Practice Pulse - Issue #1 2022

QUESTION: How long must we keep medical records?

A: The DBPR, “Rule 61G18-18.002(1), Florida Administrative Code, provides that you must keep records three years from the date of last entry, including X-rays.”

61G18-18.002 Maintenance of Medical Records:

(1) There must be an individual medical record maintained on every patient examined or administered to by the veterinarian, except as provided in (2) below, for a period of not less than three years after the date of last entry. The medical record shall contain all clinical information pertaining to the patient with sufficient information to justify the diagnosis or determination of health status and warrant any treatment recommended or administered.

QUESTION: I had a practitioner in our area who recently retired and asked what the recommended time frame for a practitioner to continue to carry liability insurance in case of a claim that arises post-retirement for a case the practitioner was managing prior to retirement.

A: “The statute of limitations for professional services malpractice is two years. Carrying malpractice for two years after retirement would cover this.” This is called “tail coverage,” which is less costly considering the veterinarian is no longer actively practicing.

QUESTION: Who keeps track of my CE hours?

A: Per the DBPR, “it is the responsibility of the licensee to keep track of his or her continuing education hours. If you are audited by the board, you will be required to show proof of your 30 hours.” The FVMA keeps records of any conferences, wet labs and online CE courses attended. If you need an additional copy of a certificate of attendance, please email membership@fvma.org.

QUESTION: Are all 15 hours for CVTs allowed to be online during this next renewal period? Or are in-person classes required?

A: Current CVT certifications are valid through December 31, 2023. Continuing education requirements are evaluated each cycle and the FVMA will communicate requirements with ample time to be satisfied. Please continue to check FVMA correspondence for any updates.

QUESTION: We've recently had a change in management with policies that seem misguided for our controlled drug record keeping. We had been told by previous management that it is a requirement to write a patient's address and the reason we are administering the controlled medication in the written drug logs.

We currently use a computerized system for our medical records that contain all this information, and I would like to perform the correct policy. Is it a requirement to have this information in the written drug log since we have it in our computerized system?

A: The Code of Federal Regulations lists the information that is required to be maintained, but it doesn’t say how. The records must be "readily retrievable." The definition of “readily retrievable” is: "Readily retrievable means that certain records are kept by automatic data processing systems or other electronic or mechanized recordkeeping systems in such a manner that they can be separated out from all other records in a reasonable time and/or records are kept on which certain items are asterisked, redlined, or in some other manner visually identifiable apart from other items appearing on the records." So, electronic records are allowed as long as they are readily retrievable.

QUESTION: We see in the law it states that 24-hour emergency services must be provided by the DVM at the practice, or from another licensed veterinarian. Does this mean that if we chose to discontinue providing emergency services, we can provide the contact information for the closest 24-hour emergency location and that would be sufficient to meet what the law requires?

The minimum standards (61G18-15.002) state that a telephone must be answered 24 hours a day, which one may call for emergency service, and that a legible phone number should be posted for emergency service. So, can this number be the number for the 24-hour emergency clinic, and that will meet the two above items? Lastly, the closest clinic that provides 24-hour service is about 58 minutes away. I do not find anything in the law that dictates distance, can you advise?

A: If the veterinarian does not personally provide 24-hour emergency care, the requirement for providing such emergency services is satisfied by providing the phone number and contact information for the nearest 24-hour veterinary emergency clinic. That must be done by the phone answering machine having that information for after-hours calls, as well as by posting that contact information at the clinic in a way that it can be read by anyone from the outside while the clinic is closed.

If the nearest 24-hour clinic is one hour away, that is the nearest clinic.

QUESTION: In the past, I reached out concerning the role a veterinary technician or veterinary assistant plays in performing dental procedures. We are hoping to understand, specifically regarding dental extractions, what the staff may perform under the supervision of the attending DVM. The guidelines are fuzzy, and we are hoping to clearly understand what their boundaries are.

A: The Board's rule on tasks that may be delegated specifically fails to list tasks that can be delegated. So, there is no specific rule we can point to that states a technician cannot perform extractions. Keeping in mind that the veterinarian remains responsible for any task delegated, the answer then is that it is up to the veterinarian whether to delegate (or not) that task. That will take into consideration the experience / training / certification of the technician, so it is on a case-by-case basis.

A quick review of other states’ regulations shows that some states specifically prohibit veterinary technicians from extracting teeth, but the majority do allow (or do not specifically prohibit it, like Florida). There is also the issue of extracting loose teeth versus extracting teeth during anesthesia. Finally, some states specifically provide that, although a veterinary technician may perform an extraction, the technician cannot perform “surgery” (periosteal elevation, sectioning of tooth, re-sectioning of bone).

Taking all of that into consideration, it seems that the best answer is that a technician can extract loose teeth but should not extract teeth under anesthesia. If the veterinarian feels that an individual technician can extract teeth, that would be up to the veterinarian. No veterinarian should delegate to a technician the “surgery” aspect as defined in statute.

QUESTION: We recently hired a new graduate veterinarian who is still in the process of taking her NAVLE accreditation. As part of the process, we want to start her in a mentorship program under the supervision of our DVMs (we have four other doctors helping in this process). Are there written guidelines on what a graduate student can and cannot do in this type of arrangement?

A: The new graduate will be acting as a veterinary aide/technician. The Board’s rule on delegation of tasks is very broad.

1G18-17.005 Tasks Requiring Immediate Supervision. (1) All tasks which may be delegated to a veterinary aide, nurse, laboratory technician, intern, or other employee of a licensed veterinarian shall be performed only under the “immediate supervision” of a licensed veterinarian as that phrase is defined in Section 474.202(5), F.S., with the exception of the following tasks which may be performed without the licensed veterinarian on the premises:

(a) The administration of medication and treatment, excluding vaccinations, as directed by the licensed veterinarian; and (b) The obtaining of samples and the performance of those diagnostic tests, including radiographs, directed by the licensed veterinarian. (2) The administration of anesthesia and tranquilization by a veterinary aide, nurse, laboratory technician, intern, or other employee of a licensed veterinarian requires “immediate supervision” as that phrase is defined in Section 474.202(5), F.S.

(3) The administration of any vaccination by a veterinary aide, nurse, technician, intern or other employee of a licensed veterinarian which is not specifically prohibited by Rule 61G18-17.006, F.A.C., requires “immediate supervision” as that phrase is defined in Section 474.202(5), F.S.

So long as she is unlicensed, she should not be administering vaccinations or treatments for any of the conditions listed in 61G18-17.006. If she is doing anesthesia or administering any other allowable vaccination she should do so under onpremises supervision.

61G18-17.006 Diseases which Only a Veterinarian May Immunize or Treat. For the purpose of implementing the exemption provisions of Section 474.203(5)(a), F.S., the Board recognizes that the following diseases are communicable to humans and are of public health significance, and that only a veterinarian may immunize or treat an animal for these diseases:

(1) Brucellosis. (2) Tuberculosis. (3) Rabies. (4) Equine Encephalomyelitis.

What other treatments/tasks can be delegated will be an individual decision, taking into consideration her education, training and experience. Once she takes the exams and is awaiting results, she can practice under the provision of §474.207(5):

(5) An unlicensed doctor of veterinary medicine who has graduated from an approved college or school of veterinary medicine and has completed all parts of the examination for licensure is permitted, while awaiting the results of such examination for licensure or while awaiting issuance of the license, to practice under the immediate supervision of a licensed veterinarian. A person who fails any part of the examination may not continue to practice, except in the same capacity as other nonlicensed veterinary employees, until she or he passes the examination and is eligible for licensure.

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