Practice Pulse

QUESTION: I have a form requesting medical information regarding my patient from a doctor of chiropractic who is also certified by the American Veterinary Chiropractic Association to adjust animals. The form states that I am referring this patient to her for treatment. How do I respond and is she legally able to treat this dog?

A: A chiropractor cannot adjust an animal under their license. If a chiropractor associates with a veterinarian, the chiropractor can treat an animal under the veterinarian’s authority. It is a properly delegable task that can be done under responsible supervision of the veterinarian. Issues of responsibility and risk must be handled between the parties. The veterinarian must ensure they or the chiropractor has the proper insurance to handle the amount of risk that may be associated with treatment. There is a large disparity of risk if the treatment is for a million-dollar racehorse as opposed to a companion animal. The veterinarian’s license is “on the line” if they delegate to a person that is not qualified by licensure, training or experience.

We've reproduced the Rule in the Florida Administrative Code below, which applies in this case.

61G18-19.002 Complementary or Alternative Veterinary Medicine.

(1) Definition – Complementary, alternative and integrative therapies means a heterogenous group of preventive, diagnostic and therapeutic philosophies and practices, which at the time they are performed may differ from current scientific knowledge, or whose theoretical basis and techniques may diverge from veterinary medicine routinely taught in accredited veterinary medical colleges, or both. These therapies include, but are not limited to, veterinary acupuncture, acutherapy and acupressure, veterinary homeopathy, veterinary manual or manipulative therapy (i.e., therapies based on techniques practiced in osteopathy, chiropractic medicine, or physical medicine and therapy); veterinary nutraceutical therapy and veterinary physiotherapy. (2) Communication of treatment alternatives – A licensed veterinarian who offers to provide a patient with complementary or alternative health care treatment must inform the owner of the patient of the nature of the treatment and must explain the benefits and risks associated with the treatment to the extent necessary for the owner to make an informed and prudent decision regarding such treatment option. In compliance with this subsection: (a) The licensed veterinarian must inform the owner of his or her education, experience and credentials in relation to veterinary complementary or alternative health care treatment option. (b) The licensed veterinarian may, in his or her discretion, communicate the information orally or in written form directly to the owner or to the owner’s legal representative. (c) The licensed veterinarian may, in his or her discretion and without restriction, recommend any mode of treatment that is, in his or her judgment, in the best interests of the patient, including complementary or alternative health care treatments, in accordance with the provisions of his or her license. (3) Records – Every licensed veterinarian providing a patient with a complementary or alternative health care treatment must indicate in the patient’s record the method by which the requirements of subsection (2) were met. (4) Effect – This section does not modify or change the scope of practice of any licensed veterinarian, nor does it alter in any way the provisions of Chapter 474, F.S., which require licensees to practice within standards of care, and which prohibit fraud and exploitation of clients.

QUESTION: I am a practicing veterinarian in Vero Beach, Florida, and my pharmacy has just told me that, according to a law passed in January of this year, all prescriptions after July 1st are to be electronic only. They will no longer accept written scripts, emails or faxes. Do you have a recommendation on a company that we should use?

A: This law does not apply to veterinarians. It only applies to “health care practitioners” as defined in F.S. 456 (DOH). Veterinarians are governed under F.S. 474 which is not included in the 456.001 Definitions (4) F.S.

QUESTION: I'm currently a licensed veterinarian in Florida and recently spoke with another vet who claimed that in the state of Florida the VCPR is specific to the veterinarian and not to the clinic. That is to say, for example, if a veterinarian has not personally examined a patient, but the patient has been seen regularly and within the last 12 months by another veterinarian employed at the same clinic, it would be unlawful for the veterinarian who has not seen the patient to authorize prescription refills or prescribe new medications. Is this correct?

A: The VCPR is with the veterinarian, not with the clinic. Nevertheless, a VCPR can be established if the veterinarian has sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis of the medical condition of the animal, which means that the veterinarian is personally acquainted with the keeping and caring of the animal and has recently seen the animal or has made medically appropriate and timely visits to the premises where the animal is kept, and • Is available or provides follow-up care and treatment in the case of adverse reactions or failure of the therapy regimen. • Maintains records documenting patient visits, diagnosis, treatment and other relevant information required under this chapter.

GOT A QUESTION? THE FVMA CAN HELP. One of the benefits of an FVMA membership is our helpline (800.992.3862), which is available to members Monday through Friday from 8 a.m.-6 p.m. Our helpline also provides insight to the FVMA staff of the challenges and concerns of our members. In this feature, we will highlight topics from the questions we received in preceding weeks as a part of an effort to keep our members up to date on current concerns, as well as regulatory and legislative changes.

This is a situation that depends on specific facts and professional judgment. In the case of a patient of the clinic, the veterinarian can acquire sufficient knowledge of the animal by reviewing the records. They are available to provide follow-up care and will maintain records by updating the existing record. The second veterinarian may not have recently seen the animal or perhaps may have seen it at the clinic previously. This part is intended for agricultural animals because of the mention of medically appropriate visits to the premises where the animal is kept.

So, in the case of authorizing a refill, there is a much stronger case than with new medication for a new condition that may require specific testing or physical examination to diagnose. At the end of the day, the veterinarian is supposed to take care of the patient. In human medicine, a physician on call in the same situation is authorized to prescribe. It is understood that the on-call physician is not taking over treatment but just assisting the physician of record. The same must be true in the veterinary setting.

QUESTION: I have a question regarding the telemedicine guidelines. My doctor is doing telemedicine consults as she is at high risk during the pandemic. Regarding the guidelines for telemedicine, can the client just have a VCPR with the hospital or does the VCPR need to be with that specific doctor performing telemedicine?

A: This depends a lot on what the telemedicine consultation is about. If the veterinarian has access to the patient records from the clinic and she is dealing with something that would not require a fullblown physical examination, then perhaps. If the client brings the animal to the clinic and someone performs a physical exam, then the vet could use those results to guide her professional judgment.

QUESTION: Do amendments for 61G18-16.002 Continuing Education Requirements for Active Status License Renewal, which became effective April 4, 2020, require business and wellness courses in biennial CE for licensure?

A: They do not require hours in either one of those subjects. They LIMIT the number of hours to no more than 5 hours in either subject.

QUESTION: Can a VCPR be extended by a telemedicine visit? In other words, if I see a previously established patient via telemedicine today, and their VCPR was originally set to expire on June 1, 2020, is that date the new anniversary of the VCPR?

A: Referring to the disciplinary guidelines, Rule 61G18-30.001(1)(y)3., F.A.C., which contains a definition of the documented VCPR:

The documented patient/client/veterinarian relationship cited in section 474.214, F.S. is herein defined as a veterinarian’s record of a client’s animal which documents that the veterinarian has seen the animal in a professional capacity within a period of 12 months or less.

So, and for the purpose of prescribing medication, the 12 month time would be required. Examining the patient via telemedicine meets the requirement of “seeing the animal in a professional capacity,” so as long as the animal is seen within one year from the date of the last visit, either in person or via telemedicine, the VCPR remains intact.

QUESTION: Can you clarify if, as a sole practitioner, I do not need to renew my HCCE permit IF I order Rx medications under my personal name instead of my LLC?

A: As a sole practitioner you can do both and you do not need an HCCE. If you order drugs under your company however, we advise that you provide a letter to your wholesaler which confirms your status as a sole practitioner operating business as a professional service corporation or limited liability company.

END NOTE: The ultimate responsibility in the practice of veterinary medicine lies with the licensed veterinarian. Professional discretion must always be exercised.