Testimony: Authority of non-veterinarians to perform dental procedures

September 15, 2010

House Committee on Agriculture, Forestry and Economic Development of the Arkansas General Assembly

Rep. Roy Ragland, Chair

Rep. Jerry Brown, Vice Chair

Representative Ragland, Representative Brown and members of the committee, my name is Lyndon H. Tate. I am currently a member of the Arkansas Veterinary Medical Licensing Board, having assumed this position in March of 2009. I am a practicing Veterinarian with emphasis on equine and small animal medicine, who graduated from Oklahoma State University College of Veterinary Medicine, May of 1970.

In response to Rep. Jim House's Interim Study Proposal 2009-244, I will first of all answer, to best of my ability, the questions set forth in Patrick Ralston's letter dated September 1, 2010.

The Veterinary Medicine Practice Act was set up to protect the welfare of animals, and the rights of the animal owner, from the practice of sub-standard Veterinary Medicine. We investigate complaints filed against any Arkansas Veterinarian, Technician, or lay person who may cause harm to any animal and/or person in the course of their care, as set forth by the rules of the Act.

This Act has taken many changes since its inception, always responding, to better protect and serve the patient and/or its owner. During this time, a provision was included, allowing civil penalties to be placed. As far as I know, no changes were ever made to lower the threshold or decrease the protection and authority as outlined in the Veterinary Practice Act. Legislators and Veterinarians have always provided the needed laws and services to protect our animal population and animal owners.

Knowing the economic impact that medical expenses place on the animal owner, provisions were made to allow an owner and his/her employees doing routine farm/ranch work, to provide on farm basic medical care, including dehorning, castration and other actions in routine farm/ranch management. Medical procedures outside the routine farm/ranch management that are provided by non-employees who receive compensation are not allowed. This safeguards the animal and owner from un-trained, un-ethical acts with potential harmful consequences.

The currently licensed Veterinarians per type of practice are: Equine exclusive – 15; Bovine exclusive – 2; Large animal all species – 9; Mixed (over 50% large) – 25; Mixed (50-50) large/small – 46; Mixed (over 50% small) – 150; the total number of active Arkansas resident licensed veterinarians is 625. (What kind of practice are the remaining 378 in?)

The Oklahoma Legislators in just this past session, made changes to the Oklahoma Veterinary Medical Practice Act allowing certain exemptions. One of these exemptions was allowing non-veterinarians to practice equine tooth floating. It also made provisions for potent drugs to be dispensed to the tooth floater as a courier under certain conditions. This allows individuals with no or limited training to perform dental procedures on our horses. This allows procedures to be performed without the basic knowledge of anatomy, physiology, pharmacology, diagnostics and very importantly, the ability to follow through if unforeseen complications develop.

Two very important cases come to mind, pertaining to animals having dental procedures performed by non-veterinary lay people. Case one involved a 3 year old horse that had too many teeth removed. Complications developed and the owner was out over $8000.00 to correct the damage. Case two involved an older horse, where the non-veterinary lay person attempted to remove a large molar tooth- breaking it off above the gum line. The owner took the animal to a veterinarian, who referred it to a specialist, posing great expense to the owner, not counting the unnecessary procedures and pain placed on the animal.

Dental procedures can be classified into two broad classes. Non-Invasive and Invasive.

Non-invasive would involve diagnostics to determine what medical procedure was needed, if any. The approach should include a history of the problem, an oral examination, the taking of radiographs or X rays and the expertise of the dentist to perform the needed procedures (just as in human dental cases—see Figure 8)*. This would also include the practice of "teeth floating" where sharp points are removed from the teeth (Figure 2) *.

Invasive procedures would be much more involved, needing more advanced training in diagnostics such as taking and evaluating radiographs, the use of sedatives and anesthetics, anatomy of not only the mouth but surrounding structures of muscle, blood vessels, and nerves, and surgery to remove diseased teeth. If it involves getting into the areas where blood vessels are present the procedure is Invasive.

The practice of farriery (horse shoeing) has never been an issue with the Board. Most veterinarians have a very close relationship with their farrier. They work in tandem for the best possible outcome involving equine hoof maladies and disease. I would not like to practice without my farrier. He is very knowledgeable and always comes to me for diagnostics and/or needed invasive procedures.**

The Arkansas Veterinary Medical Licensing Board strongly opposes changing the Veterinary Medical Practice Act to allow lay people to perform dental procedures for hire without the supervision of a licensed veterinarian.

Let us remember the unforeseen risks and complications.

1. The use of prescription drugs where the user has no knowledge of pharmacology and side effects. Veterinarians possess the knowledge necessary to administer the medications at the correct dosages, use the appropriate routes of administration, safely monitor animals while they are under the effects of the drugs, and immediately address potentially devastating or fatal side effects or adverse reactions. ***

2. The procedure gone badly with uncontrolled bleeding, fractures of teeth and/or jaw bone.

3. The child or adult who gets exposed to these potent sedatives to the point of even causing death. This is a great public health issue!

4. The injuries (owner, operator and animal) that occur when horses object to the procedures without proper restraint. Another public health issue!

5. The damage and paralysis of nerves because of the lack of knowledge involving anatomical landmarks. Many times these are permanent damages.

6. The use of power dental tools that can cause extensive damage to teeth, gums, and jaw if not used properly (Figures 1, 4, 5, 6, 7)*.

7. If drug issues arise, the Pharmacy Board and/or Federal Department of Drug Enforcement may get involved.

8. Misdiagnosis; Cancer of the gums, mouth (Figure 3) *. By removing the tooth the owner was under a false sense of hope that animal was going to recover. Spread of devastating contagious disease i.e. vesicular stomatitis.

I ask this committee to remember our responsibility to the animals we care for and the owners. This state and legislators have always been progressive in providing the needed laws and rules for animal production and care. They have always moved forward from the time of non graduate veterinarians until today, with a commitment of never compromising. We feel you would be compromising our ability to provide the best and most appropriate care for our animal industry. Proposal 2009-244 would place Arkansas well outside the mainstream of veterinary practice acts.

Who will monitor licensing and complaints? Will basic and continuing education be required? Will there be civil penalties for offenses? Will veterinarians be held to a higher standard for doing the same procedure?

It is the responsibility of the Board to protect the rights of owners and welfare of animals, whether it's food animal, equine, exotics, or small animal pets. We uphold the rules as set forth in the Practice Act, which you formulated and made into law. You will be making changes which will lessen our ability to protect the public and their animals from what could be compromised medicine. But, we will uphold and enforce to the best of our ability, the Act as you so legislate.

Look and listen to all the facts, issues and concerns. Please study the Practice Act and become knowledgeable of what is considered The Practice of Veterinary Medicine? When you are satisfied, reject this proposal, 2009-244 to change the Arkansas Veterinary Medicine Practice Act.

As an afterthought, I was surprised that the various humane societies did not get involved in the Oklahoma Act because of the abuse that would occur if no sedatives, anesthetics or pain medications are given during or after the dental procedures.

Respectfully submitted,

Lyndon H. Tate, DVM


*Figure images not included

**Model Veterinary Medical Practice Act (2003)

     Exemptions; Horseshoeing

***Federal Regulation 21CFR530 (which implements the Animal Medicinal Drug Use Clarification Act [AMDUCA]

Source:  Staff research, AVMA State Legislative and Regulatory Affairs Department
Contact:  Adrian Hochstadt, Assistant Director, AVMA State Legislative and Regulatory Affairs Department, 847-285-6780.