HOD discusses constraints of providing emergency care, updates to model practice act

Veterinarians have an ethical responsibility to provide emergency care, according to the AVMA Principles of Veterinary Medical Ethics, but practicing that responsibility can prove to be challenging in certain situations.

The AVMA House of Delegates discussed the responsibility to provide emergency care as well as needed updates to the AVMA Model Veterinary Practice Act—possibly including updates related to license portability, veterinary technicians, and telehealth—at the Veterinary Information Forum during the regular annual session of the HOD, held July 28-29 in Philadelphia in conjunction with AVMA Convention 2022.

This spring, the AVMA Council on Veterinary Service initiated its scheduled review of the AVMA Principles of Veterinary Medical Ethics and AVMA Model Veterinary Practice Act.

Annotations to the AVMA Principles of Veterinary Medical Ethics indicate that, “In emergencies, veterinarians have an ethical responsibility to provide essential services for animals when necessary to save life or relieve suffering.”

On the floor of the HOD, delegates discussed their own experiences with providing emergency services, particularly at a time when many practices can’t keep up with the demand for veterinary services overall.

The reference committee that discussed the responsibility to provide emergency care suggested the following points for the Council on Veterinary Service to consider while reviewing the Principles of Veterinary Medical Ethics.

• Define “emergencies.” Is this meant to refer to immediate life-threatening situations and situations in which the animal is in intractable pain and suffering?
• Address payment.
• Add wording regarding whether providing the emergency care is prudent, with considerations to include the following:
  • The number and skill level of available staff members. 
  • Available equipment.
  • Working conditions that are safe for veterinary team personnel.
  • Sufficient knowledge of the species.
  • Geography or location of the emergency, particularly for large animal or mobile practices.
  • Whether a veterinarian-client-patient relationship has been established. In other words, is it an established client and patient?
• Clarify that euthanasia is acceptable to prevent intractable pain and suffering even if a client is not identified, for example, an animal brought in by animal control or other government agency.

Ahead of the HOD meeting, most of the comments from AVMA members about updating the AVMA Model Veterinary Practice Act were to support the idea of providing license portability from state to state.

Dr. Kristen Obbink, delegate for the American Association of Food Safety and Public Health Veterinarians, said some members of the AAFSPHV believe license portability should be an advocacy priority for the AVMA.

Dr. Deborah Whitmer, delegate for the uniformed services of the United States, said service numbers are frequently reassigned and often carry multiple state licenses so they don’t have to obtain one when they leave duty—and a fair number of active-duty veterinarians have spouses who are also veterinarians and must obtain multiple state licenses.

Dr. Juan Amieiro, Puerto Rico delegate, said he thinks veterinarians can look to other health professions and get to a place where license portability could work, with a universal license not being the expectation.

Jim Penrod, executive director of the American Association of Veterinary State Boards, suggested in a reference committee that his organization’s Veterinary Application for Uniform Licensure Transfer program may be one potential solution. The goal is to get as many states to participate in this national, centralized database with real-time licensure data to make available to veterinary medical boards so they can more quickly verify information and issue licenses.

Regarding veterinary technicians, Dr. Steve Dullard, Illinois delegate, said Illinois defined the duties of certified veterinary technicians versus noncertified individuals about 10 years ago. Dr. Jennifer Glass, Idaho delegate, said her state does not define roles for veterinary technicians, but veterinarians in her state are pushing now to define those roles in the state practice act.

Dr. Gary Marshall, alternate delegate for Washington state, noted that an apprenticeship program for veterinary technicians has been proposed in his state. The program would allow veterinary technicians to become licensed without graduating from an AVMA Committee on Veterinary Technician Education and Activities–accredited educational program. He expressed concern about veterinary technicians becoming licensed without going through proper channels.

Pertaining to telehealth, Dr. Lindy O’Neal, Arkansas delegate, said she would like to see an emphasis in the model practice act on the requirement for an in-person examination to establish a veterinarian-client-patient relationship before initiating telehealth.

Dr. Steve Stelma, North Carolina delegate, echoed her comments about the VCPR. He said: “I think it’s insane for states to allow that to be established without a physical exam—without eyes on, nose on, ears on a patient. I don’t see how it’s possible.”