1.1. Scope. -- This rule establishes the standards of practice
and professional conduct required of veterinarians licensed and
regulated by the West Virginia Board of Veterinary Medicine.
1.2. Authority. -- W. Va. Code §30-10-1 et seq.
1.3. Filing Date. -- May 8, 2017.
1.4. Effective Date. -- July 1, 2017.
2.1. “Advertising” means communication designed to inform the
public about the availability, nature, and prices of products or
services, or to attract clients or business.
2.2. "Ambulatory practice" means a professional visit to the
location of a patient or client and includes house calls and farm calls.
2.3. “Convenient access” means capable of being utilized without delay.
2.4. “Dental procedure" means the application or use of any
instrument or device to any portion of an animal's tooth, gum or any
related tissue for the prevention, cure or relief of any wound,
fracture, injury, disease or other condition of an animal's tooth, gum
or related tissue.
2.5. “Emergency clinic” means a facility that provides after hours or 24 hour emergency care.
2.6. “Exercise run” means an enclosed area under roof and climate
controlled of sufficient size to allow for free ambulation for the
comfort and exercise of patients or kenneled animals that are housed
within the facility.
2.7. “General anesthesia” means the inducement of a complete absence
of sensation and consciousness by the administration of injectable drugs
or inhalation gas.
2.8. “Humane disposal” means euthanasia by or under the general supervision of a veterinarian or by an euthanasia technician.
2.9. “Immunization clinics” means an event conducted to provide easy
access to the public for routine preventative health care for their
animals. The clinics may occur at a veterinarian’s permanent facility
location or alternative sites for easy public access.
2.10. “Impervious” or “impervious surface” means incapable of being penetrated by water or other liquids.
2.11. “Prescription drugs” mean drugs that are approved by the U.S.
Food and Drug Administration (FDA) and that are required by federal or
state law to be dispensed to the public only on prescription by a
licensed provider.
2.12. “Mobile” means a facility that may be transported or moved
from one location to another. With this type of practice, the patient
is examined and treated in the mobile unit.
2.13. “Sedation” means the calming of mental excitement or reduction of physical activity, by the administration of a drug.
2.14. “Stationary facility” means a fixed, non-moveable structure.
2.15. “Sterile surgery” means procedures in which aseptic technique
is practiced in patient preparation, instrumentation, and surgical
attire.
2.16. "Surgery" means that branch of veterinary medical science
which uses operative measures for treating diseases, deformities,
injuries, and for reproductive sterilization or elective operative
procedures.
2.17. "Veterinarian" means a person who is licensed to practice veterinary medicine pursuant WV Code §30-10-1 et. seq. \
2.18. “Veterinarian in charge" means a veterinarian who holds an
active license in West Virginia and who is responsible for maintaining a
veterinary practice within the standards set by the W. Va. Code
§30-10-1 et seq. and W.Va. Code R. §26-1-1
et. seq.
2.19. “Veterinary practice” means any ambulatory, emergency, mobile,
or stationary, practice wherein veterinary medicine or surgery is
conducted.
3.1. It is unprofessional and a violation of this rule for any
veterinarian to represent conflicting interests, except by express
consent of all persons concerned, given after a full disclosure of the
facts. Within the meaning of this rule, a veterinarian represents
conflicting interests if, when employed by a buyer to inspect an animal
for soundness, he or she accepts a fee from the seller. Acceptance of a
fee from both the buyer and seller is prima facie evidence of fraud.
3.2. A veterinarian may not make any effort, direct or indirect,
which in any manner is calculated to influence the sound professional
judgment of another veterinarian. It is the right of any veterinarian,
without fear or favor, to give proper advice to those seeking relief
against unprofessional or neglectful veterinary services
3.3. A veterinarian shall expose without fear or favor before the
proper tribunal of the Board any and all malpractice, incompetence,
corrupt or dishonest conduct in the profession
3.4. A veterinarian shall not render any service or advice contrary
to the law. A veterinarian shall also advise clients to observe the law.
3.5. A veterinarian shall not render any service or advice directed
toward the corruption of any person or persons exercising a public
office or private trust, or participate in deception, or betrayal of the
public.
3.6. Any veterinarian who uses a present or past position, or an
office of trust, deliberately to create an individual professional
advantage, or to coerce, or to deceive the public is in violation of
this section.
3.7. A veterinarian whose accreditation has been disciplined by
state or federal authority may be subject to disciplinary action by the
Board upon proof of removal of accreditation by that authority.
3.8. A veterinarian shall decide what medical cases will be accepted
in his or her professional capacity. In the event the veterinarian
chooses not to provide services, the client shall be notified.
3.9. The professional services of a veterinarian shall not be
controlled or exploited by any lay agency, personal or corporate, which
intervenes between the client and the veterinarian. A veterinarian shall
avoid all relationships which could result in interference or
intervention in the veterinarian's practice by any person or entity. A
veterinarian is responsible for his or her own actions and is directly
responsible to the client and for the proper care and treatment of the
patient. This is to include information on how clients may receive
emergency care when the veterinarian is not available.
3.10. A veterinarian shall exercise the same degree of humane care,
skill, and diligence in treating patients as is ordinarily used in the
same or similar circumstances by reasonable members of the veterinary
medical profession.
3.11. A veterinarian in this State shall not issue a certificate of
health unless he or she knows through actual inspection and appropriate
tests of the animals, that the animals meet the requirements for the
issuance of the certificates.
3.12. It is professionally dishonest for a veterinarian to guarantee
a cure. A veterinarian shall avoid bold and confident assurances to
clients.
3.13. A veterinarian shall conduct his or her practice with honesty,
integrity, and fair dealing to clients in time and services rendered.
3.14. A veterinarian shall not violate his or her confidential relationship with the clients.
3.15. A veterinarian may represent himself or herself as a
specialist only if they have completed the process of Board
certification in a recognized veterinary specialty area. To become
Board certified, a veterinarian must have a credential review and
examinations set by the given specialty area. The Board shall annually,
before the first of January, provide a list of AVMA approved veterinary
specialty organizations for the next calendar year.
3.16. Veterinary Medical Records are considered privileged and
confidential. Disclosure of records is prohibited unless the client has
provided written or documented verbal consent. A veterinarian shall
provide a client medical records within 30 days of request. However,
records may be released by court order, subpoena or compliance with
local, state or federal law as deemed necessary to protect the animal or
public health. Sharing of necessary medical information between
veterinarians or facilities is allowed for treatment, Boarding and
diagnosis without client consent. Reasonable cost for copying the
medical record and or images may be charged.
3.17. A veterinarian may not initiate or knowingly participate in
any form of advertising or solicitation that contains a false, deceptive
or misleading statement or claim. In order to advertise 24 hour
emergency service, a practice must be a facility that provides that
service.
4.1. The following are classifications of veterinary practices:
4.1.a. Ambulatory
4.1.b. Emergency
4.1.c. Mobile
4.1.d. Stationary
5.1. All classifications of veterinary practice as referenced or defined by §26-4-4 shall meet these mandatory standards.
5.1.a. A veterinarian shall deliver veterinary care in a competent and humane manner.
5.1.b. A veterinarian shall perform all
aspects of veterinary medicine and surgery in a manner compatible with
current veterinary medical practice.
5.1.c. Upon the formation of a
veterinarian/client/patient relationship, in order for a veterinarian to
exercise properly the rights granted by a veterinary license, the
veterinarian shall:
5.1.c.1. Perform a physical examination
of the animal. A group of animals of one species under single ownership
may be considered as a single entity. A veterinarian/client/patient
relationship is established for the whole group if a representative
number of animals have been examined.
5.1.c.2. Discuss with the client a
diagnostic assessment and treatment plan, including medications and
follow up recommendations. This information shall be entered into the
patient's medical record.
5.1.d. Licenses and permits issued by the
Board shall be posted in a place conspicuous to the public at the
establishment where veterinary services are being provided. Licensees
who do relief or temporary work in an establishment shall carry a
license with them or post it at the establishment. Ambulatory veterinary
practices that do not have an office accessible to the public shall
carry their licenses and permits in their vehicles.
5.1.e. The practice shall comply with
federal, state, and local regulations in regards to the maintenance and
disposal of all chemical and pharmaceutical agents.
5.1.f. A veterinarian who performs euthanasia shall do so in a competent and humane manner.
5.1.g. A veterinarian shall provide and
maintain sanitary methods for the disposal of deceased animals in
compliance with the local, state and federal health rules and
regulations, and provide refrigeration exclusively for carcasses of
companion animals that require storage for 12 hours or more.
5.1.h. A veterinarian shall dispose of medical waste including sharps in accordance with local, state and federal laws.
5.1.i. Equipment currently in use shall be maintained in working order within manufacturer guidelines.
5.1.j. Current veterinary journals and
textbooks or immediate internet access to the information provided by
current veterinary journals and textbooks need to be available for ready
reference.
5.1.k. A veterinarian shall have a method of correctly weighing an animal.
5.2. Medical Records
5.2.a. A veterinarian shall maintain
individual records at his or her place of business in such a way that
any veterinarian shall be able to proceed with the continuity of care
and treatment of that patient which records shall include, but not be
limited to, identification of the patient, the patient's medical
history, immunization records, diagnostic procedures performed,
diagnosis, and treatment plan.
5.2.b. The practice owner shall keep and
maintain current patient records on the business premises for a period
of 3 years beyond the last patient visit and the records are the
responsibility and property of the owner of the veterinary practice. If
the practice is closing or being sold and the location of the practice
moving, clients shall be notified a minimum of four weeks prior to a
permanent practice closing or moving as to how they may acquire a copy
of their animal’s medical records. Records must be made available for
client retrieval at convenient times and accessible locations for a
period of no less than one month.
5.2.c. When appropriate, the words
"herd", "flock", “litter”, or other collective group terms may be used
in place of the word "patient" in subdivision a and b of this
subsection. Records maintained on these animals may be kept in a daily
log or the billing records; provided that the information that is
entered is adequate to substantiate the identification and treatment of
these animals.
5.3. Pharmacology
5.3.a. A veterinarian shall not
prescribe, dispense or administer any prescription drug without the
establishment of a veterinarian/client/patient relationship.
5.3.b. The veterinarian shall be
responsible for assuring that any drugs, biological agents, or other
products prescribed for use in the veterinary practice are properly
administered.
5.3.c. The veterinarian shall be
responsible for maintaining accurate records in the patient’s medical
history which shall include the strength, dosage and quantity of all
medications used or prescribed.
5.3.d. The veterinarian shall provide appropriate instruction to clients on the storage and administration of drugs
5.3.e. The veterinarian shall maintain
all drugs and biological agents in compliance with state and federal
laws. No drugs shall be dispensed that are beyond the date of
expiration.
5.3.f. Special handling requirements for
drugs (eg. refrigeration or light sensitive) shall be included in your
instructions. A veterinarian shall store all repackaged drugs dispensed
for animals in approved safety closure containers. This provision does
not apply to drugs dispensed to a person who requests that the
medication not be placed in these containers, or to drugs in such form
or size that they cannot be dispensed reasonably in these containers.
5.3.g. All drugs dispensed, including repacked drugs, shall be labeled with the following:
5.3.g.1. The name, address and telephone number of the practice;
5.3.g.2. The name of the prescribing veterinarian;
5.3.g.3. The date dispensed;
5.3.g.4. The client's nam
5.3.g.5. The patient's name;
5.3.g.6. The directions for use;
5.3.g.7. The name of the drug;
5.3.g.8. The strength of the drug if more than one dosage form exists;
5.3.g.9. The quantity or volume dispensed;
5.3.g.10. The number of refills, if any; and
5.3.g.11. The expiration date.
5.3.h. A veterinarian that has a Federal
Drug Enforcement Administration (DEA) number and uses, dispenses,
administers or prescribes controlled substances shall comply with the
federal and state laws pertaining to the dispensing, prescribing,
storage and usage of controlled substances; including maintaining a
register, which shall indicate the following:
5.3.h.1. The name of the prescribing veterinarian;
5.3.h.2. The name of the medication dispensed or prescribed;
5.3.h.3. The quantity dispensed or prescribed;
5.3.h.4. The dosage of the medication, if applicable;
5.3.h.5. The number of refills;
5.3.h.6. The date of the dispensing or prescribing;
5.3.h.7. The patient name and name of the client record;
5.3.h.8. The expiration date;
5.3.h.9. The method used for prescribing, such as written script, phone, fax or any other electronic means; and
5.3.h.10. The name and phone number of
the pharmacy or pharmaceutical agent which received the script from the
veterinarian, if not delivered directly to the client.
5.3.i. Veterinarians shall honor a client’s request for a prescription in lieu of dispensing.
5.3.j. Prescriptions may be refilled for
up to one year or the maximum number of refills prescribed from the
examination date at the prescribing veterinarian’s discretion. After 1
year, the patient shall be re-examined before an additional prescription
is validated.
5.4. Laboratory Services
5.4.a. Each practice shall maintain
laboratory services using either an in-house and/or an outside
laboratory in order to meet the current standards of care for the
profession.
5.5. Radiological Services (if performed)
5.5.a. A veterinarian shall store and
maintain radiographs (including dental images), whether in film or
digital format for a minimum of 3 years.
5.5.b. All radiographs in any format
shall have a permanent identification bearing the client’s name, the
patient’s name, the date and either left or right markers.
5.5.c. Diagnostic x-ray equipment shall be kept in compliance with state and federal laws, rules and regulations.
5.5.d. Practices using x-ray equipment must have:
5.5.d.1. Lead aprons and gloves;
5.5.d.2. Thyroid shields and;
5.5.d.3. Personal radiation exposure badges and corresponding monitoring reports.
5.6. Surgical Services (if performed):
5.6.a. A veterinarian shall practice surgery in accordance with species specific standard of care.
5.6.b. The following surgical technique and attire is required for aseptic surgery;
5.6.b.1. The disinfection of the surgeon's hands using a disinfecting solution; and
5.6.b.2. A veterinarian shall wear clean clothing and sterile gloves should be changed between patients.
5.6.b.3. Clean water shall be accessible to the sites of the surgical procedure.
5.6.b.4. Emergency drugs for cardiac and pulmonary resuscitation readily accessible.
5.6.c. A veterinarian shall use an
acceptable method of sterilization of all appropriate equipment
sufficient to kill spores on all instruments, packs, and equipment
intended for use in sterile surgical procedures. A steam pressure
sterilizer or an appropriate method of sterilizing instruments shall be
used.
5.6.d. The use of sterilization
indicators, both internal and external, are required on all surgical
packs. A sterilized date shall be marked on all sterilized items.
5.6.e. The veterinarian shall provide a
method for the client to obtain emergency advice pertaining to surgical
and post treatment problems after the animal is released to the owner or
agent following the completion of the surgery or treatment;
5.7. Dental Services (if performed)
5.7.a. All dental procedures shall be
carried out by a veterinarian, technician or veterinary assistant under
the general supervision of a veterinarian.
5.7.b. Dental instruments shall be clean and/or sterilized as appropriate between patients.
5.8. Anesthesia/Ventilation Services (if performed)
5.8.a. A method of respiratory
monitoring, such as observing chest movements, watching the rebreathing
bag, or use of a respirometer. Some method of cardiac monitoring is
required, and may include use of a stethoscope or electrocardiographic
monitor.
5.8.b. A veterinarian shall provide every
animal with a pre-surgical assessment within 12 hours prior to the
administration of an anesthetic, and the results of this examination
shall be noted in the patient’s medical record.
5.8.c. A veterinarian or his or her
assistant shall monitor every animal as long as the patient is under
general anesthesia.
5.8.d. A veterinarian shall not release any patient
from veterinary supervision to the owner or client until it is
responsive and recovered from anesthesia. A veterinarian is not
required to comply with the provisions of this subdivision if the client
demands to take the animal home against the veterinarian’s advice and
judgment. In this case, the veterinarian shall request that the client
sign a release form stating that the client has been advised to leave
the animal; realizes the risks involved; and is taking the animal
against the advice and judgment of the attending veterinarian.
6.1. In addition to the requirements of §26-4-5, mobile and stationary facilities must meet the following facility standards:
6.1.a. A reception room and office, or a combination of the two;
6.1.b. An examination area, species
suitable, which is separate from other areas of the facility of
sufficient size to accommodate the veterinarian, technician or
assistant, patient, and client. The area shall also at a minimum have:
6.1.b.1. Lighting adequate to perform a thorough physical examination;
6.1.b.2. Convenient access to a sink with hot and cold running water.
6.1.c. Indoor lighting sufficient for the safety of staff and patients.
6.1.d. A kennel, stall, or housing area
where animals can be retained for treatment and post surgical
observation. This area shall have separate compartments for each animal
which shall be maintained in a sanitary manner and allow for the comfort
of the animal.
6.1.e. If animals are housed overnight, an isolation area with the proper protocol to handle infectious diseases.
6.1.f. Examination table with an
impervious surface which can be easily cleaned and disinfected. An
examination table is optional in large animal mobile practices.
6.1.g. All floors, counter tops and wall
surfaces in the traffic or working areas of the hospital constructed
with an impervious material that can be easily washed and disinfected.
6.1.h. Small animal practices which house
animals overnight must have at least 1 exercise run maintained in a
clean and sanitary condition. The surfaces (walls and flooring) shall
be impervious so that they can be sanitized and disinfected.
6.1.i. Surgical Services
6.1.i.1. A room designated solely for
surgery, separated by doors, and distinct from all other rooms. The room
shall have at a minimum:
6.1.i.2. Lighting adequate to perform
surgery. A surgery room shall be equipped with either a ceiling mounted
or free standing surgery light with a light source capable of being
adjusted or redirected. Backup emergency lighting is required of
sufficient intensity to conclude surgery in case of power outage;
6.1.i.3. A surgery table with an impervious surface which can be cleaned and easily disinfected.
6.1.i.4. An illuminated X-ray viewer or a device to view digital images readily accessible to the surgery room;
6.1.i.5. Walls, floors, and counter tops
constructed with an impervious material capable of being cleaned and
routinely disinfected.
6.2. In addition to the mandatory standards, emergency facilities
shall
have:
6.2.a. An electrical cardio graphic monitoring device.
6.2.b. A veterinarian on the premises at all times during the posted hours of operation.
7.1. The veterinarian-in-charge of a veterinary establishment is responsible for:
7.1.a. Being on site as necessary to
provide routine oversight to the veterinary establishment for patient
safety and compliance with law and regulation.
7.1.b. Performing or overseeing the
biennial controlled substance inventory and ensuring compliance at the
facility with any federal or state law relating to controlled
substances. The performance of the biennial inventory may be delegated
to another licensee, provided the veterinarian-in-charge signs the
inventory and remains responsible for its content and accuracy.
7.1.c. Notifying the Board in writing of the closure of the permitted facility 10 days prior to closure.
7.1.d. Notifying the Board immediately if no longer acting as the veterinarian-in-charge.
7.1.e. Ensuring the establishment maintains a current and valid permit issued by the Board.
7.2. Upon any change in veterinarian-in-charge, these procedures shall be followed:
7.2.a. The veterinarian-in-charge
registered with the Board remains responsible for the establishment and
the stock of controlled substances until a new veterinarian-in-charge is
registered or for five days, whichever occurs sooner.
7.2.b. An application for a new permit,
naming the new veterinarian-in-charge, shall be made five days prior to
the change of the veterinarian-in-charge. If no prior notice was given
by the previous veterinarian-in-charge, an application for a new permit
naming a new veterinarian-in-charge shall be filed as soon as possible
but no more than 10 days after the change.
7.2.c. The previous establishment permit
is void on the date of the change of veterinarian-in-charge and shall be
returned by the former veterinarian-in-charge to the Board five days
following the date of change.
7.2.d. Prior to the opening of the
business, on the date of the change of veterinarian-in-charge, the new
veterinarian-in-charge shall take a complete inventory of all Schedule
II-V drugs on-hand. He shall date and sign the inventory and maintain
it on-premises for three years. That inventory may be designated as
the official biennial controlled substance inventory.\
8.1. A new veterinary facility shall be inspected by the Board prior
to opening. The Board, shall grant an authorization to begin operation
while the facility awaits its initial inspection if this inspection is
delayed for reasons not associated with the practice or its operators.
8.2. A registered veterinary facility shall be inspected by the
Board on a rotating basis every 2 years, except when the Board requires a
re-inspection due to the facility not meeting all requirements for that
type of facility at the routine inspection. Additionally, the Board may
inspect a facility at any time for just cause. Only after the Board
determines that the facility meets the respective provisions for
operation under this rule may it lawfully operate.
8.3. Should a veterinary facility change ownership, the new owner
shall notify the Board within 5 days of such purchase and will be
subject to re-inspection.
8.4. An owner of veterinary practices operating shall complete and
file annually, on or before June 30, on a form approved by the Board, an
annual veterinary practice registration, and shall pay the veterinary
practice annual permit fee, as prescribed by 26CSR6.
8.5. If the owner of a veterinary practice does not file an annual
veterinary practice registration by June 30 and the Board performs
inspections in the region without knowledge of the existence of the
facility, the veterinary practice is liable for the additional trip to
inspect the non-compliant practice, and the fee for inspection is double
the usual and customary fee for practice inspection as specified in the
Schedule of Fees.
8.6. The Board shall not issue a renewal license to a veterinarian
who is an owner of a veterinary facility situated in this state that has
not filed an annual facility registration, or that has refused to allow
a representative of the Board to inspect the veterinary facility during
the facilities regular business hours.
8.7. The Board may revoke or suspend a facility registration for not
being in compliance with this
Rule.
9.1. An "abandoned animal" means any animal placed for treatment or
boarding by its owner or an agent of the owner in the care and custody
of a veterinarian, which is not retrieved by the owner or agent of the
owner from the veterinarian within 72 hours of the veterinarians
specified release date of a hospitalized animal or the scheduled release
date of a boarded animal. The owner or agent of the owner shall be sent
a certified letter to his or her last known address, return receipt
requested, informing him or her that the animal is available for pickup.
The letter to the owner or agent of the owner shall also state the
amount owed, if any, to the veterinarian for the treatment and care of
the animal, set by the W.Va. Code R. §26-4-9.2. that the veterinarian
may elect the humane disposal of an abandoned animal no sooner than 7
days after the veterinarian has mailed a certified letter.
9.2. A veterinarian may elect the humane disposal of an abandoned
animal no sooner than 7 days after the veterinarian has mailed a
certified letter to the owner or agent of an abandoned animal indicating
his or her intent to humanely dispose of the animal. In the event the
owner or agent cannot be notified by certified mail, return receipt
requested, the veterinarian may elect humane disposal any time after 7
days following the mailing of the certified letter, providing the
veterinarian has a posted receipt from the mailing entity verifying the
mailing date of the certified letter. The veterinarian shall keep an
accurate record of the date and method of disposal, and the name,
address and telephone number of the person or shelter receiving the
animal, if it is not destroyed.
9.3. The humane disposal of abandoned animal shall not relieve the
owner or agent of any financial obligation incurred for treatment,
boarding or care by the veterinarian. Alternatively, an animal may be
placed in a suitable home or animal shelter, which shall not include any
home or shelter which engages in animal experimentation or, by sale or
otherwise, makes animals available for the purpose of animal
experimentation.
9.4. Notification and humane disposal as provided in this section
relieves the veterinarian of any further liability regarding the
abandoned animal.\
9.5. The veterinarian shall post a copy of this section in a conspicuous location at the veterinary facility.
10.1. Immunization clinics shall be operated by a veterinarian
licensed by the Board who has a registered veterinary practice in the
county or adjoining counties where the clinic is being held. Any
immunizations provided at the clinic other than rabies vaccinations
shall be administered by a veterinarian or a registered veterinary
technician supervised by the veterinarian on site.
11.1. In the event of a natural disaster or local malfunction of
utilities, veterinary practices may temporarily operate their businesses
outside of these standards of practice if the veterinarian makes amends
to alleviate as much as possible the problems associated with the
temporary loss of facilities, utilities, or transportation. All efforts
are directed to keep patients safe while continuing to provide needed
veterinary and lifesaving services. Every effort will be made by the
practice owner to bring the facility into full compliance with the
standards of practice as quickly as possible.