House asks for review of unlicensed practice

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Dialogue in the AVMA House of Delegates about the unlicensed practice of veterinary medicine led to two recommendations forwarded to the Board of Directors.

The topic was one of three chosen for discussion during the Veterinary Information Forum portion of the House’s regular winter session Jan. 13 in Chicago.

Dr. Melanie Marsden, Colorado delegate, introduced the discussion, saying unlicensed practice threatens patient safety. One category of unlicensed practices she cited involves nonveterinarians without adequate education, training, or supervision by veterinarians offering animal care. Common examples include alternative and complementary therapies, equine dentistry, and nonanesthetic dental cleanings.

Another scenario involves veterinarians temporarily coming into a state where they are not licensed to work, such as for animal cruelty investigations or to provide subsidized care such as low-cost surgery. Dr. Marsden said state practice acts and statutes have specific language prohibiting such things, with penalties ranging from misdemeanor to felony charges, and fines up to $100,000 or more. However, she noted that enforcement is often “hamstrung by underfunded, understaffed, uninterested state governments,” public ignorance these practices are illegal, and veterinarians’ unwillingness to be whistleblowers.

What tools are available at the state level to combat unlicensed practice, and how can the AVMA help?

From the HOD floor, Dr. Michael Ames, Arizona delegate, said his state veterinary board cannot fine nonveterinarians for the unlicensed practice of veterinary medicine, only issue a cease-and-desist order. “Courts refer to AVMA policy, state boards in their efforts refer to AVMA policy, and I personally would like to see a recommendation to create such a policy” on unlicensed practice, he said. “It’s overdue in the face of the continued assault on veterinary medicine by various groups.”

Maine delegate Dr. Anne Del Borgo said, “District attorneys and attorneys general are just not interested in pursuing this. Only if an animal is seriously harmed are they willing to pick it up.”

In Puerto Rico, said delegate Dr. Juan Amieiro, “Our members are becoming increasingly frustrated because they don’t understand the difficulty in prosecuting (these cases).” Team building with government institutions is one thing the veterinary profession in Puerto Rico is doing.

Maine’s delegate, Dr. Anne Del Borgo, speaks to the issue of unlicensed practice of veterinary medicine. (Photo by R. Scott Nolen)

Georgia alternate delegate Dr. Michael Zager said, “No state will do it to protect veterinary medicine; they’re going to enforce (licensing) to protect consumers.”

Veterinarians must be willing to submit a report when an unlicensed individual has treated one of their patients, said Dr. Douglas Kratt, delegate from Wisconsin. Dr. Stephen Dullard, alternate delegate from Illinois, suggested the AVMA develop media information with “consistent bullet points” about the dangers of unlicensed practice and act as a clearinghouse to determine the extent of the problem. “We don’t know the level it compromises our patients,” he said. Another delegate proposed the AVMA find a way to reprimand veterinary colleagues who practice medicine without a license.

Speaking for the National Association of Federal Veterinarians, delegate Dr. Michael Gilsdorf said, “We think this is a great topic but needs to be expanded to public practice. These fields are being taken over.”

Drs. Richard Williams and Gary Ailes, Florida and Nevada acting delegates, respectively, each addressed the need to define alternative modalities in state practice acts so they fall within the purview of veterinary medicine. Dr. Elizabeth Boggier, New Jersey’s alternate delegate, said she sees many owners taking their pets to places besides veterinary clinics, places where no veterinarian is on staff. “Rehab, in particular, is getting very big,” she said.

Discussion of unlicensed practice continued in the HOD reference committee assigned to address the topic, chaired by Dr. Marsden. Much of the focus was on alternative and complementary therapies.

“Why do these unlicensed people do it? Is it because we aren’t?” asked Dr. Jennifer Glass, Idaho alternate delegate. The American Holistic VMA’s temporary alternate delegate, Dr. Colleen Smith, replied, “The more we work together, the less these persons get used.”

Dr. Lori Teller, District VIII Board member, said, “One of the issues is physical therapists are trying to bypass veterinarians.” She said the American Physical Therapy Association is working to remove animal rehabilitation from the practice of veterinary medicine. The stated purpose of the APTA Animal Rehabilitation Special Interest Group within its Orthopaedic Section is to provide a forum for physical therapists and physical therapist assistants to discuss, promote, and advance the practice of animal rehabilitation. The APTA position states that “the practice of animal rehabilitation by physical therapists is permissible.”

Some state veterinary boards have elected to collaborate with other professional boards to craft or guide development of appropriate language regarding scope of practice and veterinary oversight in rules, regulations, and statues, Dr. Marsden noted.

Dr. Kendall Houlihan of the AVMA Animal Welfare Division read the definition of the “practice of veterinary medicine” from the AVMA Model Veterinary Practice Act. The definition includes “use of complementary, alternative, and integrative therapies,” and the definition of those therapies includes “physical medicine and therapy.”

Dr. Houlihan said that, under the current definitions, physical therapists could argue that “physical medicine and therapy” are not complementary or alternative. More specific language would prevent confusion over whether the practice act places them under the definition of veterinary practice.

Kate Tormey of the AVMA State Advocacy and Leadership Division said the model practice act will undergo regular review later this year.

The Council on Veterinary Service has already begun to look at it. Areas of discussion could include the terminology “physical medicine and therapy” versus “physical medicine and rehabilitation,” for example, and the definition of physical therapy as a component of complementary, alternative, and integrative medicine.

Dr. Teller also spoke about Texas dealing with high school students doing wellness and heartworm examinations and vaccinating animals, all without veterinary supervision, in a misguided effort to get students into a STEM (science, technology, engineering, and mathematics) field.

The committee proposed and the House approved a recommendation that the Board of Directors refer review of the Model Veterinary Practice Act to the appropriate entities. The review could lead to the addition of language specific to unlicensed practice, development of an official policy on unlicensed practice, or both.

During the reference committee meeting, there was also intense discussion over nonveterinarians inspecting animals for slaughter. Dr. John Sanders, a veterinarian with 30 years of public practice experience who was sitting in on the meeting, said, “The issue is you have people who do not have the same level of qualifications as veterinarians would inspecting meat, potentially signing export certificates, or advising veterinarians on how they should sign export certificates.”

He also expressed concern that this could lead to other agencies allowing nonveterinarians to sign animal health certificates.

Dr. Sanders and a veterinarian from the Department of Agriculture’s Food Safety and Inspection Service said the consensus is that having veterinarians in senior management of food agencies would promote public health.

That led to a second recommendation, which the House also approved. It calls for the Board “to consider developing a policy to encourage collaborative work with the United States Government regarding the proper utilization and employment of veterinarians to ensure food safety and security decisions are made with the highest consideration to public health.”