Tougher rules sought on informed consent

MADISON, WIS. — Wisconsin veterinarians are railing against plans to implement what is being billed "the most restrictive informed-consent law in the United States."

Proposed by Wisconsin Veterinary Examining Board (WVEB) members, the rule, if passed, requires practitioners to obtain informed consent from every client on "all" viable treatment options and procedures.

That three-letter word creates a standard so burdensome, no private practitioners will be able to comply, critics argue. Regulators counter that the benchmark mirrors physician requirements and is intended to raise the bar in veterinary medicine. At press time, the board was scheduled to discuss and possibly vote on the proposal during an Oct. 24 hearing. In response, the Wisconsin Veterinary Medical Association (WVMA) plans to go on the defensive.

"This is a standard that's too high," WVMA Executive Director Leslie Grendahl says. "It's a Draconian concept that would cause a tremendous amount of confusion and litigation. It's a nightmare."

Regulators downplay that assessment, suggesting the move merely cements what's already expected from private practitioners. But detractors say it adds an arduous level of red tape to examinations and invites lawsuits against veterinarians. Documenting discussions with clients about every treatment option and diagnostic test available will prove so cumbersome, daily practice will suffer, contends WVMA President Tom Gilligan, DVM.

"This could halt all commerce in a veterinary practice," warns Gilligan, owner of North Lake Veterinary Clinic in North Lake, Wis. "For example, if you look at an algorithm for inappropriate urination in a cat, it's incredible what can be offered diagnostically and treatment-wise. It will become so you really need to pull out Ettinger for every situation."

The sky is not falling

That analogy is too dramatic and inaccurately reflects what regulators are proposing, counters Dr. Marty Greer, WVEB member and owner of Lomira Small Animal Clinic in Lomira, Wis.

While the new rule makes failing to obtain informed consent enforceable from the board's perspective, it merely codifies what's already expected from practitioners, Greer says.

"You go into the exam room, you tell your client all their options. That takes 15 seconds and you write that down in your records," she says.

"I do it every day in practice. This is not as tough as people make it out to be."

It's also what the public demands, she adds. "We are dealing with a much more sophisticated client base than we used to. We need to stay one step ahead of them."

WVMA and the University of Wisconsin's veterinary school have offered the board alternatives to the draft's "all" specification. But Greer expects erasing the word will not be accepted.

"We are open to listening, but we are not controlled by the WVMA. It seems veterinarians think that it's our job to protect them, and it's not. The reality is that we're working for the public," she explains.

Inviting lawsuits

That same public will use the word "all" to sue veterinarians, critics contend.

It's a prediction echoed by experts advising the WVEB on its stance. Board documents reveal that an attorney, Pamela Stach, with the State of Wisconsin Department of Regulation and Licensing's Division of Enforcement, admitted such language would aid in prosecutions. But that same attorney acknowledged that the change would increase public protection, outlining how current rules fail to adequately ensure that clients receive communication from veterinarians regarding viable treatment alternatives, their risks and benefits.

Gilligan argues that there are laws already in place to discipline veterinarians performing below the standard of care.

In addition, modeling the rule after human medicine is unfair, says Grendahl, adding that the regulation for physicians has been litigated so extensively they now know what's expected of them.

"It's a dangerous path to walk down, to have veterinary medicine pattern itself after human medicine. When we do that, we are now saying that animals are worth more than property. We're nervous about this," she says.

The mechanics of implementing rules

Those concerns likely will be addressed during the Oct. 24 hearing, where alternative suggestions will be considered. But if board members approve their rule, veterinarian critics will be unable to directly stop its enactment. Following the board's affirmative vote, a report will be prepared by the Department of Regulation and Licensing and included with the draft language for legislative review. Both chambers of the Legislature will receive the proposed rule in final draft form. Within seven working days of receipt, each presiding officer will then refer the rules to a standing committee within their respective houses. The committee review lasts 30 days from the date of referral. If no action is taken, the rule is returned to the WVEB for adoption and becomes effective, explains Tom Ryan, director of the Wisconsin Bureau of Health Professions.

That leaves little chance beyond the meeting to effectuate change, Grendahl says.

"They're either going to pass what they already have, or we're going to wear them down," she says. "My guess is we don't have much of a chance."