Legal update: Telemedicine for veterinary practices during COVID-19
As the spread of COVID-19 continues to increase rapidly across the globe, there are still many uncertainties between the relationship of animals and the virus. The Centers for Disease Control and Prevention (CDC) is only aware of a small number of animals infected with the virus after close contact with infected people. While human to animal transition of COVID-19 is rare, the CDC and American Veterinary Medical Association (AVMA) constantly provide updated guidelines on the operation of veterinary practices, as they are deemed essential healthcare businesses.
The CDC recommends that veterinarians minimize contact with pet owners through the use of telemedicine for consults and for helping triage patients. However, States vary on their requirements for the ability to use telemedicine and establish a veterinary-client-patient relationship (VCPR). For instance, in Hines v. Alldredge, 783 F.3d 197 (5th Cir. 2015) the Fifth Circuit upheld the Texas State Board of Veterinary Medical Examiners (TBVME) requirement for an initial in-person examination to establish a VCPR. While the TBVME has issued guidelines on telemedicine, the Board holds that veterinarians must adhere to Texas laws and regulations regardless of whether they’re offering face-to-face services or services by telephone, internet, or other electronic means. Since Texas law prohibits a veterinarian from forming a VCPR solely by telephone or electronic means, the veterinarian must perform an in-person examination. In such cases, the veterinarians must abide by the CDC operating guidelines.
Similarly, Georgia, Illinois, Indiana, Mississippi, Utah, Tennessee, and Washington, are all additional states that do not allow VCPR to be established solely by telephone, computer, or other electronic means. On the other hand, some states have comparatively relaxed VCPR requirements, especially since the onslaught of COVID-19. For instance, in California, under the Code of Regulations Title 16 Section 2032.1, a VCPR is established where the client has authorized the veterinarian to assume responsibility for making medical judgements regarding the health of the animal, the veterinarian has sufficient knowledge of the animal to initiate a preliminary diagnosis, and the veterinarian has assumed responsibility for making such medical judgements regarding the health of the animal. There is no mention of a specific in-person initial examination, and thus, telemedicine can be conducted within an existing VCPR through such means in California.
In New Jersey, on March 19, 2020, Governor Murphy signed into law P.L. 2020, c. 3, which authorized the waiver of any state requirement necessary to facilitate the provision of health care services using telemedicine during the state of public emergency declared in response to COVID-19. Recently, as of June 18, 2020, Administrative Order and Notice of Rule Adoption Pursuant to P.L. 2020, C. 18, provides that veterinarians are authorized to provide the full scope of veterinary services. One of the requirements of the Administrative Order is to avoid person-to-person contact with animal owners and clients, encouraged through the use of telemedicine to the greatest extent possible. Thus, New Jersey is an example of a state with relaxed veterinary guidelines.
Overall, each state has its own guidelines to follow in terms of veterinary telemedicine practices. The AVMA informs that most smartphones, tablets, and laptops provide the necessary audio, visual, and data transfer capabilities to conduct basic telemedicine consults. Furthermore, in cases where no VCPR exists, the veterinary care professionals can only offer general advice that is not specific to a particular patient. Some of the areas where veterinarians are utilizing telemedicine services with an existing VCPR include: general wellness care, after-hours care, post-surgical care, hospice care, and facilitating access to veterinary care. Thus, veterinary telemedicine is decreasing in-person interaction and helping to prevent further spreading of COVID-19, while still providing for the health care needs of animals.
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