By Steve Dale, CABC
The following is an opinion of the author and does not necessarily represent the views or position of NAVTA or its Board of Directors. NAVTA encourages open dialogue and welcomes your replies to editor@navta.net
The new Florida Providing Equity in Telehealth Services (PETS) Act (House Bill 849) allows veterinarians to practice telehealth, enabling them to diagnose and treat patients, as well as to prescribe medications through telecommunications technology. That is, they are able to create a veterinary client patient relationship (VCPR) based solely on a one-time meeting on the Internet.
I feel this is a wasted opportunity for veterinary practices, and specifically for veterinary technicians/nurses, to have their value supported.
The bill is patterned after Florida’s legislation for human telehealth. However, pets are not humans.
How did this regressive bill manage to pass so easily? Remember the credo ‘First, do no harm.’ Imagine a client contacting a veterinarian with a sick pet. How does the veterinary professional diagnose accurately without seeing the pet, knowing the pet and its history, or knowing the clients? Most of all, how can they do this when they are unable to perform real diagnostics, such as bloodwork, hearing the heart, palpating, checking for parasites, etc.? For the most part, it must be guesswork. How is that the best medicine possible?
Let’s take one of the most common complaints, diarrhea in dogs or cats. Of course, the list of explanations for this is very long, ranging from dietary indiscretion to swallowing a foreign object, to stress, to parasites, to kidney disease, to any number of GI-related issues, and the list goes on and on. And the action taken depends on the diagnosis. How is it possible to make a diagnosis without an in-person exam or imaging?
Is there a history of an identical complaint? People often don’t recall what the specific medical diagnosis was or what may have been prescribed at that time or may recall incorrectly. And even if they do remember, does this mean it’s an identical explanation for the problem today? Maybe yes and maybe no.
Throwing a pharmaceutical at the problem and hoping it sticks is exactly what today’s medical professionals are taught not to do.
Many of these third-party direct-to-consumer providers follow a script. Veterinary (and human) medical schools are teaching individualized medicine. Florida’s approach is in direct contradiction.
“With many Floridians struggling to access veterinary care amidst a veterinary shortage, empowering veterinarians to use telehealth technology will provide another tool for veterinarians to reach more pet patients to help reduce animal suffering, keep more pets in their homes, and extend the capacity of animal shelters to serve their communities,” said Jennifer Hodgood, senior director of state legislation for the American Prevention for the Cruelty of Animals (ASPCA) Southern Division.
I understand pet parents’ frustration when an immediate appointment isn’t available. However, veterinary practices can ensure that Veterinary Technicians/nurses are available. Data from the American Veterinary Medical Association (AVMA) clearly suggests most pet parents prefer to go to veterinarians or technicians they know, or at the very least someone from a familiar practice. Arguably, even more than a veterinarian, you – the Veterinary Technician/Nurse — represent what they know and trust. True enough, technicians and nurses can’t prescribe drugs. However, you can always go back to the veterinarian to have that done if that is relevant.
For all 50 states, assuming the pet has visited within a year (and potentially in some places and circumstances beyond one year), there is an established VCPR. As such, you will have instant access to medical records. And odds are fairly good you have met the client and pet and might even know them well.
Meanwhile, in Florida as desperate pet parents may be, getting an incorrect diagnosis or no diagnosis at all will mean the pet will suffer longer. Depending on the issue, the situation may spiral into a potentially life-threatening emergency. Any of this will cost the pet parent more money. This is not the way for the profession to go.
This significant redefinition of VCPR in Florida, I suggest, borders on supporting unethical care or, at the very least, inadequate care.
Make no mistake, telehealth is a very useful tool with existing clients, which the AVMA strongly supports. And here’s arguably the most important point: Veterinary Technicians/Nurses familiar with the patient and client are, I believe, far more useful than a random veterinarian or technician with whom there is no real relationship.
I believe the Florida law is contradictory to progress and poorly conceived and only benefits the direct-to-consumer providers, not pets or pet parents, or the veterinary profession.
Addendum: NAVTA Support for VCPR
NAVTA has publicly supported the Model Regulations – Scope of Practice for Veterinary Technicians and Veterinary Technologists published by the American Association of Veterinary State Boards (AAVSB). That document includes the following clause:
A Veterinary Technician may be allowed to perform the [certain] acts under the direction, supervision, and responsibility of a Veterinarian, who has established the Veterinarian-Client-Patient Relationship (VCPR).
You can access the full document here: https://www.aavsb.org/board-services/current-topics/100.