Practice Pulse

QUESTION: I'm a veterinarian pursuing the ECFVG program. Surgical experience is required for step 4 of the program. I presently work as a veterinary technician, and I would like to know what legislation is there regarding foreign graduates performing spays/ neuters in the state of Florida in order to attain their surgical experience? Can I work under a doctor’s supervision or in a rescue facility? If I can, what is the legislative reference that allows this?

A: As a veterinarian in the ECFVG program, the exemption under §474.203(2) seems to be applicable. You should be able to perform spays/neuters under supervision.

(2) A person practicing as an intern or resident veterinarian who does not hold a valid license issued under this chapter and who is a graduate in training at a school or college of veterinary medicine located in this state and accredited by the American Veterinary Medical Association Council on Education or a school or college recognized by the American Veterinary Medical Association Commission for Foreign Veterinary Graduates. Such intern or resident must be a graduate of a school or college of veterinary medicine accredited by the American Veterinary Medical Association Council on Education or a school or college of veterinary medicine recognized by the Educational Commission for Foreign Veterinary Graduates of the American Veterinary Medical Association. This exemption expires when such intern or resident completes or is terminated from such training. Each school or college at which such intern or resident is in training shall, on July 1 of each year, provide the board with a written list of all such interns or residents designated for this exemption, and the school or college shall also notify the board of any additions or deletions to the list.

QUESTION: Do I need to have national accreditation to keep my state accreditation? My practice has been sold, and I am close to retirement. I still want to do interstate health certificates and puppy sales certificates. Also, what records do I need to keep and for how long for the HCCE permit? Like I said, my practice has been sold, and we are moving the business records out for the new owner.

A: For clarification regarding your accreditation question, please contact Robert S. Chadwell at the State Veterinarian’s Office. You can also learn more about the National Veterinary Accreditation Program online at: https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/ nvap

As for the second part of your question, we recommend erring on the safe side and keeping records for three years. According to the Rules of the Drugs, Devices & Cosmetics Program, 61N-1.012(10):

10) All required records must be retained for a period of two years following disposition of the drug, device or cosmetic, or three years after the creation of the records, whichever period is longer; and must be available to the department for such period or as long as records are retained if longer. Records must be retained beyond the retention period if the person has been notified that an investigation or inspection has been initiated by the department and the investigation has not been completed when the mandatory retention period expires.

QUESTION: A pit bull came to our clinic badly bitten and torn up in the left shoulder area with a major artery bleeding. The gentleman who brought him in was not the owner of the dog. The gentleman called the dog’s owner who then texted back that he wanted the pet euthanized. He showed the text to staff but did not authorize or sign anything. He left the dog with us. We could not reach the owner by phone as he did not answer. We contacted the police but could not wait on them to make a decision as the pet was bleeding out. The vet attending the case was very concerned as to where we stood legally. What is FVMA's opinion on the correct course of action?

A: Euthanasia would be appropriate under the circumstances. The veterinarian saw a text message from the owner who wanted the pet euthanized. The other theory is that the dog, being extensively injured and having been abandoned, was handled humanely by the veterinarian.

QUESTION: When a client comes back for an expected refill of a medication, do they have to be put under the doctor's name that refilled it or can it be refilled under another category like OTC? The doctor's name is still on the refill label, it's just how it is recorded in the computer software.

A: This is not a simple question to answer. All medication dispensed to a client/patient must be properly recorded in the patient’s record. If the medication is a controlled substance, there are additional requirements for recording/recordkeeping. If you are recording those in a computer, you must be able to print out a record of all controlled substances dispensed and who prescribed.

Assuming that all applicable recording requirements are being complied with, and that the proper records can be produced, we see no problem if a practice wishes to also record such transactions in a different way for their own administrative purposes. However, if by recording these transactions as OTC or in any other way renders you unable to comply with the recording/recordkeeping requirements, then that would be an issue.

QUESTION: My client’s dog attacked another dog. The dog that was attacked has been seen by two other hospitals and now by me. All three of us agree the dog now has a medial luxating patella and is probably a surgical candidate. I am still trying to get complete medical records on the injured animal. My client is questioning if the injured dog had a preexisting patellar problem, and if so, how much he is liable for because he is going to pay the bill for the surgery. My question is, if I find the injured dog had a preexisting patellar issue, am I allowed to share this information with my client? If he is paying the bill, is he entitled to such information?

A: I would not discuss the medical condition of the injured dog with your client. Although you have a VCPR with the client, it does not involve the injured dog. Although the client may be paying the bill for the surgery, he is doing so to cover the damage caused by his dog. Hopefully, there will be no preexisting condition and no disclosure problem. If there is a preexisting condition, the veterinarian must tell his client that he cannot confirm or deny anything contained in the confidential patient records unless the dog’s owner approves.

One of the benefits of an FVMA membership is our helpline (800.992.3862), which is available to members Monday through Friday from 8 a.m.-5 p.m. Our helpline also provides insight to the FVMA staff of the challenges and concerns of our members. In this feature, we will highlight topics from the questions we received in preceding weeks as a part of an effort to keep our members up to date on current concerns, as well as regulatory and legislative changes.

QUESTION: Is there a resource where I can review my legal obligations regarding the release of records and x-rays to a client? We last saw the patient 13 months ago.

A: The statute of reference is 61G18-18.002 Maintenance of Medical Records. F.A.C. In summary:

• A veterinarian shall, upon a written request, furnish, in a timely manner without delays for legal reviews, a true and correct copy of all of the patient records to the client, or to anyone designated by the client. Such records release shall not be conditioned upon payment of a fee for services rendered, except for the reasonable cost of duplication. • What constitutes a reasonable cost of duplication? Not more than $1.00 per page for the first 25 pages, and not more than 25 cents per page for each page in excess of 25 pages. • What about reproducing x-rays? Actual costs. In other words, the cost of the material and supplies used to duplicate the record, as well as the labor costs and overhead costs associated with such duplication. • A patient record should be kept for 3 years after the last entry.

QUESTION: When can I start working as a veterinarian after graduation?

A: If you have graduated from an approved college or school of veterinary medicine, your license application is complete, and you have taken the Laws and Rules examination, you may work under the supervision of a licensed veterinarian while awaiting the test results. If you fail the examination, you cannot work under supervision until you achieve a passing score.

QUESTION: Last year, I was advised by one of my drug distributors that Florida was requiring HCCE permits for veterinarians. I obtained this and have just received the application for renewal. I have a single doctor (me) house-call practice in Florida. I do purchase medications for dispensing to clients for patients. My practice is incorporated as an S-corp.

A: No, the permit is not required by a solo practitioner operating a veterinary practice.

QUESTION: It has been brought to my attention that Marion County requires microchipping of all pets being sold within our county. This is not required in the Florida Statutes. Could you please clarify if microchipping of sold pets is required versus optional?

A: The county government has the authority to mandate microchipping by local ordinance as long as it does not conflict with state or federal law. Marion County, Florida, did promulgate such an ordinance in May, 2019, and (b) below, does mandate microchips for pets that are sold. Sec. 4-10. - Mandatory microchipping. a. No shelter, humane society, rescue organization, or similar organization, whether public or private, whose principal purpose is securing the adoption of dogs and cats, shall release any such animal to its owner, custodian or an adopter unless the dog or cat has first been implanted with an electronic animal identification device (microchip). b. Every breeder is required to have a dog or cat implanted with an electronic animal identification device (microchip) prior to the sale of the dog or cat. c. No dog or cat need be microchipped if a licensed veterinarian, exercising appropriate professional judgment, certifies in writing and under oath that an animal is medically unfit for the microchipping procedure because of a physical condition which would be substantially aggravated by such procedure or would likely cause the animal's death. d. It shall be unlawful for a shelter, humane society, rescue organization, or similar organization to refuse or fail to have a dog or cat implanted with an electronic animal identification device (microchip) as required in this chapter.

QUESTION: If a fourth year graduating vet student has passed the DVM exam but has not taken the Florida licensing exam, can the student operate under the direction of any Florida licensed veterinarian in the practice? How long after graduating can they take the Florida Board licensing exam?

A: You cannot practice under supervision if you have not completed all parts of the examination.

Florida Statute 474.207 (5): An unlicensed doctor of veterinary medicine who has graduated from an approved college or school of veterinary medicine and has completed all parts of the examination for licensure is permitted, while awaiting the results of such examination for licensure or while awaiting issuance of the license to practice under the immediate supervision of a licensed veterinarians. A person who fails any part of the examination may not continue to practice, except in the same capacity as other nonlicensed veterinary employees, until she or he passes the examination and is eligible for licensure.

Your application to take the required examinations remains valid for twenty-four months. You may find a great resource on Veterinary Medicine FAQs online at: http://www.myfloridalicense.com/DBPR/ veterinary-medicine/faqs/#1488479371253-872f97e5-2e03

END NOTE: The ultimate responsibility in the practice of veterinary medicine lies with the licensed veterinarian. Professional discretion must always be exercised.