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Report to Licensees
of the
LOUISIANA
BOARD OF VETERINARY MEDICINE
Volume 18, No. 1
February 2009
Board
Members 2008-09
William H. Green, DVM,
President
John C. Prejean, DVM,
Vice-President
Steven V. Slaton, DVM,
Secretary-Treasurer
Mica F. Landry, DVM, Member
Gary T. Levy, DVM, Member
Table of Contents
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The Board will certainly miss departing member,
Patrick R. Bernard, DVM, whose term with the Board expired October 31,
2008. During his 6 year term, Dr. Bernard has shared insight and
experience pertinent to veterinary medicine and regulatory functions of
the Board, particularly in the equine area. The Board appreciates his
service and wishes him well on future endeavors.
The members of the Louisiana Board of Veterinary
Medicine and staff of the Board office would like to welcome new Board
member, Gary T. Levy, DVM. Dr. Levy currently practices in New Orleans (a
predominantly small animal practice) and has been appointed to serve
through July 30, 2013. We extend a warm welcome and best wishes for a
productive team.
Additionally, a welcome back is extended to Mica F.
Landry, DVM, who is returning to the Board to fill the vacancy of Dr.
Bernard. Dr. Landry practices in Donaldsonville, LA and has been appointed
to serve through July 30, 2013.
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Continuing
Education and Late License Renewal
The LA Veterinary Practice Act, enacted by the State
Legislature, requires continuing education for annual license renewal.
However, the State Legislature delegates to the Louisiana Board of
Veterinary Medicine (LBVM) the authority to promulgate rules to implement
the specifics of the requirement. The LBVM has complied with its mandate
and the results can be viewed in Chapter 400 of the Rules.
At the outset, it is not the objective of this article
to discuss what constitutes approved continuing education nor the protocol
for obtaining pre-approval of continuing education. There are also
exemptions from the continuing education requirement, such as disability,
retirement, and active military duty. For answers to questions regarding
these topics, I refer you to the LBVM’s website and/or the board office.
The primary purpose of this article is to address the
issues of failure to timely obtain the required continuing education hours
necessary for annual license renewal and the effects of such failure. More
specifically, Rule 403 A states, in pertinent part, that “a minimum of 20
actual hours is required each fiscal year (July 1 through June 30) as a
prerequisite for annual renewal of a license.”
As you are aware, all licenses terminate on September 30
of each year. See Rule 305. In order to timely renew a license for the
next year (beginning October 1), all requirements for annual renewal
(including continuing education) must be completed and submitted to the
LBVM along with the renewal application prior to the September 30
deadline. Therefore, as an example, a veterinarian has from July 1, 2007
through June 30, 2008 to obtain his required 20 hours of approved
continuing education for annual renewal ‘08-‘09. This information is
required to be submitted to the Board office via completed license renewal
application on or before September 30, 2008.
Rule 405 A states that “a licensee who fails to obtain
the required approved minimum of 20 hours within the prescribed 12 month
period (i.e. July 1 through June 30) will not meet the requirements for
renewal of his license. Such a license shall expire on September 30
for any licensee who does not timely and properly comply with the annual
continuing education requirement. Thereafter, a licensee may apply for
renewal of his expired license, however, he shall be unable to lawfully
practice veterinary medicine until such time as the requirements for
renewal have been met and documented to the satisfaction of the board. Any
late fees and/or fines assessed by the board shall be paid before the
renewal is issued.” Please note the above underscored language “license
shall expire on September 30” and “unable to lawfully practice veterinary
medicine.”
Furthermore, Rule 413 D provides that “failure to obtain
the required number of hours in the specified time period shall be
considered a violation of the rules of professional conduct” for which a
veterinarian can be sanctioned. Rule 413 D also provides for “a grace
period of no more than 90 days may be granted by petitioning the board for
an extension. A late fee of $25 and a fine of up to $50 may be levied.”
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Continued: However, for the grace
period to be considered by the LBVM, Rule 405 B requires there to be
“extenuating circumstances,” as well as the requirement that the “licensee
requesting the extension must petition the board at least 30 days prior to
the expiration date of the license.” In short, the rule requires that the
request for an extension (maximum of 90 days) must be submitted to the
board office in writing on or before August 30. Even with the granting of
an extension, the LBVM may still assess a late fee ($25) and/or fine (up
to $50).
What could happen if (1) the petition for an extension
is not timely submitted on or before August 30, and/or (2) the board
rejects the explanation of extenuating circumstances necessary to grant
the extension? The former licensee cannot lawfully practice veterinary
medicine until he secures a current license.
While some may question the actual effect “a lack of a
piece of paper” will have on the level of practice of veterinary medicine,
please consider several consequences that quickly come to mind if one were
to practice without a current license. First, there is the effect on DEA
and LA Board of Pharmacy registrations and the use of controlled
substances. Second, there is the effect of denial of insurance coverage
for civil claims made during the period of cessation of licensure, as well
as culpability and damages for practicing without proper authority. Third,
there are potential criminal penalties imposed by the courts for
practicing without a license. Fourth, sanction by the LBVM (perhaps actual
denial of a license depending on the facts of the case?) for practicing
without a current license.
In closing, the LBVM has been asked on occasion about
the possibility of required continuing education hours being extended over
a two year period. The substance behind the request is generally to allow
folks additional time to obtain the same, or even an increased number of,
approved hours. Unfortunately, the “roll over” and “two year” scenarios
are not applicable as continuing education coincides with annual license
renewal as required by the Legislature, as well as the accounting/tracking
standards established in the board office.
Please keep in mind that the public policy behind the
requirement of continuing education is to assist the profession with
continued competency which can be annually monitored. The pursuit of
continued competency is the Legislature’s primary objective with requiring
continuing education. Second, anyone that has attended a Board meeting can
attest to the substantial amount of the Board’s business agenda during a
board meeting devoted to the consideration of continuing education issues
regularly presented to the Board. There is also the many hours of work by
the Board’s office staff regarding continuing education between board
meetings. A roll over or two year scenario would only add to an already
difficult and time consuming accounting/tracking protocol for the Board
and its office staff.
In concluding, it is hoped that this brief article on
timely acquisition and reporting of approved continuing education has
answered some questions. As always, if you have any questions or comments
regarding this topic or any others, please submit them in writing to the
Board office for review and response.
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2009 Board Meeting
Dates
The Louisiana Board of Veterinary
Medicine will meet at 8:30 a.m. on the following dates: Thursday, February
5, April 2, June 4, July 30, October 1, and December 3, 2009.
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Rules Update
– Please call or write the Board office for a copy of any
Notice of Intent or Rules described below.
Final Rule 700, 711 – Mobile Practice Vehicle –
Effective February 20, 2009. Amended Rule clarifies the requirements for a
veterinary mobile practice vehicle for other than large animals.
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Medical Records
Issues regarding medical records seem to surface from
time to time. In general, pursuant to Rule 701, a medical record shall be
maintained for a period of five (5) years from the date of last treatment
and is the responsibility and property of the veterinarian. A copy or
synopsis of a patient’s record shall be provided to the client or the
client’s authorized representative upon request of the client. A
reasonable charge for copying and providing a patient’s record may be
required by the veterinarian. The veterinarian shall not release a copy of
the record to any person other than the client or a person authorized to
receive the copy for the client.
With regards to what constitutes a medical record, I
will direct you to the Board Rules 701 et seq. which were amended recently
and clearly address the Board’s position on this subject. Rule 701A.1
requires that the medical record be “written, or computer generated,...”
which does allow a veterinarian to maintain a computer based record.
However, it is the veterinarian’s obligation to be able to provide a hard
(written) copy of the record to the owner, a subsequent attending
veterinarian, and/or the Board (or its representative) upon proper
request. In addition, records are of the utmost importance in the event
the patient is presented to another veterinarian who can review the
records to determine what has been administered or provided by way of
veterinary services. In short, you must still comply with the other
provisions in the Rules regarding records if you elect to pursue computer
generated records.
The Board also strongly suggests the maintenance of
original signed consent forms, as well as diagnostic test results, which
may be required if the validity of such items are brought under review and
question. These documents and film, as well as any others items not
specifically discussed herein, may be extremely beneficial to you in
disputing allegations/claims made against you regarding these matters.
Your “records” may be the only defense you can assert in a given inquiry.
If you cannot produce defensible records, then your defense will not be
persuasive. In addition, while the reliability of technology is ever
growing, there still remains the unforeseeable occurrence of
hard-drive/software glitches, failures, and human error.
However, for purposes of this article, it can be stated
that a medical record is required when there is an establishment of the
veterinary-client-patient relationship (VCPR). The Board’s Rules also
clearly defines the VCPR and when it is established. See Rule 700.
The primary objective of this article is to address the
specific issue of production of the medical records to the client or the
client’s authorized representative (which may include a subsequent
attending veterinarian) upon request of the client. Obviously, the
requirement of client consent is predicated on the concept of
confidentiality.
The identity of the client should be determinable by the
medical record and the facts of a particular case; however, the more
challenging issue is who can be considered the owner’s authorized agent
regarding confidentiality. It is suggested that if you are in doubt,
perhaps you should first communicate with your client and satisfy yourself
that the “authorized agent” of the owner is in fact authorized to request
a copy of the medical record on behalf of the client. It is also suggested
that you document your file accordingly in the event any action on your
part in releasing, or refusing to release, a copy of the medical record is
legally defensible in a given case.
In addition, perhaps it may be an accepted common
practice for the second veterinarian to sign an authorization for the
client (without communication from the client to the former attending
veterinarian) in a “second opinion” or “new vet chosen by client”
scenarios, but potential legal problems with this approach presents
themselves for the sending veterinarian to protect himself from claims of
breach of confidentiality submitted by the client. If a complaint of this
nature is ever filed by the client, then the sending veterinarian would be
subject to sanction. There is no “implied” legal consent when it comes to
confidentiality. The consent given must be actual and express which means
that the client must affirmatively consent to and name the authorized
agent. So, for the new veterinarian to simply call the former veterinarian
to “get the file” does not satisfy the client consent requirement.
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Medical Records Continue: There may
be some with the opinion that “it should be a professional courtesy” to
provide the records to the subsequent veterinarian (for a second opinion
or new client/patient relationship). More than likely, the veterinarian
with this opinion will be the one with the new client/patient. But,
professional courtesy does not supersede the VCPR and confidentiality
requirements. Board Rule 1041 clearly states that “a licensed veterinarian
shall not violate the confidential relationship between himself and his
client.” In addition, the Board has also adopted, by Rule, the Code of
Veterinary Ethics of the AVMA. Principle II.L of the Code of Ethics states
that a veterinarian should protect the personal privacy of the
client-patient, however, disclosure of confidential information is legally
permissible “if required by law or it becomes necessary to protect the
health and welfare of other individuals or animals.”
Please keep in mind that a “referral” for care to a
subsequent veterinarian, which the client has consented to, would satisfy
the issue of consent. However, the file should properly document the
client’s consent. A document signed by the client consenting to the
referral would be optimum to defeat a claimed breach of confidentiality.
Additionally, it is well known that veterinarians
discuss various cases with one another. Such conduct is aimed at the best
care to be provided to the respective patient. This conduct is not a
breach of confidentiality, generally speaking, if there is no sharing the
identity of the client and patient, but only a discussion regarding the
veterinary care issues involved in the case.
As an aside, in the absence of a court order (subpoena)
or client consent, the Board has concluded that a veterinarian may only
disclose information regarding rabies vaccination, i.e., if the
vaccination is current, due to the overwhelming concern for public health
and welfare. In fact, as you know, in Louisiana only a licensed
veterinarian can lawfully administer a rabies vaccination. The method to
verify the timely administration of rabies vaccine by a licensed
veterinarian is appropriate documentation, i.e., medical record to
evidence administration of the vaccination, as well as a certificate/tag.
It is beyond dispute that without appropriate documentation, there is no
proof that the animal has indeed been timely and properly vaccinated by a
licensed veterinarian. There is also the public policy behind the law
regarding the prevention of a rabies outbreak.
Therefore, the administration of a rabies vaccination in
Louisiana by a lay person does not legally count. In the event the animal
bites another animal, or worse yet a person, without confirmation that the
biter has been timely and properly vaccinated, the ramifications regarding
medical treatment for rabies, and the resulting financial and legal woes
between the owner of the biter and the person bitten, could be
significant.
Also, keep in mind that in the event of a court order
(subpoena) or client consent, a veterinarian may legally disclose other
information, beyond current rabies vaccination, normally considered
confidential by Rule 1041 within certain limitations. The client-patient
information which may be lawfully disclosed is then, of course, defined
and limited by the terms of the court order (subpoena) or client consent.
It is hoped that this article will be of assistance to
you. If you have any questions or comments, please submit them in writing
to the Board office for review and response.
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Please Take Note…Per Rule 305D:
“It is the duty of the licensee to maintain
a current address with the office of the Board of Veterinary Medicine and
to notify the board’s office if an annual re-registration form is not
received.”
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License Renewal Statistics 2008-2009
Active DVM – 1071,
Inactive DVM – 219, RVT – 83, CAET – 105, RED - 5
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