Chester Clinic

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AnnuAl BoArd updAte STATE OF NEVADA BOARD OF VETERINARY MEDICAL EXAMINERS
From The President Richard Simmonds, DVM, MS
Richard Simmonds, DVM, MS, ACLAM I am honored to have been selected by my is regulatory in nature and charged with enforcing colleagues on the Nevada Board of Veterinary the Nevada Practice Act and the Association is a Craig Schank, DVM
Medical Examiners (Board) to serve as President for professional organization charged with fostering the the coming year. That said, I must admit that I'm interests of its members, there has been an exceptional intimidated by having to follow Dr. Craig Shank in degree of cooperation and, in general, agreement this position as he has provided exemplary leadership between our respective activities. Both organizations William Taylor, DVM, ABVP
during his term as President. As you will note from enjoy superb management by their respective staffs some of the articles in this issue of the Update, the and have uniformly indicated a desire to provide past year has been a very active one, including an exceptional Veterinary Medical service to Nevada intensive legislative session that produced some animal owners and their animals. While there has Scott Bradley, DVM
significant statute revisions that impact the Board's been the odd disagreement regarding some regulatory operation and the practice of veterinary medicine issue, the ensuing discussions have always been civil in Nevada. President Shank, along with the superb Ron Sandoval, DVM
and with no recriminations afterwards. All licensees work of our Executive Director, Debbie Machen, and should be very proud to be a member of the Nevada our Lobbyist, Neena Laxalt, laid out the strategy for veterinary community! Mark Iodence, DVM, ABVP
our responses to the legislative issues that proved Finally, please remember that your suggestions and to be quite successful in minimizing the impact on comments are always welcomed by the Board and the Boards' operation and passing several bills that you are always welcome to attend the Board meetings will be good for Veterinary Medicine in Nevada. On and, if you do attend during the discussion of the behalf of the Board members, I extend our sincere complaints, you can even earn some CE credit. Also, and grateful appreciation to Craig for his nine years I would welcome you to contact me directly anytime of outstanding service to our profession. (CELL Phone: 775-742-7944). Best regards to you This past year we have enjoyed excellent continuity all and best wishes for a successful and satisfying in regards to our membership and staff so, as of the upcoming year.
Executive Director writing of this message in late September, I have no personnel changes to report to you. However, the Tracie Estep
terms of three serving members of the Board expire in Administrative Assistant October and, until it is determined whether or not the Governor reappoints them or appoints new members, Michael Chumrau, DVM
we will not know the complete makeup of the 2011 Board. There will be at least one new member, the Christina Johnson, LVT
replacement for President Shank.
Compliance Inspector Having actively participated in organized Veterinary Medicine in several states and, in Nevada, having been an active member of the Nevada Veterinary Medical Association (Association) - and Past-president - for Louis Ling, Esq.
over 20 years and a Board member for 10 years, I believe that our profession here in Nevada is healthy and, best of all, exceptionally organized and dedicated to a high level of professionalism. While the Board 4600 Kietzke Ln. O-265Reno, NV 89502Phone- (775) 688-1788Fax-(775) 688-1808Email vetbdinfo@vetboard.
nv.govWeb-site www.nvvetboard.us ANNUAL BOARD UPDATE NOVEMBER 2011 New Legislation Passed by 2011 Legislature By Richard Simmonds, DVM, MS, ACLAMRelating to Veterinary Practice: SB17 – Redistribution of Drugs – This bill authorizes licensed
veterinarians or veterinary facilities to voluntarily accept "certain drugs dispensed for, but not used by, an animal" donated by animal owners and authorizes licensed veterinarians to "reissue the drug free of charge for certain animals" The intent is that the "free" drugs would be reissued to indigent clients. Provisions of the bill also provide liability immunity for veterinarians who participate in such reissuance of drugs. The Board of Veterinary Medical Examiners is authorized to develop implementing regulations any time after May 31, 2011. The provisions of this bill became effective October 1, 2011.
SB294 – Veterinary Assistants – This bill authorizes unlicensed
veterinary assistants to "possess" and administer, at the direction of his or her supervising veterinarian, "dangerous" drugs. Regulations to implement the provisions of this act may be proposed any time after Of Potential Interest: June 16, 2012. The effect of this change is that unlicensed veterinary assistants, under direction, may prepare medications for dispensing to SB223 – Animal Cruelty – The provisions of this bill increased the
clients; however, it is expected that a licensed veterinarian or veterinary severity of the criminal penalties for deliberate acts of animal cruelty technician will verify that the contents of the prepared items are correct and provides for anonymous allegations of animal abuse or cruelty to before they are given to the clients.
be made. The provisions of this bill became effective October 1, 2011.
AB98 – Temporary Licensure of Out-of-State Veterinarians
and Veterinary Technicians during Declared Emergencies – This
SB299 – Animal Breeders – The provisions of this bill require
bill authorizes the temporary licensure of veterinary professionals that "the board of county commissioners of each county and the (licensed and in good standing) with their home state's Board of governing body of each incorporated city to adopt an ordinance Veterinary Medical Examiners to volunteer to provide veterinary requiring commercial breeders of dogs and cats to obtain a permit services in Nevada during declared emergencies. The implementation to act as a breeder under certain circumstances." The bill contains a of the provisions of this bill will be the responsibility of the Nevada specific definition of "breeder" which includes the verbiage that the Division of Emergency Management of the Department of Public term applies only to "the business of breeding dogs or cats for sale or Safety. The Nevada Board of Veterinary Medical Examiners is trade" and that "the term does not include a person who breeds dogs authorized by this bill to "impose administrative sanctions upon such or cats as a hobby." Furthermore, there are specific restrictions on registered volunteers for certain conduct, to report such sanctions to the "breeders" in regards to the minimal age of the animal when first bred, state in which the volunteer is licensed, and to impose administrative the frequency of pregnancies thereafter, and the care of the animals sanctions upon a health practitioner licensed in this state [Nevada] for being bred. Regulations to implement the provisions of this act may certain conduct in another state if the practitioner was volunteering be proposed any time after June 16, 2012. in that state under this Uniform Act." Regulations implementing the SB191 – Animal Crematoriums – This bill eliminates certain
provisions of this bill may be proposed any time after June 2, 2011.
restrictions on where animal crematories may be located, delegating much of the permitting process to the Nevada counties, cities, and Relating to Board Operation: towns. Further, provisions of the bill require that, in facilities where human remains are also cremated, the animal cremations must be AB37 – Hours of Operation – This bill authorizes state agencies to
accomplished in facilities dedicated to that purpose and that the modify office hours as they see best, in order to serve their stakeholders dedicated area must be posted so that the public may be aware of this so long as there is a forty hour work week. There must be public fact. The provisions of this bill became effective October 1, 2011. notification of any changes in office hours at least 30 days prior to implementation of the changes and office hours must be posted at the agency's office and on its Internet site. If there are any changes in The full text of all of the bills listed above may be accessed at: the hours of operation of our office, we will let you know in advance. The provisions of this bill became effective July 1, 2011.
AB257 and AB59 – Open Meeting Law – These bills implemented
changes in the operation of our meetings that increase the opportunity for public comment and provide an opportunity for public comment about any citations public boards receive regarding violations of the open meeting regulations. Applicable portions of this bill became effective on July 1, 2011.

ANNUAL BOARD UPDATE NOVEMBER 2011 The Evolving Standard of Care By Scott Bradley, DVM Of the many challenges and issues the Nevada State Board of Veterinary treatment plan based Medical Examiners engages in regularly the topic of the Standard of Care on the available frequently generates the greatest discussion. Reviewing sources such information is as the AVMA, AAHA, the American Association of Veterinary State deemed adequate Boards, and VIN indicate this is not isolated to our board. State practice acts do not set specific guidelines because the concept of "Standard of documentation of the Care" is inherently dynamic. The rapid increase in technology, advances client communication in science, and proliferation of specialists contribute to the ever evolving and development of standard. The Standard of Care (SOC) of 2006 is not the SOC of 2011. that treatment plan This difference has placed a greater emphasis on the continuing education is supportive. This requirements for veterinarians and licensed technicians as evidenced by documentation can the recent increase in Nevada's continuing education requirements for be a key factor in these groups.
the determination James Wilson, DVM, JD states in "Law and Ethics of the Veterinary of whether or not a Profession", that under the negligence law that we are to provide a complaint is dismissed or a decision is made to proceed with SOC equal to other practitioners and under the malpractice law we are disciplinary action.
"to exercise the care and diligence as is ordinarily exercised by skilled veterinarians". He explains that the "reasonable man" concept is the In the past, the SOC was influenced more significantly by locality, rural basis of the law of negligence and malpractice and adds that the law vs. suburban/urban, and the proximity of specialists and overnight care says that reasonable practitioners, not the best or the most highly skilled facilities. Clients who animals would benefit from close monitoring in a professionals, set the standard. Specialists and boarded doctors are held to locale in which on-site overnight care is available should be informed of a higher level of SOC. As long as we are not using outdated or blatantly that option. Likewise, where patients that could possibly be better served inferior skills, we should be able to achieve the SOC for the average by a specialist in the vicinity, that option should be presented to the owner and such a discussion with the owner should be documented regardless of the choice made by the owner. At times, we all struggle with decisions During the discussion of consumer complaints filed with that balance the best interests of the clients and patients with practicing in the Board, we address possible omissions of medically indicated a manner that is geared toward avoiding litigation or potential disciplinary diagnostics as well as acts that produce adverse or undesired action. Diligence in our client communication and documentation serves results. Tempering the concerns regarding diagnostic omissions both sides of that challenge well. The NSBVME office has a number of or choice of treatment plans are the economics of a case; if the examples of effective release forms available for practitioners to adapt to owner cannot afford confirmatory diagnostics then a reasonable their existing forms that will enhance the communication process.
Letters of Caution By Louis Ling, ESQ.
One of this Board's primary responsibilities is to investigate complaints aspect of his or her practice made to this Board by Nevada's citizens who claim to have suffered could be improved so that harm as the result of the acts of our state's veterinarians and veterinary the practice's patients are technicians. The Board takes these complaints very seriously and better and more safely investigates every one. Many investigations find that no violation of served and so that the Nevada's veterinary laws occurred; a few investigations find that a veterinarian or veterinary provable violation of Nevada's veterinary laws did occur.
technician can avoid future complaints and scrutiny Occasionally an investigation finds that a veterinarian's practices and from the Board. Only acts could be improved. In these types of cases, the evidence may in the rare case where a not be strong enough to fairly charge the veterinarian or veterinary veterinarian or veterinary technician involved, but there was enough found to merit cautioning technician ignores or the veterinarian or veterinary technician. In such cases the Board may contravenes a letter of caution does its existence come to light in the issue a letter of caution.
unfortunate context of a formal, public disciplinary action.
A letter of caution is NOT disciplinary action, and a letter of caution The Board commends Nevada's veterinarians and veterinary is NOT publicly reported, either through the Board's website, through technicians who want to serve their patients to the best of their abilities a public records request, or to national databases. Instead, a letter of and in compliance with all applicable laws. The Board has found caution is the Board's way of communicating - just between the Board that letters of caution are a valuable tool to provide specific guidance, and the veterinarian or veterinary technician - that there were things suggestions, and reminders to Nevada's veterinarians and veterinary found in an investigation that caused the Board concern. The intent technicians who have drawn a consumer complaint. is always to inform the veterinarian or veterinary technician that some

ANNUAL BOARD UPDATE NOVEMBER 2011 The Traveling Pet By Richard Simmonds, DVM, MS, ACLAM As a result of a complaint received by the Board involving Further, within its policy, the AVMA suggests the following an acclimation limitation placed on a heath certificate by the verbiage for the acclimation statement: "The animal(s) in this examining veterinarian, the requirements and cautions regarding shipment appear healthy for transport but need(s) to be maintained health certificates were investigated and, as a service, we are at a range of ambient temperatures to which the animal(s) has/ publishing here a summary of our findings.
have been acclimated, as determined in consultation with the owner/authorized agent to be no lower than (W degrees) F for The specific content of intrastate, interstate, and international (X) minutes and no higher than (Y degrees) F (not to exceed 85 health certificates for animals can vary significantly between states F) for no longer than (Z) minutes." and countries as well as be dependent on the species involved. When completing a health certificate, veterinarians should be sure If the statement of acclimation is not written directly on the they are familiar with the requirements of the state in which they health certificate, the statement should contain the following are practicing (in regards to intrastate transport and export of the information even if it duplicates what is on the health certificate animals from the state) and the requirements of the state or country to which the statement is attached: "(1) Name and address of to which the animals are being transported. Currently, U.S. Federal consignor; (2) The number and identification of animals in the regulations regarding health certificates are limited to "dogs, cats, shipment; (3) A certifying statement; (4) The signature of the USDA nonhuman primates or additional classes of animals designated accredited veterinarian, assigned accreditation number, and date." by USDA regulation." Furthermore, most states have mandated, or will accept, the USDA "Certificate of Health Examination for Small Animals" (APHIS Form 7001) and the various health examination forms for livestock and exotic species; most of these certificates are only valid for 30 days from the date of execution. In regards to inclusion of "acclimation statements" on health certificates, AVMA policy states: "An acclimation certificate is used to allow airlines to ship dogs and cats when the airline cannot guarantee compliance with animal welfare regulations, specifically the minimum temperature allowed by the regulations. Veterinarians may advise clients not to ship animals with transporters or airlines that cannot guarantee compliance with animal welfare regulations. In accordance with the Code of Federal Regulations 9 CFR section 3, regardless of the temperature range suggested by the owner/authorized agent or veterinarian, ambient temperatures listed in the acclimation certificate cannot be higher than 85 F for more than four consecutive hours while in animal holding areas of airport terminals or for more than 45 minutes while transferring the animal between the aircraft and the animal holding area. Carriers or intermediate handlers whose facilities fail to meet the minimum temperature allowed by the standards may accept for transportation or transport, in commerce, any live The Board and staff would like to thank Craig Schank, animal if the consignor furnishes to the carrier or intermediate DVM, Past-President, for his nine years of leadership, handler a certificate executed by an accredited veterinarian stating dedication, and commitment to this Board and the that such live animal is acclimated to air temperatures lower than citizens of Nevada.
those prescribed in the CFR (45 degrees F)."

ANNUAL BOARD UPDATE NOVEMBER 2011 Hospital Inspections By Christina Johnson, LVT Another milestone has been accomplished this year. Every hospital in Nevada has now been inspected at least once; now we are on to our second and third round of inspections. One of the most asked questions during inspections is, "How does my hospital compare to others?" Every hospital is its own entity and not to be compared to one another but against the state standards. Again, I have had complaints this year, "How can you put me in a box and compare my hospital to these standards?" There must be a starting point for everything, these are standards set as a minimum starting point and most hospitals are doing much more than the required minimum, the inspection committee applauds these efforts. This year some improvements were seen in the number of violations per hospital; however, the Board is still seeing a lot of the same violations. Surgical equipment is expired or inappropriately sterilized, expired controlled drugs and inaccurate controlled drug logs are still the top three violations substances very seriously, as the holder of the DEA number for your facility you must know what drugs are being received and Surgical equipment regardless of method of sterilization, what is going out, know if you have a loss and insure that your wrapping method or storage must be sterilized at least every logs are balanced to protect your DEA privileges. There is no year. Instruments that are not going to be used within that one hard and fast rule about how your drug log has to look or be set year window are to be kept unwrapped and sterilized as needed up. It can be on paper or paperless. in order to avoid expired equipment and breakdown of equipment The Board is here to help, if you have any questions or need due to over sterilization without use.
more information please feel free to contact us.nvvetbd@vetboard.
Expired controlled drugs no longer need to be picked up by nv.gov, or (775) 688-1788.
the Pharmacy Board or DEA. In Nevada, the Pharmacy Board
and DEA have agreed to allow veterinarians to destroy expired Form 41 mailing addresses:
controlled substances‘in clinic' to avoid large volumes of drugs Nevada State Board of Veterinary Medical Examiners
piling up or waiting for pick-up and avoid diversion. The form 4600 Kietzke Lane, Building O, Suite 265, Reno, NV 89502 required for disposal is easily acquired, simply google DEA form
41 pdf. Controlled substance tablets are crushed first and liquids Drug Enforcement Agency
are draw out of vials, these are mixed with either dirty kitty litter 255 East Temple Street, Los Angeles, CA 90012 or used coffee grounds, everything needs to be double bagged
and disposed of in the trash or incinerated. The form requires that Nevada State Board of Pharmacy
the disposal be witnessed and the form is signed by that witness. 431 West Plumb Lane, Reno, NV 89509 The form once complete is copied three times with the original sent to DEA, one copy to the Pharmacy Board, one copy to the Veterinary Board and one kept for your records.
Drug logs are the most important violation that needs to be addressed. Controlled substances need to be a top priority in every clinic. DEA and Pharmacy Board take a loss of controlled

ANNUAL BOARD UPDATE NOVEMBER 2011 What Clients Expect, What I Expect By Beverly Willard, Public Member "I am your client. Satisfy my wants and the needs of my pets. Add personal attention and a friendly touch, and I will become a walking advertisement for your services and What an important statement! Have you ever just walked in, sat down in your reception area and taken a look around and Is it a clean friendly area? Are your clients and their pets greeted with a warm smiling face and a gentle voice? Does your staff show genuine concern for helping with the needs of your clients and their pets? "Ignore my needs, show carelessness, inattention, and poor manners, and I will simply cease to exist as far as you are money I spend. When I am dissatisfied, take heed. The source Too many times we receive complaints from the public of my discontent lays in something you or the service you gave about the lack of concern or caring on the part of the staff has failed to do. Find that source and eliminate it or you will and/or of the veterinarian not taking that extra minute to lose my business and that of all my friends as well; for when I communicate whatever it takes for the client to understand and criticize your services I will talk to anyone who will listen." feel his or her animals are given the best care possible.
The paragraphs in italic are part of a statement my "I am sophisticated, much more than I was a few years husband presented to all of our employees. He would give ago. I am proud. My ego needs the nourishment of a friendly, them a cash bonus if they could memorize and recite it without personal greeting from you. It is important to me that you appreciate my business." I will close with this statement "People equally informed "I am a perfectionist. I want the best I can get for the seldom disagree." Disciplinary Action The following is summary of disciplinary action taken by the Board in the past year: Conditions of the Order NAC 638.041 (3), in that the Licensee failed to obtain the • The Licensee shall be audited, at a minimum, from 2011-2013. required continuing education.
• The Licensee will pay attorney fees and investigative and Board costs of $250.00 and a fine of $500.00.
NAC 638.045 (2), negligence, based upon the allegation that • Probation 1 year the licensee failed to provide the owner with choices regarding • Adopt and use a medical records form approved by the the treatment and diagnostics. Board's President NRS 638.1402 (4), altering medical records and in presenting • Practice monitor for term of Probation the altered records to the Board. • Pay attorney fees and investigative and board costs of NAC 638.0475 (2), failing to make and maintain sufficient medical records. NAC 638.045 (2) negligence, a departure from the standard • The Licensee shall take an additional five hours of continuing of care for veterinary medicine when a diagnoses of education specifically to thyroid diseases in felines.
hyperthyroidism was made and Methimazole was prescribed • Pay attorney fees and investigative and board costs of $400.00.
and timely testing was not performed to monitor for possible adverse side effects for the treatment with Methimazole.
NAC638.045 (2), negligence in the assessment of the dog • Pay attorney fees and investigative and board costs of $400.00.
because the licensee did not recognize the gas in the stomach to be a potential dangerous life threatening sign and failed to inform the owner of what signs and symptoms to watch for, and what to do if the signs and symptoms may have occurred.

ANNUAL BOARD UPDATE NOVEMBER 2011 Frequently Asked Questions About Extra Label Drug Use & AMDUCA By Craig L. Schank, DVM I have titled my article after a previously published A.V.M.A. article with the same title. It is my intent to reacquaint us with a bit of legislation passed in October 1994 that broadened our ability as veterinarians in the treatment of our animal patients. That act was called "The Animal Medicinal Drug Use Clarification Act of 1994" or A.M.D.U.C.A. In essence, it gives us the legal ability to prescribe extra-label uses of approved animal and human drugs "when the health of the animal is threatened or when suffering or death may result from the failure to treat animals".
There are a few guidelines to follow to keep us "legal" as we use these drugs "extra-label". I will ask and answer just a few questions included in the above mentioned article with the hope that this will pique an interest to read the entire article: http://www.avma.org/ 1. A horse needs to be treated with enrofloxacin based on culture and sensitivity results. No horse-labeled products are available so the veterinarian could consider using a bovine-labeled 1. Q: What is Extra Label Drug Use? (ELDU)
A: ELDU describes the use of an approved drug in a manner 2. A dog being treated for conjestive heart failure by its that is not in accordance with the approved labeling yet meets the veterinarian and furosemide is part of that therapeutic plan. conditions set forth by AMDUCA and FDA regulations. These There are FDA approved products labeled for use in dogs but deviations may include use in other species, use for a different the veterinarian recommends the human product from the local indication, use at a different dosage or frequency, or different routes pharmacy for economic reasons; a prescription for ELDU of of administration.
the human product is acceptable. 2. Q: Isn't ELDU only for food producing animals?
5. Q: Do I need to tell my client when I have prescribed an
A: No, ELDU regulations apply to all animal species.
A: You should always discuss the available treatment options with your clients, especially when extra-label use is indicated. It is 3. Q: Who regulates ELDU and enforces regulations?
important for the client to understand that you are prescribing a drug A: FDA Center for Veterinary Medicine regulates ELDU and, in a manner that is uncommon and there may be risks associated in cases of violations, can issue warning letters, seizure of product, issue fines, injunctions or criminal prosecution.
I again encourage you to click on the A.V.M.A. link and become 4. Q: When is ELDU necessary?
more familiar with this important legislation that allows us to treat and prescribe under the guidelines of A.M.D.U.C.A., and many A: The A.V.M.A. has developed an algorithm to help other important questions that are commonly asked are covered.
veterinarians determine when it is appropriate to use ELDU. See: http://www.avma.org/reference/amduca/extralabel_brochure.pdf Items in the article have been reprinted with permission from Dr. Kimberly May, co-author of the article titled Frequently Asked Here are a couple of examples of circumstances in which ELDU Questions about Extralabel Drug Use and AMDUCA. ANNUAL BOARD UPDATE NOVEMBER 2011 Frequently Asked Questions By Tracie Estep Q - How long do I need to keep medical records? A - (NAC 638.0475)
How long do I need to keep x-rays? Does it matter Medical records, including x-rays, for an animal, alive or deceased,
if the animal is deceased?
need to be kept in Nevada for four (4) years.
Q - How many hours of CE do I need every year. A - (NAC 638.041)
How many can be done online? Can I carry them Veterinarians/Diplomates – must complete 20 hours of CE every
calendar year.
NAC 638.042 Courses deemed approved by Board. (NAC 638.041)
Licensed Veterinary Technicians – must complete 10 hours of CE every 1. The American Veterinary Medical Association; calendar year2. A specialty group of the American Veterinary (NAC 638.770) Medical Association; Animal Physical Therapists – must complete 5 hours of CE every 3. The Western Veterinary Conference, the Wild West Veterinary Conference or any other regional (NAC 638.820) veterinary conference; Animal Chiropractor – Must complete 15 hours of CE every year 4. The State Department of Agriculture; CE CANNOT BE CARRIED OVER FROM YEAR TO YEAR
5. The United States Department of Agriculture; 6. The American Animal Hospital Association; 7. The American Association of Veterinary State 8. The Nevada Veterinary Medical Association; 9. An institution of the Nevada System of Higher 10. A school of veterinary medicine that is accredited by the Council on Education of the American Veterinary Medical Association; or 11. A program for veterinary technicians that is approved by the Committee on Veterinary Technician Education and Activities of the American Veterinary Medical Association.
Q - Where in the "law" does it state that I have to A – (NAC 638.620)
examine an animal before vaccinating it?
Duties of veterinarian before administration of vaccine.
1. A veterinarian who administers vaccines at a vaccination clinic or a veterinary facility shall, before administering a vaccination to an animal, conduct a physical examination of that animal.
Q - What are the procedures for abandoned
A - (NAC 638.051)
Ten days after the date it was agreed that the animal was to be claimed the animal may be deemed abandoned. A certified letter must be sent to the last known address of the owner stating the veterinarian will dispose of the animal if it is not claimed within 10 days from the date the letter is mailed. "Claim" means to remove the animal from the custody of the
Q - How do I change my mailing/home/facility A –
There are three ways to change your contact information with the Board.
1) Website – www.nvvetboard.us Under online services - Address/Name Changes 2) Call the Board Office (775) 688-1788 3) Fax information (775) 688-1808 ANNUAL BOARD UPDATE NOVEMBER 2011 Q - How long do I have to send medical records after A – (NAC 638.0475)
they have been requested? Can I hold them if the The records must be available for inspection by the owner of the animal
owner's bill has not been paid?
during normal business hours at least 5 days each week. Except as otherwise provided in this subsection, the licensed veterinarian shall provide a copy of that record to the owner of the animal receiving veterinary services not later than 48 hours after receiving a request from the owner of the animal. Each X ray is the property of the veterinarian who caused it to be prepared. An X ray may be released to the owner of the animal. An X ray must be released within 48 hours after the request is made to another veterinarian who has the authorization of the owner of the animal to which it pertains. The X ray must be returned within a reasonable time to the veterinarian to whom it belongs. You cannot hold the medical record for nonpayment.
Q – Does a veterinarian have to be registered
A – (NRS 453)
with the pharmacy board and the DEA in order
A veterinarian who is not registered with the Drug Enforcement to administer, prescribe, or dispense a controlled Administration of the United States Department of Justice and the State
Board of Pharmacy as described in subsection 1 may possess, administer, prescribe or dispense a controlled substance at a veterinary facility if the a. Is an employee or agent of the veterinarian who is registered pursuant b. Practices in the same veterinary facility as the veterinarian who is registered pursuant to subsection 1; c. Possesses, administers, prescribes or dispenses the controlled substance in the normal course of his or her employment; and d. Complies with all the requirements and duties prescribed by law relating to the possession, administration, prescription and dispensing of a prescription drug.
Q - During a vaccination clinic do I (the veterinarian) A – (NAC 638.610)
have to keep a full medical record?
Conduct and record of examination to determine whether animal may be 1. An examination conducted to determine whether an animal may be vaccinated at a vaccination clinic or a veterinary facility must include, without limitation, an examination of the temperature, pulse and respiration of the animal to determine: (a) The presence of any respiratory, intestinal or other organ disease that may affect the efficacy of the vaccine; and (b) Whether the hydration of the animal is normal.
2. A medical record of the examination must be kept.
Q – When do I qualify to be a Veterinary
A – (NAC 638.0525)
Technician-in-Training? When does my VTIT
1. A person may perform the tasks of a veterinary technician under the immediate supervision of a supervising veterinarian or licensed veterinary technician while the person is receiving the training and experience required by paragraph (h) of subsection 2 if he or she is registered with the Board pursuant to this section.
2. To be registered as a veterinary technician in training, a person must be: (1) A fourth-year student enrolled in a 4-year program, a second- year student enrolled in a 2-year program or a student enrolled in an accelerated program and the program of training must be accredited by the Committee on Veterinary Technician Education and Activities of the American Veterinary Medical Association or be approved by the Board; or (2) A person who has graduated from a program of training described in subparagraph (1) and is scheduled to take, or has taken but not yet received a score for, the Veterinary Technician National Examination; 3. A registration issued pursuant to this section between: (a) January 1 and August 31 of any year expires on September 1 of the next subsequent year; and (b) September 1 and December 31 of any year expires on September 1 of the year immediately following the next subsequent year, unless the Board grants an extension of the period of registration.
ANNUAL BOARD UPDATE NOVEMBER 2011 Record Keeping for Consultations By Bill Taylor, DVM, ABVP Nevada law states: The medical record must contain the following information, in The name of each person who is not an employee of the veterinar- ian who provided professional advice or performed treatments, exam- inations or other services pertaining to the animal; (NAC 638.0475) In our practices, each of us consults with our fellow veterinarians. The documentation of "consults in the medical records was recently discussed at a Board Meeting. Most of the veterinarians on the Board are actively practicing and realize that we do not want to make com- plying with this law onerous to the practitioner. I have detailed some of the types of consultations and how the medical record might "con- tain the information." 5. The traveling specialist or practitioner – Hopefully, when the Types of Consultations: surgeon or ultra-sonographer performs a procedure at our hospital they will provide a written report. A note would be 1. Outside consultations with an involved specialist – There are made in the medical record stating: "Dr. D performed a TPLO many specialists with whom we might consult: a laboratory on the right leg." If they do not provide a description of the consultant or pathologist, radiologist, cardiologist, etc. who procedure, it is your responsibility to do so.
have access to our patients' data and can give us an opinion based on this information and any other that we supply during 6. The in-hospital consult - Many times, we may discuss a case the discussion. The record might look like this: "08/14/2011 among our fellow practitioners in the hospital. If they agree - Dr. A at ABC Laboratory recommended Bile Acid Tolerance with your previous diagnosis or plan, it is not necessary to if abnormal followed by an ultrasound. DDX: vacuolar hepa- make comment unless you wish a corroborating opinion. If topathy {we ALL love that one!!}, neoplasia, infectious hepa- they present an opinion that changes our course of action, this should be noted in the record: "During rounds, Dr. E recom- mended to add IV metronidazole." There's the fly-by consult 2. Telephone or personal conversation with a specialist – We call by a specialist or associate, "Yep there's a cranial drawer" or a friend, classmate, or speaker from a conference to discuss a "that looks like an obstructive pattern"; the Board does not case. After providing an Hx, diagnostic results and our clinical expect the individual to stop and write a report in the record, impressions, they provide us with a wealth of information and unless they wish to, but we should write: "Dr. F palpated the suggestions. The record might look like this: "08/14/2011 - Dr. left stifle and felt a cranial drawer." B at Missouri VMTH recommended testing for tick-born dis- ease, fungal titers and a joint aspirate with cytology and culture." 7. The surgery report – While this does not directly fall under this statute, it is a problem we often find in medical records 3. Online Consultations – There are several sites that allow us to we review. It is not necessary to write the details of every post questions on an internet message board regarding a case. neuter, but a detailed description can be written and kept on The information may contain history, physical exam, lab data, file and referred to in the record as: "followed routine ABC- images, etc., and may be from specialists and fellow practitio- AH procedure for closed castration using 2-0 vicryl for liga- ners. The record may read: "See copy of the VIN post." tures and closure." For paperless practices, a prewritten de- scription could be inserted; any variance or changes would be 4. The "bar napkin" consultation – After a meeting or at dinner noted. For less frequently performed procedures that would with a fellow practitioner, we discuss a case and say something not have a pre-written description, you would note: "routine like "boy I saw a weird one today, whataya think?" The medi- lateral approach to the femur" or "followed the procedure for cal record may reflect this conversation by stating: "Discussed PU as described in Bojarb's Current Techniques." with Dr. C, and he suggested adding gabapentin and acupunc- ture to help in pain control until the liver values return to normal." ANNUAL BOARD UPDATE NOVEMBER 2011 Creating and Maintaining Medical Records By Mike Chumrau, DVM NAC 638.0475 requires that each licensed veterinarian in the state of Nevada maintains for a period of at least four years, a separate medical record of each animal receiving medical services. The record must include a physical examination of the animal sufficient to develop a Veterinary-Client-Patient- Very often consumer complaints come to the board after a series of treatments have been tried without acceptable results When someone picks up a medical record with the intent of and the owner has gone for a second opinion. At the secondary learning what happened during the period of care of a patient the hospital, testing is done that results in a diagnosis. Additionally, information required in the record needs to be in a chronological, the owner wants to know why the tests were not done before organized, and detailed order. The record tells the story of what and if it was acceptable medicine not to require the tests. The happened, when it happened, how it happened, and why it medical record defends that the tests were offered and declined. happened. It is not uncommon for the board to receive a medical In the end, it is the medical record that defends what has been record that is not complete, illegible, and does not contain an done while the animal was in your care.
organized communication log recording conversations between the client and veterinarian.
At the end of an appointment, clear written instructions should be reviewed with the client and noted in the record. Don't Each visit requires its own record that starts with the owner's forget the client has also accepted responsibility in the care of reasons for coming to the hospital. The signs or behaviors that the animal and has agreed to follow your instructions. Warnings cause the concerns need to be recorded as they are presented; this concerning the use of certain drugs and their side effect should portion of the record can be created by the technician in the exam be in writing and of record such as NSAIDS. It is prudent that room. It has always been of great interest what an owner will any suggestions about offering referral to a specialist appear at a tell a tech that they won't tell a doctor. A point to be made here reasonable time in the record and all conversations regarding the is that ID (initials) of the person entering into the record should animals care and status need to appear as part of a comprehensive appear by the entry. The physical examination data and answers medical record. You should have a person on your staff assigned to questions posed to the owner will determine the objective to review medical records prior to filing. entries made by the veterinarian and these can be presented as symptoms. This is the place in the record to detail tentative diagnosis and/or rule outs and to record the recommendations and the diagnostic and therapeutic plan. If the owner declines your recommendation, this needs to be recorded as well.
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Source: https://www.nvvetboard.us/glsuiteweb/clients/nvbov/public/NVBOV_Information/NVBOV_Newsletter_2011.pdf