Board Members

David Lamb, D.V.M., Chairman - 06/1999; Michele R. Tulis, D.V.M., Secretary - 06/99; Nancy Carey; Vice-Chairperson - 12/2001; Robert E. Treat, D.V.M. - 12/2001; Mark A. Basol, D.V.M.. - 12/2003; and Heather Hoisington - 01/2000. Members are appointed by the Governor.

The Board generally meets the 2nd Thursday, every other month, beginning in January.

Introduction

The Vermont State Veterinary Board is pleased to bring you its first issue of our Newsletter. We want to inform you about current amendments to our statute and rules, and provide you with updated Board Policy statements. We encourage your feedback and input in these matters.

A copy of this newsletter is also available in electronic format on the Board's homepage at www.vtprofessionals.org/veterinarians

IMPORTANT INFORMATION YOU SHOULD KNOW!

1. Continuing education now required for licensing renewal. Twenty-four hours of Veterinary continuing education credit earned between June 1, 1999 and May 31, 2001 will be required for your NEXT license renewal (in 2001). See below for details.

2. Licensure by Endorsement now available in Vermont. See below for details.

3. Have questions about alternative therapies?

Prescription writing?

Providing emergency care?

Withholding records?

Veterinary consulting?

See below for answers.

New Laws and Rules

§ 2426. Continuing Education Requirements

Effective July 1, 1998, the Board obtained statutory authority to require: (b) As a condition of renewal, a licensee shall complete continuing veterinary medical education, approved by the board by rule, during the preceding two-year period. For purposes of this subsection, the board may require, by rule, not more than 24 hours of approved continuing veterinary medical education as a condition of renewal.

Board Rule 3.1 is proposed to read as follows:

3.7 CONTINUING EDUCATION REQUIREMENTS

Documentation of 24 continuing education units (CEU) from Board-approved state, regional, or national veterinary medical education programs is required for license renewal. Programs offered by the following organizations do not require advance approval: Vermont Veterinary Medical Association (VVMA), AVMA, AVMA-accredited veterinary colleges, or programs certified by the AAVSB through its Registry of Approved Continuing Education (RACE). Articles in Veterinary Learning Systems Compendium for continuing education may be used for up to eight credit hours if the licensee provides proof of successful passage of the corresponding examinations. Other programs may be accepted at the Board's discretion if the program outline, including learning objectives, and the names and qualifications of the presenters are submitted to the Board.

CEU's may not be transferred or carried over from one renewal period to another.

The Board may conduct random audits to verify completion of continuing education up to six years after a license is renewed. Upon request by the Board, the licensee shall submit certificates of completion for all programs listed in the licensee's renewal application.

Before renewing a license, the Board may require an applicant who fails to complete sufficient CEU's for license renewal to develop and complete a specific corrective action plan within 90 days. The Board will not renew the license of an applicant who fails to complete such a corrective action plan within the 90-day grace period.

For applicants granted initial licensure by the Board, the requirement to accumulate CEU's shall commence on the opening date of the first biennial renewal period following grant of initial licensure.

Not more than four hours of practice economics or practice management will be accepted for continuing education credit per renewal period.

Licensure by Endorsement

Effective July 1, 1996, § 2424 Licensure Without Examination of the Vermont State Veterinary Board's law was amended to include language for licensure by endorsement which is summarized as follows: a person who (1) holds a current license in good standing (2) has passed: (A) the NBE/CCT or its successor examination, (B) an examination prepared by the American Association of Veterinary State Boards (AAVSB); or (c) an equivalent examination, as established by the board; and (3) actively practiced clinical veterinary medicine for 3,000 hours during the three years proceeding application; (b) passage of a state laws exam (c) graduates of non-accredited veterinary schools must hold an Educational Commission for Foreign Veterinary Graduates (ECFVG) or Certificate of qualification issued by the Canadian Veterinary Medical Association, unless at the time the applicant became licensed in the state, territory or province from which they are applying, an ECFVG certificate was not required by this state. See laws for complete requirements.

Veterinary Board Policies and Positions on Current Issues

Alternative Therapies, i.e, Dentistry, Physical Therapy, Acupuncture, Chiropractic, etc. in Veterinary Medicine

Currently, in Vermont, there are no provisions to allow a person other than a licensed veterinarian to administer treatment or to authorize treatment to animals. The exception is a person treating his or her own animal. A veterinarian may be assisted in the practice of veterinary medicine by a person other than a licensed veterinarian if that person is acting under the veterinarian's direct supervision.

Therefore, an acupuncturist, physical therapist, physician, chiropractor, dentist, dental hygienist, dental assistant, herbalist, animal dental technician, or other practitioner of medical arts, who is not a veterinarian may assist a licensed veterinarian in treating animals by administering treatments upon them, but only when the treatment has been prescribed by the veterinarian and the treatment is provided under the veterinarian's on-premise supervision. This applies to therapies and procedures on large and small animals.

It would constitute unlicensed practice if the veterinarian failed to exercise his or her independent judgement in the diagnosis and prescribing of appropriate treatment for the animal and merely acted as a "conduit" for the unlicensed person to practice on animals.

A person, including an acupuncturist, herbalist, physical therapist, physician, chiropractor, dentist, dental hygienist, dental assistant, or animal dental technician, etc., who is not a veterinarian and who represents that he or she practices veterinary medicine independently of a veterinarian by treating animals, is in violation of the practice act and may be subject to criminal prosecution.

Any veterinarian who aids and abets the unlicensed practice of veterinary medicine may have action taken against his or her license for unprofessional conduct.

Policy adopted: 07/23/92, Amended: 05/13/93, and Amended: 07/15/93.

Veterinary-Chiropractic Policy and Protocol

1.The State Boards of Chiropractic and Veterinary Medicine agree that under the conditions set forth below, certain animal patients may benefit from chiropractic treatment, and that consumers should be able to avail themselves to this alternative therapy if medically warranted.

2.The State Veterinary Board will prosecute the unlicensed practice of veterinary medicine.

3.A licensed chiropractor who treats an animal patient under the terms of a referral as set forth below will not be considered to be practicing veterinary medicine without a license.

4.A licensed chiropractor who treats an animal patient, under the terms of a referral as set forth below, may not do so in his or her regular place of business where he or she sees human patients.

5.The State Veterinary Board holds the veterinarian fully responsible for all treatment provided by the chiropractor.

Protocol

1.Except as set forth in 2 below, a chiropractor shall not initiate chiropractic treatment of an animal unless the chiropractor has received the following referral information from a licensed veterinarian, in writing.

A. The name of the patient and the name and address of the patient's owner.

B. A description of the patient's condition and the identity of any medication or treatment already undertaken by the veterinarian.

C. A treatment plan which sets forth a systematic effort to cure the illness and to relieve symptoms with whatever therapeutic means may be appropriate.

D. A mean for consultation on an on-going basis to coordinate treatment and to allow the veterinarian to monitor the patient's on-going plan of care.

2.The chiropractor may accept a verbal referral in order to commence treatment, but the information listed in section 1 must be confirmed in writing within 10 days of the verbal referral by the referring veterinarian.

3.After the chiropractor has completed an examination and evaluation, he or she must consult with the referring veterinarian to confirm that chiropractic care is appropriate, to coordinate complementary treatment, and to establish a supervision plan for on-going communication to assure proper patient care.

4.It is the responsibility of the veterinarian to ensure that accurate and complete records of chiropractic treatment are maintained in the patient's veterinary medical record.

Adopted: 01/15/98

Policy Regarding Consulting

The Vermont State Veterinary Board has had several inquiries from veterinarians about what constitutes "consulting" in veterinary medicine, in this State. Veterinarians, who are regularly licensed in another state, and who consult with licensed veterinarians in this state are exempt from the need for licensure in Vermont, according to the statute.

Our interpretation of the statute is that a consulting veterinarian is providing information or instruction to a licensed veterinarian in Vermont. If this information or instruction is provided directly to a Vermont animal owner, the consulting veterinarian is no longer exempt from the licensure requirements. In practical terms, we feel that any veterinarian who comes to Vermont to do an actual examination or surgery on an animal in Vermont needs to be licensed by this Board, even when summoned by a licensed Vermont veterinarian. This applies to specialists in most any veterinary field.

If you anticipate bringing a specialist or any veterinarian to Vermont to conduct examinations or surgery, as a "consultant," please be aware that they are not exempt from licensure in Vermont and can be subject to penalties for unlicensed practice if they do not apply to the Vermont Veterinary Board for licensure. We are not aware of this being a problem at the present time and wish to merely state our position for the record and in response to inquiries.

Adopted: 11/92

Writing Prescriptions

The Board has received inquiries about whether veterinarians may refuse to write prescriptions. Apparently, some owners wish to use veterinary services but fill prescriptions elsewhere. In many cases, veterinarians examine animals and simply dispense medications directly to owners without writing prescriptions.

Vermont does not have a statute that requires a veterinarian to write a prescription, when indicated, at a client's request. The Board's unprofessional conduct statute, 26 V.S.A. § 2431(b)(7), does require a veterinarian to provide a requesting owner with copies of documents prepared for and purchased by the owner in connection with veterinary services. For example, if a veterinarian examined an animal, wrote a prescription in connection with the examination, and then, for some reason, decided not to give the prescription to the animal's owner after the owner had paid for the examination and asked for the prescription, the veterinarian would still have to provide the owner with a copy of the prescription.

Licensees should review Board Rule 3.5 (Veterinarian-Client-Patient Relationship). This rule provides, among other things, that veterinary prescription drugs should be dispensed only by or on the order of a licensed veterinarian in the presence of a valid veterinarian-client-patient relationship.

Release of Records

Scenario: You have treated an animal, but have not yet been paid. Your client(s) now want the medical records. What do you do?

The Board was presented with this situation recently, and in consultation with its Board Counsel have the following recommendation: Do not withhold medical records as "ransom."

Applicable laws: 26 V.S.A. § 2431, 3 V.S.A. § 129a. Unprofessional Conduct

1) 26 V.S.A. § 2431 (7). Unprofessional conduct means: failing to make available, upon request of a person using the licensee's services, copies of documents in the possession or under the control of the license, when those documents have been prepared for and purchased by the user of services; (effective July 1, 1993)

2) 3 V.S.A. § 129a (8). Failing to make available promptly to a person using professional health care services, that person's representative, succeeding health care professionals or institutions, upon written request and direction of the person using professional health care services, copies of that person's records in the possession or under the control of the licensed practitioner.

§ 129a (11). Exercising undue influence on or taking improper advantage of a person using professional services, or promoting the sale of services or goods in a manner which exploits a person for the financial gain of the practitioner or a third party.

§ 129a (d). In the case where a standard of unprofessional conduct as set forth in this section conflicts with a standard set forth in a specific board's statute or rule, the standard that is most protective of the public shall govern. (Effective July 1, 1997)

Section 2431 uses the word "purchased" and one might assume that it means paid for in full. It is also been defined as "making a verbal commitment."

Section 129a (11),and (d) do not mention payment and (d) clearly states that if there is any conflict, the most protective of the public shall govern.

Certainly each case is different and the results of a hearing cannot be predicted. However, historically the Office of Professional Regulation, established through hearings with other regulatory boards, licensees who hold medical records as "ransom" for payment, has consistently been found to be unprofessional conduct.

It is certainly clear that you should keep your own records and x-rays, and you may charge a reasonable fee to make copies for the client. But the Board strongly recommends that you do not withhold copies of records for full payment of services.

Emergency Care

There have been at least three complaints to the Vermont Veterinary Medical Association office in the last month or so because veterinarianshave not provided emergency coverage at night, weekends, days off, etc. It seems appropriate to spell out what the Vermont Veterinary Practice Act says about this, and how the Veterinary Board views the situation.

While the issue of emergency care provision is not dealt with directly by the Practice Act, Section 129a of Title 3, the umbrella law regulating professions in Vermont, describes unprofessional conduct as a "...failure to use and exercise...that degree of care, skill and proficiency which is commonly used by the ordinarily skillful, careful, and prudent practitioner...". The Vermont Veterinary Board has adopted the Principles of Veterinary Medical Ethics of the American Veterinary Medical Association (AVMA) as its official ethical policy. These principles state, in part:

"In emergencies, veterinarians have an ethical responsibility to provide services for animals when it is necessary to save life or relieve suffering.

1. When veterinarians cannot be available to provide services, they should arrange with their colleagues to assure that emergency services are available, consistent with the needs of the locality.

2. Veterinarians who are not qualified to manage and treat certain emergencies should arrange to refer their clients to other veterinarians who can provide the appropriate emergency services."

It would seem, therefore, that veterinarians who cannot provide coverage at all times, should have arrangements with colleagues to cover emergencies, and should have a method (answering machine or answering service) to inform their clients where they can find that emergency coverage. The fact that these AVMA ethical principles are widely available to veterinarians indicates that the "ordinarily skillful, careful, and prudent practitioner" should be aware of them, and would intend to abide by them.

To date, the Veterinary Board has not had a complaint about a practitioner in this regard. A word to the wise may help us keep it that way.

For a complete copy of the current laws and rules, you may access the Board's homepage: www.vtprofessionals.org

The Board welcomes questions and concerns addressed to: Vermont State Veterinary Board, Office of Professional Regulation, 26 Terrace Street, Redstone Bldg., Drawer 09, Montpelier, VT 05609-1106. Phone: (802) 828-2875, or Fax 828-2465, or E-mail: "cpreston@sec.state.vt.us"

Other Web addresses: VT Dept of Health: www.state.vt.us/health

VT Legislature: www.leg.state.vt.us

VT Dept. of Agriculture:

www.agr.state.vt.us