A Change in the Veterinary Practice Relationship – Part 1

This blog entry is the first of a three-part series of entries regarding issues that Veterinarians face when there is a change in the practice relationship. This can be a veterinarian leaving a practice, a clinic selling a practice, or a practice that is closing. The series examines the following questions:

  1. Who owns and is responsible for veterinary patient medical records and making sure they are available when clients request them?
  2. What steps need to be taken regarding a change in the Veterinary-Client-Patient Relationship?
  3. What steps do the veterinarians need to take when dissolving the practice to defend against Veterinary Medical Board complaints and malpractice claims?


Responsibility for Veterinary Medical Records

The Premises Licensee is Responsible for the Records

The Veterinary Practice Act is clear about the obligation to keep records. Business and Professions Code section 4855 provides:

A veterinarian subject to the provisions of this chapter shall, as required by regulation of the board, keep a written record of all animals receiving veterinary services, and provide a summary of that record to the owner of animals receiving veterinary services, when requested. The minimum amount of information which shall be included in written records and summaries shall be established by the board. The minimum duration of time for which a licensed premise shall retain the written record or a complete copy of the written record shall be determined by the board.

Section 4856 makes clear that the records must be open to inspection by the Board—thus they need to be on the premises. Board regulations also make clear that the records must be kept for three years from the date of the last visit (Title 16, Cal. Code Regs. § 2032.3.)
When a client requests records, the veterinarian may provide the records or a “summary” of the records that includes:

  1. Name and address of client and animal.
  2. Age, sex, breed, species and color of animal.
  3. History or pertinent information as it pertains to each animal´s medial status.
  4. Data, including that obtained by instrumentation, from physical examination.
  5. Treatment and intended treatment plan, including medications, their dosage and frequency of use.
  6. All medications and treatments prescribed and dispensed, including, strength, dosage, quantity, and frequency.
  7. Daily progress, if relevant, and disposition of case.

(Title 16, Cal. Code Regs. § 2032.3(b)).
The Board has amended its regulations recently regarding who is responsible for the practice –the premises licensee. (See discussion – California Veterinary Premises Licensees – Ready to be Wholly Responsible?) Basically, if anything goes wrong at the practice, the premises licensee will suffer license discipline:

(a)       A Licensee Manager is the California licensed veterinarian named as the Licensee Manager on a facility’s premises permit.

(b)       The Licensee Manager is responsible for ensuring that the premises for which he/she is manager complies with the requirements in sections 4853, 4854, 4855 and 4856 of the Business and Professions Code, Division 2, Chapter 11, Article 3. The Licensee Manager is responsible for ensuring that the physical and operational components of a premises meet the minimum standards of practice as set forth in sections 2030 through 2032.5 of the California Code of Regulations, Title 16, Division 20, Article 4.

(c)       The Licensee Manager is responsible for ensuring that no unlicensed activity is occurring within the premises or in any location where any function of veterinary medicine, veterinary surgery or veterinary dentistry is being conducted off the premises under the auspices of this premises license.

(d)       The Licensee Manager shall maintain whatever physical presence is reasonable within the facility to ensure that the requirements in (a) – (c) are met.

(e)       Each licensed veterinarian shall be responsible for their individual violations of the Veterinary Medicine Practice Act or any regulation adopted thereunder.

(Title 16, Cal. Code Regs. § 2030.05).
Therefore, the Board’s position is clear—if there is a recordkeeping violation (which almost every Veterinary Medical Board Accusation and Citation contain), the premises licensee can be held responsible. Even the Board’s “Frequently Asked Questions” confirm this:

Q:  My veterinarian has moved or closed down, how can I get my records?

A:  Each managing licensee of a veterinary facility is required to maintain a current address of record. If the facility has moved or closed down, the VMB recommends that you contact the Board for the most recent address of record and then send a written request for a summary of your animal’s records to that address. If there is no response, then you should file a complaint with the Veterinary Medical Board.

Thus, the records issue must be dealt with in the transition of ownership of a veterinary practice.

Confidentiality of the Records

To further complicate matters, veterinary records are confidential and cannot be disclosed without owner consent except in limited circumstances. To save time, I am including the entire section 4857 of the Business and Professions Code:

(a)  A veterinarian licensed under the provisions of this chapter shall not disclose any information concerning an animal receiving veterinary services, the client responsible for the animal receiving veterinary services, or the veterinary care provided to an animal, except under any one of the following circumstances:

(1)  Upon written or witnessed oral authorization by knowing and informed consent of the client responsible for the animal receiving services or an authorized agent of the client.

(2)  Upon authorization received by electronic transmission when originated by the client responsible for the animal receiving services or an authorized agent of the client.

(3)  In response to a valid court order or subpoena.

(4)  As may be required to ensure compliance with any federal, state, county, or city law or regulation, including, but not limited to, the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).

(5)  Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians or facilities for the purpose of diagnosis or treatment of the animal who is the subject of the medical records.

(6)  As otherwise provided in this section.

(b)  This section shall not apply to the extent that the client responsible for an animal or an authorized agent of the client responsible for the animal has filed or caused to be filed a civil or criminal complaint that places the veterinarian’s care and treatment of the animal or the nature and extent of the injuries to the animal at issue, or when the veterinarian is acting to comply with federal, state, county, or city laws or regulations.

(c)  A veterinarian shall be subject to the criminal penalties set  forth in Section 4831 or any other provision of this code for a violation of this section. In addition, any veterinarian who negligently  releases confidential information shall be liable in a civil action for any damages caused by the release of that information.

(d)  Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians and peace  officers, humane society officers, or animal control officers who are acting to protect the welfare of animals.

This section seems to prevent two practices from sharing pet records unless it is for the purpose of treating the pet. Thus, the ultimate decision must be made, who gets the records of each client and who will assume responsibility for keeping them confidential, available for Board inspection, for client request, and for three (3) years?