Abandoned Animals and Emergency Care
Accreditation and Travel Certificates
Handling a Difficult Client
Licensure and Delegation
Medical Waste and Sharps
Prescriptions and Internet Pharmacies
Vaccinations and Expired Medication
Who Can Own a Veterinary Practice?
The Abandoned Animal Law, Public Health Code 333.18838, states:
Disposal can mean adopting the animal out, turning the animal over to a local shelter or humane society or, as a last resort, euthanasia. Sample letters can be found here: 1st Notification, 2nd Notification
As stated in the Good Samaritan act, effective March, 2000, a veterinarian or veterinary technician is not liable for civil damages if an animal has been brought to the veterinarian by a person other than the owner of the animal. Also, the veterinarian will not be held responsible if he/she does not know who owns the animal or is unable to contact the owner of the animal before a decision must be made with respect to emergency treatment or euthanasia. The immunity granted by the Good Samaritan Act applies to both of the following: an injury to an animal or death of an animal that results from acts or omissions by the veterinarian or veterinary technician in providing treatment to the animal or; the euthanasia of a seriously injured or seriously ill animal.
This section does not, however, apply to an act or omission by a veterinarian or veterinary technician amounting to gross negligence or willful and wanton misconduct in providing treatment to an animal. Also, the veterinarian should notify the animal control authority in the county in which the animal is found of the disposition of the treatment rendered to the animal before the end of the first business day following the day treatment is rendered.
Accreditation is handled by USDA APHIS and more information can be found on their website.
The client must have their animal examined by a veterinarian. If the animal meets the destination country’s requirements, the veterinarian can issue the health certificate.
Your client should check the requirements from the destination country to determine whether an accredited veterinarian must complete the health certificate. Many countries, including all of the European Union, require the veterinarian who examines your animal or pet and issues the health certificate to be federally accredited. Some countries refer to accredited veterinarians using various terminologies such as competent authority, official veterinarian, or issuing authorized veterinarian.
In the fall of 2014, a bill was passed that became Public Act 280. This law was written for human medicine, but called into question the practice of compounding within veterinary medicine. More specifically, the practice of compounding in-house as well as keeping a large quantity of compounded medication on-hand for use on a per patient basis or in case of emergency was no longer allowed.
The rules on compounding within this new law had been in dispute because although they did not specifically exempt licensed veterinarians, the State of Michigan did not originally intend to include them and reportedly did not enforce the new rules. To this end, the MVMA has been working with LARA and the State of Michigan to provide further clarification with the goal that exemption language would be developed.
Recently LARA clarified this issue with an FAQ on their website, located here. Question no. 20 directly addresses the issues on compounding within veterinary medicine, and reads as follows:
The MVMA will continue to work with LARA and the State of Michigan to educate compounding pharmacies on the true intention of the rules change to ensure veterinarians can continue to practice in such a way that protects both their patients and their license. We will update our members as more information on this issue becomes available.
The importance of documentation cannot be over-emphasized. Even exemplary advice and patient care is difficult to demonstrate without documentation. Signed consent forms document that the service was authorized and risks were acknowledged by the client – which is what attorneys refer to as informed consent. Consider the use of consent forms prior to anesthesia, surgery, dental procedures, euthanasia, adoption, boarding, hospitalization or transportations and for situations involving behavior modification and zoonoses. Utilization of consent forms may provide an additional layer of protection and discourage certain types of allegations.
The foregoing question is probably not something that keeps most practice owners awake at night. Maybe it should be. Not properly handling a relief veterinarian relationship can lead to a finding by state and/or federal agencies that a relief veterinarian is an employee of the practice, and lead to the practice being liable for past income, FICA, unemployment insurance, and other taxes not withheld for other practice employees. In a worst-case scenario, such a relief veterinarian could be entitled to all the benefits of an employee, not only related to employment taxes, but also related to benefits and payments made by the practice to other employees, including paid time off, 401 (k) contributions, and the like.
To help ensure that relief veterinarians are considered independent contractors, practices should follow the following guidelines:
Yes, you can give a client a two-month supply, but please only do so only for a client with whom you have an established veterinarian/client relationship and keep detailed records of the transaction.
Yes, you can get the drug you need from a neighboring clinic. However, if you are transferring a schedule 2, you would need to fill out the DEA 222 form. If you are transferring schedule 3-5, you will need to create an invoice for your records. Not having a clearly defined paper trail is simply inviting trouble, should something go wrong and the DEA investigates.
Licensees must maintain an inventory of all controlled substances under their control and submit an annual inventory of these substances to the State between April 1 and June 30. An inventory is required for each location where controlled substances are kept, beginning on the day the licensee first engages in the practice. The inventory shall be signed and dated (including whether it is the opening or closing of the day), and include the licensee’s name, address and DEA number.Sample State of Michigan Annual Controlled Substance Inventory Form
Schedule 2 drugs should be listed separately from all other drugs and exact counts should be made. For substances listed in schedules 3, 4 and 5, the count or measure may be estimated, but if the container holds more than 1,000 dosage units (pills, etc.), then an accurate count is required. Federal law requires a biennual inventory be taken and kept on the premises. Saving a copy of the annual state inventory will put the veterinarian in compliance with this requirement.
Send the state inventory to: Bureau of Professional Licensing, Attention: Drug Monitoring Section - MAPS, PO Box 30670, Lansing, MI 48909.
Please note the inventory required by the State of Michigan is different from the inventory required by the DEA. After the initial inventory is taken, the DEA requires a new inventory of all stocks of controlled substances on hand to be done at least every two years. The biennial inventory may be taken on any date, which is within two years of the previous biennial inventory date. It requires the same information as the initial inventory of all controlled substances on hand and is maintained at the registrant’s location for two years and is not sent to the DEA.
Board of Pharmacy Administrative Rule 338.3162b states all pharmacies, dispensing practitioners and veterinarians who dispense controlled substances in Schedules 2-5 are required to electronically report this prescription data to the Michigan Automated Prescription System (MAPS).
In an effort to provide more accurate and current prescription information to health professionals, the current reporting schedule has been changed from the 1st and 15th of every month to a daily reporting requirement starting July 1, 2014. More information can be found on the LARA website.
You may report your data to the State using one of the two following ways:
1. MAPS Online
In addition to requesting MAPS reports, MAPS Online provides pharmacies and dispensing practitioners the option to submit prescription data via the Data Entry link within the MAPS Online portal. Submitting prescription data through MAPS Online offers tracking mechanisms to the user, to ensure data has been downloaded successfully and to view any prescription record errors, 24 hours after the upload. Registration to MAPS Online is required to request MAPS reports and to submit prescription data.
MAPS Online Registration
Instructions for MAPS Online Registration
Prescription Data Entry Instructions
2. State of Michigan Data Exchange Gateway
The State of Michigan Data Exchange Gateway (DEG) is the file transfer method used to transfer prescription data to MAPS and also provides users the option of automated data submissions. Registration to the DEG begins with the user emailing MAPS at firstname.lastname@example.org with their request for access to the DEG. Registration materials will be forwarded to the user for assistance with access to the DEG along with a user id and password (please allow 5-7 business days for processing).
State of Michigan Data Exchange Gateway Web-Interface Users Guide
State of Michigan Data Exchange Gateway SSLFTP/SFTP Client Setup
Contact the Michigan Board of Pharmacy with specific questions through their website or at 517/373-1737.
A veterinarian with a Michigan Controlled Substance License and DEA Registration may delegate the administration of a controlled substance to another veterinarian who does not possess a Michigan Controlled Substance license. It’s important that veterinarians realize that this delegated function falls under the Public Health Code Section 333.16215 (I) which states that "a license shall not delegate a task or function that requires the level of education, skill, and judgment required of a licensee.” To comply with the law, the licensed veterinarian must make the determination that a controlled substance is required and must prescribe the substance before the unlicensed veterinarian administers the substance. This means that the unlicensed veterinarian is working under the same constraints as a veterinary technician when controlled substances are involved (such as with euthanasia).
While an associate would save the cost of the DEA registration fee, we ask our members to carefully consider these factors:
Most distributors will take back expired medications, but some will not due to the cost associated with destroying the substances. However, the instructions on how a veterinary practice should destroy these substances are not any different than what is recommended for the same task in a personal household. Unless you have a large quantity of substances that need to be discarded. If this is the case you will need to hire an approved contractor to assist with this.
View DEA Disposal Instructions Here
The DEA agent stressed that the two most important parts are to make the substance non-retrievable, and to record your action:
“The process utilized to render a substance "non-retrievable" shall permanently alter the substance's physical or chemical condition or state through irreversible means and thereby render the substance unavailable and unusable for all practical purposes. A substance is considered "non-retrievable" when it cannot be transformed to a physical or chemical condition or state as a controlled substance or controlled substance analogue.”
You will need to complete a Registrant Record of Controlled Substances Destroyed DEA Form 41. If you are destroying a schedule 2 substance, you will need to complete and submit a 222 form. Substances considered schedule 3-5 do not have a special form, but you should record in detail your actions with these substances in case you need to submit proof to the DEA.
Veterinarians may choose whom they will serve. If there is ongoing treatment, providing a referral rather than severing the veterinary-client-patient relationship, veterinarians may avoid allegations of abandonment. When there is not ongoing medical condition, you can inform the client, preferably in writing, that veterinary services will no longer be provided. In an emergency, you should render service to the best of your ability. Notify the client of your intentions before an emergency arises to help avoid misunderstandings at a potentially emotional time.
The Department of Licensing and Affairs (LARA) handles all licensure for health professionals in the State of Michigan. Anyone can verify a license by contacting LARA’s Verification Unit at 517/241-9427 or visiting the State of Michigan website.
Within the Board of Veterinary Medicine's Administrative Rules, there is a delegation clause which states:
"A veterinarian shall not delegate the performance of acts, tasks, or functions that fall within the practice of veterinary medicine unless the veterinarian has first examined the animal on which the delegated procedures are to be performed and determined the need for such veterinary services. The delegating veterinarian shall observe and monitor the performance of the delegated procedures to the extent necessary to ensure that the activities of the delegatee are within the scope of the orders, assignments or prescriptions of the veterinarian."
This clause applies to anyone working in a veterinary practice. Also, the definition of "practice of veterinary medicine" in the public health code is:
Therefore, you would not be able to do those 3 things.
Persons with varying degrees of educational experience are staffing the veterinary hospital. Tasks performed in the hospital, to provide animal care, should be assigned to persons in the level where education and training exists to ensure a positive outcome for the patient. There may be times when an employee may be asked to work at a level below their expertise, but in keeping with the philosophy of quality animal care, the opposite should not take place.
The veterinarian is solely responsible for diagnosing, prognosing, prescribing medication and performing surgery. They are ultimately responsible for all patient care and outcomes. Most veterinarians apply for veterinary medical school admission while obtaining a bachelor degree in a compatible field. If accepted into a medical school, the course of study usually takes another four years, making that a grand total of eight years of schooling. Every state requires a veterinarian to take and pass a licensing exam. Successful candidates are given a license to practice veterinary medicine.
The veterinary Technicians and technologists are educated to be the veterinarian’s nurse, laboratory technician, radiography technician, anesthetist, surgical nurse and client educator. Many veterinary technicians and technologists are placed in a supervisory role in veterinary practices, research institutions and other employment options. Veterinary technicians can find employment in veterinary practices, biomedical research, zoo/wildlife medicine, industry, military, livestock health management, pharmaceutical sales, etc. A veterinary technician is a graduate from a two-year, American Veterinary Medical Association (AVMA) accredited program from a community college, college or university. A veterinary technologist has graduated from an AVMA accredited bachelor degree program. Almost every state requires a veterinary technician/technologist to take and pass a credentialing exam. Passing this exam ensures the public that the veterinary technician has entry-level knowledge of the duties they are asked to perform in the veterinary clinic or hospital.
Michigan does not have a definition for the veterinary assistant per se. The legislation does clearly discuss the technician being a para-professional with a protected title.
Yes, practicing chiropractic on an animal without a veterinary license is illegal according to the Michigan Board of Veterinary Medicine. The veterinary licensing board however has no jurisdiction because the violator is not licensed. This would be the responsibility of the local prosecutor.
In May 2006 MVMA adopted the following position statement: The examination, diagnosis and treatment of nonhuman animals through manipulation and adjustments of the spine, specific joints, cranial sutures, or other tissue, is the practice of veterinary medicine and to be performed only by licensed veterinarians or licensed chiropractors working under the direct supervision of a licensed veterinarian.
See item no. 4 below. Per changes to the Veterinary Administrative Rules there is now a law that governs the data contained in and maintenance of records at a veterinary clinic: R338.4921 Medical records; requirements. Rule 21.
A veterinarian who practices veterinary medicine in Michigan shall maintain a medical record for each patient that accurately reflects the veterinarian’s evaluation and treatment of the patient. Entries in the patient record shall be made in a timely fashion. The patient record shall contain documentation of a valid veterinarian-patient-client relationship.
A record shall be maintained on either a herd or flock, or an individual patient. Records shall be legible and shall be retrievable. A record shall be maintained in either a written, electronic, audio, or photographic format.
A record for an individual patient, group, herd, or flock shall document all of the following:
Based on the statute of limitations for bringing certain claims against veterinarians, other general record guidelines include professional malpractice (2 years), negligence (3 years), property damage (3 years) and breach of contract (6 years).
There is no law regarding this subject in Michigan. While the records do belong to the veterinary practice, ethically the veterinarian should provide the client a copy or summary of the medical records when requested. The AVMA’s Principles of Veterinary Medical Ethics states as follows on the topic of medical records:
The Michigan Department of Environmental Quality has the best information.
Sharps are part of the medical waste that is regulated by the State of Michigan. They include needles, scalpels, syringes and IV tubing with needles attached, and those parts of a syringe, with or without an attached needle, that are contaminated with an infectious agent.
The State of Michigan has provided several documents to help get you started:
Michigan's Medical Waste Regulatory Program
Sample Medical Waste Management Plan
Medical Waste Regulatory Program Frequently Asked Questions
Information on Sharps
Sharps Collection Programs for Michigan Residents
The Michigan Department of Agriculture & Rural Development's rules entitled "Bodies of Dead Animals" for on farm composting were approved with the Great Seal on September 26, 2007. The rules provide for composting of dead animals and animal tissue within a structure, in open piles, windrows, and contained vessels. These additional alternatives for disposal of dead animals will assist producers who have no rendering services, licensed landfills that accept dead animals, or soil types for proper burial. Learn More Here
According to the Board of Veterinary Medicine, microchipping for identification purposes is not considered a veterinary procedure as I understand the process and therefore is routinely done be shelters, breeders, etc. The chip numbers should be recorded with the company that manufactures the chips so they can be put in a national database.
R 338.4920 Safeguards for drugs used in practice of veterinary medicine. Rule 20. (1) If drugs are dispensed in the manufacturer's original container, the
original instructions shall be included.
(2) If drugs are dispensed in other than the manufacturer's original container, both of the following provisions shall apply:
(a) The container shall be equipped with a child-safe lock mechanism, if appropriate.
(b) The veterinarian's own label shall be affixed to the container and shall include all of the following information:
(i) The date the drug was dispensed.
(ii) The name of the patient.
(iii) The name of the client.
(iv) Complete instructions for use of the drug.
(v) The name of the drug.
(vi) The strength for unit dose.
(vii) The quantity dispensed.
(viii) The withholding time for food-producing animals and poultry.
(ix) The expiration date of the drug, when appropriate.
(x) The veterinarian's name or clinic's name, telephone number, and any appropriate precautionary statements, such as "Keep out of reach of children."
May I fill a prescription written by another veterinarian if I have a relationship with the veterinarian but not with the client?
There are three main ways a client may fill any prescription written for use in their animal: from the issuing veterinarian if they keep it in stock; the veterinarian can write (or call in) a prescription to a local pharmacy that stocks the medication; the veterinarian can provide a prescription so the client can get the medication from an online pharmacy. In Michigan veterinary prescription drugs are to be used or prescribed only within the context of a veterinarian-client-patient relationship (VCPR). Although it sounds like you have a standing relationship with the doctor, if the VCPR isn’t in place we would strongly recommend you do not fill the prescription. If there were to be an issue after the animal ingests the drug your license may be at risk if the VCPR isn’t in place. If the doctor in question doesn’t work with another pharmacy, etc. it might be better to transfer the drug in question to the clinic itself and then allow them to dispense as appropriate. You had stated this was not a controlled substance, but the recommendation is based on the best way to protect your actions in general.
To comply with Public Health Code 333.16221(A) a veterinarian is obligated to honor a client’s request for a prescription versus dispensing providing the drug is deemed medically necessary and in the animal's best interest by the veterinarian. The AVMA and MVMA also recommend that a valid Veterinarian Client Patient Relationship (VCPR) is in place. Veterinarians are not obligated to prescribe when requested to do so by a third party, i.e. a pharmacist. The request must be made by the client. It is ethical for veterinarians to refuse a prescription if clients do not follow instructions, i.e. yearly heartworm test, lab work to evaluate drug effects, etc. Veterinarians should be willing and able to explain to a client when a prescription is appropriate based on AVMA Principles of Veterinary Medical Ethics.
The American Veterinary Medical Association (AVMA) does not have a position on this subject. According to the Michigan Board of Pharmacy, there are no regulations preventing a veterinarian from charging a fee for writing a prescription. In general, veterinarians must charge adequately for their professional services to cover the costs of maintaining a veterinary clinic, paying staff, and offering quality medical care to a client’s animal. Some veterinarians have chosen to charge a prescription issuance fee in those cases when the veterinarian does not directly dispense the medication to the client. Some have considered implementing a policy to charge a specified fee, whether a drug is dispensed or prescribed. Others have reviewed fees and the need for any adjustments within the context of all services rendered. And still others charge for their professional services using units of time (e.g. when reviewing prescription drug authorizations or conducting telephone consultations with clients).
If you are asked to approve a prescription, you should do so only if the prescription is medically appropriate for the patient and you have a valid veterinarian-patient-client relationship. The decision as to whether a prescription drug should be used for a patient is made by you – the veterinarian – not a pharmacy.
No, the client has the option of filling a prescription at any authorized pharmacy. In this example, the veterinarian’s practice of veterinary medicine, which would include writing a prescription, would be confined to his or her state.
Veterinarians may want to advise clients who choose to fill prescriptions through the Internet to select a VIPPS pharmacy - one that is certified by the National Association of Boards of Pharmacy and has its seal of approval. The national pharmacy association developed the Verified Internet Pharmacy Practice Sites (VIPPS) program in 1999 in response to public concern over the safety of Internet pharmacy practices. VIPPS pharmacy sites are designated by a hyperlink seal. To be VIPPS certified, a pharmacy must comply with the licensing and inspection requirements of the state in which it is located and in each state where it dispenses pharmaceuticals. These pharmacies must also demonstrate compliance with criteria that include patient rights to privacy, authentication and security of prescription orders, adherence to a recognized quality assurance policy, and provision of meaningful consultation between patients and pharmacists.
Report it! The American Veterinary Medical Association (AVMA) has created a Pharmacy Complaint Form to simplify the reporting process for practitioners. The form identifies the organizations to which the form should be sent. Regulatory agencies cannot act unless they have factual complaints to pursue. Forms can be found on the AVMA website. If you are unable to locate this form on the web contact MVMA at 517/347-4710 and we will send you a copy of the complaint form.
After consulting with the Michigan Board of Veterinary Medicine, we received the following recommendation: "Veterinarians should not fill prescriptions for human treatment. It is probably a fairly common practice as the drugs are the same but it is still dispensing to treat humans and that is practicing human medicine without a license."
The employer must determine who is at risk of rabies exposure in a practice. Once that is determined, the owner should be sure that only those people come in contact with high risk animals. Veterinarians are not necessarily obligated to provide the Rabies Pre-Exposure Immunization, but they should be aware that if a person does receive the pre-exposure vaccination and they are exposed to rabies the post exposure treatment is different - much shorter and much less expensive.
A kennel owner, who is not a licensed veterinarian, may not give routine vaccinations to another person’s dog unless the kennel owner is licensed to practice veterinary medicine as a veterinary technician, or is acting under the supervision of a licensed veterinarian. Assuming the individual is not acting under the direct supervision of a veterinarian, this practice would be illegal under the Michigan Public Health Codes, Act 368 Public Acts of 1978, Article 15, Part 188, Section 18808 which is overseen by the Michigan Department of Community Health. Under this Act, the administration of any vaccination to someone’s animal is considered "the practice of veterinary medicine” and thus should only be done by a licensed veterinarian or by a licensed veterinary technician under the direct supervision of a veterinarian.
In a disciplinary context, the Board has determined that a veterinarian's use of outdated prescription drugs is a violation of the Practice Act because that conduct fails to conform to the standards of acceptable and prevailing veterinary medical practice. Dispensing expired medications is also a violation of the Federal Food, Drug, and Cosmetic Act and/or the Drug Enforcement Administration (DEA) requirements. The level of active drug may be below the labeled specifications and, therefore, will not give the desired result in the patient. Therefore, it is recommended that animal owners discard expired pharmaceuticals and see their veterinarian for 'proper-dated' medication, if needed. Veterinarians are asked to contact their sales representatives or customer service to arrange for return of the short-dated or expired medicine.
Based on a review of the Michigan laws regarding the formation of a business, it is our opinion that only licensed veterinarians may be an owner of a veterinary practice. Veterinarians and other professionals frequently incorporate their practices to limit their exposure to certain liabilities. If a veterinarian chooses to incorporate the practice, we recommend that they do so as a professional corporation (referred to as a “PC”) or a professional limited liability company (referred to as a “PLLC”). A licensed veterinarian may also form a partnership but only another licensed veterinarian may be a partner of the partnership. Each type of business entity varies in the amount of liability protection afforded to the owners and each has different tax consequences. Regardless of the form of business entity, Michigan law requires that each owner be licensed to render the same professional service; i.e., veterinary medicine. A non-licensed veterinarian may not own a business that engages in the practice of veterinary medicine.
MVMA members have access to the full opinion and legal analysis done by our attorney on this issue. Please contact us for additional information.