Proposed Regulations
BOARD OF VETERINARY MEDICINE
Title of Regulation: 18 VAC 150-20. Regulations Governing the Practice of Veterinary Medicine (amending 18 VAC 150-20-10, 18 VAC 150-20-30, 18 VAC 150-20-70, 18 VAC 150-20-75, 18 VAC 150-20-100, 18 VAC 150-20-110, 18 VAC 150-20-120 through 18 VAC 150-20-140, 18 VAC 150-20-180 through 18 VAC 150-20-200, and 18 VAC 150-20-210; adding 18 VAC 150-20-171, 18 VAC 150-20-172, and 18 VAC 150-20-181; repealing 18 VAC 150-20-205).
Statutory Authority: § 54.1-2400 and Chapter 38 (§ 54.1-3800 et seq.) of Title 54.1 of the Code of Virginia.
Public Hearing Date: August 22, 2002 - 9 a.m.
Public comments may be submitted until October 11, 2002.
(See Calendar of Events section
for additional information)
Agency Contact: Elaine J. Yeatts, Agency Regulatory Coordinator, Department of Health Professions, 6606 W. Broad Street, Richmond, VA 23230, telephone (804) 662-9918, FAX (804) 662-9114 or e-mail .
Basis: Section 54.1-2400 of the Code of Virginia establishes the general powers and duties of health regulatory boards including the responsibility to promulgate regulations, levy fees, administer a licensure and renewal program, and discipline regulated professionals.
Chapter 38 (§ 54.1-3800 et seq.) of Title 54.1 of the Code of Virginia provides the statutory authority for licensure and regulation of veterinarians, veterinary technicians, and veterinary practices.
Purpose: The purpose of the amended regulation is to clarify certain provisions as follows:
1. Amendments related to the terminology of animal facilities, veterinary facilities, animal hospitals, or veterinary practices were added to clarify that each establishment is responsible for registering with the board. For the health, safety and welfare of the animals and their owners, each establishment must be accountable to the board.
2. The amendment to change the renewal cycle to a calendar year is intended to provide a logical time for expiration of a license rather than an arbitrary date of March 1. It is believed that renewal compliance may improve and late fees may be avoided.
3. Amendments to further specify and clarify the duties of the veterinarian-in-charge (VIC) address questions about whether the VIC is always required to practice on-site and concerns about notification to the board if the VIC leaves the practice and discontinues serving in that role. The purpose is to ensure that there is someone responsible and accountable to the board for the establishment and for the stock of controlled substances on premises without unduly burdening either the veterinarian or the practice if the discontinuation of the VIC is unexpected or on short notice.
4. Other amendments set the parameters for delegation of certain tasks by a licensed veterinarian to unlicensed assistants. Those tasks that may be delegated are those that do not require independent judgment and discretion; they are tasks that may be taught on the job and do not require a formal education. Patients are protected by requirements for the veterinarian to remain responsible for any tasks delegated to an unlicensed person.
Substance: Amendments clarify that the board registers the veterinary establishment and will further specify the duties and responsibilities of the veterinarian in charge of each practice. To provide guidance for standards of practice, the amendments set in regulation the delegation of duties to a veterinary technician or unlicensed veterinary personnel.
Issues: The primary advantages to the public of implementing the amended regulations are as follows:
1. By determining that dental extractions and closures do not constitute surgery and may be performed by a veterinary technician, the veterinarian may delegate those duties and spend more time seeing patients and making diagnoses.
2. By specifying in regulations the expanded tasks that may be delegated to veterinary assistants, the veterinarian may train additional staff to provide care to animals in his practice.
While it could be argued that the treatment and care being delivered by a technician or an assistant rather than by a veterinarian is not the optimum for patients, the availability of persons to deliver that treatment and the access to veterinary care may be enhanced by changes to regulations. Given that veterinarians remain wholly responsible for the animals in their care and for the actions of unlicensed persons in their employ, the public is reasonably protected.
There are no specific disadvantages to the public. As stated above, some consumers of veterinary services are critical of an expansion of the duties for technicians and assistants. In testimony before the board, many expressed their concern about a diminution in the quality of care, but others, including veterinarians, testified that the delegation of tasks to trained assistants was no different from the practice of human medicine.
There are no advantages or disadvantages to the agency; the amended regulation does not impose a new responsibility on the board and does not involve additional cost or staff time.
Department of Planning and Budget's Economic Impact Analysis: The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007 G of the Administrative Process Act and Executive Order Number 25 (98). Section 2.2-4007 G requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. The analysis presented below represents DPB’s best estimate of these economic impacts.
Summary of the proposed regulation. Following a periodic review of this regulation, the Board of Veterinary Medicine proposes to amend the Regulations Governing the Practice of Veterinary Medicine to address issues that have been confusing to licensees and members of the public, including delegation of veterinary tasks, veterinary facility requirements, duties of the veterinarian-in-charge, and the licensure renewal date. The proposed changes include the following:
1. The definition of surgery is revised to specify that dental extractions and closures do not constitute surgery and may therefore be performed by a veterinary technician;
2. A provision is added to the regulation to set the parameters for tasks that may be delegated to unlicensed veterinary assistants. This area is currently only addressed by guidance documents issued by the Board of Veterinary Medicine;
3. The term “animal facility” is replaced throughout the regulation with the term “veterinary establishment” to clarify the entities that are required to register with the board;
4. The requirement for the biennial drug inventory is revised to comply with updated Drug Enforcement Administration rules;
5. Record-keeping requirements are relaxed to permit one record per group of animals in the same litter up to the age of four months. Currently, separate records must be kept on each animal;
6. The rules concerning facility requirements are amended to (i) specify that there must be a door, rather than a partition or small opening, to the surgery room, (ii) remove antiquated and nonessential equipment from the list of required equipment, and (iii) specify that a small animal practice may be conducted in a mobile, as well as a stationary, establishment;
7. The provisions addressing the duties and responsibilities of the veterinarian in charge (VIC) are amended to (i) clarify responsibilities of the VIC when leaving a practice or no longer serving in that role, and (ii) specify that a veterinarian must regularly (at least monthly) be on site and provide routine oversight of the practice at the establishment for which he is named VIC. The existing regulations require the VIC to practice on the premises full-time; and
8. The licensure renewal date is changed from March 1 to January 1 or each year.
Estimated economic impact. The majority of the proposed changes are clarifications of current practices and do not represent any change in the Board of Veterinary Medicine’s implementation of these regulations. Although these clarifications may make the regulation easier to understand and more useful for licensees, they are not likely to have any economic effects. Other proposed changes, such as permitting a joint record for animals in the same litter up to four months and removing nonessential items from the list of required equipment, are less stringent than the current requirements. Since these changes are not expected to reduce the quality of veterinary services provided, the reduction in regulatory burden may provide some economic benefit.
The amendment to change the renewal cycle to a calendar year is intended to provide a logical time for expiration of a license rather than an arbitrary date of March 1. The board believes that renewal compliance may improve and late fees may be avoided. The change in the renewal schedule should not result in any additional cost, as the board plans to prorate the fee for during the one-time transition from March to January.
The board also proposes to set into this regulation the parameters for delegation of duties to a veterinary technician or unlicensed veterinary personnel. Those tasks that may be delegated are those that do not require independent judgment and discretion; they are tasks that may be taught on the job and do not require a formal education. According to the board, patients are protected by requirements for the veterinarian to remain responsible for any tasks delegated to an unlicensed person. By delegating appropriate tasks, veterinarians may be able to spend more time seeing patients and making diagnoses. Some consumers of veterinary services are critical of an expansion of the duties for technicians and assistants. In testimony before the board, many expressed their concern about a diminution in the quality of care, but others, including veterinarians, testified that the delegation of tasks to trained assistants was no different from the practice of human medicine. Since the guidelines for delegation of duties in the proposed regulation mirror the guidance documents issued by the Board of Veterinary Medicine over the past several years, this proposed change is unlikely to have any significant economic impact aside from providing a regulatory basis for this policy.
Businesses and entities affected. There are currently 2,924 veterinarians, 792 veterinary technicians, and 800 veterinary facilities licensed by the Board of Veterinary Medicine in Virginia.
Localities particularly affected. The proposed changes will not affect any particular localities as they apply statewide.
Projected impact on employment. The proposed changes are not expected to have any significant impact on employment in Virginia.
Effects on the use and value of private property. The proposed changes are not expected to have any significant effects on the use and value of private property in Virginia.
Agency's Response to the Department of Planning and Budget's Economic Impact Analysis: The Board of Veterinary Medicine concurs with the analysis of the Department of Planning and Budget for the fee increases in the proposed regulation, 18 VAC 150-20.
Summary:
The proposed amendments update facility requirements and clarify certain provisions that have been confusing or problematic to licensees, especially related to the appropriate delegation of veterinary tasks to licensed technicians or unlicensed assistants.
18 VAC 150‑20‑10. Definitions.
The following words and terms when used in this chapter shall have the following meanings, unless the context clearly indicates otherwise:
"Animal facility" or "veterinary facility" means any fixed or mobile establishment, veterinary hospital, animal hospital or premises wherein or whereon or out of which veterinary medicine is practiced.
"Automatic emergency lighting" is lighting which that is powered by battery, generator, or alternate power source other than electrical power, is activated automatically by electrical power failure, and provides sufficient light to complete surgery or to stabilize the animal until surgery can be continued or the animal moved to another facility establishment.
"AVMA" means the American Veterinary Medical Association.
"Board" means the Virginia Board of Veterinary Medicine.
"Full‑service facility establishment" means a stationary or ambulatory facility which shall provide that provides surgery and encompass encompasses all aspects of health care for small or large animals, or both.
"Immediate and direct supervision" means that the licensed veterinarian is immediately available to the licensed veterinary technician, either electronically or in person, and provides a specific order based on observation and diagnosis of the patient within the last 24 hours.
"Preceptorship" means a formal arrangement between an AVMA accredited college of veterinary medicine or an AVMA accredited veterinary technology program and a veterinarian who is licensed by the board and responsible for the practice of the preceptee.
"Professional judgment" includes any decision or conduct in the practice of veterinary medicine, as defined by § 54.1‑3800 of the Code of Virginia.
"Restricted service facility establishment" means a stationary or ambulatory facility which does not meet the requirements of a full‑service facility establishment.
"Surgery" means treatment through revision, destruction, incision or other structural alteration of animal tissue. Surgery does not include routine dental extractions or closures performed by a licensed veterinary technician upon a diagnosis and pursuant to direct orders from a veterinarian.
"Veterinarian in charge" means a veterinarian who holds an active license in Virginia and who is responsible for maintaining a licensed facility veterinary establishment within the standards for facilities set by this chapter, for complying with federal and state drug laws and regulations, and for notifying the board of the facility's establishment's closure.
"Veterinary establishment" means any fixed or mobile practice, veterinary hospital, animal hospital or premises wherein or out of which veterinary medicine is being conducted.
18 VAC 150‑20‑30. Posting of licenses; accuracy of address.
A. All licenses and permits issued by the board shall be posted in a place conspicuous to the public at the facility establishment where veterinary services are being provided.
B. It shall be the duty and responsibility of each licensee and holder of a registration permit to operate an animal facility a veterinary establishment to keep the board apprised at all times of his current address. All notices required by law or by this chapter to be mailed to any veterinarian, certified veterinary technician, or holder of a permit to operate an animal facility a veterinary establishment, shall be validly given when mailed to the address furnished to the board pursuant to this regulation. All address changes shall be furnished to the board within 30 days of such change.
18 VAC 150‑20‑70. Licensure renewal requirements.