Lost in translation: VCPR regulations and real life

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The veterinarian-client-patient relationship (VCPR) is the foundation for interaction between veterinarians, clients, and patients, and it is critical to the animal’s health. VCPR rules differ a little for each state, and the legal language can also have varying interpretations. Misinterpretations can cost a veterinarian their license, but how does someone who graduated from veterinary school fully understand complicated legal laws? Moreover, how does this lawyerly language translate to real-life situations? We really need more cooperation and support from veterinary medical associations to help us understand VCPR regulations and better serve our patients while staying compliant.

Overview

The veterinary accrediting agency for each state issues its rules of professional conduct or (state) veterinary practice act. These directives outline licensure requirements and many other factors addressing appropriate veterinarian conduct. Rules can slightly differ from state to state. The Principles of Veterinary Medical Ethics of the American Veterinary Medical Association (AVMA) and the AVMA Model Practice Act provide general guidelines for state laws and regulations, which most states follow when drafting their veterinary practice rules and developing their individual licensing requirements. Once veterinarians fulfill the licensing requirements, they must comply with their state veterinary medical association’s rules and regulations to keep their license. One important aspect of it is understanding and following the VCPR laws.

World legal practice

To understand and observe any law, the terms used within the law must be clearly defined. When they need additional clarification, lawyers routinely refer to dictionaries to define concepts in easy-to-understand language. During the Supreme Court terms 2000 to 2001 through 2009 to 2010, the Justices referenced dictionary definitions to define nearly 300 words or phrases.¹ In 2011, Chief Justice John G. Roberts Jr. consulted the usual legal materials, as well as 5 dictionaries, to determine the meaning behind federal law in a patent case.² In 1 month alone, the Justices cited dictionaries in eight cases to determine what legislators meant when they used words including prevent, delay,and report. Throughout the Court’s history, Justices have used dictionaries to define ordinary words, such as now, also, any, and if, as well as more lawyerly terms, such as attorney and common law.

For any law to be usable, the concepts must be clearly defined so the law can be correctly understood and interpreted. The Legal Terms Glossary defines more than 100 common legal terms in easy-to-use language to assist US attorneys in interpreting laws, since a wrong interpretation can lead to disastrous consequences.³ Similar regulations have been instituted in the veterinary industry.

• World Organization for Animal Health (OIE)—The OIE specifies in their guidelines on veterinary legislation⁴: “Veterinary legislation should be normative and should be drafted in a manner that prevents ambiguity in interpretation.”
• Royal College of Veterinary Surgeons (RCVS)—The RCVS specifies in their Code of Professional Conduct for Veterinary Surgeons⁵: “Certificates should not use words or phrases which are capable of more than one interpretation.”

Applying legal language to real-life medical scenarios

Several questions arise when determining each state’s VCPR regulations, because most veterinarians are not trained to interpret legal jargon. Confusing scenarios include:

• A VCPR is established when a pet is seen by a veterinarian—A veterinarian can see a pet through a computer monitor. Does that count as establishing a VCPR?
• No prescription drug shall be prescribed, dispensed, or administered without establishing a documented and valid VCPR—If a veterinarian has established a VCPR through physical examination and documents their findings via the medical record, can another veterinarian employed by the same practice prescribe a drug for that pet? It would be useful to have some further guidance on how to understand these requirements.

By misinterpreting these requirements, veterinarians can unintentionally violate VCPR regulations and lose their license. Some may choose to refuse treatment if they are unsure what the VCPR allows or require a patient to undergo an additional physical exam to re-establish VCPR—even if it has just been performed—if the law is not clear about how VCPR is established or transferred between colleagues. None of these scenarios benefit veterinarians or pets. Lack of understanding of the VCPR boundaries halts the development of the industry and prevents pet owners from having full access to care.

The Canadian Medical Protective Association is taking proactive strides to remedy such situations by providing a Medico-legal handbook that offers information about basic legal concepts and the underlying principles that govern physicians in their practices.⁶ The handbook is frequently updated, and helps Canadian physicians better understand what standards and requirements the law imposes. This knowledge reduces the stress of a physician involved in legal proceedings, and it equips all physicians to recognize and avoid medico-legal difficulties.

California experience

California’s telemedicine regulations are strict, stating that the VCPR must be established in person and applies to only 1 veterinarian.⁷ In addition, telemedicine can be used only for specific medical conditions that the veterinarian has already diagnosed during an in-person examination of the animal. However, California’s state VMA took an additional step to ensure they were preserving veterinary licenses by providing clear, well-defined language to help veterinarians practicing in their state. The Department of Consumer Affairs Veterinary Medical Board provides an explanation for the California Code of Regulations (CCR), Title 16, Sections 2032.1, 2032.15, and 2032.25 in their Frequently Asked Questions Regarding Veterinarian-Client-Patient Relationship (VCPR) section. Questions answered include⁸:

Question: Can a veterinarian prescribe a treatment after a previous associate veterinarian, at the same premises, did a wellness exam?

Answer: No; for a second veterinarian to prescribe treatment of a condition, the condition would have to be diagnosed under the original VCPR. If no condition is diagnosed, a new VCPR must be established by the second veterinarian to treat the new condition. (CCR, tit. 16, sec. 2032.1, subs. (b)(2), (3), 2032.15, subs. (a)(3), (4).)

Q: If Doctor A initially examined the animal patient and established a VCPR, can Doctor B (within the same premises) treat the patient for additional follow-up and/or treatment without establishing a new VCPR?

A: Yes; Doctor B can treat the animal patient for the condition diagnosed by Doctor A, and no new exam is required to change the treatment plan for that condition. (CCR, tit. 16, sec. 2032.15.) However, if Doctor B diagnoses a new condition, Doctor B would need to establish a new VCPR to treat this new condition. (CCR, tit. 16, sec. 2032.1, subs. (a), (b)(2), (3), 2032.15, subs. (a)(4).)

Q: If Doctor A has established a VCPR with the animal patient, can Doctor B (within the same premises) prescribe a new medication to treat the condition?

A: Yes; Doctor B can prescribe a new medication to treat the same condition diagnosed by Doctor A. To do so, Doctor B must consult the animal patient’s medical record or Doctor A (primary veterinarian), communicate the change in treatment to the client, and document the new prescription in the animal patient’s medical records. (CCR, tit. 16, sec. 2032.15, subs. (a), (b), 2032.3, subs. (a)(12).)

Q: Doctor A does relief work at “XYZ Emergency Hospital” and establishes a VCPR with an animal patient at that location. Doctor A then sees this same animal patient at Doctor A’s home hospital. Can Doctor A prescribe for this animal patient without establishing another VCPR?

A: Yes; Doctor A can issue a prescription while working at the home hospital to treat the animal patient without establishing a new VCPR, as long as the treatment is for the same condition that Doctor A previously diagnosed. (CCR, tit. 16, sec. 2032.1, subs, (b)(2).) A VCPR is established by the veterinarian and client for treatment of the animal patient; accordingly, the VCPR follows the veterinarian, not the veterinary premises.

Q: Can a veterinarian do laboratory tests on an animal patient if no VCPR is established?

A: Yes; A VCPR is required only when the veterinarian is administering, prescribing, dispensing, or furnishing a drug medicine, appliance, or treatment to the animal patient (except for wild or unowned animals). Part of establishing the VCPR is obtaining sufficient knowledge of the animal, which includes laboratory testing to initiate a general or preliminary diagnosis of their medical condition. (CCR, tit. 16, sec. 2032.1, subs. (a), (b)(2).) If the client requests treatment for the animal patient after the laboratory tests are returned, a VCPR, including a physical exam, must be established. (CCR, tit. 16, sec. 2032.1, subs. (a), (b).)

Providing detailed, unambiguous answers can help veterinarians keep their licenses while providing as much access to care as is legally allowed.

Conclusion

Legal compliance is necessary in any field, but clarity of laws is especially important in veterinary medicine as to not create additional barriers to access care. California set a great example of demonstrating how legal language can easily be translated to real life situations in the veterinary field to help veterinarians practicing in their state be more productive. If other state VMAs will answer these questions, all veterinary professionals will be able to practice more confidently and consistently, without fear of losing their license.

References

1. Kirchmeier JL, Thumma SA. Scaling the lexicon fortress: the United States supreme court’s use of dictionaries in the twenty-first century. Marquette Law Review. March 16, 2011. Accessed July 8, 2022. https://scholarship.law.marquette.edu/mulr/vol94/iss1/3/
2. Liptak A. Justices turning more frequently to dictionary, and not just for big words. The New York Times. June 13, 2011. Accessed July 8, 2022. https://www.nytimes.com/2011/06/14/us/14bar.html#:~:text=A%20new%20study%20in%20The,an%20explosion%20by%20historical%20standards
3. Legal terms glossary. Office of the United States Attorneys. Accessed July 8, 2022. https://www.justice.gov/usao/justice-101/glossary
4. Guidelines on veterinary legislation. World Organization for Animal Health (OIE). Accessed July 8, 2022. https://www.woah.org/app/uploads/2021/06/a-guidelines-vetleg.pdf
5. Code of professional conduct for veterinary surgeons and supporting guidance. Royal College of Veterinary Surgeons (RCVS). Accessed July 8, 2022. https://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/pdf/
6. Medico-legal handbook for physicians in Canada. Canadian Medical Protective Association. May 2021; Revised February 2022. Accessed July 8, 2022. https://www.cmpa-acpm.ca/en/advice-publications/handbooks/medical-legal-handbook-for-physicians-in-canada
7. VCPR by state. TeleVet. Accessed July 8, 2022. https://televet.com/vcpr
8. Frequently asked questions regarding veterinarian-client-patient relationship (VCPR). California Veterinary Medical Board. Accessed July 8, 2022. https://vmb.ca.gov/licensees/vcpr_faqs.shtml