Veterinarians shoot down pre-vaccination exam waiver


Portland, Ore. — Overwhelming protest by the veterinary community quashed a proposed amendment to Oregon regulations that would have allowed some animals to be vaccinated without an examination by a veterinarian.

The Oregon Veterinary Medical Examining Board (OVMEB) proposed the amendment to the Oregon Administrative Rules March 5, based on complaints from the public. Although pre-vaccination examinations have been required for at least five years, there were never many complaints about the process until now, explains OVMEB Executive Director Lori Makinen.

“We’re not sure why it’s an issue now,” she says. “I think some veterinarians were encouraging the public to complain about it.”

Taking note of the complaints, the board offered up an amendment that would have allowed veterinarians to waive an exam for an apparently healthy animal presented for vaccination. The rule would not have indemnified veterinarians from responsibilities for adverse outcomes if an unhealthy animal was vaccinated and problems resulted.

When the board opened the rule up for comment, many veterinarians spoke out in opposition.

“The comments were so overwhelmingly opposed that the board didn’t feel it would be reasonable to adopt the rule,” Makinen says.

The Oregon Veterinary Medical Association (OVMA), which was opposed to the rule amendment, conducted a survey of its members during the comment period. Sixty-seven percent sided with the association. Only 28 percent of survey respondents favored the rule change, OVMA says. The remaining 5 percent of respondents expressed other comments.

OVMEB received another 61 written comments about the rule amendment. Most were from veterinarians, and most were against the change. Only five written comments were submitted in favor of the rule change.

Those in favor cited concerns about the affordability of veterinary care and questioned whether some pet owners would forego vaccinations due to cost.

“Since the Oregon law was clarified to require an exam for vaccinations, I have had numerous people become irate (about) the need for this action, stating they will not vaccinate,” says Jennifer Betz, DVM, of Sandy Animal Clinic in Sandy, Ore.

Betz also questioned why animals can’t be vaccinated without an examination while people can receive flu vaccines from pharmacy staff without a physical examination.

“People are clearly aware of this difference and are verbally stating that veterinarians are only in it for the money,” she continues.

Those in opposition to the proposal say there is an obvious reason for the rules as they they stand.

“Our patients can’t complain about the new swelling they found under their armpit, or the fact that their left knee hurts when they first get up in the morning, or that they are always thirsty, or that the are losing weight without trying,” says Tanya M. ten Broeke, DVM, owner and medical director of Gladstone Veterinary Clinic in Milwaukie, Ore. “Isn’t our responsibility to care for our patients, rather than just check off a box every year for rabies, distemper, parvo and Bordetella vaccines?”

Other concerns about the ruling involved the public’s perception of the veterinary profession and what the amendment would mean to practitioners.

When the board revised its rules to clarify the veterinarian-client-patient relationship (VCPR) several years ago, mandating examinations to establish a VCPR prior to vaccination, ten Broeke says that she was happy to see the OVMEB raise the bar on minimum care. The rule amendment, she continued, would have made it more difficult for veterinarians to establish their worth to clients.

“One of the most frustrating challenges I face every day is explaining the difference between high-quality, preventive medicine, rather than just ‘giving the dog his shots.’”

Cheryl Lopate, DVM, MS, Dipl. ACT, of the Wilsonville Veterinary Clinic in Wilsonville, Ore., and Reproductive Revolutions in Aurora, Ore., says the amendment would have underscored the importance of regular veterinary care.

“As a profession, we are struggling now to show clients the importance of our professional services rather than the product/vaccine/diet we sell. We are trying diligently to reduce costs for products and minimize markups and show clients that what we perceive as important and worth the cost is the exam, diagnostics and treatment plan that we perform, review and prepare,” Lopate says. “If the OVMEB thinks our services are worthless, why should a client believe otherwise?”

A number of other veterinarians questioned whether exam-less vaccinations would be a danger to animals, who may have an underlying medical condition that could have been caught during a physical examination.

“I do not believe it is possible for an animal to be called ‘apparently healthy’ without a physical exam, because animals are very good at hiding illness,” says Christine Ortner, DVM, Dipl. ABVP of Cascade Summit Animal Hospital in West Linn, Ore. “If they are having other health problems at the time of vaccination, such as chronic kidney failure in cats, a mild vaccine reaction is all it would take to push them over the edge into a crisis. The definition of ‘apparently healthy’ is too vague.”

But the amendment wouldn’t have prevented veterinarians from requiring pre-vaccination exams or mandate the cost associated with the exam, adds Daniel Koller, DVM, JD of Companion Pet Clinic in Beaverton and Gresham in testimony about this issue.

“The veterinarian or hospital can still require examinations prior to any vaccination. They are free to charge or not charge for such examinations,” he says. “The only thing this amendment does is take away the illegal effect of not examining a pet with an owners’ waiver. It allows the owner to make the determination that his/her pet is healthy and can be vaccinated without an examination.”

Additionally, Oregon animal owners already are permitted to perform a number of veterinary tasks on their own. In fact, there is a rule on the books that states any animal owner, agent or employee can perform humane veterinary medicine, surgery or dentistry. This includes giving vaccinations, Koller says.

Makinen says the law was enacted to allow ranchers and farmers to help one another, and only dictates that compensation cannot be attached to such services.

Since animal owners could already walk into any feed store and legally vaccinate their own animals without a veterinarian’s examination, Koller says, “it seems to me that it would be much more beneficial to have the pet vaccinated by trained personnel and veterinarians that are willing to vaccinate ‘client-determined healthy pets’ than have the owners do it to their own pets,” he says.

Although the board voted down the rule amendment at its July 23 meeting, Makinen says, OVMEB is seeking a new perspective from large-animal veterinarians and clients. Different rules could be proposed for large-animal situations as the board continues discussions on the issue at its next meeting Nov. 13-14. Makinen says she expects this to be a recurring topic at the next several OVMEB meetings.

“Ideally, the thing is to get as many animals vaccinated as possible,” she says. “But we don’t want to drop the minimum standards any lower.”