Vague rules leave some veterinarians in a black hole of confusion and lawlessness
Veterinarians struggle to comply with rules no one understands.
How many of you are old enough to remember the episode of the original "Star Trek" where the intrepid space travelers discover a planet where there is no crime?
You know all the rules by heart right?: When you find yourself scratching your head in confusion, always ask. Get the proper person on the phone, whether it's about rabies reporting, medical waste compliance or the state sales tax.
Kirk and Spock teleport down to the newly discovered world to make contact with the seemingly advanced civilization where legal violations never occur. Problems developed quickly, though, when a member of the landing party slips and falls into somebody's flower bed. The unlucky crew member is immediately arrested and scheduled for execution because on this particular planet, every violation of law was punishable by death and intent didn't matter.
You've got to love big government! You have to applaud a world where serious penalties await anybody who steps out of line — even when he didn't mean to, and nobody let him know in advance what behavior is punishable and what behavior is expected by the authorities.
Of course, these interstellar explorers didn't need to travel through the universe to find a civilization similar to the one in that episode. They just needed to travel back to the United States in the year 2010. I could have guided them through the veterinary medical world, where citizens are absolutely bound to follow the law but find it nearly impossible to figure out what the law actually is.
I am a great believer in supporting the efforts of public health officials in protecting the citizens from dangerous diseases. However, complying with rabies regulations can be pretty time consuming. I've reached the point where I feel obligated to contact the local health department for legal guidance in virtually every bite case.
I never know what to tell pet owners or bite victims when they ask me what to expect after I report the bite incident to the authorities. Will the county impose a quarantine for their pet? Will the owners be allowed to supervise the quarantine themselves? If there is a quarantine, how long will it last?
Will that last rabies vaccination truly be considered valid for three years? I may be told "yes," but just a month before, the health department considered it valid for only one year because it was a second administration given too soon after the first.
Years ago, back when I was a naïve veterinary lawyer, I simply requested current written guidelines when I came across such cases. The guidelines were promised to me repeatedly. I'm still waiting for them. I have a new approach now, one I strongly recommend you follow as well:
When you have any doubt at all about how to proceed in a matter of public health law and compliance (including rabies reporting, sample submission, quarantine, etc.), call the local health department. It is vital to get an actual person on the phone and have them to commit to what, precisely, your legal obligations are in that specific instance.
Then, ask the person for his or her name and title. Write all of this information in the medical record, and note the time of the call. Then, if your subsequent efforts to follow the rules amount to a metaphoric slip and fall into a flower bed, only the person on the other end of that phone call is likely to be executed — metaphorically.
Medical waste compliance
This is an issue that is near and dear to my heart because I just paid my medical disposal hauler's invoice. My veterinary team is very good at minimizing medical waste truck visits, so it was almost exactly two years ago when we last sent out biohazard trash. My office manager was shocked when the bill arrived. In 2007, the price was $160 per box. In 2009, the same box cost $317.
Naturally, I want to dispose of as little medical waste as possible while still complying with state medical waste disposal laws. But do you think I can find anybody to tell me, definitively, what does and does not constitute medical waste?
Vaccine vials? What if the contents were killed virus?
Controlled substance bottles? What if they still contain some expired product?
Certainly, hypodermic needles are medical waste, but what about dosing syringes? (Hmmm, is it Wednesday or Thursday? The laws seem to change daily.)
Don't expect to get useful information from your colleagues either. Many of them will tell you that the whole concept of medical waste is a myth. The waste-hauling companies know that the law is mercurial and subject to broad interpretation, so they usually suggest that all waste is pretty much medical waste, so throw whatever you have in a red jug, and everything will be just fine.
If you have lots of time on your hands — and in our profession, who doesn't? — call your veterinary society and your state legislative offices. Get the latest definitive word on what you need and do not need to have carted away by a certified hauler. Do your best to comply, using up-to-date advice.
Meanwhile, try not to be too discouraged if you have definitive instructions from two authoritative sources that don't match.
State sales tax
It's good that the planet visited by the starship Enterprise in that old episode didn't have any state sales tax. If it had, it's likely that nobody would have been left alive because every life form would have been tripped up by the law at some point.
Back on earth, I am pleased to report that absolutely accurate guidance from states concerning which veterinary services are taxable and which are not is readily available — but only in states where all veterinary services and products are taxable. Everywhere else, sales tax law compliance is a crap shoot.
When, after all, is a medicated bath actually a medical necessity? Is a therapeutic diet a medical necessity for an obese pet? If so, it might well be non-taxable. What if that same dog is using it to keep the life-threatening weight off? Surprise! You as the seller may be obligated to collect and remit tax on that food. But try to find some written guidance on the issue.
The only written guidance you are likely to receive is a deficiency notice from your state revenue department after its on-site audit reveals that you have not been charging sales tax frequently enough.
Fortunately, the sales tax issue isn't as big a problem as it used to be for us veterinarians on sales of prescription medications. Most consumers buy those from an Internet pharmacy with a fully staffed legal department. If those pharmacies don't like what the state says about their sales tax compliance, they just take the state in question to federal court. I promise, the pharmacies will find out the definitive word on the law.
I wonder why that Star Trek crew member with the death sentence didn't think of that?
Dr. Allen is president of the Associates in Veterinary Law P.C., which provides legal and consulting services to veterinarians. Call (607) 754-1510 or visit firstname.lastname@example.org.