PROPOSED RULEMAKING
[ 49 PA. CODE CH. 31 ]
Responsibility to Clients and Patients
[39 Pa.B. 5438]
[Saturday, September 19, 2009]The State Board of Veterinary Medicine (Board) proposes to amend § 31.21, Principle 7 (relating to rules of professional conduct for veterinarians, responsibility to clients and patients) to read as set forth in Annex A. The amendment would specify two exceptions to the existing rule that veterinarians may choose whom they will serve. First, the proposal would require a veterinarian to provide humane euthanasia to relieve the suffering of an animal physically presented to the veterinarian's facility during the veterinarian's business hours. Second, the proposal would require a veterinarian to provide notice and a reasonable time to secure alternative services if a veterinarian decides to discontinue treatment of an animal.
In addition, the proposal would clarify an existing provision related to protecting the personal privacy of clients. The proposal would also specifically require veterinarians to practice in accordance with current advancements in veterinary medicine and acceptable and prevailing standards of care, including work with respect to drugs used by a veterinarian. Finally, the proposal would specifically require veterinarians to utilize analgesic drugs and therapies in accordance with current veterinary medical knowledge and acceptable and prevailing standards of care.
Effective Date
The amendment will be effective upon publication of the final-form rulemaking in the Pennsylvania Bulletin.
Statutory Authority
Section 21(11) of the Veterinary Medicine Practice Act (act) (63 P. S. § 485.21(11)) provides that the Board ''shall suspend or revoke'' a licensee or certificateholder who ''depart[s] from or fail[s] to conform to the standards of acceptable and prevailing veterinary medical practice.'' The Board's proposed subsections (d) and (f) are consistent with this provision.
Section 21(12) of the act provides that the Board ''shall suspend or revoke'' a licensee or certificateholder who is found guilty of ''[e]ngaging in practices in connection with the practice of veterinary medicine which are in violation of the standards of professional conduct as defined herein or prescribed by the rules of the board.'' Section 5(2) of the act (63 P. S. § 485.5(2)) authorizes the Board to ''[a]dopt rules and regulations of professional conduct appropriate to establish and maintain a high standard of integrity, skills and practice in the profession of veterinary medicine.'' The Board's proposed amendment of subsections (a)—(c) and (e) update the Board's rules of professional conduct and set forth standards to maintain high standards of integrity, skills and practice in the profession.
Background and Need for Amendments
The Board published an earlier draft of this rulemaking as proposed rulemaking at 37 Pa.B. 1038 (March 3, 2007). The Board received comments from individual veterinarians and the Pennsylvania Veterinary Medical Association (PVMA). Both the House Professional Licensure Committee (HPLC) and the Independent Regulatory Review Commission (IRRC) provided comments as part of their review of the proposed rulemaking. The Board's original proposal related to the refusal to provide emergency services. Based on the extensive comments received by the Board, in writing and at a public hearing held on March 20, 2008, the Board made extensive revisions to the proposal. Due to the extent of the revisions, the Board determined it should republish as proposed rulemaking.
The act was amended in December 2002; in part, the amendments defined ''veterinarian-client-patient relationship.'' See 63 P. S. § 485.3. Based on this statutory amendment, the Board proposes to rename Principle 7 ''Responsibility to clients and patients.''
The amendment is needed to conform the Board's regulatory mandates with current expectations for professional practice.
Description of Proposed Amendments
The Board proposes to add exceptions to the general rule that veterinarians may choose whom they will serve, to account for circumstances in which a veterinarian is presented with an animal in grave condition that is physically presented to the veterinarian during the veterinarian's regular business hours. The proposed amendment provides that a veterinarian may not refuse to provide humane euthanasia to relieve the suffering of an animal. The proposed amendment requires a veterinarian to make a reasonable attempt to identify and contact the owner of such an animal and permits the veterinarian to proceed without client consent if the owner cannot be identified or contacted. This provision would also allow a veterinarian to euthanize an animal brought to the veterinary facility in a life-threatening condition without the owner's consent if, in the veterinarian's professional judgment, euthanasia is the only appropriate option.
When the rulemaking was previously proposed, IRRC asked if this provision would have a disproportionate impact on farm animal veterinarians. The Board does not believe that the provision will have a significant effect on farm animal practitioners because it is unlikely that an owner would be able to load a cow that is in a grave condition into a trailer to transport it to a veterinary facility so that it can be physically presented to the veterinarian during regular business hours.
Second, the proposed amendment would permit a veterinarian to discontinue treatment of an animal after giving notice to the client of the veterinarian's intention to withdraw and after providing the client with reasonable time to secure alternative treatment. The proposal specifies that a reasonable time is based on the condition of the animal and the availability of alternative services. This provision protects the public by ensuring that the public will have a reasonable time to find another veterinarian.
The Board proposes to delete the second sentence of subsection (b) as redundant.
The Board's current provision in subsection (c) requires veterinarians to ''protect the personal privacy of clients.'' This provision has caused confusion among licensees. Therefore, the Board proposes to expand subsection (c) to provide guidance on the provision.
The Board proposes to delete the current text of subsections (d) and (e), which the Board believes is self-evident and does not need to be set forth in regulation.
The Board proposes an amendment to what is currently subsection (e), but will become subsection (d). An individual approached the Board with the suggestion that the Board require veterinarians to provide a ''client information sheet'' whenever the veterinarian dispenses nonsteroidal anti-inflammatory drugs (NSAIDs). Virtually any drug may cause an adverse reaction. In addition, some drugs and other treatment options are not indicated for use in animals with certain health problems or animals receiving certain other drug therapies. The Board believes that its regulations should provide broad protection to the public in relation to veterinary medical diagnosis and treatment rather than focusing on one narrow class of drugs. The Board finds that public protection will be advanced by requiring veterinarians to inform clients of the benefits, risks and side effects of all recommended treatments, from surgeries to drug therapies, and to document client consent to or rejection of treatment in the animal's veterinary medical record. The latter requirement was promulgated as part of the Board's regulation related to recordkeeping. See, 49 Pa. Code § 31.22(4), published at 37 Pa.B. 3240 (July 14, 2007).
The Board proposes to expand this provision by requiring client signature for euthanasia and other treatments that have significant risks. The signature would not be required prior to performing the treatment, because the client is not always physically present. In such a case, the client may give oral consent, and the veterinarian may subsequently obtain the client's signature.
The former Chairperson of the Department of Agriculture's Animal Health and Diagnostic Commission, Dr. Paul Kneply, submitted comments to the Board on its draft rulemaking. The comments inquired about the implications of proposed subsection (f) for ''normal farming activities and practices used in production animal medicine, such as castration and dehorning.'' Dr. Kneply noted, ''A veterinarian may not normally administer anesthesia for these practices,'' and asked whether the proposed language would ''prohibit 'normal animal agricultural practices' without anesthesia and pain medication.'' The Board is aware that the acceptable and prevailing standard of veterinary medical practice in producing animal medicine does not always include the administration of anesthesia or analgesia for the performance of procedures that, if performed on a companion animal, would require the administration of anesthesia or analgesia, or both. For this reason, the Board amended the draft language of subsection (f) to include language that the expectation of analgesia is consistent with the acceptable and prevailing standards of veterinary medical practice.
Finally, the Board proposes to add to subsection (g) the requirement that the veterinary medical record of an animal be provided to another veterinarian within a reasonable time. The Board declined to propose a specific time because, in many cases, all that is required is a one-page document, for example, of blood test results. In such cases, the document should be faxed upon request. Other requests for records may take longer. In any event, it would not be reasonable to take longer than the 72 hours permitted under the Board's regulations for responding to a request for records from a client.
Compliance with Executive Order 1996-1
In accordance with Executive Order 1996-1 (February 6, 1996), in drafting and promulgating the proposed amendment, the Board sent the text of the draft proposed amendment to interested parties, including State and regional veterinary medical associations and considered the comments made by these interested parties.
Fiscal Impact and Paperwork Requirements
The proposed amendment should not have any financial impact on licensees, the Board or any other State entity. The proposed amendment will have no fiscal impact on the public. There are no additional paperwork requirements associated with the rulemaking.
Sunset Date
The Board continuously monitors its regulations. Therefore, no sunset date has been assigned.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on September 2, 2009, the Board submitted a copy of this proposed rulemaking and a copy of a Regulatory Analysis Form to IRRC and to the Senate Consumer Protection and Professional Licensure Committee (SCP/PLC), and the House Professional Licensure Committee (HPLC). A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey any comments, recommendations or objections to the proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections must specify the regulatory review criteria that have not been met. The Regulatory Review Act specifies detailed procedures for review of comments, recommendations and objections by the Board, the General Assembly, and the Governor, prior to final publication of the rulemaking.
Public Comment
Interested persons are invited to submit written comments, recommendations or objections regarding this proposed rulemaking to Michelle Roberts, Board Administrator, State Board of Veterinary Medicine, P. O. Box 2649, Harrisburg, PA, 17105-2649, www.dos.state.pa. us/vet within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin.
THOMAS J. MCGRATH, D.V.M.,
ChairpersonFiscal Note: 16A-5722. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 31. STATE BOARD OF VETERINARY MEDICINE
PROFESSIONAL CONDUCT § 31.21. Rules of Professional Conduct for Veterinarians.
* * * * * Principle 7. [Veterinarian/client/relationships] Responsibility to clients and patients.
(a) [Veterinarians] Except as provided in this subsection, veterinarians may choose whom they will serve[. Once they have undertaken the care of an animal, however, they may not neglect the animal], but may not neglect an animal with which the veterinarian has an established veterinarian/client/patient relationship.
(1) During a veterinarian's regular business hours, a veterinarian may not refuse to provide humane euthanasia to relieve the suffering of an animal that is physically presented to the veterinarian at the veterinarian's facility. A veterinarian may provide humane euthanasia for an animal under this paragraph without a veterinarian/client/patient relationship. If the owner is unknown, the veterinarian shall make a reasonable attempt to determine the identity of the animal's owner. If the owner is known or identified, the veterinarian shall make a reasonable attempt to contact the owner and obtain consent to euthanasia or treatment. If the owner cannot be identified or cannot be contacted, the veterinarian shall exercise proper veterinary medical judgment to determine whether to provide humane euthanasia or other veterinary medical care to the animal.
(2) If a veterinarian deems it necessary to discontinue the treatment of an animal with which the veterinarian has a veterinarian/client/patient relationship, the veterinarian shall give notice to the client of his intention to withdraw and provide reasonable time to allow the client to obtain necessary veterinary care for the animal. A veterinarian shall exercise proper veterinary medical judgment by determining the length of time that is reasonable based on the condition of the animal and the availability of alternative veterinary medical services.
(b) [In their relations with clients, veterinarians should] Veterinarians shall consider first the welfare of the animal for the purpose of relieving suffering and disability while causing a minimum of pain or fright. [Benefit to the animal should transcend personal advantage or monetary gain in decisions concerning therapy.]
(c) Veterinarians and their staffs shall protect the personal privacy of clients, unless the veterinarians are required by law to reveal the confidences or it becomes necessary to reveal the confidences to protect the health and welfare of an individual, the animal or others whose health and welfare may be endangered. Personal information that should be protected under this section includes a client's Social Security number and sensitive financial information and confidential health information about the client. Veterinary medical records of a client's animals shall be released to the Board or its agents upon demand, as set forth in section 27.1(b)(1) of the act (63 P. S. § 485.27a(b)(1)). Any portion of a veterinary medical record relevant to public health shall be released to public health or law enforcement officials upon demand. Veterinary medical records shall be released to the general public only with the written consent of the client, subpoena or court order.
(d) [Veterinarians shall be fully responsible for their actions with respect to an animal from the time they accept the case until the animal is released from their care.
(e) In the choice of drugs, biologics or other treatments, veterinarians should use their professional judgment in the interests of the animal, based upon their knowledge of the condition, the probable effects of the treatment and the available scientific evidence that may affect these decisions.] Veterinarians shall practice in accordance with current advancements and acceptable and prevailing standards of care in veterinary medicine, including using current proven techniques, drugs and scientific research that may affect treatment decisions. Veterinarians shall practice in accordance with advancements and acceptable and prevailing standards of care related to the pharmacologic properties, indications and contraindications of drugs and biologics.
(e) Veterinarians shall explain the benefits and significant potential risks of treatment options to clients. Veterinarians shall document, by client signature, the client's consent for euthanasia and other treatments that have significant potential risks. If the client is not present to provide a signature, veterinarians shall obtain oral consent and subsequently obtain the client's signature.
(f) Veterinarians shall serve as patient advocates especially regarding the alleviation of pain and suffering, consistent with the acceptable and prevailing standards of veterinary medical practice. Veterinarians shall utilize analgesic drugs, dosages, treatment intervals and combination therapies proven to be safe and effective in different species and in various conditions of age, illness or injury in accordance with current veterinary medical knowledge and acceptable and prevailing standards of care.
[(f)] (g) If a client desires to consult with another veterinarian about the same case, the first veterinarian shall readily withdraw from the case, indicating the circumstances on the veterinary medical record of the animal, and shall forward copies of the animal's veterinary medical records in a reasonable period of time to other veterinarians who request them.
[(g)] (h) If a client requests referral to another veterinarian or veterinary hospital, the attending veterinarian shall honor the request and facilitate the necessary arrangements, which shall include forwarding copies of the veterinary medical records of the animal to the other veterinarian or veterinary hospital.
* * * * *
[Pa.B. Doc. No. 09-1722. Filed for public inspection September 18, 2009, 9:00 a.m.]
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