Report to Licensees
LOUISIANA BOARD OF VETERINARY MEDICINE
263 Third Street, Suite 104, Baton Rouge, LA
70801, (225) 342-2176, (225) 342-2142 fax, firstname.lastname@example.org, www.lsbvm.org
12, No. 1 August 2002
Robert Lofton, DVM, President °
J. Edwin Davis, DVM, Vice-President ° Glenn
Walther, DVM, Secretary/Treasurer ° Lon
Randall, DVM, Member ° George Gowan,
Pharmacies and Related Matters
By Michael Tomino, Board
As you may be aware, the Pharmacy Boards of various states,
including Louisiana, as well as the Louisiana Board of Veterinary
Medicine, have been engaged in a legal conflict with a well known internet
pharmacy regarding the filling of prescriptions for patients without the
appropriate veterinarian-client-patient relationship being established.
The Board notified a well known internet pharmacy by
certified mail, dated September 24, 2001, of violations of the Veterinary
Practice Act and Rules and Regulations promulgated by the Board being
committed in Louisiana. More particularly, the internet pharmacy was
dispensing prescription drugs to the owners of animals in Louisiana upon
demand (1) without a license to practice veterinary medicine issued by the
Board; (2) without a prescription issued by a person licensed to practice
veterinary medicine in Louisiana; and (3) without the establishment of the
It is the Board’s understanding that on or about April 16,
2002, a Consent Agreement was entered into by the internet pharmacy with
the Florida Board of Pharmacy wherein it was disciplined and, more
particularly, ordered to : (1) not knowingly fill, dispense, or distribute
medication for prescriptions written by veterinarians who have not
physically examined the animal for whom the prescription is written; and
(2) immediately terminate the internet pharmacy’s alternate veterinarian
program regarding veterinarians under contract or employed to write
prescriptions for medication when the veterinarian has not physically
examined the animal for whom the prescription is written.
Thereafter, a Consent Order was entered into by the same
internet pharmacy and the Louisiana Board of Pharmacy, regarding the
improper dispensing of veterinary medication to a client in violation of
applicable laws and violations pertaining to the practice of pharmacy.
The internet pharmacy entered pleas of no lo contendere to cited
violation in exchange for the Louisiana Board of Pharmacy dismissing any
and all other complaints it received against the company as of March 6,
The substance of the Consent Agreements the internet
pharmacy entered into with the Louisiana and Florida Boards of Pharmacy
echo the legal authority set forth in the cease and desist letter
forwarded by your Board referenced above, dated September 24, 2001. It is
the Board’s understanding that such illegal activities will cease due to
recent decisions by the Louisiana and Florida Boards of Pharmacy which
have primary jurisdiction over this internet pharmacy.
During the pendency of the conflict with the internet
pharmacy, the Board received complaints and inquires from various sources,
including clients, regarding a veterinarian’s legal obligation to provide
a prescription. The Board considered several legal authorities in forming
its position on this issue.
Pursuant to Rule 705.G(3), “a veterinarian may refuse to
write a prescription if it is not directly requested by a client
with whom a veterinary-patient-client relationship exists.” (underscore
added) Furthermore, Rule 1014 provides that a licensed veterinarian shall
not violate the confidential relationship between himself and his client.
For a veterinarian to provide a prescription to an internet pharmacy
without a direct request from his client, also subjects the veterinarian
to disciplinary action by the Board for violating the confidential
relationship between himself and his client by sharing treatment
information with a faceless third party by way of internet and/or
Additionally, Rule 705.G(2) states that a veterinarian
shall not be required to write a prescription for any medication that in
his medical opinion is not appropriate for the patient’s medical care.
While the American Heartworm Society may have an opinion that suggests
testing for heartworms every two (2) to three (3) years, if a veterinarian
is of the medical opinion that his patient must be seen and/or tested on
an earlier basis, such is within the scope of his professional judgement
pursuant to the Veterinary Practice Act and the Board’s Rules. Of course,
a veterinarian must act in a reasonable manner and conform to the
prevailing standard of veterinary medical practice regarding such issue.
You may also wish to note that pursuant to Rule 1001 the
Board has adopted the Principles of Veterinary Medical Ethics of the
American Veterinary Medical Association. Principle VI.A(1) provides that
attending veterinarians are entitled to charge a fee for their
professional services. In interpreting this Principle, the Board has
ruled that a reasonable fee to review a patient’s file and write a
prescription directly requested by the client is not a violation of the
Veterinary Practice Act or Board’s Rules.
More recently, the Board has been asked whether a
veterinarian can refuse to give a prescription to a paying customer if the
drug is one he is prescribing and using on that customer’s animal. The
factual scenario at issue involves a veterinarian providing the annual
examination and shots to a dog. The veterinarian in the past provided
Advantage and Heartguard to the client for administration to the patient.
However, in this particular instance the client directly requested the
prescriptions so that she might “price shop”. The veterinarian then
refused to provide the prescriptions.
In applying Rules 705.G(2) and (3) to the factual scenario
described, it is the Board’s opinion that the veterinarian can not legally
refuse to provide the prescriptions requested directly by the client.
This opinion is based on the premise that these drugs would have been the
same drugs that the veterinarian would provide and/or administer to the
In concluding, with regards
to the issue of providing prescriptions, please keep in mind your legal
obligations, as well as your rights, so as to avoid any unnecessary and
legal woes. Also, the Board office and I are available to answer any
questions you may have concerning the issue of prescriptions.
2003 License Renewal Deadline
The renewal period for the 2003-year
licensing period began on July 1, 2002. Renewal packets were mailed to
licensees the last week of June 2002. If you have not received a renewal
packet, please contact the Board office via telephone at (225) 342-2176 or
email at email@example.com to check the address on file and request another
packet. General renewal information and a generic renewal form are
available on the Board’s website at www.lsbvm.org. Currently held licenses
will expire unless renewed by September 30, 2002.
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Preceptorship Program – Host Facilities
What is the preceptorship program requirement for Louisiana licensure?
The Louisiana Board of Veterinary Medicine
(Board) has authority under La. R.S. 37:1518(10) and has established
requirements under LAC 46:LXXXV.1101-1123 for a preceptorship program required
to obtain Louisiana veterinary licensure. The preceptorship program is
required to be completed by applicants for veterinary licensure prior to a
license being issued. The preceptorship consists of eight-full weeks in
training under a practitioner whose veterinary facility has been pre-approved
by the Board.
Veterinary facilities who wish to participate
in the preceptorship program as a Board-approved host facility must complete a
Practice Assessment Questionnaire which is used by the Board to determine if
the practice meets the minimum standards required. The questionnaire includes
a job description sheet which must be completed and accepted as part of the
assessment questionnaire for approved host status. The job description sheet
requires general descriptions of duties to be performed and instructions to be
given to the preceptee by the preceptor including administrative instruction
(such as office management, financial activities, personnel supervision,
client relations), as well as medical and surgery activities. By copy of the
job description, it should be ensured that both parties to be involved in the
preceptorship understand what is to be expected during the preceptorship.
Facility approval is granted for a two-year period. Update questionnaires are
sent out for facilities that wish to continue to be a Board-approved
preceptorship host facility.
The host facility’s (preceptor’s)
responsibilities include assuming the role of instructor during the
preceptorship period by working with the preceptee under direct supervision.
Direct supervision mean that the licensed supervising veterinarian
(instructor) is on the premise with the preceptee at all times. Under direct
supervision the preceptee may perform certain activities during the
preceptorship time that an unlicensed person cannot do at any time under any
circumstance. The preceptee may legally perform surgery, diagnosis, prognosis,
and prescribing of drugs, medicines and appliances under direct supervision
and only during the registered preceptorship time. The preceptor host should
never consider or represent the preceptee (student) as being a licensed
veterinarian. The preceptor should ensure that the preceptee’s assignments
cover all aspects of private practice including office management,
bookkeeping, and economics as well as medical and surgical aspects. The
preceptor is required to evaluate the preceptee’s performance at the end of
the preceptorship time.
The Board does not have a policy or
requirements for financial compensation of preceptees during a preceptorship.
This issue is left up to the preceptor and preceptee and should be negotiated
prior to the start of the preceptorship. The Board strongly recommends that
liability insurance be carried for the practice and the preceptee during the
preceptorship. Usually an inexpensive rider can be purchased through your
insurance carrier. Neither the Board nor the preceptee’s school carries
insurance for this purpose.
This eight-week preceptorship is a serious
requirement towards receiving a license to practice veterinary medicine in
Louisiana. It is not associated with any outside preceptorships that may be
required by the applicant’s school. The preceptor or host facility should
stress this fact to any perspective preceptees and have the perspective
preceptee contact the Board office for details. Preceptorships performed as
part of the applicant’s school curriculum will not be accepted towards
completion of the preceptorship required for licensure unless the facility is
pre-approved by the Board and the applicant registers the time to be spent at
a facility with this licensing Board prior to the start of the time by
submission of the required Preceptorship Agreement form.
If you may be interested in becoming a
Board-approved preceptorship host facility, you can contact the Board office
for information and to have the assessment questionnaire sent to you or visit
the Board’s website at www.lsbvm.org.
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For Your Information:
Ketaset/ Ketamine Scam
The Drug Enforcement Administration (DEA) would like to
inform practitioners regarding a scam being perpetrated involving Ketaset/Ketamine.
Someone is soliciting information about Ketaset/ Ketamine from
veterinarians to possibly set up a scam to have the product returned to a
recall center or to determine which veterinary clinics have a large supply
of Ketamine for possible future burglaries. According to the DEA, there is
no recall or problem with Fort Dodge Ketamine/ Ketaset products. The
company has not issued a recall or sent out a survey to any veterinarians
concerning stocks of the drug. If you have been contacted by someone in
this capacity, you may contact DEA.
|Forged Prescription Reporting |
The Drug Enforcement Administration’s New Orleans
Divisional Office (DEA) is implementing a new Forged Prescription
Reporting Program. Whenever a practitioner or pharmacy calls the DEA to
report information concerning a forged prescription, the DEA will email
the information to participating pharmacies. Pharmacists can use the
information to alert them as to which practitioners’ names are being used
on the forged prescriptions. Participation in the program is encouraged
but voluntary on the part of the pharmacies. This program will aid in the
reduction of forged prescriptions being inadvertently filled by an
If someone has been using your name and DEA registration
to forge prescriptions, contact the DEA at (504) 840-1100 to provide them
with as much information as possible. The DEA will email the information
to all participating pharmacies in an attempt to place them on the alert.
In addition to reporting it to the DEA, you must also contact your local
police department so they can conduct an investigation in an attempt to
catch the individual.
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[Please call or write the Board office for a copy of
any Notice of Intents or Rules described below.]
|Continuing Education |
The Board’s intent to amend Rule 403 relating to
continuing veterinary education requirements was presented in the April
2002 newsletter. These rule amendments became effective June 20, 2002 and
will apply for the 2003 renewal period, CE period July 1, 2002 to June 30,
2003, for the 2004 renewal year.
|Preceptorship Program |
The Board’s intent to amend Rules 1103 and 1115 relating
to the Board’s current preceptorship program was presented in the April
2002 newsletter. These rule amendments became effective June 20, 2002.
|Licensure Procedures |
The Board has issued a Notice of Intent, dated May 20,
2002, regarding amendments to Chapter 3, Rules 301 and 303 relating to
education certification of foreign veterinary school graduates. The
proposed amendments will further assist the Board in its ability to
certify the education of foreign veterinary school graduates by giving the
currently accepted backlogged program relief in allowing another avenue
for foreign veterinary school graduates to get their foreign education
certified thereby shortening the time in becoming licensed to practice
veterinary medicine in Louisiana. These rule amendments are anticipated to
take effect September 20, 2002. The Board has adopted an emergency rule of
these rule amendments to be in effect for the maximum time allowed by law
or until adoption of the final rule.
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Questions from the Real Lives of
Veterinarians and Other Interested Persons
Q: Who may adjust animals with chiropractic services;
are chiropractors (human) allowed to adjust animals; under direct
supervision with the veterinarian present; must a chiropractor complete
additional specific certification to be able to adjust animals?
A: The Board is of the opinion that the provision of
chiropractic care is included within the scope of the practice of
veterinary medicine which is regulated by the Board. The provision of
chiropractic care by an individual not licensed by the Board would be in
violation of the Louisiana Veterinary Practice Act.
Q: Is a veterinarian legally required to notify clients
that drug manufacturers do not stand behind their products unless the
product is purchased through the veterinarian?
A: There does not appear to be a legal requirement in
the Louisiana Veterinary Practice Act for veterinarians to notify their
clients that drug manufacturers do not stand behind their products
unless they are purchased through the veterinarian. Perhaps the
obligation to notify potential users of such items rests with the drug
manufacturers directly. A veterinarian is responsible for the course of
treatment which will be followed once he has accepted employment (a
client) and for advising questionable or unusual treatments. A
veterinarian must conduct his practice on the highest plane of honesty,
integrity, and fair dealing with his clients in services rendered. A
veterinarian may refuse to provide a written prescription to a client
when in the veterinarian’s medical opinion, the prescribed substance is
not medically safe for in-home administration by the client. The issue
of civil rights and obligations between private parties is not within
the Board’s jurisdiction. The Board suggests contacting private legal
counsel for advise on civil liability issues.
Q: Can a veterinarian charge a “veterinary/pharmacy
consultation” fee to an internet pharmacy requesting payment of the fee
from the internet pharmacy with a credit card payment at the time a faxed
prescription request is received and prior to authorizing the internet
pharmacy to fill the prescription for a client?
A: A veterinarian can charge (the client) a reasonable
fee for reviewing a file and providing a prescription pursuant to a
client’s request. A veterinarian may refuse to write a prescription if
it is not directly requested by a client with whom a
veterinary-client-patient relationship exists. The Louisiana Veterinary
Practice Act and Board promulgated rules do not address charging a
consultation fee to an internet pharmacy for a prescription. This issue
involves a business issue rather than a regulatory issue.
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Case No. 01-0929V – Based on the Consent Order agreed to
by the Board, the Board found that the respondent veterinarian was in
violation of LSA R.S. 37:1511 et seq. and Board Rules, specifically Title
46, Part LXXXV, Sections 700, 701, and711.A(5), in that the respondent did
not have access to a properly functioning diagnostic x-ray machine and
developing equipment. Disciplinary action taken included payment of a
$1,000 fine and $2,159 in administrative costs and the requirement for the
review of the Louisiana Veterinary Practice Act and Board Rules.
Case No. 01-0925V – Based on the Consent Order agreed to
by the Board, the Board found that the respondent veterinarian was in
violation of LSA R.S. 37:1526.A(14) and Board Rules, specifically Title
45, Part LXXXV, Sections 701.B, 1409 and 1415, in that the respondent
failed to cooperate with an investigation of complaint information
submitted against him. Disciplinary action taken included reprimand of the
license, payment of a $250 fine and $1,500 in investigative costs and the
requirement for the review of the Louisiana Veterinary Practice Act and
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Comparison of ECFVG and
September 11, 2002
Thank you for your interest in the action of the
Louisiana Board of Veterinary Medicine and its decision to accept the PAVE
program as recommended by the AAVSB. I can assure you that the LBVM has no
intentions of lowering the standards for veterinarians being licensed in
the State of Louisiana. In fact, the Board is very concerned about
assuring that veterinarians who practice within the state are well
educated and practice quality veterinary medicine. It is the
responsibility of the LBVM to protect the public.
Over a period of several months, the LBVM carefully
reviewed the PAVE process and is of the opinion that it is at least equal
to and in some ways more stringent than that of the AVMA’s ECFVG. A chart
comparing the two programs is on the reverse side of this sheet. The PAVE
program requires the successful completion of a qualifying examination
covering the basic science material taught in the first three years of
veterinary education. This qualifying exam must be passed before a student
may enter the clinical evaluation phase. There is no qualifying
examination per se as a part of the AVMA’s ECFVG program. Students must
achieve clinical competency to pass the clinical phase of PAVE
certification. Also, all applicants will have to be fluent in English,
both written and spoken, by either program.
The LBVM is very cognizant of its legal obligation to
provide every legitimate applicant equal protection of the law. The
standards for foreign educated applicants must be equal to the standards
of domestically educated applicants. The LBVM will accept either the
AVMA’s ECFVG program or the AAVSB’s PAVE program results as qualifying to
apply for licensing in Louisiana.
The LBVM also respectively denies the statement that
there is no shortage of veterinarians in the United States. It is the
understanding of the LBVM that currently there are numerous employment
opportunities available for licensed veterinarians in Louisiana. In any
event, it is the legal duty of the LBVM to protect the public by licensing
qualified applicants, and not becoming involved in determining the number
of licenses in the state or their respective market share.
I welcome the opportunity to respond to any questions
you may have with regards to this letter or provide clarification of
references to the credentials evaluation of foreign applicants for
Robert M. Lofton, DVM
Comparison of ECFVG and PAVE
American Veterinary Medical Association
American Association of Veterinary State Boards
Educational Commission for Foreign Veterinary Graduates (ECFVG)
for the Assessment of Veterinary Education Equivalency (PAVE)
INITIAL REQUIREMENTS – STEPS 1 – 3
Certification – Approval of Teaching Institution Based on
Council of Education Standards
1. Credential Certification
– Approval of
Teaching Institution Based on Council of Education Standards
|2. English Fluency
Tests – Test of English
as a Foreign Language (TOEFL), Test of Written English (TWE), and
the Test of Spoken English (TSE)
2. English Fluency Tests
– Test of
English as a Foreign Language (TOEFL), Test of Written English (TWE),
and the Test of Spoken English (TSE) – higher standard than ECFVG
(required of all applicants + higher score on TOEFL)
Successful completion of
National Veterinary Licensing Examination (NAVLE);
developed by the National Board of Veterinary Medical Examiners; a
test of entry level knowledge necessary to be licensed as a
developed by the National Board of Veterinary Medical Examiners as a
test of basic science knowledge acquired in veterinary college
courses prior to the 4th year or clinical portion of a
CLINICAL REQURIEMENTS – STEP 4
4. Clinical Requirements:
completion of one postgraduate year of evaluated clinical experience
at an AVMA accredited veterinary college
completion of the Clinical Proficiency Examination
4. Clinical Requirements:
completion of the clinical rotations at an AVMA accredited
veterinary college (senior year or postgraduate) – to be evaluated
based on the same standards as regularly enrolled students, and
following the same curriculum.
(b) Successful completion of the
Veterinary Clinical Skills Assessment Examination being developed by
the National Board of Veterinary Medical Examiners to evaluate
clinical skills through a hands-on clinical examination.
No additional requirements prior to
state licensing examinations.
completion of the
National Veterinary Licensing Examination (NAVLE)
eligibility for individual state licensing examinations. Developed
by the National Board of Veterinary Medical Examiners to test entry
level knowledge necessary to be licensed as a veterinarian.
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