This edition of the CFVC Blog is more geared toward the legal/procedural side of veterinary medicine, but it’s an important topic that is worth discussing. It is quite common for us to receive a call from a pet owner requesting medication for their pet for one reason or another. Things can become frustrating for the owner if they learn that their pet must be seen and examined prior to receiving the particular requested treatment. Similar frustrations may arise when it is learned that our doctors cannot diagnose a condition or disease over the phone.
There are a number of reasons why a patient must be examined before we can prescribe various types of medications. Primarily, it is vital to know exactly what the condition is that we’re treating and the status of the condition. For example, a dog may have had an ear infection in the past, but any doctor ought to know the present condition before blindly prescribing a treatment (Dr. Khuly’s link below explains why). This is good medicine, and good medicine looks out for the best interest of the patient.
Additionally, the concept of a Veterinary-Client-Patient Relationship (VCPR) cannot be overlooked. A VCPR is a legal term with legal ramifications to which we as veterinarians must adhere.
What exactly constitutes a VCPR? Patty Khuly, VMD, from Sunset Animal Clinic in Miami, Florida, gives a very good explanation of just what a VCPR is on her blog, Fully Vetted. The American Veterinary Medical Association also has a good Q&A re: VCPR. The quick run-down is that all three parties (the patient, the owner and the veterinarian) must be present and participating for treatment to be given. The VCPR is for the protection of the pet, the owner and the veterinarian (as Dr. Khuly’s blog post demonstrates). The time-frame for a VCPR is generally 12 months, meaning particular treatments for known, ongoing conditions can be prescribed within 12 months of the patient’s most recent physical examination. (Think: Heartworm preventive, thyroid supplementation, anti-inflammatory therapy, etc.)
There are some categories of medications, such as anti-seizure medication, that Ohio law requires the VCPR to be current to every six months. In other words, a patient must have been examined by the veterinarian and appropriate labwork completed within the past six months in order to have the necessary prescription filled. While this may seem like a hardship, these requirements are in place with the best interest of the patient. And we remain compliant with state and federal law. George Miller, Regulatory Affairs Manager for Butler Animal Health, put it this way:
“The dispensing or administering of a prescription drug requires a Veterinarian-Client-Patient Relationship or VCPR. A VCPR is the basis for interaction among veterinarians, their clients, and their patients. Without a VCPR, the dispensing of a veterinary prescription drug, to include controlled substances, or the extra-label use of any pharmaceutical is unethical and is illegal under federal law. The registration, the dispensing, the administering and the VCPR are important factors to prove no misuse or abuse of controlled substances.”
In Ohio, the law reads like this…
Ohio Revised Code Chapter 4729 (Pharmacy Law) requires that licensed veterinarians can only prescribe, administer and dispense drugs to their own clients/patients. Only a licensed pharmacy can dispense medications upon the prescription of a veterinarian or other licensed health care provider.
Prior to providing drugs to a client/patient, Ohio Revised and Administrative Code Chapter 4741 (Veterinary Law) requires that a veterinarian have a valid veterinary client patient relationship as defined in ORC 4741.04. Among the provisions of a “valid relationship” are that “The veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient. In order to demonstrate that the veterinarian has sufficient knowledge, the veterinarian shall have seen the patient recently and also shall be acquainted personally with the keeping and care of the patient either by examining the patient or by making medically appropriate and timely visits to the premises where the patient is kept.” The requirement for this level of knowledge of the animal’s medical condition prior to prescribing or dispensing drugs is conveyed in Ohio Administrative Code 4741-1-05.
A veterinary facility should not dispense, administer or otherwise provide drugs absent a veterinarian who works at that facility having examined the animal. While the medical judgment of another veterinarian in providing a prescription to the client in question is valuable, the law does not allow a veterinarian in your facility to act solely on that judgment with respect to providing drugs. To do so without first examining the animal violates both pharmacy and veterinary sections of Ohio law.
An axiom that is ingrained into all veterinary students and practicing veterinarians is, “Above all else, do no harm.” All of the treatments, both medical and surgical, that we recommend and provide have as the end goal to improve our furry companion’s quality-of-life, not diminish it. It is important that, as an animal receives treatment for a particular condition, the treatment actually improves the life of the animal and doesn’t cause harm. This is our primary focus at the Cuyahoga Falls Veterinary Clinic. Our aim is not to be an inconvenience, but to be an advocate for our patients and provide the best health care for them that we can.