This blog entry is the second 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:
- Who owns and is responsible for veterinary patient medical records and making sure they are available when clients request them?
- What steps need to be taken regarding a change in the Veterinary-Client-Patient Relationship?
- What steps do the veterinarians need to take when dissolving the practice to defend against Veterinary Medical Board complaints and malpractice claims?
The Veterinary-Client-Patient Relationship
This issue must be addressed and is similar to the records issue. It must be made clear to each client of the practice who will be assuming the responsibilities set forth above and who will be maintaining the Veterinary-Client Patient Relationship (“VCPR”). Lack of clarity on this issue could lead to license discipline and complaints to the California Veterinary Medical Board (“Board”) .
Definitions
The American Veterinary Medical Association (AVMA) has defined the VCPR as follows:
A VCPR is present when all of the following requirements are met:
- The veterinarian has assumed the responsibility for making clinical judgments regarding the health of the patient and the client has agreed to follow the veterinarians’ instructions.
- The veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient. This means that the veterinarian is personally acquainted with the keeping and care of the patient by virtue of a timely examination of the patient by the veterinarian, or medically appropriate and timely visits by the veterinarian to the operation where the patient is managed.
- The veterinarian is readily available for follow-up evaluation or has arranged for the following: veterinary emergency coverage, and continuing care and treatment.
- The veterinarian provides oversight of treatment, compliance, and outcome.
- Patient records are maintained.[1]
The Board has indicated the consequences of failure to establish a proper VCPR and also defined it:
(a) It is unprofessional conduct for a veterinarian to administer, prescribe, dispense or furnish a drug, medicine, appliance, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture or bodily injury or disease of an animal without having first established a veterinarian-client-patient relationship with the animal patient or patients and the client, except where the patient is a wild animal or the owner is unknown.
(b) A veterinarian-client-patient relationship shall be established by the following occur:
(1) The client has authorized the veterinarian to assume responsibility for making medical judgments regarding the health of the animal, including the need for medical treatment,
(2) The veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s). This means that the veterinarian is personally acquainted with the care of the animal(s) by virtue of an examination of the animal or by medically appropriate and timely visits to the premises where the animals are kept, and
(3) The veterinarian has assumed responsibility for making medical judgments regarding the health of the animal and has communicated with the client a course of treatment appropriate to the circumstance.
(c) A drug shall not be prescribed for a duration inconsistent with the medical condition of the animal(s) or type of drug prescribed. The veterinarian shall not prescribe a drug for a duration longer than one year from the date the veterinarian examined the animal(s) and prescribed the drug.
(d) As used herein, “drug” shall mean any controlled substance, as defined by Section 4021 of Business and Professions code, and any dangerous drug, as defined by Section 4022 of Business and Professions code.
Steps to Address this Issue
The Board will file disciplinary charges against a veterinarian who fails to clearly define the VCPR. And it is the veterinarian’s job (not the client’s) to make sure this is clear.
In a case where a practice is splitting up and different clients are going with each of the practice groups, all licensed veterinarians, especially the premises licensees, must communicate in writing with the clients and make sure they know:
- Who is going to be their veterinarian (or that they get to choose) and who is responsible for the VCPR?
- Who will be competent and up to speed to provide ongoing care sufficiently to comply with the requirements of the VCPR (or even emergency care while the practice is splitting up)?
- Who will have the patient records?
- Will practice A provide care, practice B, or neither?
- If the client picks another practice other than Practice A or B, that the records will be provided right away.
Regardless of any dispute among owners of the practice, the mutual goal is to avoid Board complaints, investigations, citations, and discipline, as well as lawsuits, and bad online reviews, etc.
[1] See https://www.avma.org/KB/Resources/Reference/Pages/VCPR.aspx.