Practicing veterinary medicine can be challenging at times – Let IVMA help!
Below is a sampling of questions arranged by topics posed by IVMA members. Maybe you have had this question or issue too!
*Remember…in your particular case, be sure to consult with your own legal counsel.
(IVMA counsel provided by Stoll Keenon Ogden in Indianapolis.
What is the current Indiana law regarding writing a prescription?
Indiana Code 25-38.1-4-5 Prescriptions written by licensed veterinarian; veterinarian-client-patient relationship requirement (a) A licensed veterinarian may write prescriptions. Pharmacists shall give the prescriptions written by a licensed veterinarian the same recognition given the prescriptions of persons holding an unlimited license to practice medicine or osteopathic medicine. (b) A valid veterinarian-client-patient relationship must exist before a licensed veterinarian dispenses or prescribes a prescription product. (c) Veterinary prescription products, including drugs and immunizing products restricted by state and federal law for use by licensed veterinarians, may not be diverted or transferred to an individual for use on an animal if there is not a current veterinarian-client-patient relationship with the original prescribing veterinarian. (d) If a veterinarian prescribes a drug for the client’s animal, upon request, the veterinarian shall provide the prescription to the client, unless prohibited by state or federal law or to prevent inappropriate use.
Do I have to have a Controlled Substances Registration (CSR) and DEA for every location where I practice veterinary medicine? I have a clinic where I practice but I also do volunteer work at the local humane shelter and sometimes I do house calls.
A veterinarian does not have to have a separate CSR for every location where the “prescribe” controlled substances. However, IC 35-48-3-3(f) makes it clear that a separate registration is required at each location where the veterinarian “possesses” or “dispenses” controlled substances. It is the presence of the drugs that requires registration. The CSR would be in the name of the location (i.e. hospital, clinic, office, etc.) rather than the name of the veterinarian. Of course, in many cases, the name would be one and the same.
What are the legal issues surrounding a veterinarian dispensing compounded drugs?
“Compounding” is defined as the manipulation of a drug to make a different drug to meet the needs of a particular patient. Manipulation might include mixing, diluting, concentrating, flavoring, or changing a drug’s dosage form to accommodate a specific patient’s needs. Examples of compounding would include: mixing two injectable drugs; creating an oral suspension from crushed tablets or an injectable solution; or adding flavoring to a commercially available drug.
Compounding can be performed by a veterinarian or by a pharmacist upon receipt of a veterinarian’s prescription for a particular patient. A veterinarian must have a veterinarian-client patient relationship to legally prescribe or prepare a compounded product.
Compounding for non-food animals may be necessary when no approved drug exists to treat a pet’s diagnosed condition or when approved drugs need to be modified to sufficiently treat the patient (e.g. flavoring, diluting, or changing the form of medications from tablet to suspension).
In contrast, compounding that circumvents the drug approval process and mass markets products that have been produced with little or no verified quality control or manufacturing standards is clearly outside the bounds of traditional compounding. Such manufacturing of unapproved drugs might be termed “piracy” if the product mimics an FDA approved animal or human drug. Veterinarians might have seen businesses that offer their version of a popular approved brand name drug at lower prices than the approved product. Such a product is not custom-compounded for a particular patient upon a veterinarian’s prescription and is illegal.
Veterinarians can prescribe that pharmacists compound drugs for the veterinarian’s “in-office use.” The veterinarian may administer such drugs to patients, but re-dispensing of these products by the veterinarian to a client is generally prohibited.
Learn more by clicking here.
How many continuing education hours do I need to renew my veterinary license?
According to Indiana law, ” a veterinarian licensed in Indiana is required to complete forty (40) clock hours of continuing education in the area of veterinary medicine for biennial license renewal on October 15 of each odd-numbered year.” Ten of those hours can be through self-study, but it must have a test or post-evaluation.
I see so many different continuing education brochures come across my desk. How do I know what is approved for continuing education in order to renew my veterinary license every two years?
According to rules set by the Indiana Board of Veterinary Medical Examiners, some programs are automatically approved for continuing education. Programs sponsored by the following organizations are approved:
- American Veterinary Medical Association or any of its constituent organizations.
- Indiana Veterinary Medical Association, local veterinary medical associations, or any other state or provincial veterinary medical association.
- American Animal Hospital Association or any other veterinary specialty organization.
- Indiana Veterinary Technician Association.
- Purdue University College of Veterinary Medicine or any other accredited veterinary school in the United States.
- American Association of Laboratory Animal Science.
- Any other continuing education offering must be approved by the Indiana Board of Veterinary Medical Examiners. You can call them at 317/234-2054 to see if it has already been approved or if you would have to submit for approval.
How long do I need to retain animal health records?
The Indiana Administrative Code states that animal records “shall be retained and shall be readily retrievable for a period of three (3) years following the last treatment or examination.”
What does a veterinary medical record include?
According to Indiana law, veterinary medical records include the following: (1) Written records and notes, radiographs, sonographic images, video recordings, photographs or other images, and laboratory reports. (2) Other information received as the result of consultation. (3) Identification of any designated agent of the owner for the purpose of authorizing veterinary medical or animal health care decisions. (4) Any authorizations, releases, waivers, or other related documents.
Given that animal medical records are confidential, can I give a boarding facility an update of the vaccination record of an animal?
A boarding facility can obtain proof of vaccinations without written consent from the client if the boarding facility is owned by a veterinarian. That veterinarian is “involved in the care … of the animal.” If the boarding facility is not owned by a veterinarian, however, or the animal is not under the care of a veterinarian at the boarding facility, then written consent from the client would be required.
Do I have to provide emergency care to an animal?
There is no statutory (i.e., legal) requirement that veterinarians must provide emergency care to animals. That said, if it is widely accepted that minimal care will be provided, then that is the “standard of care.” That is the care that should be provided. The standard of care is established by veterinarians, not by statute, so the guiding principle in an emergency situation should be, “What would a reasonable, prudent veterinarian do in these circumstances?” It is an exercise of judgment. A presumption that the standard of care, which is “minimal care,” includes an ethical obligation to relieve suffering through appropriate palliative measures or euthanasia, if appropriate. If a client is requesting extraordinary measures the veterinarian believes are inappropriate or futile, the decision on whether to refuse to provide the care requested should be made based on the circumstances and the exercise of professional judgment. As always – document, document, document – the circumstances, the medical decision-making, as much of any verbatim conversation as can be recounted contemporaneously at the time of the incident. Have clients sign acknowledgements of any advice given, even if quickly drafted, regarding discussions about care. There is no magic to this. It is just sound risk management for avoiding a bad result if there should be a complaint or litigation later.
I have a client that won’t, or can’t, pay their bill. Can I hold the animal until payment is made?
Just as an auto shop owner can hold onto a car until paid for services, a veterinarian may refuse to return a pet until paid for services rendered. Animals for the most part are treated as other personal property, and the provisions of the Uniform Commercial Code apply to them. Therefore, you would be within your rights to refuse to return the animal to its owners until acceptable provisions for payments are made.
I have had clients waive recommended blood work because they just can’t afford it. What do you think? Some clients can’t afford yearly blood tests, etc. to renew their pet’s maintenance prescription (i.e. heartworm preventative, etc.). Rather than not renew the scrip to the detriment of the pet, can the veterinarian have the client sign off on a waiver for the lab work? Does this absolve the veterinarian from the standard of care?
Again, the standard of care is not a legal construction, but one established by members of the profession. By definition, care that falls below the standard of care is negligent. Veterinarians cannot contract out of liability for care that is negligent by obtaining a waiver or a consent from a client. That said, clients can assume risk in certain circumstances through principles of informed consent. This occurs with surgical procedures, for example, where the risk of anesthesia or complications is part of the decision-making process. If the blood work is not required by law, but is a recommended practice as per the medication manufacturer’s guidelines, a waiver may potentially be crafted. The principles of informed consent apply. An informed consent should explain the source of the “requirement” that yearly blood work be performed and the basis for the requirement (i.e., a requirement imposed by law, a recommendation from the manufacturer, etc.) An informed consent needs to document any pertinent details of the animal’s health history that might mitigate or increase the risk of harm. It should then state what the risks are, and that needs to include full disclosure of adverse effects, even risk of death. The document would then require the client to acknowledge he or she read the document, had an opportunity to ask questions of the veterinarian, and has requested that the veterinarian provide maintenance prescriptions for the animal without blood work. The document should be signed and witnessed by someone other than the veterinarian. Vet techs or other employees of the veterinarian’s office are sufficient for this purpose. In suggesting this can be accomplished through an informed consent process, it is also assumed that veterinarians will not prescribe heartworm preventative or other maintenance prescriptions if they have a reasonable belief based on the animal’s condition there is more than a negligible risk of harm. Finally, if veterinarians are discussing this with each other and, as a group, are of the general consensus that providing maintenance prescription renewals to clients unable to afford yearly blood work is preferable to not doing so, then that is the standard of care. As always, good documentation of discussion with clients about care provided or not provided in such circumstances is a must for good risk management.
I recently got married and have changed my name. What should I do about my veterinary license to change the name?
You need to request the name change in writing with a copy of marriage certificate, divorce decree, or other legal documentation. Call the Veterinary Licensing Board at 317-544-2409 for more information.
What are the requirements for veterinary licensure in Indiana?
The following lists the general requirements for veterinary licensure in Indiana. For specific questions and a licensure/examination application, you must contact:
Indiana Veterinary Licensing Board
1202 East 38th Street Suite 100, Indianapolis, IN 46205
Email: vetboard@vetboard.in.gov
Phone: 317-544-2409
Click here for veterinary licensing information.
Can you define who the “owner” of the animal is? In the case of divorce or death, it can be confusing.
Client is defined as “the owner, the owner’s agent, or other person who is responsible for an animal that is examined or treated by a veterinarian.” Ind. Code § 25-38.1-1-7.3. Ownership issues can be confusing at times(i.e., divorce). The veterinarian can treat any animal that they reasonably believe has been presented by a “client.” They may assume that the person bringing in the animal for treatment has the authority to do so unless they have reason to believe this is not true. The request by a person to euthanize a reasonably healthy animal is a circumstance where further inquiry should be made to assure that the person has the legal right to request such a service. In the case of the death of the known owner of an animal, the veterinarian can provide services to relatives or others presenting the animal as long as they have reason to believe that the person “is responsible” for care of the animal.
I think I have an abandoned animal. What does the law say about this?
According to IC 25-38.1-4-8 Abandoned animal, the law provides the following: “Sec. 8. (a) An animal placed in the custody of a veterinarian is considered to be abandoned five (5) days after the veterinarian has given written notice to the individual who delivered the animal to the veterinarian that the animal should be reclaimed by the individual. Written notice must be delivered by certified mail to the place given by the individual as the individual’s mailing address at the time the individual delivered the animal to the veterinarian. (b) Abandonment of an animal under this section constitutes the relinquishment of all rights and claims by the owner of the animal. An abandoned animal may be sold or otherwise disposed of as the veterinarian may see fit. The purchaser or recipient of an abandoned animal shall receive full and clear title to the animal. (c) The giving of notice as provided in this section relieves the veterinarian and all persons who receive an abandoned animal from the veterinarian of criminal or civil liability.(d) The individual who delivered an animal abandoned under this section is liable for all reasonable and customary expenses incurred for diagnosis, treatment, hospitalization, surgery, board, euthanasia, and disposal of the abandoned animal.”
I have recently been called for jury duty in my county. Am I exempt?
The automatic exemption for veterinarians and many other people was repealed in the 2006 legislative session. In its place, all persons were given the opportunity to defer jury duty for up to one year with a legitimate reason. How this will work is that when a person receives notice of jury duty, they can contact the person that sent them the notice and explain the conflict they have with the proposed time to serve. They will then be excused from service at that time but will be required to serve within one year.