February 1, 2017

Dear Board of Veterinary Medicine Members,

                My name is Dr. Joseph A. May and as most of you know, I just finished serving eight years on the Board of Veterinary Medicine. I have concerns about the following changes to the regulations concerning the practice of Veterinary Medicine posted on the Town Hall Web Site.

5. Advertising in a manner which that is false, deceptive, or misleading or which that makes subjective claims of superiority

Suggest rewriting to make it flow better:

 5. Advertising in a manner that is false, deceptive, misleading, or makes subjective claims of superiority

B. Injections involving anesthetic or chemotherapy drugs, subgingival scaling, or the placement of intravenous catheters shall not be delegated to an assistant. An assistant shall also not be delegated the induction of sedation or anesthesia by any means. The monitoring of a sedated or anesthetized patient may be delegated to an assistant, provided the patient is no longer intubated and provided a veterinarian or licensed veterinary technician remains on premises until the patient is fully recovered.

This proposal has caused a great deal of angst among Veterinarians especially in rural practices. It basically prohibits an assistant from monitoring or recovering an anesthetized patient. I have been told that the words “provided the patient is no longer intubated and” was accidently added from wording from a previous document that the Board approved and will be deleted. I do remember the wording above without the added words but do not ever remember ever seeing a document with the added words in it. It is possible that it came from a committee to study revisions but to my knowledge, it was never discussed by the full board or approved. I along with several other board members would never approve of such a proposal as it would create a severe hardship on many practitioners. There seems to be a push by some in the Veterinary community to restrict more things routinely done successfully for years by assistants trained within the hospital to licensed personnel only. To me, this is extremely short sighted and creates an extreme hardship on many practitioners. Currently there is only one licensed LVT for every four practitioners and many rural practices can simply not attract LVTs to come to their area and work in the practice. The Licensed DVM remains responsible for the safety of the patient regardless of who is helping with that patient and regulations should not restrict his ability to use his professional judgement. In addition, regulations such as this also hampers the ability of an LVT to train and delegate staff they are supervising so they can use the skills they were trained for to take over tasks typically done by the DVM to improve overall patient care. They are highly trained and should not be regulated into doing tasks that others can be easily trained to do. Instead of passing regulations to restrict assistants, we should take a cue from our human counterparts and allow LVTs to use their skills and play a greater part in patient care similar to the way Nurse Practitioners assist MDs.

B. Additional C. The following tasks that may be delegated by a licensed veterinarian to a properly trained assistant include but are not limited to the following:

1. Grooming;

2. Feeding;

3. Cleaning;

4. Restraining;

5. Assisting in radiology;

6. Setting up diagnostic tests;

7. Prepping for surgery Clipping and scrubbing in preparation for surgery;

8. Dental polishing and scaling of teeth above the gum line (supragingival);

9. Drawing blood samples; or

10. Filling of Schedule VI prescriptions under the direction of a veterinarian licensed in Virginia.

In the proposal above, I feel the words “include but are not limited to the following” needs to remain in the regulation and not be deleted. By removing it, it restricts assistants to doing ONLY those tasks listed. There are many more tasks not listed that a trained assistant can safely do and as mentioned previously, the Licensed DVM remains responsible whenever a task is delegated.  Again, rural practitioners often do not have the opportunity to have an abundance of LVTs in their practice and must rely on trained assistants to lend a helping hand. If you notice “assist with surgery” is not listed above so with a strict interpretation of the regulation, it would prohibit a trained assistant from donning a pair of sterile gloves and helping with a difficult abdominal surgery which could actually lead to the animal dying on the table. I see no reason to change this wording and I actually made a motion to leave it when it was discussed by the board but my motion failed for a lack of a second. I hope the board will reconsider.

I would also suggest replacing “Clipping and scrubbing in preparation for surgery” with “assisting in surgery” to be more comprehensive.

3. Whenever the establishment is closed, all general and working stock of Schedule II through V drugs and any dispensed prescriptions that were not delivered during normal business hours shall be securely stored as required for the general stock.

4. Prescriptions that have been dispensed and prepared for delivery shall be maintained under lock or in an area that is not readily accessible to the public and may be delivered to an owner by an unlicensed person, as designated by the veterinarian.

While the two proposals above are designed to help prevent diversion of drugs meant for our patients, I am concerned that it would also limit the opportunity of assistants or kennel personnel to administer prescribed controlled drugs such as phenobarbital to boarders when a DVM or LVT is not on the premises. It is a common practice for these folks to treat animals in the hospital when they come in to feed and clean on weekends or after hours and provisions need to be made to allow this.

A. Agricultural or equine ambulatory practice. An agricultural or equine ambulatory establishment is a mobile practice in which health care is performed at the location of the animal. Surgery on large animals may be performed as part of an agricultural or equine ambulatory practice provided the establishment has surgical supplies, instruments, and equipment commensurate with the kind of surgical procedures performed. All agricultural or equine ambulatory establishments shall meet the requirements of a stationary establishment for laboratory, radiology, and minimum equipment, with the exception of equipment for assisted ventilation.

B. House call or proceduralist establishment. A house call or proceduralist establishment is an ambulatory practice in which health care of small animals is performed at the residence of the owner of the small animal or another establishment registered by the board. A veterinarian who has established a veterinarian-owner-patient relationship with an animal at the owner's residence or at another registered veterinary establishment may also provide care for that animal at the location of the patient.

1. Surgery may be performed only in a surgical suite at a registered establishment that has passed inspection.

In the proposed regulations above concerning House Call Practices, there is no provision to attend an animal at a place other than “the owner’s home or an establishment registered by the Board”.  Practitioners need to be able to see a patient at a boarding kennel or wherever it is located and the wording should be more like those concerning Ambulatory practice above. It should also not restrict them to only see patients they have seen before and already have a veterinary-owner-patient relationship.  I would suggest clarifying the first sentence to include all locations and delete the second sentence. I do not think the Board is intentionally restricting this but likely has just not thought of the consequences.

The proposal above concerning the restriction on Surgery really needs to be eliminated or modified as well. “Surgery” is a term that can encompass many procedures from lancing an abscess or suturing a small wound under a local to thoracic surgery requiring specialized equipment and numerous personnel. As written above, it prevents a house call practitioner from doing any minor surgical procedures that could easily and safely do in the field. These include lancing of abscesses, draining seromas, or removing small bumps and suturing small wounds under local anesthesia. Again, the practitioner is ultimately responsible for all decisions concerning patient care and he should be allowed to use his professional judgement on how best to treat his patients after discussing it with the owner. I would suggest either eliminating the wording above or modifying it so that it only pertained to surgeries that require general anesthesia.

While I am on the subject of surgery, there are other regulations that restrict surgical procedures to be performed in a room specifically set up for surgery and others that prohibit certain equipment from being in the room. I agree completely that any hospital performing surgery should have a room set up for it but there needs to be a common sense approach to the regulations. As I have said before, the practitioner is ultimately responsible for the results and he should be allowed to use his professional judgement on where and how to perform a specific surgery. There are many surgeries that should only be performed in a sterile room but there are others such as repairing contaminated or infected wounds or lancing abscesses that should not be. Advanced dental extractions are clearly surgical procedures but they should be performed in an area set up specifically for dental procedures where dental equipment and dental x-rays are readily available and not necessarily in an operating room set up for other procedures. Often, more than one type of surgery such as a neuter combined with a dental extraction and teeth cleaning are performed on a single patient.  It makes perfect sense to do both procedures at a single location rather than extending anesthesia to move the patient between two locations in the hospital.

I respectfully ask that the Board review regulations and modify them as needed with these points in mind. It is far better to allow the practitioner to use his best judgement than to create restrictive regulations that are not based on common sense.

Thank you for the opportunity to express my opinions and I hope the Board will find it helpful.

Joseph A. May, DVM

Collinsville, Virginia