Lay practice debate erupts in Fla., Colo.

ORLANDO, FLA. — Florida veterinarians are constructing a comprehensive strategy to beat back lay practitioners' attempts to gain unregulated access to animals to perform complementary and alternative procedures.

If successful, their legislative maneuver could spark copycat initiatives across the United States. When it comes to facing complementary and alternative modalities, Florida is not alone. The push in recent years by non-veterinarians looking to gain authority for procedures traditionally performed by DVMs or not at all is a thorn in the side of most state veterinary medical associations. The argument to extend lay services to animals is heard within regulatory, veterinary and legislative offices from coast-to-coast.

The Florida Veterinary Medical Association (FVMA), like most state veterinary groups, spent years muffling calls to exempt modalities such as acupuncture and chiropractic therapy from the veterinary practice act. Yet unlike other state challenges, promoters of non-traditional modalities in Florida have banded together, challenging the veterinary practice act's guidelines by advocating owners' rights.

"Animals are property, that's how they're going at it. But no one has carte blanche to do whatever they want," FVMA Executive Director Donald Schafer says. "You'll hear all the time, 'I can do whatever I want to my animal.' That's bologna."

The cornerstone of FVMA's defense draws a parallel between animal patients and human patients, both which need to be protected from unlicensed activity. Schafer admits that argument works well — for now. "If you scratch below the surface in every state, there are one or two legislators who think that alternative and complementary modalities should gain greater recognition in human medicine. Those same people see getting legislation passed on the animal side as a stepping stone," he contends.

That perception coupled with tiresome efforts to fight encroachment on DVM practice pushed FVMA to go on the offensive. In doing so, group leaders plan to tear open the practice act and submit their proposals to the Legislature by 2008. Their goal is threefold: Commit the arduous task of addressing everything from chiropractic medicine to horse whispering, attain the veterinary licensing board power to hold non-veterinarians responsible for veterinary practice act violations and spell out veterinary medicine's relationship to allied health workers the same way human medicine has done.

The language is drafted, Schafer says. "What we're saying is animal medical care that's not done by a licensed and qualified individual is not good for the animal. We've learned our lesson that our exemptions for lay practice need to be tightened. Right now, if someone violates the practice act, the veterinary medical board isn't involved in his prosecution. We want our regulators to have more power."

One modality at a time

If successful, Florida becomes the nation's seventh state to grant veterinary regulators the power to impose criminal penalties. And like Florida, Colorado Veterinary Medical Association (CVMA) officials seek increased authority for its state regulators as well.

Challenges to garner lay practice autonomy for various modalities have weighed on lawmakers in Colorado as well as other states. To ease the onslaught, CVMA is in talks with the Colorado State Board of Veterinary Medicine about creating a regulatory model for lay practitioners involved in the delivery of animal care and treatment regarding physical therapy.

At the concept level, things look good, CVMA Executive Director Ralph Johnson says. Board officials want to incorporate the model into the state's statutes and rules.

But the initiative, in bill form, must first jump through various bureaucratic hoops, starting with approval by the Department of Regulatory Agencies before moving to the Legislature. Johnson won't reveal all the details because the measure is under wraps but acknowledges the language is physical therapy-specific. It calls for creating a registry within the Colorado State Board of Veterinary Medicine for licensed physical therapists who meet educational thresholds outlined by DVM regulators. Qualifying therapists would be subject to the board's disciplinary authority and required to maintain liability insurance in order to be eligible for a DVM to incorporate his or her services in practice.

"We call it delegation," Johnson says. "They can delegate a treatment, and there's a whole protocol that goes with this in terms of communication, such as medical records and direction by a DVM. Our proposal calls for immediate supervision by a veterinarian at least during the initial treatment."

Such effort closes a gap in disciplinary oversight not unique to Colorado. "This issue represents a constant conversation within most states, and as usual there is divided opinion," Johnson says.

Exposure

Adrian Hochstadt, the American Veterinary Medical Association's director of State Regulatory and Legislative Affairs concurs. He advises veterinary associations to reach internal accords on how to regulate non-traditional therapies before going to state lawmakers and notes that AVMA offers guidelines on alternative and complementary therapies for direction.

But in today's expanding environment, those guidelines illustrate why modality-specific regulations might not be enough, Schafer says.

"AVMA really defines what constitutes alternative therapies, and in researching this, what you'll find out very quickly is there are a whole bunch of human licensed providers who are already out there and looking to move into animal health," he says. "There's magnetic therapy, oils, hydrotherapy and flower essence therapy — anything on the human side is making a play for animals. Feed stores offer vitamins and minerals. They're providing a treatment service and, in theory, that's acting as a nutritionist."

In line with the veterinary profession's general consensus, Schafer advocates leeway for animal husbandry practices, noting that producers have on-the-job training and a financial interest to keep an animal healthy.

Equine dentistry

But few subjects showcase the range of DVM opinions more than equine dental healthcare.

The modality, specifically teeth floating, raises the question of how to address the demand for a procedure many veterinarians have little knowledge about and would rather not perform.

In a few states, the practice of lay equine dentistry is permitted or overlooked by regulators. But those who attempt to impose rules and fines come up against a number of hurdles officials might not initially expect.

There aren't many veterinarians who perform teeth floating. It's not regularly taught in veterinary school and, in some circles, the age-old method has been replaced by new technology.

Those issues make equine dentistry ripe for challenge by lay practitioners, Hochstadt says. Last year, Arizona and Florida each exempted equine dentistry from their state veterinary practice acts. Virginia veterinarians are battling a bill that allows equine dentistry without DVM supervision. And a crackdown by Minnesota regulators resulted in an ongoing civil suit by one determined lay equine dentist.

One major problem is that even among veterinarians, there is no general consensus about the level of oversight necessary or who should be allowed to perform the procedures.

"It's really something that the state associations need to come to a consensus on internally," Hochstadt says. "It's one of those issues that aren't that obvious. Everyone has a different opinion."

Training gap

And it's not only in equine dentistry that trained veterinarians are lacking. DVMs who lobby for control reveal that it's tough to ban a lay practitioner's work when veterinarians aren't skilled to perform the modality for consumers. Lawmakers might question veterinary medicine's authority to limit chiropractic care without giving pet owners the alternative of having a DVM perform the procedures.

"That's always the elephant in the room," Hochstadt says. "If veterinarians want to keep these procedures within the practice act, they need opportunities for additional training in the modalities consumers want. That would undercut one of the main arguments these groups have."