Limited licensure raises many legal, liability issues

There are a number of persuasive arguments in the current debate over whether veterinarians should be trained and/or licensed to treat and care for all species or only certain ones.

From the point of view of students, at times there seems to be too much to know, too much to learn and, looking forward, too much to keep abreast of.

From the point of view of the veterinary-services consumer, particularly in the food-animal segment, there are fewer and fewer food vets around.

There are many economic and other disincentives for students to become large-animal practitioners. Is it possible that limited licensure would raise the income prospects of large-animal doctors and thereby entice more practitioners into that field?

No matter on which side of the argument you find yourself, there is no doubt that the veterinary profession is evolving and that the detail and complexity of the science continue to grow exponentially.

The primary objective, of course, always should be to provide the highest level of competence and care to the veterinary consumer/client. But is limited licensure the way to accomplish this?

Alongside the many other pro and con arguments, let's take a brief walk through some legal ramifications that could attend a switch to species-based veterinary education and licensing.

State-board authority

As soon as a new licensing system is introduced, a new and more complex bureaucracy is almost sure to follow. The authority to practice any profession is granted by the states, and the concept of multiple categories of veterinary licenses opens up a Pandora's box of potential regulation, special-interest lobbying and endless hearings to "find facts."

For example, surely the food-animal rules regarding antibiotic withdrawal times and their unique zoonotic issues involved with ruminants would require a separate (and separately funded) enforcement agency under the state bureau that evaluates small-animal clinicians. The argument, whether logical or not, would be that a specialized license can be appropriately overseen only by a specialized administrative agency.

The costs and windfall

Professional licensing can be a pretty lucrative business for states (as I am reminded when I renew my Connecticut license annually for the tidy sum of $450).

State taxing authorities might see a new source of income by requiring mixed-animal practitioners to pay for two or more separate licenses. (I am waiting for some fiscally strapped state to define "large-animal veterinarian" as a professional who holds the big four licenses: cow (beef and dairy) and horse (Thoroughbred and nag).

And, politically speaking, who will get all that extra coin? Will this new income be spent on helping develop the veterinary schools funded by the licensing state in question? How about spending it on professional-standards enforcement? Perhaps a state-managed scholarship fund to help pay educational costs for those large-animal students who are studying in-state?

I predict a lot of fingers in that pie.

Liability for malpractice

As regular readers of this column know, I have been concerned for a long time that the concept of a minimally acceptable "standard of care" is elusive and difficult to define. State licensing boards are hesitant to give specific guidelines, and the findings of state boards in individual cases often are unavailable to the public to serve as examples.

As complex and uncertain as the existing standard of care may be, all that we can realistically expect of the new, "limited license" version of the standard of care is that it will be more rigorous, more difficult to satisfy and probably less well defined than it is now.

If the new license cuts the number of species the vet needs to know about by half, is it unreasonable to think that he or she will be expected to know a whole lot more about the ones he/she is trained and licensed to treat? This question gives the licensing boards and their disciplinary arms a lot to think about. It gives the plaintiffs' attorneys a whole lot to salivate over.

Not all states created equal

As an attorney, I can't help but see a laundry list of administrative and constitutional problems (and related litigation) arising from an eventual decision by one or more states to issue limited licenses. Consider these analogies:

As a law-school graduate, I am entitled to take the bar examination in any of the 50 states. This is no problem if I am a general practitioner trained and licensed in New York. I can go to Texas, for example, which has board-certification provisions in its law. I simply have to pass the Texas bar exam and go to work.

On the other hand, if I want to get the lucrative divorce cases there, I will probably need to become board certified in matrimonial law. Otherwise, wealthy folks won't come to me for their divorces.

In the same way, Texas-trained and Texas-licensed lawyers can take the bar exam elsewhere and become general practitioners.

Here is the problem: What if there were a limited diploma and license in New York to practice, for example, trust law and that is all I had? Would Texas have to let me sit for their general practice (minimal general competency) examination? What if my law school granted me a limited diploma in litigation? Would Texas have to allow me to sit for the bar at all?

If some states were limited-license states and some were not, would one state be required to recognize another state's limited training and/or limited diploma in order to allow one to sit for its veterinary medical-licensing examination?

If a graduate in large-animal medicine decided he/she wanted to change careers, would he/she have to go back to veterinary school? If limited-area diploma holders were treated differently from full-species diploma holders during the application to a given state, would issues of equal protection be raised?

Good luck if you are certified only as a doggie doctor and you want to go to practice in England or Australia.

I see a legal train wreck if the current system is changed without a tremendous amount of forethought as to the legal and practical consequences.

It might not be a bad idea to look more carefully at the possibility of modifying the residency and board-certification infrastructure before jumping on a change in licensing laws.

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