— Adds additional definitions and updates existing definitions language for clarity.
— Renames “temporary permit” to “temporary veterinary permit” and renamed “temporary consulting permit” to “veterinary consulting permit.”
— Changes language to use the word “dispense” rather than “sell” to be more consistent with statutory language and definitions to make the language clearer and easier to understand.
— Adds a note clarifying that the board accepts “veterinary nurse” as equivalent to “veterinary technician.”
Telehealth Changes
— Adds definitions related to telehealth.
— Adds definitions related to veterinary consulting and clarifies that a consulting veterinarian or other consultant may not do any of the following:
— Visit the patient or client or communicate directly with the client without the knowledge of the attending veterinarian.
— Take charge of a case or problem without the consent of the attending veterinarian and the client.
— Clarifies that the practice of veterinary medicine takes place where the animal is located at the time of practice, in alignment with Wis. Stat. §§ 89.05 (1) and 89.02 (6). — Clarifies that in order to practice veterinary medicine in Wisconsin a veterinarian must be licensed in Wisconsin and have an established veterinary-client-patient relationship (VCPR) with the client. A VCPR must be established via an in person physical exam, or timely medically appropriate visits to the premises on which the patient is kept. It may not be established by telehealth technologies.
— Clarifies that the VCPR, once established, extends to other veterinarians within the practice, or relief veterinarians within the practice, that have access to, and have reviewed, the medical history and records of the animal.
— Clarifies that records must be kept, regardless of the encounter type.
— Clarifies, in accordance with Wis. Stat. § 89.02(8) (c), that an animal owner must be able to easily seek follow-up care or information from the veterinarian who conducts an encounter while using telehealth technologies. — Expands the delegation of medical services to allow a veterinarian to delegate the following items to a certified veterinary technician (CVT) if the veterinarian is available to communicate via telehealth technologies within five minutes. Under current rules, these items may only be delegated to a CVT if the veterinarian is personally present on the premises.
— Performing diagnostic radiographic awake contrast studies not requiring general anesthesia.
— Sample collection via a cystocentesis procedure.
— Placement of intravenous catheters.
— Suturing of tubes and catheters.
— Fine needle aspirate of a mass.
Summary of, and Comparison with, Existing or Proposed Federal Statutes and Regulations
Pursuant to 9 CFR 160 to 162, a veterinarian must be specifically authorized by the United States Department of Agriculture – Animal and Plant Health Inspection Service to perform animal disease eradication and control functions under federal animal health laws. Licensure requirements to practice veterinary medicine are established by each state and should not be affected by federal requirements.
Summary of Comments Received during Hearing and Comment Periods
Preliminary Public Hearing and Comment Period on the Statement of Scope
The Board held a preliminary hearing on SS 064-20 on August 19, 2020, with a written comment period through August 26, 2020. The Board received three comments. One comment was for information. Two comments expressed support of the scope, both expressed support of including telehealth in the scope, and one also expressed support of including addressing the circumstances under which a veterinarian may dispense a drug for a patient of another veterinarian in the scope. Comment Period on the Economic Impact Analysis
The economic impact analysis was posted for 14 days, with comments accepted through June 21, 2021. One comment was received. The comment noted a typo in the plain language analysis, which has been corrected. The comment also expressed objection to the term “veterinary nurse,” stated that there are objections from the national nursing organization regarding the term, and stated that “nurse” does not adequately encompass the skills and knowledge base of veterinary technicians. The rule draft does not use “veterinary nurse” to refer to veterinary technicians, but does include a note that states that the Board accepts the classification of “veterinary nurse” in other jurisdictions as equivalent to “veterinary technician.” While the Board, and this rule, does not use “veterinary nurse” to refer to veterinary technicians, this note clarifies that the Board accepts the term as equivalent when used by other jurisdictions.
Public Hearing and Comment Period on the Preliminary Rule Draft
The Board held public hearings on the preliminary rule draft on September 9 and 15, 2021, with comments accepted through September 29, 2021. Both hearings offered a combination of in-person access and remote access. The Board sent an email notice to licensees notifying them of the hearing and comment period, in addition to the posting in the Administrative Register. The Board received 3 comments at public hearings and 25 written comments. There were 26 total commenters. Of these 26:
— Nine expressed support of the proposed rule. Of these nine:
— Nine also specified support of the veterinary-client-patient relationship (VCPR) definition
— Eight also specified support of the omission of Assisted Reproductive Technologies (ART) procedures in delegation changes
— Two also expressed that ART procedures should not be delegated to a CVT at all
— One also expressed opposition to delegation without the veterinarian on the premises generally
— Six also expressed support of language regarding veterinarians filling prescriptions for other veterinarians
— Fourteen expressed opposition to the VCPR definition
— One expressed opposition to the omission of ART in delegation changes
— Two did not express a position for/against the proposal
— One expressed concerns about existing rabies provisions
VCPR Definition
The hearing draft created a new section regarding telemedicine and stated that “In order to practice veterinary telemedicine in Wisconsin, a veterinarian must be licensed in Wisconsin and have an established VCPR with the client. A VCPR must be established via an in-person physical exam, or timely medically appropriate visits to the premises on which the patient is kept. The VCPR may not be established by telehealth technologies.”
Comments expressing opposition to the VCPR definition expressed that:
— There are cases where a veterinarian cannot do a physical exam because of the aggression displayed by the patient
— The VCPR definition is restrictive and will negatively impact pet owners, foster care providers, and animal shelters
— Telecommunicating might make veterinary services more affordable
— Access to veterinary care in northern Wisconsin is challenging and referral after hours is to a clinic over an hour away
— Being able to establish a VCPR via virtual tool would allow more pets to receive care at critical times
— Telemedicine can provide quality, and potentially lifesaving care, improve efficiency and flexibility in scheduling options, and provide benefits to pet owners without access to transportation or who are unable to easily leave their homes
— Dogs and cats needlessly suffer, experience premature death, or are relinquished to animal shelters due to gaps in veterinary access, and telemedicine is a critical tool for the veterinary community to bridge gaps in care
— While physical veterinary medical examinations are sometimes critical, responsible use of telemedicine can bring essential care to more animals
— The education and licensing requirements that veterinarians undertake prepare them to utilize professional judgement in determining whether telemedicine is appropriate in the care of a particular animal or condition
— The rule could require safeguards with criteria for establishing a VCPR through electronic means
— Telehealth technologies have been used to create a human physician-patient relationship, including infants and nonverbal children
— The American Association of Veterinary State Boards (AAVSB) practice act model language supports allowing a veterinarian to establish a VCPR through telemedicine
— Support options 2 and 3
— Support Michigan and Washington policies
Comments expressing support of the VCPR definition expressed that:
— The statutory definition of VCPR under Wis. Stat. s. 89.02 (8) requires that the veterinarian has recently examined the patient or has made medically appropriate and timely visits to the premises on which the patient is kept, the VEB is granted authority to promulgate rules within the limits established by the statutory authority granted to it by the legislature, and the VEB may not change the VCPR definition but may allow the use of telehealth technologies within the scope of the statutory definition — The telehealth changes are good and oppose moving them beyond what was proposed in the hearing draft
— In-person contact is critical for the long-term care of the patient
— While telehealth is an excellent tool for managing very specific cases, it does not provide enough background for a broad picture view of a farm in its entirety
— There is a critical difference between providing care to animals and humans because animal patients cannot directly communicate their pain or their symptoms to a veterinarian using language
— The owner can misinterpret an animal’s condition
— A physical exam or visit to the premises provides a more complete understanding of the animal, its medical history, the environment, and the client in order to provide the highest standard of care, and it is critical to the safe and effective provision of veterinary medicine using telehealth technologies
— An in-person visit by the veterinarian serves to protect patients and clients by assuring that animals have been appropriately evaluated
