Seton Butler, VCNZ

Is remote RVM authorisation okay?

VCNZ’s Seton Butler explores what’s expected of veterinarians when authorising restricted veterinary medicines, and asks whether these expectations can be met if the authorisation is done remotely.

THE LEGAL BITS

The Code of Professional Conduct for Veterinarians specifies that every consultation must include the veterinarian being given, and accepting, responsibility for the ongoing health and welfare of the animal(s) concerned in relation to the consultation. This includes arranging emergency care after considering the circumstances and the potential for adverse effects from, or failure of, the agreed course of action.

Read: Without absolving owners of their ultimate responsibility for their animals’ welfare, consulting veterinarians must arrange emergency care for the animals in their care. This care may be provided by them, another veterinarian or another competent person. Whatever the course of action, it should not compromise the animals’ welfare.

When authorising restricted veterinary medicines (RVMs), a consulting veterinarian must gather sufficient information and must be able to defend that judgement successfully in light of common and accepted professional standards and practice of the veterinarian’s peers.

Read: The prevailing standards of the profession set the scene for how we judge veterinarians if they come under scrutiny.

The animal(s) must have been seen recently or often enough for the veterinarian to have sufficient personal knowledge of the condition/health status of the animal(s).

When considering how often to assess animals on farm, a veterinarian might think about farm staff competence, the effectiveness of treatment, the availability of reliable animal health and welfare data and the findings of previous visits.

When it comes to RVMs for future use it is reasonable to authorise a person to hold specific RVMs to be used as instructed if there are regular and appropriately frequent checks by the authorising veterinarian to confirm that the circumstances have not changed and the choice of RVM and treatment regime is still appropriate. The quantity of RVM and duration the RVM can be held must be limited and appropriate, taking into consideration the potential for the circumstances to change.

Read: Farmers can hold RVMs on farm for the early treatment of various conditions but appropriate clinical insight and oversight are required. Ensuring controlled access to RVMs (for example, by only dispensing small quantities) and undertaking appropriate animal health assessments may be a way to do this.

The consultation process must include the veterinarian determining and providing the appropriate level of advice and training so as to be satisfied that the agreed course of action can proceed as planned.

Read: Veterinarians must have confidence that each individual authorised to administer RVMs is competent in recognising and treating animal health conditions appropriately.

THE CLINICAL BITS – WHERE DOES REMOTE AUTHORISATION FIT?

Most diseases on farm are multifactorial, and effective treatment often requires an understanding of the wider farm system. This deeper understanding is arguably difficult to acquire remotely.

For example, the primary function of a dry-off consultation is to recommend appropriate products to treat infections acquired during the current lactation and prevent new infections in the dry period. However, an effective dry-off consultation goes beyond simply selling a product. It has the potential to positively influence animal welfare, milk quality, product stewardship, farm biosecurity, herd health and farm staff competence or confidence.

The ability to authorise RVMs remotely comes down to what we as veterinarians consider acceptable levels of professional standards. If the common accepted standard is a local veterinarian doing their job well, who regularly visits the farms where they provide treatment, provides required emergency care, and considers farm animal health and welfare from a holistic viewpoint, I think the bar has been set relatively high. I also think it would be very difficult for a veterinarian to provide that level of care by operating at a distance.

However, if the average veterinarian authorises farmers to have a year’s supply of antibiotics on hand, only considers the status of the animals on the farm once at the time of authorisation, and does little in the way of addressing the complexity of herd health within the wider farm system, then the clinical standard is very low.

Therefore, if we are concerned about remote authorisation, we need to ensure that, as a profession, we are providing a quality of care that can’t be matched at a distance.