Land of confusion: The sad state of state practice laws for equine practice
Kyle Palmer, CVT
Long-time dvm360 magazine and Firstline contributor Kyle Palmer, CVT, is hospital manager for VCA Salem in Salem, Oregon, as well as a practice management consultant for a number of other hospitals.
Horses: Theyre not big dogs or skinny cows. So state veterinary practice acts need to set separate regulations to guide who can offer medical care for equinesand how.
Shutterstock.comDepending on where you live, your state's veterinary practice act may be a detailed and thoughtful roadmap for all practitioners, especially newer graduates. Or it may be a confusing, ineffective and misleading set of gradually evolved thoughts on the part of the authors.
The problem is that we live in a country of 50 very different, and in many ways legally independent, states. To date, there's no one set of ideals, restrictions, permissions or practices that have any overall effect. The American Veterinary Medical Association (AVMA) has long published a model veterinary practice act that-if adopted-would resolve many of these concerns. And the model practice act has evolved as new issues arise requiring consideration. It's obvious that many states pay attention to the AVMA document, as they have adopted specific passages from it. But few have embraced the entire document.
Like most legislation, state practice acts grow and change over time, and the direction they change seems tied to the practice area that draws the most public attention: companion animal practice. As the human-animal bond flourishes in many households across the country, the focus is on pets. But what happens to equine practice, which is awkwardly positioned somewhere between companion animals and livestock?
The lack of specific direction for equine practitioners has not only made daily decisions more confusing, it's also allowed-directly or indirectly-nonveterinarians to become involved in equine health.
Many state practice acts establish the definition of “animal” in a way that includes horses-in some cases defining animals as any living organism other than a human. Unfortunately, many also use confusing, if not outright different, definitions for various types of animals. In reviewing the practice acts in our 50 states, I found some trends that rise to the surface. For the sake of equine practice, we need to revisit them.
By now, we should all be familiar with the term “valid client-patient relationship” (VCPR-also referred to as the “veterinarian-client-patient relationship”) and its purpose in our profession. Simply put, it exists to ensure that veterinarians establish a level of knowledge of a patient before providing certain services to that patient, such as prescribing medications and ordering treatments.
In many cases, establishing a VCPR requires conducting a thorough physical exam. And in some of those cases, the list of what must be examined is difficult to comply with for horses. When the exam fields include weight and abdominal palpation, it's obvious they had companion animals in mind. Some states with such language have finally added “or weight estimate for large animals” and “auscultation if applicable by species."
Perhaps most confusing is the fact that many VCPR statements allow for a different standard when dealing with livestock “herds” or “large operations,” without defining what those terms mean. And many of them specifically include horses in their definition of livestock. Most statements that include this language to establish the VCPR allow the practitioner simply to maintain an ongoing familiarity with those operations by visiting the property. This opens the door for practitioners to skip the physical exam step in horses. While this is understandable for livestock that can't be closely handled, it seems odd to leave horses in this category.
At least one state practice act clears up this confusion by stating a detailed physical exam must occur when an “individual animal” is presented for consideration. This separates typical horse ownership from other livestock. Many also use the term “food animal” to ensure that horses are addressed as a companion animal rather than other livestock. Regardless, equine practitioners looking for detailed, specific direction to establish a VCPR may struggle to find this information.
The lay dentist
When it comes to confusing or absent legislative definitions, no area of equine practice has received more attention in recent years than dentistry. Specifically, what's considered dentistry? Who can practice it and under what circumstances? You don't need to look far to find a region where nonveterinarians perform some form of equine dentistry.
Unfortunately, many state practice acts define “dentistry” in companion animal practice terms. Cleaning, scaling, polishing, altering the tooth structure and using composite material are procedures most commonly used on companion animals. And dental radiography, although not excluded from equine practice, is more typically found in companion animal dentistry. Some practice acts do use the term “teeth floating” to separate equine dentistry, but many also use ambiguous language to define who can perform the service.
Sadly, some states outright allow nonveterinarians to float equine teeth. There's no doubt that some nonveterinarians out there can float teeth professionally and effectively. And there are also likely nonveterinarians who could diagnose a multitude of other needs and probably know the proper treatment to resolve those issues. But that wouldn't be allowed in any state.
Ultimately, the question goes back to how horses are viewed legally. Are they livestock animals, which commonly need maintenance tasks performed on them without great thought to how that maintenance might affect them medically (excluding farrier work)? Or are they individual animals with specific medical needs that can have a deep impact on their health?
In the simplest of terms, equine dentistry most often deals with occlusion, while companion animal dentistry deals more often with diseases of the tooth and surrounding structure (though occlusion is also a problem). By direct statement, by implication or simply by silence on the issue, it seems that effecting occlusion in a horse is viewed by some as less imortant than effecting occlusion in a companion animal. That's a concept many veterinarians would disagree with.
What's the solution?
To resolve how equine practice is viewed by state practice acts, equine practitioners must find a way to speak collectively. While the American Association of Equine Practitioners (AAEP) has released position statements on many contentious topics, including dentistry, state boards still have the legal authority to do as they please.
Every state practice act needs to determine, with clarity, in what category they consider equine practice. And preferably the distinction would remain independent of companion animal practice and of livestock practice. Beyond that, stating clearly who has the authority to perform certain procedures and what the expectations are for those procedures might make it easier for veterinarians to practice in multiple states or to relocate from one state to another. Finally, the idea that nonveterinarians are skilled enough to impact serious medical conditions without the direct supervision of a veterinarian (at a minimum) is an idea worth reconsidering.
In addition to lobbying the AAEP, veterinarians should use regional practitioner associations and individual state veterinary medical associations as sounding boards for better definition in these legal guidelines. Write letters to the state examining board and to your local legislators. Until one voice becomes louder, these problems likely won't be resolved.
Kyle Palmer, CVT, is a Firstline Editorial Advisory Board member and a practice manager at Silver Creek Animal Clinic in Silverton, Ore.