Melissa
Kaplan's
Herp Care Collection
Last updated
January 1, 2014
AVMA Draft Model Veterinary Practice Act
The draft MVPA is causing a stir amongst some pet owners and and rescuers, but should it?
©2003 Melissa Kaplan
- Prohibit pet owners from contacting by phone, email, or other online communication, licensed veterinarians and other types of practitioners, veterinary or otherwise, on behalf of their pets.
- Prohibit anyone but licensed veterinarians from diagnosing, treating, correcting, changing, alleviating or preventing disease in animals.
Before anyone races to send off IFTA's sample letter to the AVMA, I suggest a careful reading of the MVPA, and a reading of your own state's existing rules and regulations regarding veterinary medicine and veterinarians. What follows are my own comments and observations after doing so.
Note: The MVPA currently under discussion is a revision to the existing MVPA. It provides standards developed by the American Veterinary Medical Association that states can adopt so that the laws pertaining to veterinarians will be the same from state to state. Since laws in many states are modeled on the previous version of this act, there really is not a significant change in most of the provisions, including those provisions that have caused concern in some pet owners.
It has alway, in recent history, been against the law to practice medicine, veterinary or human, without a state license. It has been against the law to prescribe or dispense medications without out first examining the patient, human or otherwise. That's not changed under the proposed MVPA.
What has changed is the increasing awareness amongst many vets that clients are demanding treatment modalities classified as complimentary and alternative for their pets.
In other words, the veterinary profession is going through the same offensive and defensive reactions that the medical profession has been dealing with: the increase in alternative practitioners claiming to be able to diagnose, treat and, in many cases, cure diseases and disorders. Vets are now faced with their clients taking their pets to alternative practitioners many of whom have no training in animal biology or physiology, are subject to no formal training programs related to the use of their preferred therapeutics on animals (nor, in many cases, on humans). Finally, with the majority of CAM practices, there is little or no science or research to back up the use of these therapeutics in animals.
In the human medical arena, some of this has slowly been changing over the years, with the recognition of formally trained and certified chiropractors and acupuncturists. The scarcity of state certification for other alternative practitioners can be traced to the lack of rigorous research supporting the modalities. The studies over the past couple of years documenting the billions of dollars people are spending on complementary/alternative medicine (CAM), including the taking of vitamins, herbs and other supplements, and the use of alternative treatment modalities, has forced the medical profession to wake up and smell all that lost revenue. As a result, they have been pressing for research and structure, and many have started to adopt some CAM into their daily practice, foraging a new specialty, Integrative Medicine. This results in a win-win situation for those doctors open to exploring and incorporating alternative practices into their essentially Western medical model, and for the patients who benefit from a wider range of therapeutic options.
Vets are where medical doctors were a couple of years ago. The nice thing is that this means that the changes that are happening in human medical practice will happen in veterinary medical practice sooner rather than later, as veterinary schools and veterinary continuing education providers start including CAM in their curriculum and CE programs.
As regards CAM for animals, please keep in mind that human medicine and research is only just realizing that humans are not all alike, that men differ greatly from women by far more than their gonads and external sex-linked paraphernalia. Human medicine and research is also finally realizing that children aren't just miniature adults. Previously accepted "truths" are being thrown out as new gender- and age-based research is documenting the vast age and gender-related differences in humans.
Now, look at veterinary medicine. We don't just have gender and age to deal with, we have thousands of species! You can't even go by classes of animals, like birds, reptiles, etc., because within classes there are huge differences in anatomy, biology, neurochemistry, endocrinology, etc. Just look at the differences between crocodiles, iguanas, and tuataras. Or snakes and amphisbaenians.
How do the various CAM protocols work in veterinary medicine when the practitioner may not only have no knowledge of animals? For the practitioner types mentioned in the original post (Herbalists, Chiropractors, Homeopaths, Lecturers, Aromatherapists, Holistic Care Consultants, Flower Essence Therapists, Animal Massage Therapists, Essential Oil Therapists, Reiki practitioners, Distance Healers, TTouch practitioners, etc.), few if any of these practices have any national organization that has developed standards of teaching and practice. There are no state boards of certification, boards that look at the formal education the applicant successfully completed and administer exams developed by the state boards or national organizations to screen out applicants who do not meet the standards of care promoted by the state and national entities.
With all too many of the CAM practitioners, the reality is that anyone can hang up a shingle and, voila!, they're in business. People come to them in good faith, believing they've been trained and certified to a certain level. The reality is that the patient (or pet owner's) trust is often misplaced, and without standards of care and a way of screening alternative practitioners, the patient's are left to learn by trial and error.
This is becoming an increasing problem when it comes to pets, one that has concerned me for some time. Based on the Draft, it concerns the vets, too: People are going to CAM practitioners, or getting a book and treating their animals themselves at home, because they see it as a cheap or "natural" alternative to going to the vet.
I get mail all the time from people wanting to know how to treat things at home that require x-rays or a sterile operating field. How many posts like that have those of you who have been reading newsgroups, message boards and mailing lists for years seen?
I know a lot of people get tired of me saying "get to the vet" when I say that in emails, mailing lists, and message boards. But the fact of the matter is that, while I (and others) can make a pretty darned good guess at what someone's animal's problem is, I can't know for sure and so, no matter how much help and suggestions I offer, the bottom line is: get to the vet for proper evaluation, diagnosis and plan of treatment.
That is also why, though I will recommend the use of things like milk thistle for liver disease, you will note that:
- I only make recommendations for substances that have some research documenting their efficacy in humans, and refer people to specific web sites for them to do their own reading;
- I do not give dosage recommendations;
- I stress that the pet owners should talk about the use of the substance, as well as dosing, with their vet.
There are simply too many variables involved for me to feel comfortable doing otherwise.
As someone who used to do a lot of rescue and rehab, I never took in someone else's animal to work on. I only worked on animals that were surrendered to me. When people didn't want to surrender their animal to me or another rescue yet kept asking what they could do, they were rarely happy with my response: get it to the vet. Yes, I make the necessary recommendations about correcting environment and diet, but if there is any suspicion on my part that there may be things going on inside that animal that correcting the diet and environment won't fix, I push the person to go to the vet.
I've had people tell me that if I didn't tell them what to do, that they would let the animal die and it would be MY fault that they animal died because I wouldn't tell the person how to remove an abscess or do something else that I feel is inappropriate for pet owners to do on their own at home.
Do I know rescues that do some things that pet owners should not do? Yes, but if the rescue is smart, they are
a) trained by a vet and/or have formal wildlife rehab or veterinary clinical nursing training,
b) have the proper materials at home to do the procedure,
c) are working on rescue animals, not someone else's pet, and
d) they have the brains to know when the situation needs to be seen and treated by their vet, not by themselves.
Those of you who used to read or post on the Pet Care Forum on Veterinary Information Network (VIN) probably noticed an integral part of the hosts' signatures: Not A Vet. That was to make it clear to others that the host who was posting advice and recommendations was not a vet. We had several vets posting, but they were just a quick as us non-vets to say, "Get your pet to the vet" because they were just as experienced as we were in knowing that you can't accurately diagnose a problem in an animal you can't see based solely on a generally incomplete and/or inaccurate history and other information provided by the pet owner. Even if someone posted all their pet's test results, much of the decision making a vet does is in part subjective, based both on reviewing the test results, his past experience with the species and other test results, and interacting with the living, breathing animal in his or her hands.
The section above also pertains to telephone and email between vet and patient. Again, the vet is relying on what the pet owner tells the vet. Now, as many of us doing rescue or helping answer questions online for years know, the words someone uses to describe a color, behavior, or even size or time period, can be so grossly off from reality you are left wondering how long that person has been abusing recreational substances. So, vets have long made it a practice to NOT diagnose or prescribe on the phone to pet owners. In fact, it is the law, not just, as some people feel, the vet trying to drum up business by making someone bring their animal in for an examination.
Now, a rescue or shelter that has demonstrated their knowledge of animal health and care practices, descriptive abilities, and understanding of when their animals should see a vet, may well develop a relationship with their vets so that they can call and get some help on the phone. Shelters/Rescues in this category are not pet owners.
Many people doing rescue are just pet owners with big hearts. They mean well, but they do not have the background or experience to develop such a working relationship with their vet. Some rescuers who started out as pet owners with big hearts decide to get serious about what they are doing. They go back to school to get formally trained in veterinary clinical nursing and/or get formal education by taking the wildlife rehab courses taught by the international or national wildlife rehabilitation organizations. Some go all the way in their training and get their state AHT/VT license and develop formal working relationships with bona fide wildlife rescues. These rescuers know when to get to the vet and their vets learn their capabilities. If they are faced with a situation they are not familiar with or that isn't responding as it should, they don't dither about or seek out an alternative practitioner: they talk to their vet or take the animal in to the vet's office. You can't put these trained and experienced people in the same category as pet owners or pet owners who take in unwanted animals from individuals or the pound.
If you, as a rescue/shelter, don't already have a working relationship with a vet, don't expect a vet you cold-call to answer your questions without first seeing your animals. The vet would be breaking existing state laws and AVMA professional standards codes if he or she did so.
Does the MVPA prevent patients from getting CAM from their vet? No, not so long as the vet they choose is "into" CAM, meaning that he or she may have or will be integrating some CAM into their practice, or they have identified chiropractic, holistic or other CAM practitioners in the area whom they feel can work on some or all of the species the vet sees in his or her practice. For reference, read the Section 6, especially items 4, 5, and 8 in the Draft. Note that Section 8 states that a veterinarian-client-patient relationship must exist for 8 to be permitted. See also page 3, Definition 21, for the definition of "veterinarian-client-patient relationship".
This sounds very much like what I've been saying for years, about how important it is for people--pet owners and rescuers--to develop a good working relationship with their vet, doesn't it?.
Before people start freaking out about this, please go to your own state's codes and look up what your state code is on veterinarians and the practice of veterinary medicine. In California, go to http://www.leginfo.ca.gov/calaw.html and do your search under Business & Professions. The California Veterinary Medical Board is at http://www.vmb.ca.gov/.
How can we as pet owners help change the way things are, get vets more interested in learning about and incorporating CAM practices into their traditional practice? The same way human health care consumers have been getting change to happen in human medicine:
- Be informed consumers. Anyone can write a book or put up a site or sell product. That doesn't mean they actually know what they are talking about or that there's any research to back them up. Learn to research the various CAM practices that interest you for whatever reason. And learn how to assess the information you find.
- Let your vet know you are interested in CAM for your pets by providing concrete information. Print out articles, make copies of book chapters, and give your vet enough information so that he or she can make some assessments on the material you provide.
[It isn't enough to say, "This woman named Melissa says that I should give Pookie milkwhistle or something like that for, uhm, I think she said for kidney? liver? Something - she said to tell you, that you'd know." Okay, so I'm exaggerating a bit. But your vet will be much more amenable to considering the use of whatever if you hand him or her a sheaf of thoughtfully selected articles printed out in an easy-to-read format. The latter often means copying and pasting into your word processor articles you find on the web (don't forget to include the actual web address and proper attributions), then reformatting it into an easily read document before saving it and printing it out.]
- Let your state assembly people who help make the state laws and statutes that you are for state boards or some sort of national certification for the various CAM practitioners. Such certification will help you make better choices as a health care consumer for yourself, and your family, human and otherwise.
- Keep your eye in web sites such as the following for updated information on CAM and alternative practices:
NIH National Center for Complementary and Alternative Medicine
FDA Drugs
FDA Animals
Recalls and Safety Alerts
And remember: read up on both drugs and any other substances you give your animals. Many of them are contraindicated, or pose problems when taken together. I have information and resources on these linked to my Drugs, Herbs and Supplements and Resources: Alternative & Complementary sites.
Sue
Solomon, reptile and licensed wildlife rehabilitator, responds:
Melissa made many good cautionary points before and including this:
> As someone who
used to do a lot of rescue and rehab, I never took in
> someone else's animal to work on. I only worked on animals that were
> surrendered to me. When people didn't want to surrender their animal
> to me or another rescue and kept asking what they could do, they
were
> rarely happy with my response: get it to the appropriate vet.
The Northern California Herpetological Society has a rescue/rehab/adoption group, some members of which have the qualifications mentioned above. I'm one of them. Under no circumstances do I take in someone else's pet for rehab. Coincidentally, we just prepared an Animal Relinquishment Form based on those used by the SPCA and animal control agencies and adapted for our use. It contains proper legal statements protecting us. There is a statement on the form that if the owner chooses to reclaim the animal before NCHS has placed or euthanized it, s/he is responsible for all vet charges we have incurred on behalf of the animal. That's because a few months ago a man asked us to take about 40 reptiles, then asked for some back later. It was only three but it was a red flag. What if we had adopted them out or euthanized them? We don't wanna know.
If someone tells me in person, by phone or by e-mail that, for example, their iguana is off feed and is scratching around the cage, I might say that animals with similar behavior patterns are often making eggs, potentially a situation with serious complications, but theirs should be seen by a vet to confirm the nature of the problem and get professional advice and treatment.
If someone tells me their snake has his head in the air "yawning" all the time, I might say snakes frequently do this when they have a potentially fatal respiratory infection or a contagious disease, and therefore I recommend an immediate visit to a reptile vet.
The difference between this and Melissa's policy is that I believe it motivates them to get to the vet if I suggest a possible, reasonable serious reason why they need to do it -- and fast.
I remember all too well the time my first snake went into shed. Her eyes turned grayish-blue. Panicked and totally ignorant, I called the UC Davis vet student advice hotline. The student who answered told me the snake might be pregnant! This particular diagnosis is amusing in retrospect but I wonder why the student volunteers weren't instructed to ask a supervisor or say "I don't know" if they were unfamiliar with the type of animal or the conditions described. Fortunately, the "problem" didn't require any treatment and the advice was irrelevant, LOL.
The other reasons for seeing a vet, even if the rescuer makes a correct diagnosis, include that that is the only way to get prescription medications in guaranteed proper doses in sterile conditions, surgical procedures, x-rays/ultrasound, and often-needed extra trained hands to do even a simple procedure like debriding and disinfecting a wound on a feisty animal (can you spell "iguana"?). A very few wildlife rescue centers can analyze bloodwork but most rescuers cannot even take blood samples.
Related Information
AVMA
Model Veterinary Practice Act (Comments and Draft)
Assessing
and Validating Information
Drugs,
Herbs and Supplements
Resources:
Alternative & Complementary
Veterinary CAM Information/Sites
Use
of Herbal Remedies to Control Pet Behavior (IVIS)
Healing
Oasis Wellness Center
American
Association of Veterinary State Boards
IVIS
Continuing Education
