Texas Veterinary licensing act SARRA LORD, LVT

Texas Veterinary licensing act All of the rules and regulations pertaining to the practice of veterinary medicine in Texas are contained in a section of the Texas Administrative Code The section containing the veterinary practice or licensing act is Title 22, Part 24 and it is named the Rules Pertaining to the Practice of Veterinary Medicine. Hereafter it will be referred to as The Rules. The Rules were last updated on September 1, 2016

Definitions

How is veterinary medicine defined in texas? The Texas Veterinary Licensing Act (The Rules) defines the practice of veterinary medicine as the diagnosis, treatment, correction, change, manipulation, relief or prevention of animal disease, deformity, defect, injury, or other physical condition, including the prescription or administration of a drug, biologic, anesthetic, apparatus, or other therapeutic or diagnostic substance or technique; representation of an ability and willingness to perform the acts above; or use titles, words, or letters to induce the belief that a person is legally authorized and qualified to perform an act listed above; or the receipt of compensation for performing an act above. (“Texas Board of Veterinary Medical Examiners”, 2016)

Practice of veterinary medicine To practice veterinary medicine a valid veterinarian-client-patient relationship (VCPR) must exist. For such a relationship to be considered valid the following applies: The veterinarian assumes responsibility for medical judgements regarding the health of an animal and the client (the owner or responsible party) agrees to follow the veterinarian’s instructions The veterinarian must possess sufficient knowledge of the animal to initiate at least a general diagnosis of the animal’s medical condition by examining the animal or visiting the premises on which the animal is kept The veterinarian is available to provide follow up medical care in the event of an adverse reaction or failure of the prescribed regimen of therapy A valid VCPR may not be established solely by telephone or electronic means These qualifications are stated in the Texas Administrative Code: Rules Pertaining to the Practice of Veterinary Medicine (2016).

How is a Licensed Veterinary technician Defined in Texas? In Texas a Licensed Veterinary Technician (LVT) is simply defined as a person licensed as a veterinary technician by the state board of veterinary medical examiners. The National Association of Veterinary Technicians (NAVTA) defines a veterinary technician as a person educated to be the veterinarian’s nurse, laboratory technician, radiography technician, anesthetist, surgical nurse, and client educator. (NAVTA, 2014) A licensed veterinary technician is a graduate of an accredited two-year program who has passed the credentialing exam and who has been granted a license to work in the state.

How does one become a licensed veterinary technician in texas? To be eligible to licensure as a veterinary technician in Texas the applicant must prove to the Texas State Board of Veterinary Examiners that they: Have graduated from an AVMA accredited Veterinary Technology program and are 18 years of age or over Have obtained passing scores on two tests The Veterinary Technician National Exam (VTNE) The Licensed Veterinary Technician Exam (LVTE) In order to apply for the LVTE the applicant must have taken and passed the VTNE first

Current Requirements for LVT Must submit to the Texas Board of Veterinary Medical Examiners (TVBME) Completed application with no blank spaces Application fee Certified copy of birth certificate Certified copy of college transcripts Passport type photo Certified copy of exam scores (75% minimum) Certified copies of licensure from other states whether active or not. 10 years of residence history

Technician licensing Facts Prior to September 1, 2014 technicians in Texas were considered registered veterinary technicians (RVT) Those of us who were currently RVT’s in the state at that time could be grandfathered in as LVT’s by submitting proof of our eligibility. We did not have to retake our tests. This is no longer an option. If not taken advantage of at that time – aspiring LVT’s will have to complete the current application process – even if that means they have to retake the VTNE and LVTE To maintain licensure the veterinary technician must obtain 10 hours of acceptable continuing education every year

What CAN LVTs do?

Scope of practice A licensed veterinary technician can do anything a veterinarian can do with the exception of: Prescribe Diagnose Prognose Perform surgery (including most dental extractions) While working under the supervision of a Texas licensed veterinarian who has entered into a valid veterinarian/client/patient relationship

Scope of practice The Texas Veterinary Licensing Act (The Rules) is the set of laws that govern the practice of veterinary medicine in the state of Texas It includes rules and regulations as to what licensed veterinary technicians can do, and includes the recommended level of supervision There are still a few states that don’t define the allowed activities for veterinary technicians in their state Licensing or Practice Act

Levels of supervision General or Indirect Supervision – a responsible veterinarian is readily available for communication even if they are not on the premises Immediate Supervision – a responsible veterinarian is within visual and audible range of the patient and the person being supervised Direct supervision – a responsible veterinarian is physically present on the premises and is readily available

Levels of supervision The Licensing Act states that the veterinarian is the one to make any decisions regarding diagnosis, treatment, and management of the animals in their care. The veterinarian should be the one to determine the appropriate level of supervision (if not specifically stated in the Licensing Act or prohibited by law) and protocols for any tasks delegated to licensed veterinary technicians or veterinary assistants. They should take into account the level of training and experience when delegating. A veterinarian may delegate tasks of greater responsibility to a licensed veterinary technician.

Direct supervision Under direct (or immediate) supervision a licensed veterinary technician may: Suture existing surgical skin incisions or skin lacerations Induce anesthesia Extract loose teeth or dental fragments that have minimal periodontal attachment Administer a rabies vaccination Use a veterinarian’s name stamp or electronic signature pad on an official document

Immediate supervision Under immediate supervision a licensed veterinary technician may: Perform euthanasia Perform other tasks that the veterinarian feels appropriate so long as they are not specifically denied in The Rules

General supervision Under general supervision a licensed veterinary technician may Draw blood Take samples for purposes of testing and diagnosis Perform tasks assigned by a supervising veterinarian Immediately supervise a veterinary assistant in performing animal care tasks

Supervision If not defined by the Licensing Act – the veterinarian will be the one to determine the appropriate level of supervision for his staff Among other things technicians can: Administer blood transfusions Give treatments Place catheters Take radiographs At a level of supervision as defined by the responsible veterinarian

Unlicensed personnel Unlicensed personnel are allowed to perform all of the same tasks that licensed personnel are, however, it must be at a greater level of supervision. Under immediate supervision they may suture existing skin incisions, induce anesthesia, and perform other tasks as directed by a veterinarian or licensed veterinary technician It is not yet a requirement in Texas that persons performing the function of a technician have to be licensed, however, the title of Veterinary Technician is protected, and unlicensed personnel should be referred to as Veterinary Assistants.

Licensed Technician Supervision of unlicensed employees Under the immediate supervision of a licensed veterinary technician an unlicensed employee of a veterinarian may: Suture to close existing skin incisions or lacerations Induce anesthesia Draw blood Take samples for laboratory testing Other tasks that aren’t prohibited by law

What Technicians Can’t do UNDER NO CIRCUMSTANCES ARE TECHNICIANS ALLOWED TO: DIAGNOSE PRESCRIBE PERFORM SURGERY PERFORM INVASIVE DENTAL PROCEDURES INITIATE TREATMENT EXCEPT IN AN EMERGENCY

Liability The veterinarian is responsible for any and all acts by a non-veterinarian employee The veterinarian is subject to discipline if they improperly delegate care or fail to properly supervise the non-veterinarian employee If a licensed veterinary technician is supposed to be supervising an unlicensed employee both the veterinarian and the licensed technician are subject to discipline

Premise inspections

Premise inspections In Texas, the TVBME has documented chronic problems in the areas of continuing education (CE), controlled substances, and prescription labeling Veterinarians are required to obtain 17 hours of CE during each licensing year, LVT’s are required to obtain 10 hours of CE each licensing year Controlled substance logs must be completed correctly with a running balance on hand Prescription labels must contain the species being treated Because of these ongoing issues an unannounced compliance inspection may be conducted at any time

In the event of a premise inspection the inspector will be looking for the following: Proper display of all licenses Complaint Notice to Clients displayed Current address information provided to Board for all licensees DEA registration verified DPS registration verified Proof of last three years of CE Satisfactory sanitiation Patient records compliant with the Rules Security of controlled substances DEA form 222 Files Controlled substance logs and balances on hand Controlled substance invoice files Labeling for prescription drugs complies with the Rules (Compliance Inspection Checklist, 2015, p. 1)

Premise Inspection - Sanitation Licensees must maintain their offices/clinics/hospitals in which they work, including mobile facilities, in a clean and sanitary condition without any accumulation of trash, debris or filth. (The Rules, 2016, p. 57) Licensees also must use properly sterilized instruments and clean supplies It doesn’t specifically say these statutes apply to licensed technicians, however, as license holders it would behoove them to ensure that their place of business complies

Minimum standards of care

Standards of care In The Rules (2016) the professional standard of care is defined thus: Licensees shall exercise the same degree of humane care, skill, and diligence in treating patients as are ordinarily used in the same or similar circumstances, including the type of practice, by average members of the veterinary medical profession in good standing in the locality or geographic community in which they practice, or in similar communities. Specialists are held to a higher professional standard than non-specialist veterinarians.

What does this mean? Standards of care are a set of guidelines that define the appropriate treatment for a particular health problem. The standard of care helps ensure the patients receive a similar basic level of care no matter where they are treated However, the standard can be difficult to define because it is based on what a reasonable and prudent veterinarian working under the same conditions would do. So the standard of care may vary from an urban area to a rural one It is up to each veterinarian to decide what minimum standard they want to achieve and if they choose poorly they may be found liable for malpractice

Record-keeping

Record keeping requirements The Rules (2016) states that individual records shall be maintained at the veterinarian’s place of business, shall be complete, contemporaneous and legible and shall include, but are not limited to: Client’s name, address and phone number Patient identification including name, species, breed, age, sex and description Patient history Dates of visits Immunization records (if any) Weight if required for diagnosis or treatment (may be an estimate) Temperature if required for diagnosis or treatment (not required in a flock or herd) Any laboratory analysis Any diagnostic images or written summary of results

Record keeping continued Names, dosages, concentration and route of administration for any drugs Other details needed to substantiate or document the examination, diagnosis and treatment provided. Any signed release forms The identity of the veterinarian who performed or supervised the procedure Date and substance of any referral recommendations, with a comment on client response The date and substance of any consultation with a colleague or specialist Copies of any official health documents

Record keeping continued Patient records are required to be kept for at least five years Patient records are owned by the veterinarian, however, clients are legally entitled to a copy. If a client requests a copy, the veterinarian has 15 days to comply with the request and may charge a reasonable fee for copy costs

Record keeping continued If a veterinarian retires or quits practicing they may transfer their patient records to another veterinarian and notify their clients of this transfer If a veterinarian retires or quits practicing and is not providing for continuation of their practice they should provide notice to their clients with a date when they will no longer be available and offer the clients an opportunity to obtain a copy of their patient’s records.

Special circumstances

Emergencies In an emergency situation where prompt treatment is essential for the prevention of death or to alleviate extreme suffering, a veterinarian may, after determining the nature of the emergency, and the condition of the animal issue treatment directions to a non-veterinarian by means of telephone, email or messaging, radio or fax and not be in violation of the Rules (2016). However, the Board may take action against the veterinarian if at their sole discretion feel that the veterinarian is using this authorization to circumvent The Rules.

Hospitalized patients Veterinarians are allowed to leave oral or written treatment orders for an animal in their care to be followed by non-veterinarian personnel (veterinary technician or assistant) The veterinarian must have examined the animal, and a valid veterinarian-client-patient relationship must exist.

Animal cruelty There are no current regulations in The Rules (2016) that implicitly state that a veterinary professional must report suspected animal cruelty There is civil immunity for the good faith reporting of suspected animal cruelty by a veterinarian The AVMA’s Model Veterinary Practice Act encourages veterinarians to report animal abuse (AVMA, 2014) If a veterinary professional is suspected of animal cruelty they should be reported to the Board of Veterinary Medical Examiners who will investigate If convicted, the licensee will be punished and their license is subject to revocation

Mandatory reporting A licensee is expected to report to the Board if they have any reason to suspect that a DVM, LVT or Equine Dental Provider (EDP) is suffering from a chemical dependency that would impair their ability to do their job. Or if they suspect that another licensee poses a threat to public welfare. They will be protected by the Board and must not be retaliated against for making a report.

References AVMA. (2014, August). Reporting requirements for animal abuse. Retrieved September 15, 2016, from https://www.avma.org/Advocacy/StateAndLocal/Pages/sr-animal-abuse-reporting-requirements.aspx Compliance inspection checklist. (2015). Retrieved from TVBME website: http://www.veterinary.texas.gov/documents/enforce/Compliance_Inspection_Checklist.pdf NAVTA. (2014). FAQ's - National Association of Veterinary Technicians in America. Retrieved September 14, 2016, from http://www.navta.net/?page=faqs Texas Administrative Code: Rules pertaining to the practice of veterinary medicine (Title 22, Part 24). (2016). Retrieved from Texas Board of Veterinary Medical Examiners website: http://www.veterinary.texas.gov/documents/rules/FULL_SET_as_of_09-01-2016-V2.pdf Texas Board of Veterinary Medical Examiners. (2016). Retrieved September 14, 2016, from http://www.veterinary.texas.gov/index.php