediately. Rather, the deal sets forth a gradual increase until it reaches $15 dollars per hour in January 1, 2024. The current minimum wage in New Jersey is $8.85 per hour. The following chart details the scheduled increases in the state’s minimum wage.
The minimum wage would then increase on January 1 by $1 each year from 2022 to 2024 until topping out at $15 per hour. The new minimum wage will apply to most workers in the state, although there are a few so called carve-outs. The deal calls for most wage earners to receive a minimum of $15 an hour by 2024, but includes a slower schedule for workers at seasonal businesses, small businesses with five or fewer employees, and farmworkers. Farm workers, for example, will see their minimum wage climb to just $12.50 an hour over five years. Seasonal workers and small businesses with five people or fewer would see their minimum wages reach $15 an hour by 2026.
II. The Business Impact
Although raising the minimum wage is generally seen as beneficial for employees, there can be certain costs for businesses operating in the state. Specifically, small businesses in New Jersey could feel the brunt of the minimum wage increases. Opponents believe that the announcement reflects another potential hit to small businesses who are already absorbing cumulative costs in other forms of new mandates by the Murphy administration. Nearly 70 percent of respondents to the latest NJBIA business-outlook survey said their businesses would be impacted in some way if the state were to enact legislation mandating a $15 minimum wage. To offset such a requirement, they said some businesses — though not a majority of them — would reduce staff and working hours, and enact price increases or turn to automation.
Overall, it is estimated that over 1 million New Jersey workers will be impacted by the minimum wage changes, according to the governor and lawmakers. As a result, employers and businesses should weigh the impact of a higher minimum wage on profitability, hiring, and overall finances.
III. Staying Compliant
Now more than ever, states, counties, and cities, who do not see movement at the federal level, are implementing specific minimum wage laws in their jurisdictions. As a result, employers must ensure that they comply with federal, state, and local minimum wage laws. While the federal minimum wage ($7.25 per hour) isn’t changing next year, the state of New Jersey and many other states will have new minimum wage rates throughout 2019.
These new minimum wage ordinances can increase compliance risks for employers, requiring new workplace postings and changes to existing workplace policies. Therefore, employers need to be cognizant of the legal liabilities they could face if company wage and hour policies are not in compliance prior to the increase. Compliance is essential; employers in violation of payroll regulations can face penalties, including steep fines and civil litigation. When dealing with questions about minimum wage and overtime statutes, it is recommended that all employers consult with experienced counsel.
IV. Preparing for the Changes: Adjusting Pay Structures
In states that have significantly increased their minimum wages, the financial impacts often occur immediately and can be burdensome for small business owners. Employers should find ways to manage the effect on increase of pay structures. For example, if the minimum wage increases and jobs that currently pay $10 an hour are not entry-level positions – but a next level up – there could be a compression issues. Thus, employers should adjust their payment structures and account for them to be shifted up. The best way for making this wage shift can depend on the specific company and its compensation structure. Employers do not have to adjust all levels, but it is important to consider adjusting lower-paid jobs from a certain hourly rate on down.
V. Employees Earning More than the Minimum Wage
When the minimum wage increases, some employers wonder if they should also provide a raise to employees already earning equal to or more than the new rate. For example, if the minimum wage increases from $9 per hour to $10 per hour, should an employee already earning $10 per hour also get a raise? While the employer is under no obligation to provide a raise, some employees may be expecting one. In this scenario, the employer should consider the potential impact on labor costs, employee morale, internal equity (how employees are paid when compared with other employees within your company based on skills and experience), and the typical merit increase schedule.
As a result of Governor Murphy’s new deal, New Jersey’s minimum wage will continue to increase, starting July 1, 2019. With the patchwork of federal, state, and local minimum wage laws becoming more complicated, employers and organizations will need to pay more attention to the these issues and payment structures. Paying small business employees fairly begins with gaining a good understanding of the minimum wage laws. In doing so, employers need to remain compliant and cognizant to changes at the federal, state, and municipal level. Advanced legal planning will help employers – both public and private sector – to comply with the new minimum wage thresholds.
Enlisting the help of outside legal counsel can assure compliance with the complex patchwork of different minimum wage laws. Mandelbaum Barrett PC is a full-service law firm focusing on providing exceptional legal counsel to its clients. Our labor and employment attorneys are uniquely qualified to assist you and your business in achieving full compliance with New Jersey labor laws. Please feel free to contact us if there are any issues that we can assist you with.
Mandelbaum Barrett PC provides legal alerts to inform readers regarding trending legal issues and developments in the law. This communication does not create, offer, or reduce to writing the existence of an attorney-client relationship. This communication is not legal advice and may not apply to the specific facts of any particular matter.
 New Jersey Becomes 4th State to Increase Minimum Wage to $15, CBS News (February 5, 2019), https://www.cbsnews.com/news/new-jersey-gov-phil-murphy-minimum-wage-increase-today-2019-02-04/.
 Nick Corasaniti, In New Jersey, the Minimum Wage is Set to Rise to $15 an Hour, new york times (Jan. 17, 2019), https://www.nytimes.com/2019/01/17/nyregion/nj-minimum-wage.html.
 Mike Catalini, New Jersey Governor, Lawmakers Make $15 Minimum Wage Deal, nbc philadelphia (Jan. 18, 2019), https://www.nbcphiladelphia.com/news/local/New-Jersey-Governor-Lawmakers-Minimum-Wage-Deal-504542452.html.
 Murphy, Dems Reach Minimum Wage Deal, nj herald (Jan. 18, 2019), https://www.njherald.com/20190118/murphy-dems-reach-minimum-wage-deal.
 NJBIA’s 60th Annual Business Outlook Survey, New Jersey Business & Industry Association, https://www.njbia.org/wp-content/uploads/2016/05/NJBIA-2019-Business-Outlook-Survey-Handout-V5.pdf.
 David Levinsky, Murphy, Legislative Leaders Reach Deal on $15 Minimum Wage, (Jan. 17, 2019) https://www.burlingtoncountytimes.com/news/20190117/murphy-legislative-leaders-reach-deal-on-15-minimum-wage.
June 30, 2019
Pot for Spot?: Legal Issues Surrounding the Treatment of Veterinary Patients with Cannabis
California has become the first state to give veterinarians the legal protection to discuss medicinal cannabis as a form of animal treatment, but the question is should other states follow suit? Under federal law cannabis is strictly illegal and is considered a schedule 1 controlled substance; which makes many veterinarians afraid to discuss cannabis use with pet owners due to the guidelines of their professional licenses. Federal law is extremely different from the various state laws which may allow medicinal/recreational use of cannabis. However, state issued laws regarding the consumption of cannabis in humans do not apply to use in animals. CBD infused products have swept the market, due to the increase in the legalization of medical and recreational marijuana throughout the United States. These factors have led many pet owners to question whether it is safe to treat their pets’ ailments with medicinal cannabis, but in 49 states they are not allowed to discuss this proposition with their veterinarian. The reluctancy from veterinarians to discuss cannabis treatment for their patients has led patients to take their animals’ treatment into their own hands, with many pet owners conducting online research and treating their animals with unregulated products that contain cannabinoids. According to a 2018 study conducted by Colorado State University’s veterinary medicine researchers, almost eighty percent of 1,068 dog owners who participated in the survey admitted to buying cannabis infused products for their pets.
The internet is flooded with CBD infused animal treats and miracle stories about how CBD saved animals lives. However, it is hard to decipher fact from falsity in an area that has been notoriously under researched and viewed as illegal. Albeit; because of the rise of the legality of cannabis use in humans, there has been a recent rise in studies concerning animals and cannabis; these studies have shown evidence that cannabis can be beneficial for cats and dogs who suffer from diseases such as epilepsy, anxiety and arthritis, without the typical side effects of prescription medication. The FDA has the authority to regulate all products which claim to have therapeutic properties; the agency focuses on the safety and efficacy of the products. Since there has not been many studies on the effect of cannabis in animals, there has only been one product that is derived from cannabis that have been approved by the FDA in a extralabel manner by veterinarians, while following the guidelines of the Animal Medicinal Drug Use Clarification Act.
In addition to the legal ramifications, and licensing concerns, there have been a substantial amount of veterinary cases of Cannabis toxicosis in pets, which usually stems from animals consuming edibles intended for human consumption. To bolster this ailment, most of the edibles are made with other products which are toxic to animals such as chocolate, raisins and xylitol; which lower the chances of the animal making a full recovery. There have been several deaths reported due to cannabis toxicosis in animals and have led many pet owners and veterinarians to be suspicious of using cannabis to treat ailments in animals.
For more information contact Peter H. Tanella at email@example.com.
June 29, 2019
Independent Contractor or Employee: What’s the Difference?
It's a vexing question for practice owners: How do you classify a potential new veterinarian who is joining your practice? Is the veterinarian an independent contractor or an employee?
The misclassification of an employee as an independent contractor can result in serious financial ramifications, including taxes, fines, and penalties from both state and federal agencies.
What is an independent contractor?
Generally, veterinarians are independent contractors if they have control over the number of patients they see and their work schedule. They are not independent contractors if they perform services that can be controlled by the practice.
Practices often classify veterinarians as independent contractors to avoid having to comply with state and federal withholding requirements and payroll taxes. The practice simply issues 1099s to the veterinarian at the end of each year, and the veterinarians are responsible for reporting their income, which is subject to self-employment tax.
What is an employee?
If the practice has control over the veterinarians' patient load and schedule, they are employees of the practice. Employees are supervised by the practice and may be entitled to certain benefits and protections under state and federal laws. For instance, the practice is responsible for withholding a portion of employees' earnings for tax purposes.
4 classification factors
Independent contractors have complete autonomy over their work lives, whereas employees must answer to and abide by their employers. State and federal agencies consider four primary factors when determining if a veterinarian is an employee or an independent contractor.
The first factor is who supervises the veterinarian. There are four questions to be answered:
This factor concerns a veterinarian’s schedule and hours:
3. Benefits and insurance
This category focuses on insurance, healthcare coverage, and more:
4. Payment and expenses
The following five questions can sometimes be contentious, so it's best to spell them out clearly:
If an agency, such as a state department of labor or the U.S. Internal Revenue Service, audits a practice and finds that the practice has misclassified a veterinarian as an independent contractor, the consequences of a misclassification can be severe. The agency will likely seek payment of unpaid employment, disability, and Social Security taxes, along with additional interest and penalties. This could potentially cost the practice millions of dollars.
In addition, the misclassified veterinarian may be retroactively entitled to insurance coverage and other benefits that should have been offered by the practice if the veterinarian had been properly classified as an employee. If the veterinarian is deemed to be a nonexempt employee and worked more than 40 hours in any given week, the practice will also be responsible for back payment of overtime.
What can a practice do to protect itself?
The only fail-safe way to survive an audit is to classify veterinarian and staff in compliance with the criteria established by federal and state laws. Although this list is not exhaustive or foolproof, it is a start for identifying the best practices for maintaining classification as independent contractors:
“Compliance with a well-crafted independent contractor agreement is the best defense in a reclassification audit.”
Compliance with a well-crafted independent contractor agreement is the best defense in a reclassification audit.
June 28, 2019
When Two-Legged Epidemics Reach Our Four- Legged Friends: Veterinarians and the Opioid Crisis
It is common knowledge that an opioid epidemic has been sweeping the nation, but many veterinarians do not realize that they have a responsibility to help curve the abuse of pain medication in their practice. Opioids are extremely powerful pain-relieving medications, that are commonly prescribed to treat intense pain. However, these drugs are also extremely addicting, and can cause overdoses in humans and in pets; but the pets are not the problem. Recently a study was conducted by the Colorado School of Public Health, which concluded that a large amount of the veterinarians who were surveyed were concerned that their clients have intentionally hurt their pets in the hope of receiving a prescription for pain killers. Out of the surveyed population, almost forty five percent of the veterinarians knew a pet owner or employee who was abusing opioids. In addition, the University of Pennsylvania Veterinary medicine school analyzed the number of opioids dispensed at their veterinary school for ten years, and concluded that prescriptions rose forty-one percent annually, when the number of new patients only rose thirteen percent.
There have been many incidents of animal abuse by a pet owner in the hopes of obtaining prescription medication. For example, a woman in Kentucky was arrested after she admitted to cutting her dog with a razor blade with the intention of obtaining and consuming pain medication through her veterinarian. The most commonly targeted pain killer that is carried in most veterinary practices is tramadol, because it is highly addictive and is typically prescribed to both humans and animals. Other commonly abused drugs by pet owners include Xanax and Valium, whose prescriptions are extremely difficult to obtain through a physician. These methods are a way for drug addicts to obtain drugs under the radar, so it is imperative for veterinarians to be observant and meaningfully participate in the effort to end the opioid epidemic.
A combination of incidents has pushed the Food and Drug Administration to offer new resources for veterinarians who stock and prescribe opioids. The resource outlines six steps that veterinarians can take to help combat opioid abuse in their practice. It is recommended that veterinarians have an emergency plan outlined if they are ever in a situation in which they suspect opioid diversion, or clients harming their animals in attempt to gain access to pain killers; local police departments are the best people to help advise veterinarians on a plan of action if they ever encounter these dangerous situations. The FDA released a list of tip-off’s that can help veterinarians determine if a client is abusing opioid medication: suspect injuries in new clients, pet owners asking for a specific drug by name, asking for refills because medication was lost or stolen, and having a general demanding attitude about their request. However, it is not only pet owners that veterinarians need to worry about, it is also necessary for them to monitor the behavior of their employees who have access to the drugs. There are many warning signs that a staff member is abusing pain medication such as: lack of focus, frequently missing work, mood swings and anxiety. In addition, it is important for veterinary practice owners to have checks and balances regarding their ordering, storage, administration and dispersion of opioids for the health of their employees and for their own legal protection. This outbreak has made many states create control measuring laws for prescribing opioids. For example, Maine enacted a Prescription Monitoring Program, which must be checked before prescribing opioids and benzodiazepines to animals. The program requires the veterinarian to state the reasoning for the prescription and the physical condition of the animal; logging it into a statewide database, which helps to limit repeat abusers. In addition, the state of New Jersey signed the most restrictive law, limiting a five-day supply of initial opioid prescriptions, and require veterinarians to share the data with fourteen other states to help combat abuse. Many groups are currently pushing for other states to adopt New Jerseys restrictive laws in order to help combat the opioid crisis that is now affecting us all.
For more information please contact Peter H. Tanella at firstname.lastname@example.org.
June 26, 2019
The Veterinary Divorce: The Considerations When Leaving a Veterinary Practice
While departing from a veterinary practice may seem like a trivial task, it can often be a complex decision and process. When dealing with a “veterinary divorce”, both parties should engage in careful considerations to protect both the clients and the veterinarians. This article will provide a brief overview of the best practices to consider for a veterinarian leaving his/her veterinary practice – from both the perspective of the veterinary practice group and the individual veterinarian(s).
First, the veterinarian and surviving practice should review their existing contracts in the event that a veterinarian leaves. The two most important agreements to consider is the employment agreement and a shareholder buy-sell agreement (if one exists). These two contracts can have a significant degree of importance if the departing veterinarian wants to continue their practice.
The Employment Agreement
Veterinary practices commonly require their employees to sign an employment agreement when they begin working for the veterinary practice. When dealing with the termination of a relationship, both the employee and employer should understand the details of their employment contract.
When changes in veterinarians causes an economic divorce, a buy-sell agreement can provide a fair resolution. A buy-sell agreement is a contract between business owners that determines what occurs to business ownership upon a triggering event, such as death, disability, bankruptcy, or disputes among shareholders. A buy-sell agreement essentially is an agreement for exiting a practice, and veterinary Buy-sell agreements frequently require a mandatory buy-back of shares.
Thus, if a buy-sell agreement exists, it should be reviewed for any buy-back provisions. The buy-sell agreement would provide a share price, either by an accounting formula or arbitration process. The agreement may also cover the following events:
Additionally, as mentioned above, the parties should beware of any non-competition or non-solicitation clauses in a buy-sell agreement.
Compensation after Termination
When a veterinarian leaves a practice, the practice may provide compensation after the termination date. First, there could be a salary owed to the date of termination plus accrued vacation time. Second, there may be compensation owed for the veterinarian’s share in accounts receivable or collection of a pro-rated share of year end-bonuses.
Exit and Severance Agreement
When an employer decides to terminate its relationship with an employee, it can be advantageous for both sides to enter into an agreement defining their rights and obligations. This agreement is often called a severance agreement. A severance agreement acts as a contract for the employee; however, there is no law requiring employers to offer severance packages. There are two major parts of a severance agreement: the agreement and the release. The agreement outlines what the veterinarian would get in return for their release, and details what the severance package consists of. The release, in essence, is a statement that releases the company from any liabilities associated with the employees exit.
Exit and severance agreements are useful for both parties because they can prevent misunderstandings that can lead to litigation. The agreements may contain provisions against future competition (“non-compete” clauses) and confidentiality provisions relating to the agreement itself. For veterinarians, severance agreements often contain the content of notice by the departing veterinarian and can discuss the duties of retaining client records. Lastly, these agreements act a useful tool for employers because they can release liability. The exit and severance agreement can control and/or negate the veterinarian’s right to pursue claims for prior acts of discrimination, harassment, equal pay, or wrongful termination.
When the relationship of veterinarians and/or veterinary practices comes to an end, it is advisable that these considerations be addressed. If not resolved by negotiation, these types of disputes can result in protracted and expensive litigation. An experienced counsel can help the parties reach an acceptable division, which can be a victory for all of the parties involved.For more information, please contact Peter Tanella at 973.243.7915 or email@example.com.
Category: General Practice Governance