Title 15

Title 15
DEPARTMENT OF AGRICULTURE

Subtitle 14 BOARD OF VETERINARY MEDICAL EXAMINERS

Notice of Proposed Action

[12-212-P]

The State Board of Veterinary Medical Examiners proposes to:

(1) Amend Regulations .03, .05, and .10 under COMAR 15.14.01 Standards of Practice and Code of Ethics for the Practice of Veterinary Medicine in the State;

(2) Amend Regulation .01, adopt new Regulations .02—.04, amend and recodify existing Regulation .06 to be Regulation .09, and recodify existing Regulations .02—.05 and .07—.10 to be Regulations .05—.08 and .10—.13 under COMAR 15.14.02 Board Hearings;

(3) Amend Regulation .05 and adopt new Regulation .07 under COMAR 15.14.07 Minimum Standards for Mobile Veterinary Clinics;

(4) Amend Regulation .04 under COMAR 15.14.11 Civil Penalty Standards for Veterinarians;

(5) Amend Regulations .02, .03, .11, and .13 under COMAR 15.14.13 Qualifications for Examination and Registration of a Veterinary Technician; and

(6) Amend Regulation .04 under COMAR 15.14.14 Minimum Standards for a Limited Use Veterinary Hospital.

Statement of Purpose

The purpose of this action is to: clarify when a veterinarian-client-patient relationship is established; indicate a veterinarian's responsibility to a patient in a non-emergency and emergency situation; define the word "specialist"; clarify record keeping requirements for medications administered; define and describe formal and informal actions, and complaint and case resolution procedures of the State Board of Veterinary Medical Examiners; require positive pressure oxygen delivery systems in mobile and limited use veterinary clinics; update civil penalty ranges based on classification of violations; amend the qualifications for examination of candidates for registration as veterinary technicians; and amend the duties and restrictions on registered veterinary technicians.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. The SBVME plans to mail copies of the revised regulatory requirements to currently registered veterinarians and veterinary technicians and to licensed veterinary hospital owners. Under Chapter 30, Acts 2010, effective October 1, 2010, the State Board of Veterinary Medical Examiners (SBVME) was granted the authority to issue a $5,000 civil penalty for a first offense or a penalty of up to $10,000 for a second or subsequent offense. Civil penalties collected by the SBVME are directed to the State's general fund. The extent of the impact on veterinarians is undeterminable because the egregiousness and number of violations cannot be predicted. However, from January 2009 to December 2011, out of the 89 veterinarians formally charged by the SBVME, 67 were ordered to pay civil penalties. Owners of mobile or limited use veterinary hospitals who do not possess a positive pressure oxygen delivery system will be required to purchase one and have it in their hospital. A small percentage of hospital owners are expected to be affected by this new requirement.

Revenue (R+/R-)

II. Types of Economic Impact.

Expenditure (E+/E-)

Magnitude

A. On issuing agency:

(E+)

$6,500

B. On other State agencies:

NONE

C. On local governments:

NONE

Benefit (+)
Cost (-)

Magnitude

D. On regulated industries or trade groups:

(1) Veterinarians

(-)

Indeterminable

(2) Mobile or limited use veterinary hospital owners

(-)

Indeterminable

E. On other industries or trade groups:

NONE

F. Direct and indirect effects on public:

Individuals who own pets

(+)

Indeterminable

III. Assumptions. (Identified by Impact Letter and Number from Section II.)

A. The SBVME will send a copy of the revised regulations to its licensed veterinarians and veterinary hospitals and to registered veterinary technicians.

D(1). Veterinarians may be charged up to a $10,000 civil penalty for a second or subsequent offense, which is an increase from the previous maximum penalty of $5,000. A review of actions taken by the SBVME over the past three years reveals that 75% of disciplined veterinarians are ordered to pay a civil penalty. Civil penalties paid to the SBVME are transferred to the general fund of the State.

D(2). An owner of a mobile veterinary clinic or a limited use veterinary clinic that does not presently have a positive pressure oxygen delivery system will need to purchase one for the clinic. A delivery system that allows the user to bag an animal and deliver positive pressure ventilation can be purchased for approximately $1,200. There are approximately 30 mobile or limited use veterinary hospitals in MD. It is estimated that approximately half of these types of hospitals already have a positive pressure oxygen delivery system in place; therefore, approximately 3% of all licensed veterinary hospitals may be affected by this requirement.

F. Amendments to Chapter 13 will help ensure that registered veterinary technicians who are not graduates of accredited veterinary technology programs have taken relevant college coursework and have provided proof not only of their skills, but of their number of hours of work experience. Additionally, when an animal is presented as an emergency, the regulations set forth both the conditions under which an RVT may treat the animal, and the information that must be provided the animal's owner if a veterinarian is not immediately available. Additionally, the requirement that owners of mobile or limited use veterinary hospitals have a positive pressure oxygen delivery system reflects a change in acceptable minimal standards for the practice of veterinary medicine for these types of hospitals. While it is estimated that the vast majority of these types of hospitals already possess this type of equipment, the expectation is that those who do not have one will see a decreased rate in morbidity among patients requiring supplemental oxygen. A patient's increased chance of survival should correlate positively with increased consumer confidence.

Economic Impact on Small Businesses

The proposed action has minimal or no economic impact on small businesses.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Laura Downes, Executive Director, State Board of Veterinary Medical Examiners, 50 Harry S Truman Parkway, Room 102, or call 410-841-5862, or email to laura.downes@maryland.gov, or fax to 410-841-5780. Comments will be accepted through September 10, 2012. A public hearing has not been scheduled.

15.14.01 Standards of Practice and Code of Ethics for the Practice of Veterinary Medicine in the State

Authority: Agriculture Article, §§2-103, 2-304, and 2-310, Annotated Code of Maryland

.03 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(7) (text unchanged)

(8) "Specialist" means an individual who has obtained certification from a specialty organization recognized by the American Veterinary Medical Association.

[(8)] (9) — [(10)] (11) (text unchanged)

.05 Choice and Selection of Patients.

[A veterinarian may choose whom he will serve. Once he has undertaken care of a patient he may not neglect him. In an emergency, however, he should render service to the best of his ability, but this does not require veterinarians to accept financial responsibility for the care and treatment of any animal.] A. Non-emergency Presentation. A veterinarian may choose whom he will serve. Once a veterinarian has undertaken care of a patient, and a veterinarian-client-patient relationship has been established, the veterinarian may not neglect the patient.

B. Emergency Presentation. In an emergency, a veterinarian should render service to the best of the veterinarian's ability, but this does not require a veterinarian to accept financial responsibility for the care and treatment of any animal. The following procedures may be performed during an emergency without such actions constituting the establishment of a veterinarian-client-patient relationship:

(1) Initial evaluation;

(2) Diagnostics to assist in the initial evaluation; or

(3) Initial treatments to stabilize a patient.

.10 Record Keeping.

A. For animals that a veterinarian treats, the veterinarian shall prepare a legibly written record that accurately and thoroughly reflects the treatment provided. At a minimum, the veterinarian's record shall include the following information, as applicable:

(1)—(7) (text unchanged)

(8) The treatment provided the animal and if medication is given, the following shall be provided:

(a) Amount in milligrams or the volume and concentration of substance used;

(b)—(c) (text unchanged)

(9)—(10) (text unchanged)

B.—G. (text unchanged)

15.14.02 Board [Hearings] Actions

Authority: Agriculture Article, §§2-302.1, 2-304, 2-307.1, 2-310, 2-310.1, and 2-311; State Government Article, §§10-207 - 10-209,

Annotated Code of Maryland

.01 Scope.

[This chapter applies to all formal hearings before the State Board of Veterinary Medical Examiners. This chapter does not apply to conferences or other formal investigations or proceedings at or upon which no formal ruling or decision is made.] This chapter concerns formal and informal actions of the State Board of Veterinary Medical Examiners to enforce the laws and regulations governing the practice of veterinary medicine in this State. The Board may take action against alleged violators, including a veterinarian, a veterinary technician, an owner of a veterinary hospital, an owner of a mobile veterinary clinic, and an owner of an animal control facility. This chapter describes the Board's procedures for investigating possible violations of the Maryland Veterinary Practice Act that it discovers, and complaints it receives within 3 years of the complained-of conduct, and older complaints upon a showing of extraordinary circumstances. Additionally, this chapter describes procedures for contested case hearings before the Board and alternative dispute resolution procedures, including confidential case resolution procedure and mediation.

.02 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Abrogate" means to rescind a prior action of the Board;

(2) "Cease and desist letter" means a letter issued by the Board directing:

(a) A licensee to cease doing a specified activity; or

(b) An unlicensed individual to cease the unauthorized practice of veterinary medicine.

(3) "Censure" means a reprimand.

(4) "Charging document" means a nonpublic document issued by the Board as a formal disciplinary action that:

(a) Alleges conduct by a licensee that the Board considers to be a violation under the Maryland Veterinary Medicine Act;

(b) Sets forth provisions of the Maryland Veterinary Practice Act that the Board considers to have been violated; and

(c) Provides notice to the licensee of disciplinary proceedings before the Board.

(5) "Civil penalty final order" means a public document issued by the Board containing a final order that disposes of a charging document when the licensee:

(a) Waives the right to a contested case hearing; and

(b) Pays the civil penalty sanction contained in the notice of Board action.

(6) "Complaint" means a nonpublic document or other information received by the Board that sets out conduct by a licensee that may:

(a) Violate the Maryland Veterinary Practice Act; and

(b) Be grounds for an investigation or disciplinary action by the Board.

(7) "Consent agreement and order" means a public document issued by the Board that includes a final order of the Board specifying certain Board action that has been negotiated and agreed to by both parties to resolve a disciplinary action.

(8) "Default order" means a proposed order issued by the Board upon the failure of a licensee to respond to a notice of Board action or to appear at a hearing.

(9) "Dismissal" means an action of the Board to dispose of a complaint or matter without taking any disciplinary action.

(10) "Disposition agreement" means a nonpublic formal agreement entered into with an impaired licensee in which the licensee agrees to comply with certain conditions.

(11) "Letter of admonishment" means a nonpublic document issued by the Board as an informal action containing strong recommendations to a veterinarian regarding conduct or practices that concern the Board but do not rise to a level of severity requiring disciplinary action.

(12) "Letter of advice" means a nonpublic document issued by the Board as an informal action containing educational advice to a veterinarian regarding conduct or practices that the Board finds could be improved but do not rise to a level of severity requiring disciplinary action.

(13) "Letter of surrender" means a public letter accepted by the Board in which the licensee agrees to surrender the licensee's license to practice veterinary medicine.

(14) "Mediation" means a confidential voluntary alternative dispute resolution (ADR) process offered by the Department to assist parties in resolving a dispute informally.

(15) "Modified order" means an order issued by the Board to abrogate, change, or modify an original order after consideration of facts not originally considered.

(16) "Probation" means a sanction imposed by the Board, in which the licensee is:

(a) Monitored by the Board for a period of time; and

(b) Subject to certain requirements by the Board.

(17) "Public document" means a document that the Board is permitted or required to disclose to the public under State Government Article, Title 10, Subtitle 6, Annotated Code of Maryland.

(18) "Recusal" means the removal of a member of the Board from participation in a matter because of interest, bias, or other reason.

(19) "Resolution conference" means a confidential meeting between a licensee and members of the Board to discuss possible settlement of a disciplinary matter.

(20) "Show cause hearing" means a nonevidentiary hearing before the Board in which the licensee may demonstrate to the Board why the Board should not issue a proposed order or take some other action.

(21) "Stay" means the withholding of Board action against a licensee, which stay may be subject to conditions imposed by the Board.

(22) "Stet" means the act of staying all further action in a proceeding, subject to the proceeding being reopened at a later date.

(23) "Summary suspension" means the indefinite suspension of a license under State Government Article, §10-226, Annotated Code of Maryland, issued if the Board finds that the action is necessary to protect the health, safety, or welfare of animals or individuals.

(24) "Veterinary review committee" means a team composed of three or more members of the Board that, under Agriculture Article §2-302.1, has the delegated authority to perform regulatory functions pertaining to veterinary practitioners under Title 2, Subtitle 3 of the Agriculture Article.

(25) "Violation of probation" means failure to comply with a requirement of probation imposed in an order of the Board.

.03 Complaint Procedures.

A. The Board or a veterinary review committee shall review a complaint received within 3 years of the conduct complained of, and may review a complaint received after 3 years of the conduct complained of upon a showing of extraordinary circumstances.

B. After reviewing a complaint, the Board or a veterinary review committee may further investigate the complaint by:

(1) Requesting relevant records;

(2) Requesting written or oral responses from the alleged violator;

(3) Requesting rebuttals from the complainant;

(4) Requesting statements from witnesses;

(5) Requesting statements from relevant third parties, including other treating veterinarians;

(6) Procuring expert opinions on relevant specialty areas;

(7) Researching areas in dispute; and

(8) Seeking legal advice.

C. After completing an investigation of a complaint, the Board or a veterinary review committee may recommend that the Board take one or more of the following actions:

(1) Dismiss the matter for lack of authority or merit;

(2) Issue a cease and desist order;

(3) Issue a letter of advice;

(4) Issue a letter of admonition;

(5) Issue a notice of action and charging document;

(6) Stay the matter;

(7) Stet the matter;

(8) Refer the matter to mediation;

(9) Refer the matter to the appropriate authorities; or

(10) Issue a summary suspension which provides the right to request within 10 days a nonevidentiary show cause hearing.

.04 Board Actions and Case Resolution Procedures.

A. The Board may resolve or dispose of a complaint by any of the following:

(1) Consent agreement and order;

(2) Civil penalty final order;

(3) Consent agreement and censure;

(4) Disposition agreement;

(5) Dismissal;

(6) Final order;

(7) Letter of advice;

(8) Letter of admonishment;

(9) Probation;

(10) Referral to appropriate authorities;

(11) Referral to mediation;

(12) Stay;

(13) Stet; or

(14) Other authorized action of the Board.

B. After the issuance of a notice of Board action and charging document to a licensee, the Board and the licensee may voluntarily agree to enter into any of the following confidential case resolution procedures, which may result in a formal or informal action of the Board:

(1) A case resolution conference call or meeting;

(2) Settlement negotiations; or

(3) Mediation of interested parties.

C. A case resolution procedure shall be completed within 180 days of issuance of a notice of Board action, unless the Board finds good cause to grant additional time upon a written request and showing by the licensee.

D. The Board may issue a default order to a licensee who, without good cause, fails to respond to a notice of agency action or to comply with a Board order.

E. A licensee who receives a default order may request a nonevidentiary show cause hearing within 10 days of receipt of the order.

F. If the Board and a licensee are unable to reach an agreement, the matter may proceed to a hearing, if the licensee requested a hearing in writing in a timely manner.

G. The Board in its discretion may abrogate a prior order or issue a modified order.

H. Except for consideration of a proposed resolution of a case, admissions, facts revealed, proposals, or positions taken, unless the information is available from other sources or through discovery, are not admissible in a contested case hearing.

I. Participation in a case resolution procedure is not ordinarily a basis for recusal of Board member from further proceedings in a case.

[.06] .09 Examination of Witnesses and Introduction of Evidence.

A.—D. (text unchanged)

E. A member of the Board shall decide a motion for recusal when the basis for the motion is that member's legal interest or bias. The presiding officer shall decide a motion for recusal, if the basis for the motion is something other than legal interest or bias of another member.

15.14.07 Minimum Standards for Mobile Veterinary Clinics

Authority: Agriculture Article, §§2-304 and 2-304.1, Annotated Code of Maryland

.05 Licensing Requirements.

A. (text unchanged)

B. The owner of more than one mobile veterinary clinic shall obtain a hospital license for each mobile clinic.

[B.] C.— [C.] D. (text unchanged)

.07 Oxygen Delivery.

A suitably equipped area shall include a positive pressure oxygen delivery system for small animal patients where medically indicated, regardless of whether surgery is performed in the mobile veterinary clinic.

15.14.11 Civil Penalty Standards for Veterinarians

Authority: Agriculture Article, §2-310.1, Annotated Code of Maryland

.04 Classification of Violations for the Purpose of Determining Penalties.

A. For a violation of Regulation .03A—F of this chapter, a penalty may be imposed by the Board considering the nature and gravity of each violation consistent with the following standards:

(1) For the first violation, a penalty of not less than [$150] $300 or more than [$1,500;] $3,000;

(2) For the second violation, a penalty of not less than [$300] $600 or more than [$3,000;] $6,000;

(3) For the third and any subsequent violation, a penalty of not less than [$1,500] $3,000 or more than [$5,000.] $10,000.

B. For a violation of Regulation .03G-J, a penalty may be imposed by the Board considering the nature and gravity of each violation consistent with the following standards:

(1) For the first violation, a penalty of not less than [$300] $600 or more than [$3,000;] $5,000;

(2) For the second violation, a fine of not less than [$1,500] $3,000 or more than [$5,000;] $10,000;

(3) For the third and any subsequent violation, a penalty of not less than [$3,000] $6,000 or more than [$5,000.] $10,000.

C. For a violation of Regulation .03K—P of this chapter, a penalty may be imposed by the Board considering the nature and gravity of each violation consistent with the following standards:

(1) For the first violation, a penalty of not less than [$1,500] $3,000 or more than $5,000;

(2) For the second violation, a penalty of not less than [$3,000] $6,000 or more than [$5,000;] $10,000;

(3) For the third and any subsequent violation, a penalty of not less than [$4,000] $8,000 or more than [$5,000.] $10,000.

15.14.13 Qualifications for Examination and Registration of a Veterinary Technician

Authority: Agriculture Article, §2-309, Annotated Code of Maryland

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) - (3) (text unchanged)

(4) "Candidate for graduation" means a student who:

(a) Is within approximately 3 months of graduating college with a degree in veterinary technology; and

(b) Has a letter sent from the college to the Board's office, indicating the student's expected date of graduation.

[(4)] (5)— [(8)] (9) (text unchanged)

.03 Qualifications for Examination.

[A. Eligibility. To be eligible to take the State Board Examination, an examination applicant shall provide:

(1) A final transcript from a school showing that the applicant is a:

(a) Graduate from a veterinary technology program approved by the AVMA,

(b) Holder of a bachelor's degree or master's degree in one of the following sciences:

(i) Agricultural or life sciences, such as biology, botany, or agronomy; or

(ii) Physical sciences, such as chemistry or physics; or

(c) Graduate of a program approved by the Committee, with equivalent training and experience equal to those candidates who have graduated from a veterinary technician program approved by the AVMA.]

A. Eligibility Requirements for Graduates or Candidates for Graduation From Veterinary Technology Programs. To be eligible to take the State Board Examination, an examination applicant shall provide a final transcript from a school showing that the applicant is a graduate or candidate for graduation from a veterinary technology program approved by the AVMA.

B. Eligibility Requirements for Applicants Who do not Meet the Educational Criteria Set Forth in §A of this Regulation. To be eligible to take the State Board Examination, an examination applicant shall provide:

(1) A school-authenticated transcript showing the applicant to be a holder of an associate's degree or above, which includes a minimum of three credits in each of the following college level courses:

(a) Biology I;

(b) Biology II;

(c) Microbiology;

(d) Chemistry;

(e) Anatomy and Physiology I; and

(f) Anatomy and Physiology II.

(2) Proof of completion of 10,000 hours of work experience as a technician, with a signed affidavit from a supervising veterinarian specifying the number of hours worked and the dates worked;

(3) A Maryland Technician Skill Assessment completed by a licensed veterinarian;

(4) Proof of having completed a minimum of 24 hours of veterinary technician continuing education; and

(5) Proof of having completed a minimum of 24 hours of work as a veterinary technician in a veterinary emergency facility.

[B.] C. Board Examination. To take the State Board Examination, an applicant shall submit the following to the State Board within 1 year from the date the Board has received the application:

(1) - (3) (text unchanged)

(4) One of the following documents:

(a) A final transcript from a school, as set forth in §A of this [regulation.] regulation; or

(b) Proof of completion of certain coursework, as set forth in §B of this regulation.

[C.] D. (text unchanged)

[D.] E. VTNE.

(1) (text unchanged)

(2) Other Type Graduate.

(a) To sit for a scheduled VTNE, an examination applicant who meets the eligibility requirements set forth in [§A(1)(b) or (c)] §B of this regulation shall have the school from which the applicant graduated submit to the Board a school authenticated copy of the applicant's final transcript and, if applicable, an English translation, for its review. The applicant shall also provide the following information in writing to the Board:

(i) - (ii) (text unchanged)

(b) - (c) (text unchanged)

.11 Requirements of Veterinary Technicians from Another State or Foreign Jurisdiction.

A. Subject to the provisions of this regulation, the Board may register an applying veterinary technician who:

(1) Is registered in another state or a foreign jurisdiction and is a graduate [of:

(a) A] of a school accredited by the American Veterinary Medical Association; [or

(b) A program approved by the Committee, with equivalent training and experience equal to those candidates who have graduated from a veterinary technician program approved by the American Veterinary Medical Association;]

(2) - (4) (text unchanged)

B. (text unchanged)

.13 Duties and Restrictions on Registered Veterinary Technicians.

A. A registered veterinary technician may not [practice veterinary medicine as defined by Agriculture Article, §2-301(f), Annotated Code of Maryland.]:

(1) Diagnose;

(2) Offer prognosis;

(3) Prescribe:

(a) Drugs;

(b) Medication;

(c) Appliances;

(4) Perform surgery; or

(5) Initiate treatment without prior instruction by a veterinarian.

B. A registered veterinary technician may perform the following procedures under the responsible direct supervision of a veterinarian:

[(1) Anesthesia induction by inhalation or intravenous injection if the veterinarian is able to maintain direct visual contact of the technician's performance;]

[(2) Anesthesia induction] (1) Inducing anesthesia by intramuscular injection;

[(3) Application of] (2) Applying casts and splints;

[(4) Dental extractions; and] (3) Simple dental extractions of loose teeth that do not involve flaps or tooth sectioning;

[(5)] (4) Suturing of existing surgical skin [incisions.] or gingival incisions; and

(5) Accessing a small working stock of Schedule II drugs under separate lock.

C. A registered veterinary technician may perform anesthetic induction by inhalation or intravenous injection if the veterinarian is able to maintain direct visual supervision of the technician's performance.

[C.] D. (text unchanged)

E. Emergency Conditions.

(1) Under emergency conditions only, the following activities may be performed by a registered veterinary technician before a veterinarian's initial examination of an animal:

(a) Provide supportive care and first aid; and

(b) Follow written protocols for specific conditions, as established by the veterinarian.

(2) If a veterinarian is not available to perform an initial examination of an animal that is presented as an emergency, a registered veterinary technician shall notify the animal's owner of the:

(a) Veterinarian's unavailability;

(b) Estimated time of arrival of the veterinarian; and

(c) Estimated distance to another veterinary hospital.

[D.] F. (text unchanged)

15.14.14 Minimum Standards for a Limited Use Veterinary Hospital

Authority: Agriculture Article, §2-304.1, Annotated Code of Maryland

.04 Minimum Standards.

A. A person who owns or operates a limited use veterinary hospital is responsible for:

(1)—(4) (text unchanged)

(5) Keeping [an artificial respirator in the room where the limited use veterinary hospital service is provided] a positive pressure oxygen delivery system for small animal patients where medically indicated;

(6)—(7) (text unchanged)

B. (text unchanged)

EARL F. HANCE
Secretary of Agriculture