ILLEGAL PRACTICE Q & A

Transcription

1 1. What is illegal veterinary practice? Anyone who engages in any aspect of the practice of veterinary medicine without having a current California veterinary license is practicing illegally. According to the California Business of Professions Code, Section 4825: It is unlawful for any person to practice veterinary medicine or any branch thereof in this State unless at the time of so doing, such person holds a valid, unexpired, and unrevoked license as provided in this chapter. 2. What constitutes the practice of veterinary medicine? According to the California Business and Professions Code, Section 4826: A person practices veterinary medicine, surgery, and dentistry, and the various branches thereof, when he or she does any one of the following: (a) Represents himself or herself as engaged in the practice of veterinary medicine, veterinary surgery, or veterinary dentistry in any of its branches. (b) Diagnoses or prescribes a drug, medicine, appliance, application, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals. (c) Administers a drug, medicine, appliance, application, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals, except where the medicine, appliance, application, or treatment is administered by a registered veterinary technician or a veterinary assistant at the direction of and under the direct supervision of a licensed veterinarian subject to Article 2.5 (commencing with Section 4832) or where the drug, including, but not limited to, a drug that is a controlled substance, is administered by a registered veterinary technician or a veterinary assistant pursuant to Section However, no person, other than a licensed veterinarian, may induce anesthesia unless authorized by regulation of the board. (d) Performs a surgical or dental operation upon an animal. (e) Performs any manual procedure for the diagnosis of pregnancy, sterility, or infertility upon livestock or Equidae. (f) Uses any words, letters, or titles in such connection or under such circumstances as to induce the belief that the person using them is engaged in the practice of veterinary medicine, veterinary surgery, or veterinary dentistry. This use shall be prima facie evidence of the intention to represent himself or herself as engaged in the practice of veterinary medicine, veterinary surgery, or veterinary dentistry. 3. What are some examples of illegal practice? Any procedure performed by a non-licensed person, and without veterinary supervision could be considered illegal. Examples include: Non-anesthetic dental procedures Equine tooth floating Castration Chiropractic Physical Therapy Rehabilitative Services Ear cropping/ tail docking Reproduction services such as Artificial Insemination, rectal palpation, ultrasound or embryo transfer Nutrition consulting Acupuncture 1

2 4. Are there any exceptions to the rule? Yes. The business and professions code states the following practice exemptions: (a) Practicing veterinary medicine as a bona fide owner of one's own animals. This exemption applies to the following: (1) The owner's bona fide employees. (2) Any person assisting the owner, provided that the practice is performed gratuitously. (b) Lay testing of poultry by the whole blood agglutination test. For purposes of this section, "poultry" means flocks of avian species maintained for food production, including, but not limited to, chickens, turkeys, and exotic fowl. (c) Making any determination as to the status of pregnancy, sterility, or infertility upon livestock, equine, or food animals at the time an animal is being inseminated, providing no charge is made for this determination. (d) Administering sodium pentobarbital for euthanasia of sick, injured, homeless, or unwanted domestic pets or animals without the presence of a veterinarian when the person is an employee of an animal control shelter and its agencies or humane society and has received proper training in the administration of sodium pentobarbital for these purposes. 5. What constitutes supervision by a veterinarian? Title 16 of the California Code of Regulations provides the following definitions: (a) Veterinarian means a California licensed veterinarian. (b) R.V.T. means a registered veterinary technician certified by the Board. (c) Unregistered assistant means any individual who is not an R.V.T. or a licensed veterinarian. (d) Supervisor means a California licensed veterinarian or if a job task so provides an R.V.T. (e) Direct Supervision means: (1) the supervisor is physically present at the location where animal health care job tasks are to be performed and is quickly and easily available; and (2) the animal has been examined by a veterinarian at such time as good veterinary medical practice requires consistent with the particular delegated animal health care job task. (f) Indirect Supervision means: (1) that the supervisor is not physically present at the location where animal health care job tasks are to be performed, but has given either written or oral instructions ( direct orders ) for treatment of the animal patient; and (2) the animal has been examined by a veterinarian at such times as good veterinary medical practice requires, consistent with the particular delegated animal health care task and the animal is not anesthetized as defined in Section (g) Animal Hospital Setting means all veterinary premises which are required by Section 4853 of the Code to be registered with the Board. (h) Administer means the direct application of a drug or device to the body of an animal by injection, inhalation, ingestion, or other means. (i) Induce means the initial administration of a drug with the intended purpose of rendering an animal unconscious. 2

3 6. What if a business is not actually performing the service, but is hosting someone who is? The law states that aiding and abetting illegal practice is a crime. According to the California Business and Professions Code section 4831: Any person, who violates or aids or abets in violating any of the provisions of this chapter, is guilty of a misdemeanor and upon conviction thereof shall be punished by a fine of not less than five hundred dollars ($500), nor more than two thousand dollars ($2,000), or by imprisonment in a county jail for not less than 30 days nor more than one year, or by both the fine and imprisonment. 7. What constitutes a dental operation? According to Title 16 of the California Code of Regulations, Section 2037 states: The term dental operation as used in Business and Professions Code section 4826 means: (1) The application or use of any instrument or device to any portion of an animal's tooth, gum or any related tissue for the prevention, cure or relief of any wound, fracture, injury or disease of an animal's tooth, gum or related tissue; and (2) Preventive dental procedures including, but not limited to, the removal of calculus, soft deposits, plaque, stains or the smoothing, filing or polishing of tooth surfaces. (3) Nothing in this regulation shall prohibit, however, any person from utilizing cotton swabs, gauze, dental floss, dentifrice, toothbrushes or similar items to clean an animal's teeth. 8. What does the law say about chiropractors working on animals? The California Code of Regulations, Title 16, Section 2038 states: (a) The term musculoskeletal manipulation (MSM) is the system of application of mechanical forces applied manually through the hands or through any mechanical device to enhance physical performance, prevent, cure, or relieve impaired or altered function of related components of the musculoskeletal system of animals. MSM when performed upon animals constitutes the practice of veterinary medicine. (b) MSM may only be performed by the following persons: (1) A veterinarian who has examined the animal patient and has sufficient knowledge to make a diagnosis of the medical condition of the animal, has assumed responsibility for making clinical judgments regarding the health of the animal and the need for medical treatment, including a determination that MSM will not be harmful to the animal patient, discussed with the owner of the animal or the owner's authorized representative a course of treatment, and is readily available or has made arrangements for follow-up evaluation in the event of adverse reactions or failure of the treatment regimen. The veterinarian shall obtain as part of the patient's permanent record, a signed acknowledgment from the owner of the patient or his or her authorized representative that MSM is considered to be an alternative (nonstandard) veterinary therapy. (2) A California licensed doctor of chiropractic ( chiropractor ) working under the direct supervision of a veterinarian. A chiropractor shall be deemed to be working under the direct supervision of a veterinarian where the following protocol has been followed: 3

4 (A) The supervising veterinarian shall comply with the provisions of subsection (b)(1) prior to authorizing a chiropractor to complete an initial examination of and/or perform treatment upon an animal patient. (B) After the chiropractor has completed an initial examination of and/or treatment upon the animal patient, the chiropractor shall consult with the supervising veterinarian to confirm that MSM care is appropriate, and to coordinate complementary treatment, to assure proper patient care. (C) At the time a chiropractor is performing MSM on an animal patient in an animal hospital setting, the supervising veterinarian shall be on the premises. At the time a chiropractor is performing MSM on an animal patient in a range setting, the supervising veterinarian shall be in the general vicinity of the treatment area. (D) The supervising veterinarian shall be responsible to ensure that accurate and complete records of MSM treatments are maintained in the patient's veterinary medical record. (c) Where the supervising veterinarian has ceased the relationship with a chiropractor who is performing MSM treatment upon an animal patient, the chiropractor shall immediately terminate such treatment. (d)(1) A chiropractor who fails to conform with the provisions of this section when performing MSM upon an animal shall be deemed to be engaged in the unlicensed practice of veterinary medicine. (2) A veterinarian who fails to conform with the provisions of this section when authorizing a chiropractor to evaluate or perform MSM treatments upon an animal shall be deemed to have engaged in unprofessional conduct. 9. What about a veterinarian who prescribes medications to or treats an animal without examining it first, is that illegal? It is, except for in a few rare circumstances such as providing lifesaving emergency care for a wild animal or for a domestic animal with no known owner. For all other instances, California state law requires that a veterinarian establish a Veterinary Client-Patient Relationship (VCPR) prior to initiating any treatment or therapy for an animal. The California Code of Regulations, Title 16, Section says: (a) Except where the patient is a wild animal or its owner is unknown, it shall constitute unprofessional conduct for a veterinarian to administer or prescribe a drug, medicine, appliance, or application or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture or bodily injury or disease of an animal without having first established a veterinarian-client-patient relationship with the animal patient or patients and the client. It shall also constitute unprofessional conduct for a veterinarian to prescribe, dispense, or furnish either a veterinary drug, as defined by Section , Title 16, California Code of Regulations, or a dangerous drug, as defined by Section 4022 of the code, without having first established a veterinarianclient-patient relationship with the animal patient or patients and the client. (b) A veterinarian-client-patient relationship shall exist when all of the following occur: (1) The veterinarian has assumed responsibility for making medical judgments regarding the health of the animal(s) and the need for medical treatment, has discussed with the client a course of treatment and if applicable has instructed the client as to the appropriate directions for administering the drugs or treatments. 4

5 (2) The veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s). This means that the veterinarian has recently seen and is personally acquainted with the care of the animal(s) by virtue of an examination of the animal or by medically appropriate and timely visits to the premises where the animals are kept, and (c) A dangerous drug or a veterinary drug shall not be prescribed for a duration which is inconsistent with the animal patient's medical condition or type of drug prescribed which in no event shall exceed more than one year from the date that the veterinarian has examined the animal patient and prescribed such drug, unless the veterinarian has conducted a subsequent examination of the patient to determine the patient's continued need for the prescribed drug. 10. If a California licensed veterinarian agrees to oversee a lay person performing a service, what does that mean for the veterinarian? Anytime a veterinarian supervises either an RVT or a veterinary assistant (in this case a lay provider), the veterinarian assumes liability. The law says: (a) The supervising veterinarian shall be responsible for determining the competency of the R.V.T. or unregistered assistant to perform allowable animal health care tasks. (b) The supervising veterinarian of a R.V.T. or unregistered assistant shall make all decisions relating to the diagnosis, treatment, management and future disposition of the animal patient. (c) The supervising veterinarian shall have examined the animal patient prior to the delegation of any animal health care task to either an R.V.T. or unregistered assistant. The examination of the animal patient shall be conducted at such time as good veterinary medical practice requires consistent with the particular delegated animal health care task. 11. Can illegal activity go on in a veterinary practice? Yes. The law states that specific tasks may be carried out by RVT s only. Other tasks may be appointed to nonlicensed veterinary assistants under varying degrees of veterinary supervision. It is illegal for a veterinarian to direct or allow a non-licensed veterinary assistant to perform RVT specific tasks. Title 16 of the California Code of Regulations states: (a) Unless specifically so provided by regulation, a R.V.T. shall not perform the following functions or any other activity which represents the practice of veterinary medicine or requires the knowledge, skill and training of a licensed veterinarian: (1) Surgery; (2) Diagnosis and prognosis of animal diseases; (3) Prescription of drugs, medicines or appliances. (b) An R.V.T. may perform the following procedures only under the direct supervision of a licensed veterinarian: (1) Induce anesthesia; (2) Apply casts and splints; (3) Perform dental extractions; (4) Suture cutaneous and subcutaneous tissues, gingiva and oral mucous membranes, (5) Create a relief hole in the skin to facilitate placement of an intravascular catheter 5

6 (c) An RVT may perform the following procedures under indirect supervision of a licensed veterinarian: (1) Administer controlled substances. (d) Subject to the provisions of subsection(s) (a), (b) and (c) of this section, an R.V.T. may perform animal health care tasks under the direct or indirect supervision of a licensed veterinarian. The degree of supervision by a licensed veterinarian over a R.V.T. shall be consistent with standards of good veterinary medical practices. Title 16, Section states: (a) Unregistered assistants shall be prohibited from performing any of the functions or activities specified in subsections (a) (b) and (c) of Section 2036 of these regulations, except that an unregistered assistant under the direct supervision of a licensed veterinarian or registered technician may administer a controlled substance. (b) Subject to the provisions of subsection (a) of this section, unregistered assistants in an animal hospital setting may perform auxiliary animal health care tasks under the direct or indirect supervision of a licensed veterinarian or the direct supervision of an R.V.T. The degree of supervision by a licensed veterinarian over an unregistered assistant shall be higher than or equal to the degree of supervision required when an R.V.T. performs the same task and shall be consistent with standards of good veterinary medical practices. 12. Can veterinarians refer patients to non-veterinarians for care or consulting services? No. It is illegal for a veterinarian to refer a patient to anyone other than another veterinarian. If a veterinarian feels that an animal needs chiropractic care, dental care, physical therapy, nutrition consulting, or any other kind of therapeutic modality, the veterinarian must supervise the person performing the task, unless that person is another California licensed veterinarian. 13. Who is responsible for investigating illegal practice and enforcing the law? The California Veterinary Medical Board, which is a subsidiary of the California Department of Consumer Affairs. According to the California Business and Professions code, Division 1, Chapter 1.5: The Legislature finds and declares that: a) Unlicensed activity in the professions and vocations regulated by the Department of Consumer Affairs is a threat to the health, welfare, and safety of the people of the State of California. b) The law enforcement agencies of the state should have sufficient, effective, and responsible means available to enforce the licensing laws of the state. c) The criminal sanction for unlicensed activity should be swift, effective, appropriate, and create a strong incentive to obtain a license. 6