KANSAS CITY, Mo. — For the 11th year in a row, Missouri is number one on the Humane Society's Horrible Hundred list of abusive or neglectful puppy breeders.
More than 30 puppy mills in the state made it on the list.
That's more than double the number from any other state.
Michelle Cole, the director of operations at KC Paws, takes in neglected animals and tries to help them heal.
"A lot of times they've never even felt grass on their feet before and that scares them," she said. "It breaks our hearts because obviously we just want to hold them and cuddle and love on them and it's scary to them. They don't know what it is to receive affection, they don't understand."
Dogs from neglectful puppy mills tend to be in bad shape, according to Cody Atkinson, state director of Missouri's Humane Society.
Atkinson says the 31 Missouri puppy mills on the list put profit over health.
"It's infuriating to put it simply," he said. "To see folks be on that list for up to a decade sometimes. And see that these animals continue to be kept in these horrendous conditions."
So what can be done to stop the abuse?
Katie Barnett, an animal law attorney, helped answer that question.
"You have a lot of laws on the books, what's problematic is how they're enforced," Barnett said. "It's not necessarily that there are these heartless enforcement agents out there, you know just ignoring this blanket animal cruelty that's going on. They're under funded, overworked."
Barnett and Atkinson agreed it comes down to how easy it is to be a breeder in Missouri, how light punishments are and how thin law enforcement is stretched in checking on the animals.
There also is confusion between agencies on whether or not enforcement of different violations are with the state or local agency's jurisdiction.
“It’s just a confusion of law, I mean it gets complicated," he said. "And so it just takes a lot of education to those different enforcement agencies. While we're fighting about the language of the law, the best thing to do is get whatever we have on the books enforced."
The only true way to cut supply provided by the mills is to cut their demand by not buying from problem mills and doing plenty of research into who is selling you an animal, Atkinson said.