Don't call veterinary employees nurses

We all know how irritating it is to read about a shelter employee who's been caught practicing veterinary medicine without a license by dispensing prescription medication. Then we get annoyed when we hear about a chiropractor who's expanding his practice by including dogs or horses on his patient list. It seems like everybody wants to practice medicine on animals without the inconvenience of obtaining a degree or following the dictates and prohibitions of the applicable state practice act.

Christopher J. Allen

The other day, a boarding kennel contacted my office because it wanted to set up an LLC to provide hydrotherapy for wounded dogs and cats. I politely told them that they really should worry about obtaining a DVM before they worry about creating an LLC. The world is full of people trying to play fast and loose with their state's veterinary practice act. The question is: Could you be unwittingly violating a state practice act? No way, you might say. But what you don't know could hurt you.

Ignorance is no excuse

You know how once in a while one of your clients will refer to your receptionist, technician or office assistant as a "nurse?" The client says, "I gave Fluffy's stool specimen to your nurse up front." Well, in New York, most of us veterinarians weren't aware until recently that the Empire State tolerates that kind of talk only from clients or customers, never from animal hospital personnel.

Turns out a New York veterinary practice had taken to this nomenclature and begun referring to its nonveterinarian employees as "nurses." The term seemed harmless enough until a disgruntled client—a people nurse—contacted the state health department and reported the practice. Shortly thereafter, government agents descended on the hospital and assembled all of the clinic staff to present the following declaration:

"Intentionally referring, in a commercial setting, to a person who does not hold a license to practice nursing issued by the New York State Department of Education constitutes a crime and a violation of the practice act governing nursing. The individuals calling themselves nurses can be charged, and the professionals permitting it can be administratively sanctioned."

Who knew? I used to have a talented licensed veterinary technician named Martin who was often referred to by my clients as "Dr. Martin," because he seemed to know more than a lot of my younger veterinarians. I hope the statute of limitations has expired on the conspiracy charges I would face for allowing that kind of misconception to exist on my premises. And God help the Rhode Island Veterinary Technician Association! If you Google that group, you'll discover that its members are blatantly committing criminal mischief, according to New York's practice acts. Yeah, you guessed it. They're "providing quality nursing care." Oh, the shame.

Know the rules governing other professions

There are probably a number of states out there that don't have a law against calling veterinary staff members "nurses." It's hard to know where you stand with the practice acts of other professions unless life at your clinic is so slow that you have time to read them all. Now, I know the technicians at our local computer repair shop (the Computer Emergency Room) come to work dressed in white lab coats bearing nametags and refer to themselves as "computer physicians." As far as I know, they aren't violating New York's Medical Practice Act.

What I do know is that in days gone by, if one of my colleagues ran out of amoxicillin and wanted to prescribe it for a pet, he'd just write a note and send it with his client over to our office. We would read the note and send the folks home with a little bottle of amoxicillin. Now we all know this is an apparent violation of the New York State Pharmacy Practice Act or some such. Today, any and all medication-related notes must be written on a state-issued prescription form that is filled by none other than a duly licensed pharmacist. To do otherwise would violate the practice act, which applies to pharmacists.

Though it may seem unfair, we're all charged with knowing the relevant aspects of not only our own practice act but also those of a number of other professions in the state where we work. And in some instances, we have to use our best guess as to what we and our staff members are allowed or not allowed to do in the clinic.

Is delegating dangerous?

Many states have a statute that provides for the licensing of veterinary technicians. But the degree to which these laws provide guidance for the technicians (and veterinarians themselves) as to what they're allowed to do in the clinic varies. Despite the lack of clarity, you'd better know the law as it applies to them.

My office knows of a recent case of a veterinarian in a southern state who was aggressively and publicly sanctioned for performing an act that's not actually addressed in her state's veterinary practice act. Rather, she acted in violation of law by permitting a licensed veterinary technician to perform a procedure that is not allowed under the technician practice act. And that prohibited procedure was added to that state's technician practice act only recently.

Does your state send you an update in the mail when its legislature or veterinary board creates an amendment to the law governing veterinary technicians? Probably not. But that doesn't mean the state won't expect you to follow the new regulation. Consequently, when you're done reading up on your state's pharmacy and nursing regulations, be sure to pick up a copy of the veterinary technician law. And make sure it's the latest edition.

A lot of us believe that the rules governing the procedures and practices our staff members are allowed to carry out are intuitive—you know, common sense. Some of us believe that spending time thinking about the parameters of our technicians' clinical authority, for example, is a waste of time. Well, consider this:

When a veterinarian puts a pet in the hands of a licensed veterinary technician so he or she can perform a dental cleaning, what the law allows the technician to do depends entirely on where he or she is standing. If that person is standing in any of several states, it's anybody's guess whether the technician is limited to being able to hand-scale while the is pet awake or is allowed to replace a jaw full of teeth with prostheses under general anesthesia. The law just doesn't say much about it.

But if that technician has his or her feet firmly planted in South Carolina, the technician better not remove any teeth, no matter how loose, because only the veterinarian can do that. That technician's colleague a few miles to the south could legally remove teeth from the same pet. But only if a tooth was really loose—or not loose at all but happens to be a canine tooth.

Yes, the state of Georgia has a nice, clear regulation on the subject. However, Georgia is not quite as clear when it comes to tracheal intubation. Licensed technicians apparently can do it, but not if the case is really serious. Huh? (Georgia Statutes, chapter 700-14.)

Don't take my word for any of this—read the laws. Suggesting you do otherwise would violate my state's practice act.

Dr. Christopher Allen is president of Associates in Veterinary Law P.C., which provides legal and consulting services to veterinarians. Call (607) 754-1510 or visit info@veterinarylaw.com.