PRACTICE Pulse

QUESTION: Our practice had to euthanize a dog, and the owner asked if we could hold the body in our freezer until she could make burial arrangements. The owner later requested we cremate the body and return the ashes. When we called to collect payment, the owner did not provide any payment details at the time. To date, they have not answered our calls. We are still holding the body in our freezer, as we will not do a cremation/ashes return without the owner prepaying. What should the next steps be?

A: Sending a certified letter is the safest option. Give the client 10 days to pay or pick up the body, and let them know that if they do neither, you will dispose.

QUESTION: We are in the process of streamlining our pharmacy protocols. We wanted to know if we are allowed to email our clients written prescriptions for non-controlled drugs or if we must hand them a physical prescription that they can then take elsewhere, including online pharmacies.

A: I see no reason why you cannot email a signed copy of a prescription for a non-controlled drug that the client can then print out and take to a pharmacy. This is assuming, of course, the prescription meets all the other requirements to be considered a valid prescription.

QUESTION: I just agreed to be a preceptor for a fourthyear veterinary student from another state. Can they legally perform procedures such as spays and neuters while under supervision by a licensed veterinarian?

A: According to Florida Statute 474.203 Exemptions, which cover veterinary medical practice:

This chapter does not apply to:

(3) A student in a school or college of veterinary medicine while in the performance of duties assigned by her or his instructor or when working as a preceptor under the immediate supervision of a licensee, if such preceptorship is required for graduation from an accredited school or college of veterinary medicine. The licensed veterinarian is responsible for all acts performed by a preceptor under her or his supervision.

If the student veterinarian is working as a preceptor and the preceptorship is required for graduation from an accredited school of veterinary medicine, then that student/preceptor is exempt. This means that anything the preceptor does under the immediate supervision of a Florida-licensed veterinarian is allowed.

QUESTION: A local law enforcement agency is asking whether their officers could administer naloxone to a police dog with suspected drug overdose based on updated canine emergency responder laws.

A: Yes, the reason being that there is an exemption in Florida Statute 474.202(5):

(5)(a) Any person, or the person’s regular employee, administering to the ills or injuries of her or his own animals, including, but not limited to, castration, spaying, and dehorning of herd animals, unless title is transferred or employment provided for the purpose of circumventing this law. 1 This exemption does not apply to any person licensed as a veterinarian in another state or foreign jurisdiction and practicing temporarily in this state. However, only a veterinarian may immunize or treat an animal for diseases that are communicable to humans and that are of public health significance.

The police dogs belong to the police department, and the police officers are “regular employees” of the owner attending to the ills of their own animals. There is also a newer exemption under paragraph (10):

(10) A paramedic or an emergency medical technician providing emergency medical care to a police canine injured in the line of duty as authorized under s. 401.254.

Nobody from the Department of Business and Professional Regulation or the Board of Veterinary Medicine is going to have any problem with a law enforcement officer administering Narcan or any other opioid antagonist to treat a canine.

QUESTION: I'm a mobile hospice and palliative care veterinarian. I just heard that xylazine is now a Schedule I drug in Florida. My distributor is still sending it to me like it's not controlled. I'm keeping it in my safe separate from Schedules II and III, but now I'm worried that I'm not allowed to even have it. I haven't gotten any information and was hoping you could help guide me.

A: Correct, xylazine is now a Schedule I drug in Florida. Even though it is not controlled under Federal law, that is about to change soon. If you still have xylazine in stock, I recommend you dispose of it. As it is not a controlled substance under federal law, you do not need to send the remaining stock to a reverse distributor, but you should pack it securely and place it in the trash.

Just to be safe, I suggest you write a short memo signed by yourself and another person — preferably a veterinarian, but it could be a technician or an office manager — attesting that on x day a (quantity) of Xylazine (lot number) was securely packed and placed in the trash in the presence of (names). If someone ever thinks of running an audit, you can provide evidence of what happened to the stock.

One of the benefits of an FVMA membership is our helpline (800-992-3862), which is available to members Monday through Friday from 8 a.m.-5 p.m. Our helpline also provides insight to the FVMA staff of the challenges and concerns of our members. In this feature, we will highlight topics from the questions we received in preceding weeks as a part of an effort to keep our members up to date on current concerns, as well as regulatory and legislative changes.

QUESTION: I wanted to know if there are any Florida regulations in place that would prevent an establishment from performing nonanesthetic dentals without a veterinarian present? I am under the impression that anesthetic procedures must be done with a veterinarian present, but what about non-anesthetic procedures like dentals? Can they be performed without a veterinarian on staff? There are several pet boarding facilities that are offering non-anesthetic dental cleanings even though they do not have a veterinarian present, and it's a technician that performs them. I would just like some clarification on this.

A: Any dental procedure on an animal, with the exception of manually floating teeth on horses, is the practice of veterinary medicine. A technician can perform certain tasks under general supervision, and non-anesthetic dental cleaning can be performed without the veterinarian present but that does not mean a veterinarian is not required. Boarding facilities that have technicians perform dental cleanings without any veterinary supervision (offpremises) are engaging in unlicensed activity.

QUESTION: I’m reaching out to get some information about releasing records to clients. We have a client that we will no longer be providing services to. This client has NOT paid their bill; are we required to release records to this client? Can we legally withhold records from clients that do not pay their bill?

A: You cannot withhold a client's records due to an unpaid bill. Please see F.S. 474.2165 Ownership and control of veterinary medical patient records; report or copies of records to be furnished. Sub Section (3):

Any records owner licensed under this chapter who makes an examination of, or administers treatment or dispenses legend drugs to, any patient shall, upon request of the client or the client’s legal representative, furnish, in a timely manner, without delays for legal review, copies of all reports and records relating to such examination or treatment, including X rays. The furnishing of such report or copies shall not be conditioned upon payment of a fee for services rendered.

QUESTION: Should an exam be performed with every rabies vaccination? Is an exam within the last year considered acceptable? If a client declines an annual exam, can a rabies vaccination still be given?

A: The standard of practice for a limited service (vaccination) clinic requires a physical exam be performed on every animal to be vaccinated. There seems to be no reason why the standard for a regular clinic would be less.

61G18-15.007 Minimum Standards for Limited-Service Veterinary Medical Practices.

(1) The term “limited-service veterinary medical practice” shall mean a privately or publicly supported vaccination clinic where a veterinarian performs for a limited time vaccinations and/ or immunizations against disease on multiple animals, and where the veterinarian may also perform microchipping and preventative procedures for parasitic control, and shall not mean a premise otherwise permitted by the Board.

(2) The Limited-Service permittee shall register each clinic with the Board of Veterinary Medicine by name, address, date of clinic, time and duration, at least 28 days prior to offering a limited-service clinic. A copy of the limited-service permit shall be clearly visible at each limited service clinic held during its hours of operation and posted at the main office where the records are stored.

(3) A veterinarian must remain on site throughout the duration of a limited-service clinic and must maintain autonomy for all medical decisions made. A physical examination and history must be taken for each patient receiving veterinary medical care at a limited-service clinic. Recommendations and preventive medicine protocols must be developed from current accepted veterinary medical practice. The veterinarian is responsible for proper immunization and parasitic procedures and the completeness of recommendations made to the public by the paraprofessional staff that the veterinarian supervises or employs. The veterinarian is responsible for consultation and referral of clients when disease is detected or suspected.

The annual exam is a fairly common standard of practice. If the animal was examined by the veterinarian/practice less than 1 year ago, another exam may not be necessary.

If a client declines an annual exam, the veterinarian should explain that the standard of practice requires that examination be performed before providing the vaccination. If the veterinarian gives the rabies vaccination without having performed some type of physical examination, and there is an adverse reaction that could have been avoided with a physical examination, the veterinarian will not be able to defend him/herself.

NOTE:

PRACTICE FOR SALE/LEASE

PRACTICE FOR SALE – ATLANTIC BEACH, FL: Single doctor practice (uses relief vets at times) at the Beaches of Florida. Last year’s gross was 1.4 M. Out the door at 4 pm, until noon on Saturday, off on Sundays, and as many holidays as we like. Walk to the beach in 5 minutes. Affluent area. Free standing modern building (category 5 construction) on THE main commercial street. The usual, Complete IDEXX lab, DR Xray, CO2 Laser, full patient monitoring 11 computer domain with Avimark. Two or three exam rooms. Upstairs is ready for an apartment (agreement for sale can include build out for such). mih1971ail@gmail.com

PRACTICE FOR SALE – KEY WEST, FL: Ten-year-old practice in old town Key West. Wonderful pet-loving clientele. Great area for fishing, scuba diving, and sailing. Great laid-back warm place. Small lease hold space, inexpensive rent. Digital x-ray leased heska blood equipment which runs out 7-24. Great net. 4.5-day workweek. Can easily be increased to more. I do minimal emergencies when I feel like it. Current manager 6 years and a CVT. Great place to set down roots. Please don’t call the practice and upset employees. Text my cell phone first then I will call you back. 305-619-4731.

PRACTICE FOR SALE – SARASOTA, FL: Storefront practice for sale. Solo veterinarian retiring. Low overhead; low stress. Fantastic clients. Gross +$300,000. Recently upgraded interior. Fully computerized. Asking $150,000 obo. Contact Lee at 941-914-3239.

PRACTICE FOR SALE – AVENTURA, FL: Desiring autonomy and a flexible schedule? Fantastic opportunity for $110K financed. Housecall practice, south FL, established 16 years, owner retiring. Friendly clients, with no emergencies and, less than 20 hour/week. Fernando 561-6097371 or fmello@tworld.com.

Realize the best of both worlds – profitability and quality patient care at a price you can’t resist. In less than 15 minutes, obtain fully quantitative results on up to 13 important biomarkers at the point of care. No contracts. No minimums. Believe it.