Today's Veterinary Business

AUG 2018

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41 August/September 2018 • TODAYSVETERINARYBUSINESS.COM Community POLITICS & POLICY By Mark Cushing, JD By Charlotte Lacroix, DVM, JD Since then, the veterinarian- client-patient relationship (VCPR) has become a hot topic as veterinarians debate whether to follow the lead of 48 states on the human medicine side and allow for digital creation of a VCPR. This debate has provoked passion, heated arguments and a newfound interest in the legislative construct we call the VCPR. Why do we use the phrase "legislative construct"? Because the term VCPR was created by state legislators as part of definitions included in state veterinary prac- tice acts, or by state boards in a few instances, and it was adopted by Congress to establish Food and Drug Administration guidelines for feed directives and extralabel use of prescription drugs. This article has one goal: to analyze and clarify the VCPR so that advocates on all sides of the telemedicine debate, as well as practitioners everywhere, know what we are talking about. If you have a question about the VCPR, then our hope is that this article answers it. If the article doesn't succeed, please email us and we'll keep trying. A Little Background Forty-six states provide a definition of the VCPR, and Michigan's is un- der review. The District of Columbia and three states — Alaska, Con- necticut and Delaware — do not refer to the VCPR in their veterinary practice acts or veterinary medi- cal board rules. State legislatures adopted this language either at the request of state or national veterinary medical associations or by the observation of practice acts adopted in other states. On the surface, the rationale for legislation establishing the VCPR was to: • Clarify that a veterinary medical board could pursue discipline against a veterinarian regarding his or her handling of an animal only if the veterinarian had an established relationship with the animal. • Instruct veterinarians as to the terms of engagement with a new client and animal. Creation of the VCPR was not driven by legislators acting inde- pendently but rather at the behest of organized veterinary medicine. The precise conditions for creating a working relationship between pet owners or producers and veterinarians were not topics of keen interest, and ranchers, farmers and pet owners were not rubbing their hands anxiously trying to determine if they had a state-ap- proved "official" relationship with their veterinarian. But when states considered veterinary practice acts, all but four jurisdictions decided to establish some framework or foun- dation for deciding what a licensed veterinarian can and cannot do. And this foundation included a definition of when and how a veterinarian "legally" becomes the veterinarian for a particular animal. Hence, the VCPR. Veterinarians are not required to report to their state veterinary medical board when they've es- tablished a VCPR with a particular The state of the VCPR Two terms rarely, if ever, were mentioned together in veterinary meetings or publications prior to January 2016: telemedicine and the VCPR. What changed in 2016 was the North American Veterinary Community's launch of the Veterinary Innovation Council and the American Veterinary Medical Association's national working group on telemedicine. The advent of telemedicine has brought a new focus to the veterinarian-client-patient relationship and its diverse definitions and interpretations. Frankly, the VCPR was something of an academic topic, although it was a baseline determination in state board actions against a veterinarian for negligence or some level of misconduct.

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