Board: Treat trauma cases, regardless

HARRISBURG, PA. — Emergency practitioners plan to weigh in on a draft mandate by Pennsylvania regulators that orders licensees to treat or euthanize animals in trauma situations regardless of any financial considerations.

A March 20 meeting in Harrisburg between emergency practitioners and the Pennsylvania Board of Veterinary Medicine is expected to address a proposed Rules of Professional Conduct amendment that would require prac titioners to "provide limited emergency care or medically appropriate euthanasia without regard to a client's ability to pay." Veterinarians can seek, after providing services, remuneration through an "appropriate judicial forum," a published regulatory bulletin states.

Board members refused DVM Newsmagazine's repeated requests seeking comment concerning the language's details, including questions regarding what prompted the measure. "This is pending legislation, so there's really nothing I can tell you," Board Administrator Michelle Roberts says.

Charlene Wandzilak, executive director of the Pennsylvania Veterinary Medical Association (PVMA), surmises that the initiative stemmed from complaints that veterinarians were turning away trauma cases involving strays as well as owners with severe financial constraints. She insists regulators are going back to the drawing board due to PVMA's laundry list of concerns, which include the draft's lack of financial compensation for veterinarians providing services in accordance with the proposed mandate. While board members estimate owners see one or two indigent cases a year, PVMA notes it's a daily occurrence in some areas and could force Pennsylvania practices to finance millions of dollars collectively.

"Right now, we're not in a position to make any formal statements," PVMA President Dr. Robert Fetterman says. "I will say that it's a good thing this rewrite is under way."

Draft presented

Yet the board's media relations official, Catherine Ennis, failed to confirm the rewrite process. Instead, she says the following excerpted text remains up for consideration:

"During a veterinarian's regulatory business hours, a veterinarian may not refuse to treat an animal which is in a life-threatening condition at the time the animal is physically presented to the veterinarian at the veterinarian's facility. The minimum veterinary medical services that shall be provided include triage of the presenting emergency ... assessment of the animal's condition, evaluation of the animal's prognosis and provision of basic life support or euthanasia, as medically appropriate. A veterinarian may provide care for an animal (in this situation) notwithstanding the lack of a veterinarian/client/patient relationship and if the owner is unknown or cannot be reached, without the consent of the owner. ... Alleviating animal suffering shall transcend personal advantage or monetary gain in decisions concerning therapy."

The language reflects a viewpoint that Dr. Gary Stamp says other state regulators have considered but, so far, have not adopted. As executive director of the Veterinary Emergency and Critical Care Society, he tracks initiatives by "well-meaning members of the public" to make treatment mandatory in emergency situations.

"We're concerned about this," he says. "If a state is going to pass this kind of mandate, it's obligatory for that state to discuss a trust fund or contingency fund to reimburse the veterinarians. We all accept that, as veterinarians, we have to do certain things before we accept payment, but I don't think we need a legal mandate."

A close look at the language

Neither does consultant James F. Wilson, DVM, JD, who upon PVMA's request drafted a report addressing the board's proposal and considers the document, as written, to be a legal minefield.

He questions what constitutes "regular business hours," and makes the contention that emergency-practice owners would be required treat a burdensome and disproportionate volume of financially needy triage cases. Treatments required to fill the basic life-support provision must also be defined as well as parameters for a patient's release, he says.

The proposed law also fails to acknowledge that there's no system in Pennsylvania to share responsibility for making decisions about the medical care of stray animals.

Bottom line: The proposed directive is an attempt to take ethical principles and transform them into a legal mandate, he states.

Real-world application

Such circumstances don't need formal regulation, contends Dr. Kenton Rexford, owner of The Veterinary Emergency Clinic near Pittsburgh.

That's because veterinarians, for the most part, already do what's necessary in emergency situations regardless of whether the animal is a stray or the owner has the ability to pay, he says.

"Every practice has to have some sort of system in place to deal with this situation," says Rexford, who plans to attend the March meeting. "We would perform a euthanasia even if the owner didn't have any money. All emergency clinics I'm aware of will do what is absolutely needed in these types of cases."