Practice Pulse

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.

QUESTION: I wanted to know if there are any Florida regulations in place that would prevent an establishment from performing non-anesthetic dentals without a veterinarian present? I am under the impression that anesthetic procedures must be done with a veterinarian present, but what about non-anesthetic procedures like dentals? Can they be performed without a veterinarian on staff? There are several pet boarding facilities that are offering non-anesthetic dental cleanings even though they do not have a veterinarian present, and it's a technician that performs them. I would just like some clarification on this.

A: For starters, any dental procedure on an animal, with the exception of manually floating teeth on horses, is the practice of veterinary medicine. A technician can perform certain tasks under general supervision, and non-anesthetic dental cleaning can be performed without the veterinarian present but that does not mean a veterinarian is not required. Boarding facilities that have technicians perform dental cleanings without any veterinary supervision (offpremises) are engaging in unlicensed activity.

QUESTION: Can I attend the New York Vet Conference to fulfill my CE requirements in Florida?

A: Yes. According to the below statue, approved courses are deemed scientific if continuing education courses are provided by:

61G18-16.003 Continuing Education Standards. (2) (a) National, State and International veterinary association meetings and Board meetings;

QUESTION: There is a lot of confusion about HB 831 and whether it applies to veterinarians prescribing drugs that are controlled by the DEA. I am hoping that you can give me some guidance on this topic. E-signatures are not something I have in my software currently, and I would need them if this bill involves veterinarians. This will certainly cause an increase in cost to get these medicines to our patients. A: As is often the case with similar bills, this is an amendment to Chapter 456 in the Florida statues and is applicable to health care practitioners as defined in Chapter 456. That chapter defines health care practitioners as:

“Health care practitioner” means any person licensed under chapter 457; chapter 458; chapter 459; chapter 460; chapter 461; chapter 462; chapter 463; chapter 464; chapter 465; chapter 466; chapter 467; part I, part II, part III, part V, part X, part XIII, or part XIV of chapter 468; chapter 478; chapter 480; part II or part III of chapter 483; chapter 484; chapter 486; chapter 490; or chapter 491.

Veterinarians are licensed under Chapter 474 in the Florida statues and, therefore, are not included.

QUESTION: We are a racetrack practice in Florida and are starting to receive these agreements to sign for use of compounded drugs. Veterinarians are curious about the ramifications of signing these agreements. We are interested in receiving an opinion from the FVMA regarding agreements such as these. What additional liability burden does this place on the practitioner? Does “compounded nonsterile medications for office use" imply that injectable medications are non-sterile?

A: The Florida Board of Pharmacy Rule is below. The agreement is part of the rule, and it incorporates the rule requirements. The only restriction that is not required is the one about dispensing the compounded medication to clients. Under (f)6., the Board recognizes that if the drug is provided to a veterinarian, the “Not for Resale” label is not required.

(3) Office use compounding, “Office use” means the provision and administration of a compounded drug to a patient by a practitioner in the practitioner’s office or by the practitioner in a health care facility or treatment setting, including a hospital, ambulatory surgical center, or pharmacy. A pharmacist may dispense and deliver a quantity of a compounded drug to a practitioner for office use by the practitioner in accordance with this section provided: (a) The quantity of compounded drug does not exceed the amount a practitioner anticipates may be used in the practitioner’s office before the expiration date of the drug; (b) The quantity of compounded drug is reasonable considering

the intended use of the compounded drug and the nature of the practitioner’s practice; (c) The quantity of compounded drug for any practitioner and all practitioners as a whole, is not greater than an amount the pharmacy is capable of compounding in compliance with pharmaceutical standards for identity, strength, quality, and purity of the compounded drug that are consistent with United States Pharmacopoeia guidelines and accreditation practices. (d) The pharmacy and the practitioner enter into a written agreement. The agreement shall specifically provide: 1. That the compounded drug may only be administered to the patient and may not be dispensed to the patient or sold to any other person or entity, 2. That the practitioner shall include on the patient’s chart, medication order, or medication administration record the lot number and the beyond-use-date of any compounded drug administered to the patient that was provided by the pharmacy, 3. That the practitioner will provide notification to the patient for the reporting of any adverse reaction or complaint in order to facilitate any recall of batches of compounded drugs. (e) The pharmacy shall maintain readily retrievable records of all compounded drugs ordered by practitioners for office use. The records must be maintained for a minimum of four (4) years and shall include: 1. The name, address and phone number of the practitioner ordering the compounded drug for office use and the date of the order, 2. The name, strength, and quantity of the compounded drug provided, including the number of containers and quantity in each, 3. The date the drug was compounded, 4. The date the compounded drug was provided to the practitioner, 5. The lot number and beyond use date. (f) The pharmacy shall affix a label to any compounded drug that is provided for office use. The label shall include: 1. The name, address, and phone number of the compounding pharmacy, 2. The name and strength of the preparation of a list of active ingredients and strengths, 3. The pharmacy’s lot number and beyond-use-date, 4. The quantity or amount in the container, 5. The appropriate ancillary instructions such as storage instructions, cautionary statements, or hazardous drug warning labels were appropriate; and, 6. The statement “For Institutional or Office Use Only – Not for Resale,” or if the drug is provided to a veterinarian the statement “Compounded Drug.” (g) In the case of compounded products intended for human use, the pharmacy must be in full compliance with 21 U.S.C. §353b, including being registered as an Outsourcing Facility. 21 U.S.C. §353b (eff. Nov. 27, 2013) is hereby adopted and incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-04180.

Also, Florida law specifically recognizes that veterinarians may dispense compounded medications. See 465.0276(5):

465.0276 Dispensing practitioner.— (5) This chapter and the rules adopted thereunder do not prohibit a veterinarian licensed under chapter 474 from administering a compounded drug to a patient, as defined in s. 474.202, or dispensing a compounded drug to the patient’s owner or caretaker. This subsection does not affect the regulation of the practice of pharmacy as set forth in this chapter.

Having stated all the above, it is the right of the pharmacy to require that the compounded drugs they provide to veterinarians will not be resold/dispensed. QUESTION: I received my Florida DVM license just a few weeks ago, and the expiration date is May 2020. Will I be required to complete all 30 hours of CE requirements or a pro-rated portion?

A: The rule on continuing education requirements states: A licensed veterinarian shall not be required to complete a continuing education requirement prior to the first renewal of his license, but it shall be required prior to any subsequent renewal.

That being said, you do not need CE for your upcoming renewal. You will be required to do 30 hours, including one hour in the area of dispensing legend drugs and two hours in the area of laws and rules governing the practice of veterinary medicine in the next biennium (from June 1, 2020 to May 31, 2022).

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