AB 1399: Veterinary medicine: veterinarian-client-patient relationship: telehealth.
- Session Year: 2023-2024
- House: Assembly
- Latest Version Date: 2023-10-08
Current Status:
Passed
(2023-10-08: Chaptered by Secretary of State - Chapter 475, Statutes of 2023.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
Existing law, the Veterinary Medicine Practice Act, establishes the Veterinary Medical Board within the Department of Consumer Affairs for the licensure and regulation of veterinarians and the practice of veterinary medicine. Existing law specifies that a violation of the act is a crime. The act prohibits any person from practicing veterinary medicine, as defined, without a license. The act authorizes the board to deny, revoke, or suspend a license or registration or assess a fine for, among other things, violation of a regulation adopted by the board and unprofessional conduct, as specified.
A regulation adopted by the board makes it unprofessional conduct to provide specified treatment of an animal without having first established a veterinarian-client-patient relationship, as specified. That regulation also prohibits a person from practicing veterinary medicine in this state outside the context of a veterinarian-client-patient relationship or as otherwise permitted by law.
This bill similarly would prohibit the practice of veterinary medicine outside the context of a veterinarian-client-patient relationship, as defined, except as specified.
Existing administrative law requires telemedicine to be conducted within an existing veterinarian-client-patient relationship, with the exception for advice given in an emergency, as specified, and defines telemedicine to mean the mode of delivering animal health care services via communication technologies to facilitate consultation, treatment, and care management of the patient.
This bill similarly would authorize a licensee to practice veterinary medicine via telehealth, as prescribed. The bill would require a veterinarian who practices veterinary medicine via telehealth, among other things, to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient and providing quality of care consistent with prevailing veterinary medical practice, be familiar with available medical resources, be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client, keep, maintain, and make an animal patient record summary available, provide the client with information about the veterinarian, and secure an alternative means of contacting the client if the electronic means is interrupted, as specified.
The bill would also define the term client for purposes of the act and make other conforming changes.
Existing law requires all veterinary premises to be registered with the board. Existing law defines premises for these purposes as inclusive of mobile units or vehicles, but exempts them from independent registration with the board if they are operated from a building or facility that is the licensee managers principal place of business, the building is registered with the board, and the registration identifies and declares the use of the mobile unit or vehicle. Existing law specifies that the registration of veterinary premises is nontransferable and requires that, in the event of change of an owner or operator of the premises, the premises registration holder notify the board within 30 days after the change.
This bill would exempt the location where a veterinarian practices telehealth from the requirement that it be registered if specified conditions are met, including, among other things, that the veterinarian does not perform any in-person examination or treatment of animal patients at that location.
Because the bill would impose new requirements and prohibitions under the Veterinary Medicine Practice Act, the violation of which is a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Veterinary Medicine Practice Act, establishes the Veterinary Medical Board within the Department of Consumer Affairs for the licensure and regulation of veterinarians and the practice of veterinary medicine. Existing law specifies that a violation of the act is a crime. The act prohibits any person from practicing veterinary medicine, as defined, without a license. The act authorizes the board to deny, revoke, or suspend a license or registration or assess a fine for, among other things, violation of a regulation adopted by the board and unprofessional conduct, as specified.
A regulation adopted by the board makes it unprofessional conduct to provide specified treatment of an animal without having first established a veterinarian-client-patient relationship, as specified. That regulation also prohibits a person from practicing veterinary medicine in this state outside the context of a veterinarian-client-patient relationship or as otherwise permitted by law.
This bill similarly would prohibit the practice of veterinary medicine outside the context of a veterinarian-client-patient relationship, as defined, except as specified.
Existing administrative law requires telemedicine to be conducted within an existing veterinarian-client-patient relationship, with the exception for advice given in an emergency, as specified, and defines telemedicine to mean the mode of delivering animal health care services via communication technologies to facilitate consultation, treatment, and care management of the patient.
This bill similarly would authorize a licensee to practice veterinary medicine via telehealth, as prescribed. The bill would require a veterinarian who practices veterinary medicine via telehealth, among other things, to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient and providing quality of care consistent with prevailing veterinary medical practice, be familiar with available medical resources, be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client, keep, maintain, and make an animal patient record summary available, provide the client with information about the veterinarian, and secure an alternative means of contacting the client if the electronic means is interrupted, as specified.
The bill would also define the term client for purposes of the act and make other conforming changes.
Existing law requires all veterinary premises to be registered with the board. Existing law defines premises for these purposes as inclusive of mobile units or vehicles, but exempts them from independent registration with the board if they are operated from a building or facility that is the licensee managers principal place of business, the building is registered with the board, and the registration identifies and declares the use of the mobile unit or vehicle. Existing law specifies that the registration of veterinary premises is nontransferable and requires that, in the event of change of an owner or operator of the premises, the premises registration holder notify the board within 30 days after the change.
This bill would exempt the location where a veterinarian practices telehealth from the requirement that it be registered if specified conditions are met, including, among other things, that the veterinarian does not perform any in-person examination or treatment of animal patients at that location.
Because the bill would impose new requirements and prohibitions under the Veterinary Medicine Practice Act, the violation of which is a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Veterinary Medicine Practice Act, establishes the Veterinary Medical Board within the Department of Consumer Affairs for the licensure and regulation of veterinarians and the practice of veterinary medicine. Existing law specifies that a violation of the act is a crime. The act prohibits any person from practicing veterinary medicine, as defined, without a license. The act authorizes the board to deny, revoke, or suspend a license or registration or assess a fine for, among other things, violation of a regulation adopted by the board and unprofessional conduct, as specified.
A regulation adopted by the board makes it unprofessional conduct to provide specified treatment of an animal without having first established a veterinarian-client-patient relationship, as specified. That regulation also prohibits a person from practicing veterinary medicine in this state outside the context of a veterinarian-client-patient relationship or as otherwise permitted by law.
This bill similarly would prohibit the practice of veterinary medicine outside the context of a veterinarian-client-patient relationship, as defined, except as specified.
Existing administrative law requires telemedicine to be conducted within an existing veterinarian-client-patient relationship, with the exception for advice given in an emergency, as specified, and defines telemedicine to mean the mode of delivering animal health care services via communication technologies to facilitate consultation, treatment, and care management of the patient.
This bill similarly would authorize a licensee to practice veterinary medicine via telehealth, as prescribed. The bill would require a veterinarian who practices veterinary medicine via telehealth, among other things, to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient, provide quality of care consistent with prevailing veterinary medical practice, be familiar with available medical resources, be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client, keep, maintain, and make an animal patient record summary available, provide the client with information about the veterinarian, and secure an alternative means of contacting the client if the electronic means is interrupted, as specified.
The bill would also define the term client for purposes of the act and make other conforming changes.
Existing law requires all veterinary premises to be registered with the board. Existing law defines premises for these purposes as inclusive of mobile units or vehicles, but exempts them from independent registration with the board if they are operated from a building or facility that is the licensee managers principal place of business, the building is registered with the board, and the registration identifies and declares the use of the mobile unit or vehicle. Existing law specifies that the registration of veterinary premises is nontransferable and requires that, in the event of change of an owner or operator of the premises, the premises registration holder notify the board within 30 days after the change.
This bill would exempt the location where a veterinarian practices telehealth from the requirement that it be registered if specified conditions are met, including, among other things, that the veterinarian does not perform any in-person examination or treatment of animal patients at that location.
Because the bill would impose new requirements and prohibitions under the Veterinary Medicine Practice Act, the violation of which is a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Veterinary Medicine Practice Act, establishes the Veterinary Medical Board within the Department of Consumer Affairs for the licensure and regulation of veterinarians and the practice of veterinary medicine. Existing law specifies that a violation of the act is a crime. The act prohibits any person from practicing veterinary medicine, as defined, without a license. The act authorizes the board to deny, revoke, or suspend a license or registration or assess a fine for, among other things, violation of a regulation adopted by the board and unprofessional conduct, as specified.
A regulation adopted by the board makes it unprofessional conduct to provide specified treatment of an animal without having first established a veterinarian-client-patient relationship, as specified. That regulation also prohibits a person from practicing veterinary medicine in this state outside the context of a veterinarian-client-patient relationship or as otherwise permitted by law.
This bill similarly would prohibit the practice of veterinary medicine outside the context of a veterinarian-client-patient relationship, as defined, except as specified.
Existing administrative law requires telemedicine to be conducted within an existing veterinarian-client-patient relationship, with the exception for advice given in an emergency, as specified, and defines telemedicine to mean the mode of delivering animal health care services via communication technologies to facilitate consultation, treatment, and care management of the patient.
This bill similarly would authorize a licensee to practice veterinary medicine via telehealth, as prescribed. The bill would require a veterinarian who practices veterinary medicine via telehealth, among other things, to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient, provide quality of care consistent with prevailing veterinary medical practice, be familiar with available medical resources, be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client, keep, maintain, and make a an animal patient record summary available, provide the client with information about the veterinarian, and secure an alternative means of contacting the client if the electronic means is interrupted, as specified.
The bill would also define the term client for purposes of the act and make other conforming changes.
Because the bill would impose new requirements and prohibitions under the Veterinary Medicine Practice Act, the violation of which is a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Veterinary Medicine Practice Act, establishes the Veterinary Medical Board within the Department of Consumer Affairs for the licensure and regulation of veterinarians and the practice of veterinary medicine. Existing law specifies that a violation of the act is a crime. The act prohibits any person from practicing veterinary medicine, as defined, without a license. The act authorizes the board to deny, revoke, or suspend a license or registration or assess a fine for, among other things, violation of a regulation adopted by the board and unprofessional conduct, as specified.
A regulation adopted by the board makes it unprofessional conduct to provide specified treatment of an animal without having first established a veterinarian-client-patient relationship, as specified. That regulation also prohibits a person from practicing veterinary medicine in this state outside the context of a veterinarian-client-patient relationship or as otherwise permitted by law.
This bill similarly would prohibit the practice of veterinary medicine outside the context of a veterinarian-client-patient relationship, as defined, except as specified.
Existing administrative law requires telemedicine to be conducted within an existing veterinarian-client-patient relationship, with the exception for advice given in an emergency, as specified, and defines telemedicine to mean the mode of delivering animal health care services via communication technologies to facilitate consultation, treatment, and care management of the patient.
This bill similarly would authorize a licensee to practice veterinary medicine via telehealth, as prescribed. The bill would require a veterinarian who practices veterinary medicine via telehealth, among other things, to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient, provide quality of care consistent with prevailing veterinary medical practice, be familiar with available medical resources, be able to refer the client to a nearby veterinarian provide the client with a list of nearby veterinarians who may be able to see the patient in person upon the request of the client, keep, maintain, and make a patient record summary available, provide the client with information about the veterinarian, and secure an alternative means of contacting the client if the electronic means is interrupted, as specified.
The bill would also define the term client for purposes of the act and make other conforming changes.
Because the bill would impose new requirements and prohibitions under the Veterinary Medicine Practice Act, the violation of which is a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Veterinary Medicine Practice Act, establishes the Veterinary Medical Board within the Department of Consumer Affairs for the licensure and regulation of veterinarians and the practice of veterinary medicine. Existing law specifies that a violation of the act is a crime. The act prohibits any person from practicing veterinary medicine, as defined, without a license. The act authorizes the board to deny, revoke, or suspend a license or registration or assess a fine for, among other things, violation of a regulation adopted by the board and unprofessional conduct, as specified.
A regulation adopted by the board makes it unprofessional conduct to provide specified treatment of an animal without having first established a veterinarian-client-patient relationship, as specified. That regulation also prohibits a person from practicing veterinary medicine in this state outside the context of a veterinarian-client-patient relationship or as otherwise permitted by law.
This bill similarly would prohibit the practice of veterinary medicine outside the context of a veterinarian-client-patient relationship, as defined, except as specified.
Existing administrative law requires telemedicine to be conducted within an existing veterinarian-client-patient relationship, with the exception for advice given in an emergency, as specified, and defines telemedicine to mean the mode of delivering animal health care services via communication technologies to facilitate consultation, treatment, and care management of the patient.
This bill similarly would authorize a licensee to practice veterinary medicine via telehealth, as prescribed. The bill would require a veterinarian who practices veterinary medicine via telehealth, among other things, to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient, provide quality of care consistent with prevailing veterinary medical practice, and be familiar with available medical resources, be able to refer the client to a nearby veterinarian who may be able to see the patient in person upon the request of the client and client, make a patient record summary available, provide the client with information about the veterinarian, and secure an alternative means of contacting the client if the electronic means is interrupted, as specified.
The bill would also define the term client for purposes of the act and make other conforming changes.
Because the bill would impose new requirements and prohibitions under the Veterinary Medicine Practice Act, the violation of which is a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Veterinary Medicine Practice Act, establishes the Veterinary Medical Board within the Department of Consumer Affairs for the licensure and regulation of veterinarians and the practice of veterinary medicine. Existing law specifies that a violation of the act is a crime. The act prohibits any person from practicing veterinary medicine, as defined, without a license. The act authorizes the board to deny, revoke, or suspend a license or registration or assess a fine for, among other things, violation of a regulation adopted by the board and unprofessional conduct, as specified.
A regulation adopted by the board makes it unprofessional conduct to provide specified treatment of an animal without having first established a veterinarian-client-patient relationship, as specified. That regulation also prohibits a person from practicing veterinary medicine in this state outside the context of a veterinarian-client-patient relationship or as otherwise permitted by law.
This bill similarly would prohibit the practice of veterinary medicine outside the context of a veterinarian-client-patient relationship, as defined, except as specified.
Existing administrative law requires telemedicine to be conducted within an existing veterinarian-client-patient relationship, with the exception for advice given in an emergency, as specified, and defines telemedicine to mean the mode of delivering animal health care services via communication technologies to facilitate consultation, treatment, and care management of the patient.
This bill similarly would authorize a licensee to practice veterinary medicine via telehealth, as prescribed. The bill would require a veterinarian who practices veterinary medicine via telehealth, among other things, to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient, provide quality of care consistent with prevailing veterinary medical practice, and be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client. client and make a patient record summary available, as specified.
The bill would also define the term client for purposes of the act and make other conforming changes.
Because the bill would impose new requirements and prohibitions under the Veterinary Medicine Practice Act, the violation of which is a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Veterinary Medicine Practice Act, establishes the Veterinary Medical Board within the Department of Consumer Affairs for the licensure and regulation of veterinarians and the practice of veterinary medicine. Existing law specifies that a violation of the act is a crime. The act prohibits any person from practicing veterinary medicine, as defined, without a license. The act authorizes the board to deny, revoke, or suspend a license or registration or assess a fine for, among other things, violation of a regulation adopted by the board and unprofessional conduct, as specified.
A regulation adopted by the board makes it unprofessional conduct to provide specified treatment of an animal without having first established a veterinarian-client-patient relationship, as specified. That regulation also prohibits a person from practicing veterinary medicine in this state outside the context of a veterinarian-client-patient relationship or as otherwise permitted by law.
This bill similarly would prohibit the practice of veterinary medicine outside the context of a veterinarian-client-patient relationship, as defined, except as specified.
Existing administrative law requires telemedicine to be conducted within an existing veterinarian-client-patient relationship, with the exception for advice given in an emergency, as specified, and defines telemedicine to mean the mode of delivering animal health care services via communication technologies to facilitate consultation, treatment, and care management of the patient.
This bill similarly would authorize a licensee to practice veterinary telemedicine, as defined. medicine via telehealth, as prescribed. The bill would require a veterinarian who practices veterinary telemedicine, medicine via telehealth, among other things, to employ sound professional judgment to determine whether using veterinary telemedicine telehealth is an appropriate method for delivering medical advice or treatment to the patient, provide quality of care consistent with prevailing veterinary medical practice, and be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client.
The bill would also define the term client for purposes of the act and make other conforming changes.
Because the bill would impose new requirements and prohibitions under the Veterinary Medicine Practice Act, the violation of which is a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Veterinary Medicine Practice Act, establishes the Veterinary Medical Board within the Department of Consumer Affairs for the licensure and regulation of veterinarians and the practice of veterinary medicine. Existing law specifies that a violation of the act is a crime. The act prohibits any person from practicing veterinary medicine, as defined, without a license. The act authorizes the board to deny, revoke, or suspend a license or registration or assess a fine for, among other things, violation of a regulation adopted by the board and unprofessional conduct, as specified.
A regulation adopted by the board makes it unprofessional conduct to provide specified treatment of an animal without having first established a veterinarian-client-patient relationship, as specified. That regulation also prohibits a person from practicing veterinary medicine in this state outside the context of a veterinarian-client-patient relationship or as otherwise permitted by law.
This bill similarly would prohibit the practice of veterinary medicine outside the context of a veterinarian-client-patient relationship, as defined, except as specified.
Existing administrative law requires telemedicine to be conducted within an existing veterinarian-client-patient relationship, with the exception for advice given in an emergency, as specified, and defines telemedicine to mean the mode of delivering animal health care services via communication technologies to facilitate consultation, treatment, and care management of the patient.
This bill similarly would authorize a licensee to practice veterinary telemedicine, as defined. The bill would require a veterinarian who practices veterinary telemedicine, among other things, to employ sound professional judgment to determine whether using veterinary telemedicine is an appropriate method for delivering medical advice or treatment to the patient, provide quality of care consistent with prevailing veterinary medical practice, and be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client.
The bill would also define the term client for purposes of the act and make other conforming changes.
Because the bill would impose new requirements and prohibitions under the Veterinary Medicine Practice Act, the violation of which is a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
The Alcoholic Beverage Control Act contains various provisions regulating the application for, the issuance of, the suspension of, and the conditions imposed upon alcoholic beverage licenses by the Department of Alcoholic Beverage Control, and defines certain terms for this purpose. This bill would make a nonsubstantive change to those provisions.The Alcoholic Beverage Control Act contains various provisions regulating the application for, the issuance of, the suspension of, and the conditions imposed upon alcoholic beverage licenses by the Department of Alcoholic Beverage Control, and defines certain terms for this purpose.
This bill would make a nonsubstantive change to those provisions.
(a)No person or entity shall dispense or furnish, or cause to be dispensed or furnished, dangerous drugs or dangerous devices, as defined in Section 4022, on the internet for delivery to any person in this state without a prescription issued pursuant to a good faith prior examination of a human or animal for whom the prescription is meant if the person or entity either knew or reasonably should have known that the prescription was not issued pursuant to a good faith prior examination of a human or animal, or if the person or entity did not act in accordance with Section 1761 of Title 16 of the California Code of Regulations.
(b)Notwithstanding any other provision of law, a violation of this section may subject the person or entity that has committed the violation to either a fine of up to twenty-five thousand dollars ($25,000) per occurrence pursuant to a citation issued by the board or a civil penalty of twenty-five thousand dollars ($25,000) per occurrence.
(c)The Attorney General may bring an action to enforce this section and to collect the fines or civil penalties authorized by subdivision (b).
(d)For notifications made on and after January 1, 2002, the Franchise Tax Board, upon notification by the Attorney General or the board of a final judgment in an action brought under this section, shall subtract the amount of the fine or awarded civil penalties from any tax refunds or lottery winnings due to the person who is a defendant in the action using the offset authority under Section 12419.5 of the Government Code, as delegated by the Controller, and the processes as established by the Franchise Tax Board for this purpose. That amount shall be forwarded to the board for deposit in the Pharmacy Board Contingent Fund.
(e)Nothing in this section shall be construed to permit the unlicensed practice of pharmacy, or to limit the authority of the board to enforce any other provision of this chapter.
(f)For the purposes of this section, good faith prior examination includes the requirements for a physician and surgeon in Section 2242 and the requirements for a veterinarian in Section 4826.6.
SEC. 2.Section 4825.1 of the Business and Professions Code is amended to read:4825.1.These definitions shall govern the construction of this chapter as it applies to veterinary medicine.
(a)Client means the individual or individuals who represent to the veterinarian that they are the owner or owners of the animal patient at the time that the services are provided.
(b)Diagnosis means the act or process of identifying or determining the health status of an animal patient through examination and the opinion derived from that examination.
(c)Animal means any member of the animal kingdom other than humans, and includes fowl, fish, and reptiles, wild or domestic, whether living or dead.
(d)Food animal means any animal that is raised for the production of an edible product intended for consumption by humans. The edible product includes, but is not limited to, milk, meat, and eggs. Food animal includes, but is not limited to, cattle (beef or dairy), swine, sheep, poultry, fish, and amphibian species.
(e)Livestock includes all animals, poultry, aquatic and amphibian species that are raised, kept, or used for profit. It does not include those species that are usually kept as pets such as dogs, cats, and pet birds, or companion animals, including equines.
(f)Synchronous means a real-time interaction between a client and animal patient with a veterinarian who is licensed in this state and located at a distant site.
(g)Telehealth means the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, synchronous video and audio communication; synchronous, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
SEC. 3.Section 4826.6 is added to the Business and Professions Code, to read:4826.6.(a)A veterinarian shall not prescribe, dispense, or administer a drug, medicine, application, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals unless a veterinarian-client-patient relationship exists or as otherwise permitted by law, except when the animal patient is a wild animal or the owner of the animal patient is unknown. A veterinarian-client-patient relationship exists if all of the following conditions are met:
(1)The client has authorized the veterinarian to assume responsibility for medical judgments regarding the health of the animal patient.
(2)The veterinarian possesses sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the animal patients medical condition.
(3)The veterinarian has assumed responsibility for making medical judgments regarding the health of the animal patient and has communicated with the client a medical, treatment, diagnostic, or therapeutic plan appropriate to the circumstances.
(b)A veterinarian possesses sufficient knowledge of the animal patient for purposes of paragraph (2) of subdivision (a) if the veterinarian has recently seen, or is personally acquainted with, the care of the animal patient by doing any of the following:
(1)Examining the animal patient in person.
(2)Examining the animal patient by use of synchronous audio-video communication.
(3)Making medically appropriate and timely visits to the premises on which the animal patient is kept.
(c)For purposes of paragraphs (1) and (3) of subdivision (a), the client may authorize an agent to act on the clients behalf.
(d)Synchronous audio-video communication is not required for the delivery of veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
(e)A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.
(f)Only a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary medicine via telehealth on an animal patient located in this state.
(g)Before delivering veterinary medicine via telehealth, the veterinarian shall inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth, including acknowledgment of all of the following:
(1)The same standards of care apply to veterinary medicine services via telehealth and in-person veterinary medical services.
(2)The client has the option to choose an in-person visit from a veterinarian at any time.
(3)The client has been advised how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate resulting from technological or equipment failure.
(h)A veterinarian who practices veterinary medicine via telehealth shall do all of the following:
(1)Ensure that the technology, method, and equipment used to provide veterinary medicine services via telehealth comply with all current privacy protection laws.
(2)Have historical knowledge of the animal patient by obtaining and reviewing the animal patients relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
(3)Employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient and providing quality of care consistent with prevailing veterinary medical practice.
(4)Be familiar with available medical resources, including emergency resources near the animal patients location, be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client, and keep, maintain, and make available a summary of the animal patient record, as specified in Section 4855.
(5)Provide the client with the veterinarians name, contact information, and license number.
(6)Secure an alternative means of contacting the client if the electronic means is interrupted.
(i)(1)A veterinarian shall not prescribe a drug for a duration of time that is inconsistent with the medical condition of the animal patient or the type of drug prescribed.
(2)A veterinarian who established the required veterinarian-client-patient relationship by examining the animal patient in person or by making medically appropriate and timely visits to the premises on which the animal patient is kept shall not prescribe a drug for a duration of time that is longer than one year from the date that the veterinarian examined the animal patient in person or visited the premises and prescribed the drug.
(3)Except as provided in paragraphs (4) to (8), inclusive, a veterinarian who practices veterinary medicine via telehealth may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant state and federal regulations.
(4)A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the animal patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the animal patient, either in person or using telehealth.
(5)A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe an antimicrobial drug to the animal patient for a period longer than 14 days of treatment. The veterinarian shall not issue any further antimicrobial drug prescription, including a refill, to treat the condition of the animal patient unless the veterinarian has conducted an in-person examination of the animal patient.
(6)The veterinarian shall not order, prescribe, or make available a controlled substance, as defined in Section 4021, or xylazine, unless the veterinarian has performed an in-person physical examination of the animal patient or made medically appropriate and timely visits to the premises where the animal patient is kept.
(7)The veterinarian shall notify the client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian shall submit a prescription to a pharmacy that the client chooses.
(8)A veterinarian shall not prescribe via telehealth any drug or medication for use on a horse engaged in racing or training at a facility under the jurisdiction of the California Horse Racing Board pursuant to Chapter 4 (commencing with Section 19400) of Division 8.
(j)As used in this section, drug means any controlled substance, as defined in Section 4021, or any dangerous drug, as defined in Section 4022.
(k)A veterinarian is permitted to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.
SEC. 4.Section 4829.5 of the Business and Professions Code is amended to read:4829.5.(a)Each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug, as defined in Section 4022, to an animal patient in an outpatient setting, the veterinarian shall offer to provide, verbally, in writing, or by email to the client, a consultation that includes the following information:
(1)The name and description of the dangerous drug.
(2)Route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug.
(3)Any special directions for proper use and storage.
(4)Actions to be taken in the event of a missed dose.
(5)If available, precautions and relevant warnings provided by the drugs manufacturer, including common severe adverse effects of the drug.
(b)If requested, a veterinarian shall provide drug documentation, if available.
(c)A veterinarian may delegate to a registered veterinary technician or veterinary assistant the task of providing the consultation and drug documentation required by this section.
(d)It shall be noted in the medical record of the animal patient if the consultation described in this section is provided or declined by the client.
SEC. 5.Section 4853 of the Business and Professions Code is amended to read:4853.(a)All veterinary premises shall be registered with the board. The certificate of registration shall be on a form prescribed in accordance with Section 164.
(b)Premises for the purpose of this chapter shall mean the location of operation where veterinary medicine, veterinary dentistry, veterinary surgery, and the various branches thereof is being practiced and shall include a building, kennel, mobile unit, or vehicle. Mobile units and vehicles shall be exempted from independent registration with the board if they are operated from a building or facility that is the licensee managers principal place of business and the building is registered with the board, and the registration identifies and declares the use of the mobile unit or vehicle.
(c)The owner or operator of a veterinary premises shall submit a premises registration application to the board. The application shall set forth the name of each owner or operator of the premises, including the type of corporate entity, if applicable, the name of the premises, and the name of the responsible licensee manager who is to act for and on behalf of the registered premises. Substitution of the responsible licensee manager may be accomplished by application to the board if the following conditions are met:
(1)The person substituted qualifies by presenting satisfactory evidence that the person possesses a valid, unexpired, and unrevoked license as provided by this chapter and that the license is not currently under suspension.
(2)No circumvention of the law is contemplated by the substitution.
(d)If the owner or operator of a veterinary premises is a veterinary corporation practicing pursuant to Article 6 (commencing with Section 4910), the application shall set forth the names and titles of each officer, director, or shareholder. Any changes in the officers, directors, or shareholders shall be reported to the board within 30 days.
(e)If the owner or operator of a veterinary premises is a corporation or other artificial legal entity other than a veterinary corporation as provided under subdivision (d), the application shall set forth the names and titles of all owners, officers, general partners, if any, and the agent for service of process. Any changes in the owners, officers, general partners, or agent for service of process shall be reported to the board within 30 days.
(f)The premises registration is nontransferable. In the event of change of an owner or operator of the premises, the premises registration holder shall notify the board of the change within 30 days after the change.
(g)This section does not authorize any person, corporation, or artificial legal entity, other than a California-licensed veterinarian or a veterinary corporation practicing pursuant to Article 6 (commencing with Section 4910) and the Moscone-Knox Professional Corporation Act (Part 4 (commencing with Section 13400) of Division 3 of Title 1 of the Corporations Code), to furnish to any person or animal patient any veterinary services, diagnosis, or treatment within the scope of California veterinarian licensure under this chapter. This section does not authorize any person, other than a California-licensed veterinarian within the scope of their license, to engage directly or indirectly in the practice of veterinary medicine, veterinary surgery, veterinary dentistry, and the various branches thereof in accordance with Section 4826. This section does not regulate, govern, or affect in any manner the practice of veterinary medicine, veterinary surgery, or veterinary dentistry by any person duly licensed to engage in such practice.
(h)The location where a veterinarian practices telehealth shall be exempt from the requirement that it be registered pursuant to this section if all of the following requirements are satisfied:
(1)The veterinarian does not perform in-person examination or treatment of animal patients at the location.
(2)No veterinary drug, medicine, appliance, or medical equipment is kept at the location.
(3)The veterinary medical records required pursuant to Sections 4855 and 4856 are created, maintained, and stored so as to protect the veterinary medical records from access by unauthorized individuals, damage, or loss.
(4)The following information shall be provided on any electronic publication, including any internet website, through which the veterinarian provides or offers to provide veterinary medical services:
(A)The veterinarians name, contact information, and California veterinarian license number, prominently displayed.
(B)Contact information and instruction for obtaining a copy of the animal patients medical records.
(C)A statement that a client may contact the Veterinary Medical Board if the client has any questions or complaints regarding the veterinarian.
SEC. 6.Section 4857 of the Business and Professions Code is amended to read:4857.(a)A veterinarian licensed under this chapter shall not disclose any information concerning an animal patient receiving veterinary services, the client responsible for the animal patient receiving veterinary services, or the veterinary care provided to an animal patient, except under any one of the following circumstances:
(1)Upon written or witnessed oral authorization by knowing and informed consent of the client.
(2)Upon authorization received by electronic transmission when originated by 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 (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(5)If the care or service was for a horse that has participated in the previous year, or is intended to participate, in a licensed horse race. In these situations, the entire medical record for the horse shall be made available upon request to anyone responsible for the direct medical care of the horse, including the owner, trainer, or veterinarian, the California Horse Racing Board or any other state or local governmental entity, and the racing association or fair conducting the licensed horse race.
(6)As otherwise provided in this section.
(b)This section shall not apply to the extent that the client responsible for an animal patient or an authorized agent of the client responsible for the animal patient has filed or caused to be filed a civil or criminal complaint that places the veterinarians care and treatment of the animal patient or the nature and extent of the injuries to the animal patient 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.
(e)Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians and facilities for the purpose of diagnosis or treatment of the animal patient that is the subject of the medical records.
SEC. 7.Section 4875.1 of the Business and Professions Code is amended to read:4875.1.(a)In order to ensure that its resources are maximized for the protection of the public, the board shall prioritize its investigative and prosecutorial resources to ensure that veterinarians and registered veterinary technicians representing the greatest threat of harm are identified and disciplined expeditiously. Cases involving any of the following allegations shall be handled on a priority basis, as follows, with the highest priority being given to cases in paragraph (1):
(1)Negligence or incompetence that involves death or serious bodily injury to an animal patient, such that the veterinarian or registered veterinary technician represents a danger to the public.
(2)Cruelty to animals.
(3)A conviction or convictions for a criminal charge or charges or being subject to a felony criminal proceeding without consideration of the outcome of the proceeding.
(4)Practicing veterinary medicine while under the influence of drugs or alcohol.
(5)Drug or alcohol abuse by a veterinarian or registered veterinary technician involving death or serious bodily injury to an animal patient or to the public.
(6)Self-prescribing of any dangerous drug, as defined in Section 4022, or any controlled substance, as defined in Section 4021.
(7)Repeated acts of excessive prescribing, furnishing, or administering of controlled substances, as defined in Section 4021, or repeated acts of prescribing, dispensing, or furnishing of controlled substances, as defined in Section 4021, without having first established a veterinarian-client-patient relationship pursuant to Section 4826.6.
(8)Extreme departures from minimum sanitary conditions such that there is a threat to an animal patient or the public and animal health and safety, only if the case has already been subject to Section 494 and board action.
(b)The board may prioritize cases involving an allegation of conduct that is not described in subdivision (a). Those cases prioritized shall not be assigned a priority equal to or higher than the priorities established in subdivision (a).
(c)The board shall annually report and make publicly available the number of disciplinary actions that are taken in each priority category specified in subdivisions (a) and (b).
SEC. 8.Section 14401 of the Food and Agricultural Code is amended to read:14401.Beginning January 1, 2018, a medically important antimicrobial drug shall not be administered to livestock unless ordered by a licensed veterinarian through a prescription or veterinary feed directive, pursuant to a veterinarian-client-patient relationship that meets the requirements of Section 4826.6 of the Business and Professions Code.
SEC. 9.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)No person or entity shall dispense or furnish, or cause to be dispensed or furnished, dangerous drugs or dangerous devices, as defined in Section 4022, on the internet for delivery to any person in this state without a prescription issued pursuant to a good faith prior examination of a human or animal for whom the prescription is meant if the person or entity either knew or reasonably should have known that the prescription was not issued pursuant to a good faith prior examination of a human or animal, or if the person or entity did not act in accordance with Section 1761 of Title 16 of the California Code of Regulations.
(b)Notwithstanding any other provision of law, a violation of this section may subject the person or entity that has committed the violation to either a fine of up to twenty-five thousand dollars ($25,000) per occurrence pursuant to a citation issued by the board or a civil penalty of twenty-five thousand dollars ($25,000) per occurrence.
(c)The Attorney General may bring an action to enforce this section and to collect the fines or civil penalties authorized by subdivision (b).
(d)For notifications made on and after January 1, 2002, the Franchise Tax Board, upon notification by the Attorney General or the board of a final judgment in an action brought under this section, shall subtract the amount of the fine or awarded civil penalties from any tax refunds or lottery winnings due to the person who is a defendant in the action using the offset authority under Section 12419.5 of the Government Code, as delegated by the Controller, and the processes as established by the Franchise Tax Board for this purpose. That amount shall be forwarded to the board for deposit in the Pharmacy Board Contingent Fund.
(e)Nothing in this section shall be construed to permit the unlicensed practice of pharmacy, or to limit the authority of the board to enforce any other provision of this chapter.
(f)For the purposes of this section, good faith prior examination includes the requirements for a physician and surgeon in Section 2242 and the requirements for a veterinarian in Section 4826.6.
SEC. 2.Section 4825.1 of the Business and Professions Code is amended to read:4825.1.These definitions shall govern the construction of this chapter as it applies to veterinary medicine.
(a)Client means the individual or individuals who represent to the veterinarian that they are the owner or owners of the animal patient at the time that the services are provided.
(b)Diagnosis means the act or process of identifying or determining the health status of an animal patient through examination and the opinion derived from that examination.
(c)Animal means any member of the animal kingdom other than humans, and includes fowl, fish, and reptiles, wild or domestic, whether living or dead.
(d)Food animal means any animal that is raised for the production of an edible product intended for consumption by humans. The edible product includes, but is not limited to, milk, meat, and eggs. Food animal includes, but is not limited to, cattle (beef or dairy), swine, sheep, poultry, fish, and amphibian species.
(e)Livestock includes all animals, poultry, aquatic and amphibian species that are raised, kept, or used for profit. It does not include those species that are usually kept as pets such as dogs, cats, and pet birds, or companion animals, including equines.
(f)Synchronous means a real-time interaction between a client and animal patient with a veterinarian who is licensed in this state and located at a distant site.
(g)Telehealth means the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, synchronous video and audio communication; synchronous, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
SEC. 3.Section 4826.6 is added to the Business and Professions Code, to read:4826.6.(a)A veterinarian shall not prescribe, dispense, or administer a drug, medicine, application, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals unless a veterinarian-client-patient relationship exists or as otherwise permitted by law, except when the animal patient is a wild animal or the owner of the animal patient is unknown. A veterinarian-client-patient relationship exists if all of the following conditions are met:
(1)The client has authorized the veterinarian to assume responsibility for medical judgments regarding the health of the animal patient.
(2)The veterinarian possesses sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the animal patients medical condition.
(3)The veterinarian has assumed responsibility for making medical judgments regarding the health of the animal patient and has communicated with the client a medical, treatment, diagnostic, or therapeutic plan appropriate to the circumstances.
(b)A veterinarian possesses sufficient knowledge of the animal patient for purposes of paragraph (2) of subdivision (a) if the veterinarian has recently seen, or is personally acquainted with, the care of the animal patient by doing any of the following:
(1)Examining the animal patient in person.
(2)Examining the animal patient by use of synchronous audio-video communication.
(3)Making medically appropriate and timely visits to the premises on which the animal patient is kept.
(c)For purposes of paragraphs (1) and (3) of subdivision (a), the client may authorize an agent to act on the clients behalf.
(d)Synchronous audio-video communication is not required for the delivery of veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
(e)A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.
(f)Only a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary medicine via telehealth on an animal patient located in this state.
(g)Before delivering veterinary medicine via telehealth, the veterinarian shall inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth, including acknowledgment of all of the following:
(1)The same standards of care apply to veterinary medicine services via telehealth and in-person veterinary medical services.
(2)The client has the option to choose an in-person visit from a veterinarian at any time.
(3)The client has been advised how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate resulting from technological or equipment failure.
(h)A veterinarian who practices veterinary medicine via telehealth shall do all of the following:
(1)Ensure that the technology, method, and equipment used to provide veterinary medicine services via telehealth comply with all current privacy protection laws.
(2)Have historical knowledge of the animal patient by obtaining and reviewing the animal patients relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
(3)Employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient and providing quality of care consistent with prevailing veterinary medical practice.
(4)Be familiar with available medical resources, including emergency resources near the animal patients location, be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client, and keep, maintain, and make available a summary of the animal patient record, as specified in Section 4855.
(5)Provide the client with the veterinarians name, contact information, and license number.
(6)Secure an alternative means of contacting the client if the electronic means is interrupted.
(i)(1)A veterinarian shall not prescribe a drug for a duration of time that is inconsistent with the medical condition of the animal patient or the type of drug prescribed.
(2)A veterinarian who established the required veterinarian-client-patient relationship by examining the animal patient in person or by making medically appropriate and timely visits to the premises on which the animal patient is kept shall not prescribe a drug for a duration of time that is longer than one year from the date that the veterinarian examined the animal patient in person or visited the premises and prescribed the drug.
(3)Except as provided in paragraphs (4) to (8), inclusive, a veterinarian who practices veterinary medicine via telehealth may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant state and federal regulations.
(4)A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the animal patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the animal patient, either in person or using telehealth.
(5)A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe an antimicrobial drug to the animal patient for a period longer than 14 days of treatment. The veterinarian shall not issue any further antimicrobial drug prescription, including a refill, to treat the condition of the animal patient unless the veterinarian has conducted an in-person examination of the animal patient.
(6)The veterinarian shall not order, prescribe, or make available a controlled substance, as defined in Section 4021, or xylazine, unless the veterinarian has performed an in-person physical examination of the animal patient or made medically appropriate and timely visits to the premises where the animal patient is kept.
(7)The veterinarian shall notify the client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian shall submit a prescription to a pharmacy that the client chooses.
(8)A veterinarian shall not prescribe via telehealth any drug or medication for use on a horse engaged in racing or training at a facility under the jurisdiction of the California Horse Racing Board pursuant to Chapter 4 (commencing with Section 19400) of Division 8.
(j)As used in this section, drug means any controlled substance, as defined in Section 4021, or any dangerous drug, as defined in Section 4022.
(k)A veterinarian is permitted to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.
SEC. 4.Section 4829.5 of the Business and Professions Code is amended to read:4829.5.(a)Each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug, as defined in Section 4022, to an animal patient in an outpatient setting, the veterinarian shall offer to provide, verbally, in writing, or by email to the client, a consultation that includes the following information:
(1)The name and description of the dangerous drug.
(2)Route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug.
(3)Any special directions for proper use and storage.
(4)Actions to be taken in the event of a missed dose.
(5)If available, precautions and relevant warnings provided by the drugs manufacturer, including common severe adverse effects of the drug.
(b)If requested, a veterinarian shall provide drug documentation, if available.
(c)A veterinarian may delegate to a registered veterinary technician or veterinary assistant the task of providing the consultation and drug documentation required by this section.
(d)It shall be noted in the medical record of the animal patient if the consultation described in this section is provided or declined by the client.
SEC. 5.Section 4853 of the Business and Professions Code is amended to read:4853.(a)All veterinary premises shall be registered with the board. The certificate of registration shall be on a form prescribed in accordance with Section 164.
(b)Premises for the purpose of this chapter shall mean the location of operation where veterinary medicine, veterinary dentistry, veterinary surgery, and the various branches thereof is being practiced and shall include a building, kennel, mobile unit, or vehicle. Mobile units and vehicles shall be exempted from independent registration with the board if they are operated from a building or facility that is the licensee managers principal place of business and the building is registered with the board, and the registration identifies and declares the use of the mobile unit or vehicle.
(c)The owner or operator of a veterinary premises shall submit a premises registration application to the board. The application shall set forth the name of each owner or operator of the premises, including the type of corporate entity, if applicable, the name of the premises, and the name of the responsible licensee manager who is to act for and on behalf of the registered premises. Substitution of the responsible licensee manager may be accomplished by application to the board if the following conditions are met:
(1)The person substituted qualifies by presenting satisfactory evidence that the person possesses a valid, unexpired, and unrevoked license as provided by this chapter and that the license is not currently under suspension.
(2)No circumvention of the law is contemplated by the substitution.
(d)If the owner or operator of a veterinary premises is a veterinary corporation practicing pursuant to Article 6 (commencing with Section 4910), the application shall set forth the names and titles of each officer, director, or shareholder. Any changes in the officers, directors, or shareholders shall be reported to the board within 30 days.
(e)If the owner or operator of a veterinary premises is a corporation or other artificial legal entity other than a veterinary corporation as provided under subdivision (d), the application shall set forth the names and titles of all owners, officers, general partners, if any, and the agent for service of process. Any changes in the owners, officers, general partners, or agent for service of process shall be reported to the board within 30 days.
(f)The premises registration is nontransferable. In the event of change of an owner or operator of the premises, the premises registration holder shall notify the board of the change within 30 days after the change.
(g)This section does not authorize any person, corporation, or artificial legal entity, other than a California-licensed veterinarian or a veterinary corporation practicing pursuant to Article 6 (commencing with Section 4910) and the Moscone-Knox Professional Corporation Act (Part 4 (commencing with Section 13400) of Division 3 of Title 1 of the Corporations Code), to furnish to any person or animal patient any veterinary services, diagnosis, or treatment within the scope of California veterinarian licensure under this chapter. This section does not authorize any person, other than a California-licensed veterinarian within the scope of their license, to engage directly or indirectly in the practice of veterinary medicine, veterinary surgery, veterinary dentistry, and the various branches thereof in accordance with Section 4826. This section does not regulate, govern, or affect in any manner the practice of veterinary medicine, veterinary surgery, or veterinary dentistry by any person duly licensed to engage in such practice.
(h)The location where a veterinarian practices telehealth shall be exempt from the requirement that it be registered pursuant to this section if all of the following requirements are satisfied:
(1)The veterinarian does not perform in-person examination or treatment of animal patients at the location.
(2)No veterinary drug, medicine, appliance, or medical equipment is kept at the location.
(3)The veterinary medical records required pursuant to Sections 4855 and 4856 are created, maintained, and stored so as to protect the veterinary medical records from access by unauthorized individuals, damage, or loss.
(4)The following information shall be provided on any electronic publication, including any internet website, through which the veterinarian provides or offers to provide veterinary medical services:
(A)The veterinarians name, contact information, and California veterinarian license number, prominently displayed.
(B)Contact information and instruction for obtaining a copy of the animal patients medical records.
(C)A statement that a client may contact the Veterinary Medical Board if the client has any questions or complaints regarding the veterinarian.
SEC. 6.Section 4857 of the Business and Professions Code is amended to read:4857.(a)A veterinarian licensed under this chapter shall not disclose any information concerning an animal patient receiving veterinary services, the client responsible for the animal patient receiving veterinary services, or the veterinary care provided to an animal patient, except under any one of the following circumstances:
(1)Upon written or witnessed oral authorization by knowing and informed consent of the client.
(2)Upon authorization received by electronic transmission when originated by 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 (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(5)If the care or service was for a horse that has participated in the previous year, or is intended to participate, in a licensed horse race. In these situations, the entire medical record for the horse shall be made available upon request to anyone responsible for the direct medical care of the horse, including the owner, trainer, or veterinarian, the California Horse Racing Board or any other state or local governmental entity, and the racing association or fair conducting the licensed horse race.
(6)As otherwise provided in this section.
(b)This section shall not apply to the extent that the client responsible for an animal patient or an authorized agent of the client responsible for the animal patient has filed or caused to be filed a civil or criminal complaint that places the veterinarians care and treatment of the animal patient or the nature and extent of the injuries to the animal patient 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.
(e)Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians and facilities for the purpose of diagnosis or treatment of the animal patient that is the subject of the medical records.
SEC. 7.Section 4875.1 of the Business and Professions Code is amended to read:4875.1.(a)In order to ensure that its resources are maximized for the protection of the public, the board shall prioritize its investigative and prosecutorial resources to ensure that veterinarians and registered veterinary technicians representing the greatest threat of harm are identified and disciplined expeditiously. Cases involving any of the following allegations shall be handled on a priority basis, as follows, with the highest priority being given to cases in paragraph (1):
(1)Negligence or incompetence that involves death or serious bodily injury to an animal patient, such that the veterinarian or registered veterinary technician represents a danger to the public.
(2)Cruelty to animals.
(3)A conviction or convictions for a criminal charge or charges or being subject to a felony criminal proceeding without consideration of the outcome of the proceeding.
(4)Practicing veterinary medicine while under the influence of drugs or alcohol.
(5)Drug or alcohol abuse by a veterinarian or registered veterinary technician involving death or serious bodily injury to an animal patient or to the public.
(6)Self-prescribing of any dangerous drug, as defined in Section 4022, or any controlled substance, as defined in Section 4021.
(7)Repeated acts of excessive prescribing, furnishing, or administering of controlled substances, as defined in Section 4021, or repeated acts of prescribing, dispensing, or furnishing of controlled substances, as defined in Section 4021, without having first established a veterinarian-client-patient relationship pursuant to Section 4826.6.
(8)Extreme departures from minimum sanitary conditions such that there is a threat to an animal patient or the public and animal health and safety, only if the case has already been subject to Section 494 and board action.
(b)The board may prioritize cases involving an allegation of conduct that is not described in subdivision (a). Those cases prioritized shall not be assigned a priority equal to or higher than the priorities established in subdivision (a).
(c)The board shall annually report and make publicly available the number of disciplinary actions that are taken in each priority category specified in subdivisions (a) and (b).
SEC. 8.Section 14401 of the Food and Agricultural Code is amended to read:14401.Beginning January 1, 2018, a medically important antimicrobial drug shall not be administered to livestock unless ordered by a licensed veterinarian through a prescription or veterinary feed directive, pursuant to a veterinarian-client-patient relationship that meets the requirements of Section 4826.6 of the Business and Professions Code.
SEC. 9.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)No person or entity shall dispense or furnish, or cause to be dispensed or furnished, dangerous drugs or dangerous devices, as defined in Section 4022, on the internet for delivery to any person in this state without a prescription issued pursuant to a good faith prior examination of a human or animal for whom the prescription is meant if the person or entity either knew or reasonably should have known that the prescription was not issued pursuant to a good faith prior examination of a human or animal, or if the person or entity did not act in accordance with Section 1761 of Title 16 of the California Code of Regulations.
(b)Notwithstanding any other provision of law, a violation of this section may subject the person or entity that has committed the violation to either a fine of up to twenty-five thousand dollars ($25,000) per occurrence pursuant to a citation issued by the board or a civil penalty of twenty-five thousand dollars ($25,000) per occurrence.
(c)The Attorney General may bring an action to enforce this section and to collect the fines or civil penalties authorized by subdivision (b).
(d)For notifications made on and after January 1, 2002, the Franchise Tax Board, upon notification by the Attorney General or the board of a final judgment in an action brought under this section, shall subtract the amount of the fine or awarded civil penalties from any tax refunds or lottery winnings due to the person who is a defendant in the action using the offset authority under Section 12419.5 of the Government Code, as delegated by the Controller, and the processes as established by the Franchise Tax Board for this purpose. That amount shall be forwarded to the board for deposit in the Pharmacy Board Contingent Fund.
(e)Nothing in this section shall be construed to permit the unlicensed practice of pharmacy, or to limit the authority of the board to enforce any other provision of this chapter.
(f)For the purposes of this section, good faith prior examination includes the requirements for a physician and surgeon in Section 2242 and the requirements for a veterinarian in Section 4826.6.
SEC. 2.Section 4825.1 of the Business and Professions Code is amended to read:4825.1.These definitions shall govern the construction of this chapter as it applies to veterinary medicine.
(a)Client means the individual or individuals who represent to the veterinarian that they are the owner or owners of the animal patient at the time that the services are provided.
(b)Diagnosis means the act or process of identifying or determining the health status of an animal patient through examination and the opinion derived from that examination.
(c)Animal means any member of the animal kingdom other than humans, and includes fowl, fish, and reptiles, wild or domestic, whether living or dead.
(d)Food animal means any animal that is raised for the production of an edible product intended for consumption by humans. The edible product includes, but is not limited to, milk, meat, and eggs. Food animal includes, but is not limited to, cattle (beef or dairy), swine, sheep, poultry, fish, and amphibian species.
(e)Livestock includes all animals, poultry, aquatic and amphibian species that are raised, kept, or used for profit. It does not include those species that are usually kept as pets such as dogs, cats, and pet birds, or companion animals, including equines.
(f)Synchronous means a real-time interaction between a client and animal patient with a veterinarian who is licensed in this state and located at a distant site.
(g)Telehealth means the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, synchronous video and audio communication; synchronous, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
SEC. 3.Section 4826.6 is added to the Business and Professions Code, to read:4826.6.(a)A veterinarian shall not prescribe, dispense, or administer a drug, medicine, application, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals unless a veterinarian-client-patient relationship exists or as otherwise permitted by law, except when the animal patient is a wild animal or the owner of the animal patient is unknown. A veterinarian-client-patient relationship exists if all of the following conditions are met:
(1)The client has authorized the veterinarian to assume responsibility for medical judgments regarding the health of the animal patient.
(2)The veterinarian possesses sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the animal patients medical condition.
(3)The veterinarian has assumed responsibility for making medical judgments regarding the health of the animal patient and has communicated with the client a medical, treatment, diagnostic, or therapeutic plan appropriate to the circumstances.
(b)A veterinarian possesses sufficient knowledge of the animal patient for purposes of paragraph (2) of subdivision (a) if the veterinarian has recently seen, or is personally acquainted with, the care of the animal patient by doing any of the following:
(1)Examining the animal patient in person.
(2)Examining the animal patient by use of synchronous audio-video communication.
(3)Making medically appropriate and timely visits to the premises on which the animal patient is kept.
(c)For purposes of paragraphs (1) and (3) of subdivision (a), the client may authorize an agent to act on the clients behalf.
(d)Synchronous audio-video communication is not required for the delivery of veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
(e)A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.
(f)Only a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary medicine via telehealth on an animal patient located in this state.
(g)Before delivering veterinary medicine via telehealth, the veterinarian shall inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth, including acknowledgment of all of the following:
(1)The same standards of care apply to veterinary medicine services via telehealth and in-person veterinary medical services.
(2)The client has the option to choose an in-person visit from a veterinarian at any time.
(3)The client has been advised how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate resulting from technological or equipment failure.
(h)A veterinarian who practices veterinary medicine via telehealth shall do all of the following:
(1)Ensure that the technology, method, and equipment used to provide veterinary medicine services via telehealth comply with all current privacy protection laws.
(2)Have historical knowledge of the animal patient by obtaining and reviewing the animal patients relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
(3)Employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient and providing quality of care consistent with prevailing veterinary medical practice.
(4)Be familiar with available medical resources, including emergency resources near the animal patients location, be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client, and keep, maintain, and make available a summary of the animal patient record, as specified in Section 4855.
(5)Provide the client with the veterinarians name, contact information, and license number.
(6)Secure an alternative means of contacting the client if the electronic means is interrupted.
(i)(1)A veterinarian shall not prescribe a drug for a duration of time that is inconsistent with the medical condition of the animal patient or the type of drug prescribed.
(2)A veterinarian who established the required veterinarian-client-patient relationship by examining the animal patient in person or by making medically appropriate and timely visits to the premises on which the animal patient is kept shall not prescribe a drug for a duration of time that is longer than one year from the date that the veterinarian examined the animal patient in person or visited the premises and prescribed the drug.
(3)Except as provided in paragraphs (4) to (8), inclusive, a veterinarian who practices veterinary medicine via telehealth may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant state and federal regulations.
(4)A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the animal patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the animal patient, either in person or using telehealth.
(5)A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe an antimicrobial drug to the animal patient for a period longer than 14 days of treatment. The veterinarian shall not issue any further antimicrobial drug prescription, including a refill, to treat the condition of the animal patient unless the veterinarian has conducted an in-person examination of the animal patient.
(6)The veterinarian shall not order, prescribe, or make available a controlled substance, as defined in Section 4021, or xylazine, unless the veterinarian has performed an in-person physical examination of the animal patient or made medically appropriate and timely visits to the premises where the animal patient is kept.
(7)The veterinarian shall notify the client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian shall submit a prescription to a pharmacy that the client chooses.
(8)A veterinarian shall not prescribe via telehealth any drug or medication for use on a horse engaged in racing or training at a facility under the jurisdiction of the California Horse Racing Board pursuant to Chapter 4 (commencing with Section 19400) of Division 8.
(j)As used in this section, drug means any controlled substance, as defined in Section 4021, or any dangerous drug, as defined in Section 4022.
(k)A veterinarian is permitted to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.
SEC. 4.Section 4829.5 of the Business and Professions Code is amended to read:4829.5.(a)Each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug, as defined in Section 4022, to an animal patient in an outpatient setting, the veterinarian shall offer to provide, verbally, in writing, or by email to the client, a consultation that includes the following information:
(1)The name and description of the dangerous drug.
(2)Route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug.
(3)Any special directions for proper use and storage.
(4)Actions to be taken in the event of a missed dose.
(5)If available, precautions and relevant warnings provided by the drugs manufacturer, including common severe adverse effects of the drug.
(b)If requested, a veterinarian shall provide drug documentation, if available.
(c)A veterinarian may delegate to a registered veterinary technician or veterinary assistant the task of providing the consultation and drug documentation required by this section.
(d)It shall be noted in the medical record of the animal patient if the consultation described in this section is provided or declined by the client.
SEC. 5.Section 4853 of the Business and Professions Code is amended to read:4853.(a)All veterinary premises shall be registered with the board. The certificate of registration shall be on a form prescribed in accordance with Section 164.
(b)Premises for the purpose of this chapter shall mean the location of operation where veterinary medicine, veterinary dentistry, veterinary surgery, and the various branches thereof is being practiced and shall include a building, kennel, mobile unit, or vehicle. Mobile units and vehicles shall be exempted from independent registration with the board when if they are operated from a building or facility which that is the licensee managers principal place of business and the building is registered with the board, and the registration identifies and declares the use of the mobile unit or vehicle.
(c)The owner or operator of a veterinary premises shall submit a premises registration application to the board. The application shall set forth the name of each owner or operator of the premises, including the type of corporate entity, if applicable, the name of the premises, and the name of the responsible licensee manager who is to act for and on behalf of the registered premises. Substitution of the responsible licensee manager may be accomplished by application to the board if the following conditions are met:
(1)The person substituted qualifies by presenting satisfactory evidence that the person possesses a valid, unexpired, and unrevoked license as provided by this chapter and that the license is not currently under suspension.
(2)No circumvention of the law is contemplated by the substitution.
(d)If the owner or operator of a veterinary premises is a veterinary corporation practicing pursuant to Article 6 (commencing with Section 4910), the application shall set forth the names and titles of each officer, director, or shareholder. Any changes in the officers, directors, or shareholders shall be reported to the board within 30 days.
(e)If the owner or operator of a veterinary premises is a corporation or other artificial legal entity other than a veterinary corporation as provided under subdivision (d), the application shall set forth the names and titles of all owners, officers, general partners, if any, and the agent for service of process. Any changes in the owners, officers, general partners, or agent for service of process shall be reported to the board within 30 days.
(f)The premises registration is nontransferable. In the event of change of an owner or operator of the premises, the premises registration holder shall notify the board of the change within 30 days after any such the change.
(g)This section does not authorize any person, corporation, or artificial legal entity, other than a California-licensed veterinarian or a veterinary corporation practicing pursuant to Article 6 (commencing with Section 4910) and the Moscone-Knox Professional Corporation Act (Part 4 (commencing with Section 13400) of Division 3 of Title 1 of the Corporations Code), to furnish to any person or animal patient any veterinary services, diagnosis, or treatment within the scope of California veterinarian licensure under this chapter. This section does not authorize any person, other than a California-licensed veterinarian within the scope of their license, to engage directly or indirectly in the practice of veterinary medicine, veterinary surgery, veterinary dentistry, and the various branches thereof in accordance with Section 4826. This section does not regulate, govern, or affect in any manner the practice of veterinary medicine, veterinary surgery, or veterinary dentistry by any person duly licensed to engage in such practice.
(h)The location where a veterinarian practices telehealth shall be exempt from the requirement that it be registered pursuant to this section if all of the following requirements are satisfied:
(1)The veterinarian does not perform in-person examination or treatment of animal patients at the location.
(2)No veterinary drug, medicine, appliance, or medical equipment is kept at the location.
(3)The veterinary medical records required pursuant to Sections 4855 and 4856 are created, maintained, and stored so as to protect the veterinary medical records from access by unauthorized individuals, damage, or loss.
(4)The following information shall be provided on any electronic publication, including any internet website, through which the veterinarian provides or offers to provide veterinary medical services:
(A)The veterinarians name, contact information, and California veterinarian license number, prominently displayed.
(B)Contact information and instruction for obtaining a copy of the animal patients medical records.
(C)A statement that a client may contact the Veterinary Medical Board if the client has any questions or complaints regarding the veterinarian.
SEC. 5.SEC. 6.Section 4857 of the Business and Professions Code is amended to read:4857.(a)A veterinarian licensed under this chapter shall not disclose any information concerning an animal patient receiving veterinary services, the client responsible for the animal patient receiving veterinary services, or the veterinary care provided to an animal patient, except under any one of the following circumstances:
(1)Upon written or witnessed oral authorization by knowing and informed consent of the client.
(2)Upon authorization received by electronic transmission when originated by 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 (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(5)If the care or service was for a horse that has participated in the previous year, or is intended to participate, in a licensed horse race. In these situations, the entire medical record for the horse shall be made available upon request to anyone responsible for the direct medical care of the horse, including the owner, trainer, or veterinarian, the California Horse Racing Board or any other state or local governmental entity, and the racing association or fair conducting the licensed horse race.
(6)As otherwise provided in this section.
(b)This section shall not apply to the extent that the client responsible for an animal patient or an authorized agent of the client responsible for the animal patient has filed or caused to be filed a civil or criminal complaint that places the veterinarians care and treatment of the animal patient or the nature and extent of the injuries to the animal patient 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.
(e)Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians and facilities for the purpose of diagnosis or treatment of the animal patient that is the subject of the medical records.
SEC. 6.SEC. 7.Section 4875.1 of the Business and Professions Code is amended to read:4875.1.(a)In order to ensure that its resources are maximized for the protection of the public, the board shall prioritize its investigative and prosecutorial resources to ensure that veterinarians and registered veterinary technicians representing the greatest threat of harm are identified and disciplined expeditiously. Cases involving any of the following allegations shall be handled on a priority basis, as follows, with the highest priority being given to cases in paragraph (1):
(1)Negligence or incompetence that involves death or serious bodily injury to an animal patient, such that the veterinarian or registered veterinary technician represents a danger to the public.
(2)Cruelty to animals.
(3)A conviction or convictions for a criminal charge or charges or being subject to a felony criminal proceeding without consideration of the outcome of the proceeding.
(4)Practicing veterinary medicine while under the influence of drugs or alcohol.
(5)Drug or alcohol abuse by a veterinarian or registered veterinary technician involving death or serious bodily injury to an animal patient or to the public.
(6)Self-prescribing of any dangerous drug, as defined in Section 4022, or any controlled substance, as defined in Section 4021.
(7)Repeated acts of excessive prescribing, furnishing, or administering of controlled substances, as defined in Section 4021, or repeated acts of prescribing, dispensing, or furnishing of controlled substances, as defined in Section 4021, without having first established a veterinarian-client-patient relationship pursuant to Section 4826.6.
(8)Extreme departures from minimum sanitary conditions such that there is a threat to an animal patient or the public and animal health and safety, only if the case has already been subject to Section 494 and board action.
(b)The board may prioritize cases involving an allegation of conduct that is not described in subdivision (a). Those cases prioritized shall not be assigned a priority equal to or higher than the priorities established in subdivision (a).
(c)The board shall annually report and make publicly available the number of disciplinary actions that are taken in each priority category specified in subdivisions (a) and (b).
SEC. 7.SEC. 8.Section 14401 of the Food and Agricultural Code is amended to read:14401.Beginning January 1, 2018, a medically important antimicrobial drug shall not be administered to livestock unless ordered by a licensed veterinarian through a prescription or veterinary feed directive, pursuant to a veterinarian-client-patient relationship that meets the requirements of Section 4826.6 of the Business and Professions Code.
SEC. 8.SEC. 9.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)No person or entity shall dispense or furnish, or cause to be dispensed or furnished, dangerous drugs or dangerous devices, as defined in Section 4022, on the internet for delivery to any person in this state without a prescription issued pursuant to a good faith prior examination of a human or animal for whom the prescription is meant if the person or entity either knew or reasonably should have known that the prescription was not issued pursuant to a good faith prior examination of a human or animal, or if the person or entity did not act in accordance with Section 1761 of Title 16 of the California Code of Regulations.
(b)Notwithstanding any other provision of law, a violation of this section may subject the person or entity that has committed the violation to either a fine of up to twenty-five thousand dollars ($25,000) per occurrence pursuant to a citation issued by the board or a civil penalty of twenty-five thousand dollars ($25,000) per occurrence.
(c)The Attorney General may bring an action to enforce this section and to collect the fines or civil penalties authorized by subdivision (b).
(d)For notifications made on and after January 1, 2002, the Franchise Tax Board, upon notification by the Attorney General or the board of a final judgment in an action brought under this section, shall subtract the amount of the fine or awarded civil penalties from any tax refunds or lottery winnings due to the person who is a defendant in the action using the offset authority under Section 12419.5 of the Government Code, as delegated by the Controller, and the processes as established by the Franchise Tax Board for this purpose. That amount shall be forwarded to the board for deposit in the Pharmacy Board Contingent Fund.
(e)Nothing in this section shall be construed to permit the unlicensed practice of pharmacy, or to limit the authority of the board to enforce any other provision of this chapter.
(f)For the purposes of this section, good faith prior examination includes the requirements for a physician and surgeon in Section 2242 and the requirements for a veterinarian in subdivision (g) of Section 4825.1. Section 4826.6.
SEC. 2.Section 4825.1 of the Business and Professions Code is amended to read:4825.1.These definitions shall govern the construction of this chapter as it applies to veterinary medicine.
(a)Client means the individual or individuals who represent to the veterinarian that they are the owner or owners of the animal patient at the time that the services are provided. The client may authorize an agent to act on the clients behalf.
(b)Diagnosis means the act or process of identifying or determining the health status of an animal patient through examination and the opinion derived from that examination.
(c)Animal means any member of the animal kingdom other than humans, and includes fowl, fish, and reptiles, wild or domestic, whether living or dead.
(d)Food animal means any animal that is raised for the production of an edible product intended for consumption by humans. The edible product includes, but is not limited to, milk, meat, and eggs. Food animal includes, but is not limited to, cattle (beef or dairy), swine, sheep, poultry, fish, and amphibian species.
(e)Livestock includes all animals, poultry, aquatic and amphibian species that are raised, kept, or used for profit. It does not include those species that are usually kept as pets such as dogs, cats, and pet birds, or companion animals, including equines.
(f)Synchronous means a real-time interaction between a client and animal patient with a veterinarian who is licensed in this state and located at a distant site.
(g)(1)Veterinarian-client-patient relationship means a relationship that exists if all of the following conditions are met:(A)The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgments regarding the health of the animal patient.(B)The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in person or using synchronous video communication, of the animal or of a group of animals of which the patient is a part, or through medically appropriate and timely visits to the premises where the animal, or the group of animals of which the patient is a part, is kept.(C)The veterinarian is readily available or has provided for followup care in case of adverse reactions or failure of treatment.(2)A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire. (h)(g)Telehealth means the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, synchronous video and audio communication; synchronous, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
SEC. 3.Section 4826.6 is added to the Business and Professions Code, to read:4826.6.(a)(1)Except as provided in subdivision (f) or otherwise permitted by law, a person shall not practice veterinary medicine outside the context of a veterinarian-client-patient relationship.(2)Synchronous video communication is not required for the delivery of veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.4826.6.(a)A veterinarian shall not prescribe, dispense, or administer a drug, medicine, application, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals unless a veterinarian-client-patient relationship exists or as otherwise permitted by law, except when the animal patient is a wild animal or the owner of the animal patient is unknown. A veterinarian-client-patient relationship exists if all of the following conditions are met:
(1)The client has authorized the veterinarian to assume responsibility for medical judgments regarding the health of the animal patient.
(2)The veterinarian possesses sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the animal patients medical condition.
(3)The veterinarian has assumed responsibility for making medical judgments regarding the health of the animal patient and has communicated with the client a medical, treatment, diagnostic, or therapeutic plan appropriate to the circumstances.
(b)A veterinarian possesses sufficient knowledge of the animal patient for purposes of paragraph (2) of subdivision (a) if the veterinarian has recently seen, or is personally acquainted with, the care of the animal patient by doing any of the following:
(1)Examining the animal patient in person.
(2)Examining the animal patient by use of synchronous audio-video communication.
(3)Making medically appropriate and timely visits to the premises on which the animal patient is kept.
(c)For purposes of paragraphs (1) and (3) of subdivision (a), the client may authorize an agent to act on the clients behalf.
(d)Synchronous audio-video communication is not required for the delivery of veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
(e)A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.
(b)(f)Only a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary medicine via telehealth. That practice shall be deemed to occur at the premises where the patient is located at the time that the veterinarian practices veterinary medicine. telehealth on an animal patient located in this state.
(c)(g)Before delivering veterinary medicine via telehealth, the veterinarian shall inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth, including acknowledgment of all of the following:
(1)The same standards of care apply to veterinary medicine services via telehealth and in-person veterinary medical services.
(2)The client has the option to choose an in-person visit from a veterinarian at any time.
(3)The client has been advised how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate resulting from technological or equipment failure.
(d)(h)A veterinarian that who practices veterinary medicine via telehealth shall do all of the following:
(1)Ensure that the technology, method, and equipment used to provide veterinary medicine services via telehealth comply with all current privacy protection laws.
(2)Have historical knowledge of the animal patient by obtaining and reviewing the animal patients relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
(3)Employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient and providing quality of care consistent with prevailing veterinary medical practice.
(4)Be familiar with available medical resources, including emergency resources near the animal patients location, be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client, and keep, maintain, and make available a summary of the animal patient record, as specified in Section 4855.
(5)Provide the client with the veterinarians name, contact information, and license number.
(6)Secure an alternative means of contacting the client if the electronic means is interrupted.
(i)(1)A veterinarian shall not prescribe a drug for a duration of time that is inconsistent with the medical condition of the animal patient or the type of drug prescribed.
(2)A veterinarian who established the required veterinarian-client-patient relationship by examining the animal patient in person or by making medically appropriate and timely visits to the premises on which the animal patient is kept shall not prescribe a drug for a duration of time that is longer than one year from the date that the veterinarian examined the animal patient in person or visited the premises and prescribed the drug.
(e)(1)(3)Except as provided in paragraphs (2) to (4), (4) to (8), inclusive, a veterinarian that who practices veterinary medicine via telehealth may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant state and federal regulations.
(2)(4)A veterinarian who established the required veterinarian-client-patient relationship using synchronous video audio-video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the animal patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the animal patient, either in person or using telehealth.
(5)A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe an antimicrobial drug to the animal patient for a period longer than 14 days of treatment. The veterinarian shall not issue any further antimicrobial drug prescription, including a refill, to treat the condition of the animal patient unless the veterinarian has conducted an in-person examination of the animal patient.
(3)(6)The veterinarian shall not order, prescribe, or make available a controlled substance, as defined in Section 4021, or xylazine, unless the veterinarian has performed an in-person physical examination of the animal patient or made medically appropriate and timely visits to the premises where the animal patient is kept.
(4)(7)The veterinarian shall notify the client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian shall submit a prescription to a pharmacy that the client chooses.
(8)A veterinarian shall not prescribe via telehealth any drug or medication for use on a horse engaged in racing or training at a facility under the jurisdiction of the California Horse Racing Board pursuant to Chapter 4 (commencing with Section 19400) of Division 8.
(j)As used in this section, drug means any controlled substance, as defined in Section 4021, or any dangerous drug, as defined in Section 4022.
(f)(k)A veterinarian is permitted to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.
SEC. 4.Section 4829.5 of the Business and Professions Code is amended to read:4829.5.(a)Each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug, as defined in Section 4022, to an animal patient in an outpatient setting, the veterinarian shall offer to provide, verbally, in writing, or by email to the client, a consultation that includes the following information:
(1)The name and description of the dangerous drug.
(2)Route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug.
(3)Any special directions for proper use and storage.
(4)Actions to be taken in the event of a missed dose.
(5)If available, precautions and relevant warnings provided by the drugs manufacturer, including common severe adverse effects of the drug.
(b)If requested, a veterinarian shall provide drug documentation, if available.
(c)A veterinarian may delegate to a registered veterinary technician or veterinary assistant the task of providing the consultation and drug documentation required by this section.
(d)It shall be noted in the medical record of the animal patient if the consultation described in this section is provided or declined by the client.
SEC. 5.Section 4857 of the Business and Professions Code is amended to read:4857.(a)A veterinarian licensed under this chapter shall not disclose any information concerning an animal patient receiving veterinary services, the client responsible for the animal patient receiving veterinary services, or the veterinary care provided to an animal, animal patient, except under any one of the following circumstances:
(1)Upon written or witnessed oral authorization by knowing and informed consent of the client.
(2)Upon authorization received by electronic transmission when originated by 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 (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(5)If the care or service was for a horse that has participated in the previous year, or is intended to participate, in a licensed horse race. In these situations, the entire medical record for the horse shall be made available upon request to anyone responsible for the direct medical care of the horse, including the owner, trainer, or veterinarian, the California Horse Racing Board or any other state or local governmental entity, and the racing association or fair conducting the licensed horse race.
(6)As otherwise provided in this section.
(b)This section shall not apply to the extent that the client responsible for an animal patient or an authorized agent of the client responsible for the animal patient has filed or caused to be filed a civil or criminal complaint that places the veterinarians care and treatment of the animal patient or the nature and extent of the injuries to the animal patient 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.
(e)Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians and facilities for the purpose of diagnosis or treatment of the animal patient that is the subject of the medical records.
SEC. 6.Section 4875.1 of the Business and Professions Code is amended to read:4875.1.(a)In order to ensure that its resources are maximized for the protection of the public, the board shall prioritize its investigative and prosecutorial resources to ensure that veterinarians and registered veterinary technicians representing the greatest threat of harm are identified and disciplined expeditiously. Cases involving any of the following allegations shall be handled on a priority basis, as follows, with the highest priority being given to cases in paragraph (1):
(1)Negligence or incompetence that involves death or serious bodily injury to an animal patient, such that the veterinarian or registered veterinary technician represents a danger to the public.
(2)Cruelty to animals.
(3)A conviction or convictions for a criminal charge or charges or being subject to a felony criminal proceeding without consideration of the outcome of the proceeding.
(4)Practicing veterinary medicine while under the influence of drugs or alcohol.
(5)Drug or alcohol abuse by a veterinarian or registered veterinary technician involving death or serious bodily injury to an animal patient or to the public.
(6)Self-prescribing of any dangerous drug, as defined in Section 4022, or any controlled substance, as defined in Section 4021.
(7)Repeated acts of excessive prescribing, furnishing, or administering of controlled substances, as defined in Section 4021, or repeated acts of prescribing, dispensing, or furnishing of controlled substances, as defined in Section 4021, without having first established a veterinarian-client-patient relationship pursuant to subdivision (f) of Section 4825.1. Section 4826.6.
(8)Extreme departures from minimum sanitary conditions such that there is a threat to an animal patient or the public and animal health and safety, only if the case has already been subject to Section 494 and board action.
(b)The board may prioritize cases involving an allegation of conduct that is not described in subdivision (a). Those cases prioritized shall not be assigned a priority equal to or higher than the priorities established in subdivision (a).
(c)The board shall annually report and make publicly available the number of disciplinary actions that are taken in each priority category specified in subdivisions (a) and (b).
SEC. 7.Section 14401 of the Food and Agricultural Code is amended to read:14401.Beginning January 1, 2018, a medically important antimicrobial drug shall not be administered to livestock unless ordered by a licensed veterinarian through a prescription or veterinary feed directive, pursuant to a veterinarian-client-patient relationship that meets the requirements of subdivision (g) of Section 4825.1 Section 4826.6 of the Business and Professions Code.
SEC. 8.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)No person or entity shall dispense or furnish, or cause to be dispensed or furnished, dangerous drugs or dangerous devices, as defined in Section 4022, on the internet for delivery to any person in this state without a prescription issued pursuant to a good faith prior examination of a human or animal for whom the prescription is meant if the person or entity either knew or reasonably should have known that the prescription was not issued pursuant to a good faith prior examination of a human or animal, or if the person or entity did not act in accordance with Section 1761 of Title 16 of the California Code of Regulations.
(b)Notwithstanding any other provision of law, a violation of this section may subject the person or entity that has committed the violation to either a fine of up to twenty-five thousand dollars ($25,000) per occurrence pursuant to a citation issued by the board or a civil penalty of twenty-five thousand dollars ($25,000) per occurrence.
(c)The Attorney General may bring an action to enforce this section and to collect the fines or civil penalties authorized by subdivision (b).
(d)For notifications made on and after January 1, 2002, the Franchise Tax Board, upon notification by the Attorney General or the board of a final judgment in an action brought under this section, shall subtract the amount of the fine or awarded civil penalties from any tax refunds or lottery winnings due to the person who is a defendant in the action using the offset authority under Section 12419.5 of the Government Code, as delegated by the Controller, and the processes as established by the Franchise Tax Board for this purpose. That amount shall be forwarded to the board for deposit in the Pharmacy Board Contingent Fund.
(e)Nothing in this section shall be construed to permit the unlicensed practice of pharmacy, or to limit the authority of the board to enforce any other provision of this chapter.
(f)For the purposes of this section, good faith prior examination includes the requirements for a physician and surgeon in Section 2242 and the requirements for a veterinarian in subdivision (f) (g) of Section 4825.1.
SEC. 2.Section 4825.1 of the Business and Professions Code is amended to read:4825.1.These definitions shall govern the construction of this chapter as it applies to veterinary medicine.
(a)Client means the individual or individuals who represent to the veterinarian that they are the owner or owners of the animal patient at the time that the services are provided. The client may authorize an agent to act on the clients behalf.
(b)Diagnosis means the act or process of identifying or determining the health status of an animal through examination and the opinion derived from that examination.
(c)Animal means any member of the animal kingdom other than humans, and includes fowl, fish, and reptiles, wild or domestic, whether living or dead.
(d)Food animal means any animal that is raised for the production of an edible product intended for consumption by humans. The edible product includes, but is not limited to, milk, meat, and eggs. Food animal includes, but is not limited to, cattle (beef or dairy), swine, sheep, poultry, fish, and amphibian species.
(e)Livestock includes all animals, poultry, aquatic and amphibian species that are raised, kept, or used for profit. It does not include those species that are usually kept as pets such as dogs, cats, and pet birds, or companion animals, including equines.
(f)Synchronous means a real-time interaction between a client and patient with a veterinarian who is licensed in this state and located at a distant site.
(g)(1)Veterinarian-client-patient relationship means a relationship that exists if all of the following conditions are met:
(A)The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgments regarding the health of the animal patient.
(B)The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in person or using synchronous video communication, of the animal or of a group of animals of which the patient is a part, or through medically appropriate and timely visits to the premises where the animal, or the group of animals of which the patient is a part, is kept.
(C)The veterinarian is readily available or has provided for followup care in case of adverse reactions or failure of treatment.
(2)A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.
(h)Telehealth means the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, synchronous video and audio communication; synchronous, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
SEC. 3.Section 4826.6 is added to the Business and Professions Code, to read:4826.6.(a)(1)Except as provided in subdivision (f) or otherwise permitted by law, a person shall not practice veterinary medicine outside the context of a veterinarian-client-patient relationship.
(2)Synchronous video communication is not required for the delivery of veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
(b)Only a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary medicine via telehealth. That practice shall be deemed to occur at the premises where the patient is located at the time that the veterinarian practices veterinary medicine.
(c)Before delivering veterinary medicine via telehealth, the veterinarian shall inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth, including acknowledgment of all of the following:
(1)The same standards of care apply to veterinary medicine services via telehealth and in-person veterinary medical services.
(2)The client has the option to choose an in-person visit from a veterinarian at any time.
(3)The client has been advised how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate resulting from technological or equipment failure.
(d)A veterinarian that practices veterinary medicine via telehealth shall do all of the following:
(1)Ensure that the technology, method, and equipment used to provide veterinary medicine services via telehealth comply with all current privacy protection laws.
(2)Have historical knowledge of the animal by obtaining and reviewing the patients relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
(3)Employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice.
(4)Be familiar with available medical resources, including emergency resources near the patients location, be able to refer the client to a nearby veterinarian provide the client with a list of nearby veterinarians who may be able to see the patient in person upon the request of the client, and keep, maintain, and make available a summary of the patient record, as required by specified in Section 4855.
(5)Provide the client with the veterinarians name, contact information, and license number.
(6)Secure an alternative means of contacting the client if the electronic means is interrupted.
(e)(1)Except as provided in paragraphs (2) to (4), inclusive, a veterinarian that practices veterinary medicine via telehealth may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant state and federal regulations.
(2)A veterinarian who established the required veterinarian-client-patient relationship using synchronous video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the patient, either in person or using telehealth.
(3)The veterinarian shall not order, prescribe, or make available a controlled substance, as defined in Section 4021, or xylazine, unless the veterinarian has performed an in-person physical examination of the patient or made medically appropriate and timely visits to the premises where the patient is kept.
(4)The veterinarian shall notify the client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian shall submit a prescription to a pharmacy that the client chooses.
(f)A veterinarian is permitted to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.
SEC. 4.Section 4829.5 of the Business and Professions Code is amended to read:4829.5.(a)Each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug, as defined in Section 4022, to an animal patient in an outpatient setting, the veterinarian shall offer to provide, verbally, in writing, or by email to the client, a consultation that includes the following information:
(1)The name and description of the dangerous drug.
(2)Route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug.
(3)Any special directions for proper use and storage.
(4)Actions to be taken in the event of a missed dose.
(5)If available, precautions and relevant warnings provided by the drugs manufacturer, including common severe adverse effects of the drug.
(b)If requested, a veterinarian shall provide drug documentation, if available.
(c)A veterinarian may delegate to a registered veterinary technician or veterinary assistant the task of providing the consultation and drug documentation required by this section.
(d)It shall be noted in the medical record of the animal patient if the consultation described in this section is provided or declined by the client.
SEC. 5.Section 4857 of the Business and Professions Code is amended to read:4857.(a)A veterinarian licensed under 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.
(2)Upon authorization received by electronic transmission when originated by 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 (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(5)If the care or service was for a horse that has participated in the previous year, or is intended to participate, in a licensed horse race. In these situations, the entire medical record for the horse shall be made available upon request to anyone responsible for the direct medical care of the horse, including the owner, trainer, or veterinarian, the California Horse Racing Board or any other state or local governmental entity, and the racing association or fair conducting the licensed horse race.
(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 veterinarians 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.
(e)Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians and facilities for the purpose of diagnosis or treatment of the animal that is the subject of the medical records.
SEC. 6.Section 4875.1 of the Business and Professions Code is amended to read:4875.1.(a)In order to ensure that its resources are maximized for the protection of the public, the board shall prioritize its investigative and prosecutorial resources to ensure that veterinarians and registered veterinary technicians representing the greatest threat of harm are identified and disciplined expeditiously. Cases involving any of the following allegations shall be handled on a priority basis, as follows, with the highest priority being given to cases in paragraph (1):
(1)Negligence or incompetence that involves death or serious bodily injury to an animal patient, such that the veterinarian or registered veterinary technician represents a danger to the public.
(2)Cruelty to animals.
(3)A conviction or convictions for a criminal charge or charges or being subject to a felony criminal proceeding without consideration of the outcome of the proceeding.
(4)Practicing veterinary medicine while under the influence of drugs or alcohol.
(5)Drug or alcohol abuse by a veterinarian or registered veterinary technician involving death or serious bodily injury to an animal patient or to the public.
(6)Self-prescribing of any dangerous drug, as defined in Section 4022, or any controlled substance, as defined in Section 4021.
(7)Repeated acts of excessive prescribing, furnishing, or administering of controlled substances, as defined in Section 4021, or repeated acts of prescribing, dispensing, or furnishing of controlled substances, as defined in Section 4021, without having first established a veterinarian-client-patient relationship pursuant to subdivision (f) of Section 4825.1.
(8)Extreme departures from minimum sanitary conditions such that there is a threat to an animal patient or the public and animal health and safety, only if the case has already been subject to Section 494 and board action.
(b)The board may prioritize cases involving an allegation of conduct that is not described in subdivision (a). Those cases prioritized shall not be assigned a priority equal to or higher than the priorities established in subdivision (a).
(c)The board shall annually report and make publicly available the number of disciplinary actions that are taken in each priority category specified in subdivisions (a) and (b).
SEC. 7.Section 14401 of the Food and Agricultural Code is amended to read:14401.Beginning January 1, 2018, a medically important antimicrobial drug shall not be administered to livestock unless ordered by a licensed veterinarian through a prescription or veterinary feed directive, pursuant to a veterinarian-client-patient relationship that meets the requirements of subdivision (f) (g) of Section 4825.1 of the Business and Professions Code.
SEC. 8.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district are the result of a program for which legislative authority was requested by that local agency or school district, within the meaning of Section 17556 of the Government Code and Section 6 of Article XIIIB of the California Constitution.SEC. 8.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)No person or entity shall dispense or furnish, or cause to be dispensed or furnished, dangerous drugs or dangerous devices, as defined in Section 4022, on the internet for delivery to any person in this state without a prescription issued pursuant to a good faith prior examination of a human or animal for whom the prescription is meant if the person or entity either knew or reasonably should have known that the prescription was not issued pursuant to a good faith prior examination of a human or animal, or if the person or entity did not act in accordance with Section 1761 of Title 16 of the California Code of Regulations.
(b)Notwithstanding any other provision of law, a violation of this section may subject the person or entity that has committed the violation to either a fine of up to twenty-five thousand dollars ($25,000) per occurrence pursuant to a citation issued by the board or a civil penalty of twenty-five thousand dollars ($25,000) per occurrence.
(c)The Attorney General may bring an action to enforce this section and to collect the fines or civil penalties authorized by subdivision (b).
(d)For notifications made on and after January 1, 2002, the Franchise Tax Board, upon notification by the Attorney General or the board of a final judgment in an action brought under this section, shall subtract the amount of the fine or awarded civil penalties from any tax refunds or lottery winnings due to the person who is a defendant in the action using the offset authority under Section 12419.5 of the Government Code, as delegated by the Controller, and the processes as established by the Franchise Tax Board for this purpose. That amount shall be forwarded to the board for deposit in the Pharmacy Board Contingent Fund.
(e)Nothing in this section shall be construed to permit the unlicensed practice of pharmacy, or to limit the authority of the board to enforce any other provision of this chapter.
(f)For the purposes of this section, good faith prior examination includes the requirements for a physician and surgeon in Section 2242 and the requirements for a veterinarian in subdivision (f) of Section 4825.1.
SEC. 2.Section 4825.1 of the Business and Professions Code is amended to read:4825.1.These definitions shall govern the construction of this chapter as it applies to veterinary medicine.
(a)Client means an the individual or individuals who represents represent to the veterinarian that they are the owner, or the agent of the owner, of an owner or owners of the animal patient at the time that the services are provided. The client may authorize an agent to act on the clients behalf.
(b)Diagnosis means the act or process of identifying or determining the health status of an animal through examination and the opinion derived from that examination.
(c)Animal means any member of the animal kingdom other than humans, and includes fowl, fish, and reptiles, wild or domestic, whether living or dead.
(d)Food animal means any animal that is raised for the production of an edible product intended for consumption by humans. The edible product includes, but is not limited to, milk, meat, and eggs. Food animal includes, but is not limited to, cattle (beef or dairy), swine, sheep, poultry, fish, and amphibian species.
(e)Livestock includes all animals, poultry, aquatic and amphibian species that are raised, kept, or used for profit. It does not include those species that are usually kept as pets such as dogs, cats, and pet birds, or companion animals, including equines.
(f)Synchronous means a real-time interaction between a client and patient with a veterinarian located at a distant site.
(f)(g)(1)Veterinarian-client-patient relationship means a relationship that exists if all of the following conditions are met:
(A)The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgments regarding the health of the animal patient.
(B)The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in person or using real-time synchronous video communication, of the animal or of a group of animals of which the patient is a part, or through medically appropriate and timely visits to the premises where the animal, or the group of animals of which the patient is a part, is kept.
(C)The veterinarian is readily available or has provided for followup care in case of adverse reactions or failure of treatment.
(2)A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.
(g)(h)Telehealth means the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, real-time synchronous video and audio communication; real-time, synchronous, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
SEC. 3.Section 4826.6 is added to the Business and Professions Code, to read:4826.6.(a)(1)Except as provided in subdivision (f) or otherwise permitted by law, a person shall not practice veterinary medicine outside the context of a veterinarian-client-patient relationship.
(2)Real-time Synchronous video communication is not required for the delivery of veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
(b)Only a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary medicine via telehealth. That practice shall be deemed to occur at the premises where the patient is located at the time that the veterinarian practices veterinary medicine.
(c)Before delivering veterinary medicine via telehealth, the veterinarian shall inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth, including acknowledgment of both all of the following:
(1)The same standards of care apply to veterinary medicine services via telehealth and in-person veterinary medical services.
(2)The client has the option to choose an in-person visit from a veterinarian at any time.
(3)The client has been advised how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate resulting from technological or equipment failure.
(d)A veterinarian that practices veterinary medicine via telehealth shall do all of the following:
(1)Ensure that the technology, method, and equipment used to provide veterinary medicine services via telehealth comply with all current privacy protection laws.
(2)Have historical knowledge of the animal by obtaining and reviewing the patients relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
(3)Employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice.
(4)Be familiar with available medical resources, including emergency resources near the patients location, be able to refer the client to a nearby veterinarian who may be able to see the patient in person upon the request of the client, and make available a summary of the patient record, as required by Section 4855.
(5)Provide the client with the veterinarians name, contact information, and license number.
(6)Secure an alternative means of contacting the client if the electronic means is interrupted.
(e)(1)Except as provided in paragraph (2), paragraphs (2) to (4), inclusive, a veterinarian that practices veterinary medicine via telehealth may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant federal regulations.
(2)A veterinarian who established the required veterinarian-client-patient relationship using real-time synchronous video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the patient, either in person or using telehealth.
(3)The veterinarian shall not order, prescribe, or make available a controlled substance, as defined in Section 4021, or xylazine, unless the veterinarian has performed an in-person physical examination of the patient or made medically appropriate and timely visits to the premises where the patient is kept.
(4)The veterinarian shall notify the client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian shall submit a prescription to a pharmacy that the client chooses.
(f)A veterinarian is permitted to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.
SEC. 4.Section 4829.5 of the Business and Professions Code is amended to read:4829.5.(a)Each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug, as defined in Section 4022, to an animal patient in an outpatient setting, the veterinarian shall offer to provide, in person or through electronic means, verbally, in writing, or by email to the client client, a consultation that includes the following information:
(1)The name and description of the dangerous drug.
(2)Route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug.
(3)Any special directions for proper use and storage.
(4)Actions to be taken in the event of a missed dose.
(5)If available, precautions and relevant warnings provided by the drugs manufacturer, including common severe adverse effects of the drug.
(b)If requested, a veterinarian shall provide drug documentation, if available.
(c)A veterinarian may delegate to a registered veterinary technician or veterinary assistant the task of providing the consultation and drug documentation required by this section.
(d)It shall be noted in the medical record of the animal patient if the consultation described in this section is provided or declined by the client.
SEC. 5.Section 4857 of the Business and Professions Code is amended to read:4857.(a)A veterinarian licensed under 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.
(2)Upon authorization received by electronic transmission when originated by 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 (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(5)If the care or service was for a horse that has participated in the previous year, or is intended to participate, in a licensed horse race. In these situations, the entire medical record for the horse shall be made available upon request to anyone responsible for the direct medical care of the horse, including the owner, trainer, or veterinarian, the California Horse Racing Board or any other state or local governmental entity, and the racing association or fair conducting the licensed horse race.
(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 veterinarians 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.
(e)Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians and facilities for the purpose of diagnosis or treatment of the animal that is the subject of the medical records.
SEC. 6.Section 4875.1 of the Business and Professions Code is amended to read:4875.1.(a)In order to ensure that its resources are maximized for the protection of the public, the board shall prioritize its investigative and prosecutorial resources to ensure that veterinarians and registered veterinary technicians representing the greatest threat of harm are identified and disciplined expeditiously. Cases involving any of the following allegations shall be handled on a priority basis, as follows, with the highest priority being given to cases in paragraph (1):
(1)Negligence or incompetence that involves death or serious bodily injury to an animal patient, such that the veterinarian or registered veterinary technician represents a danger to the public.
(2)Cruelty to animals.
(3)A conviction or convictions for a criminal charge or charges or being subject to a felony criminal proceeding without consideration of the outcome of the proceeding.
(4)Practicing veterinary medicine while under the influence of drugs or alcohol.
(5)Drug or alcohol abuse by a veterinarian or registered veterinary technician involving death or serious bodily injury to an animal patient or to the public.
(6)Self-prescribing of any dangerous drug, as defined in Section 4022, or any controlled substance, as defined in Section 4021.
(7)Repeated acts of excessive prescribing, furnishing, or administering of controlled substances, as defined in Section 4021, or repeated acts of prescribing, dispensing, or furnishing of controlled substances, as defined in Section 4021, without having first established a veterinarian-client-patient relationship pursuant to subdivision (f) of Section 4825.1.
(8)Extreme departures from minimum sanitary conditions such that there is a threat to an animal patient or the public and animal health and safety, only if the case has already been subject to Section 494 and board action.
(b)The board may prioritize cases involving an allegation of conduct that is not described in subdivision (a). Those cases prioritized shall not be assigned a priority equal to or higher than the priorities established in subdivision (a).
(c)The board shall annually report and make publicly available the number of disciplinary actions that are taken in each priority category specified in subdivisions (a) and (b).
SEC. 7.Section 14401 of the Food and Agricultural Code is amended to read:14401.Beginning January 1, 2018, a medically important antimicrobial drug shall not be administered to livestock unless ordered by a licensed veterinarian through a prescription or veterinary feed directive, pursuant to a veterinarian-client-patient relationship that meets the requirements of subdivision (f) of Section 4825.1 of the Business and Professions Code.
SEC. 8.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district are the result of a program for which legislative authority was requested by that local agency or school district, within the meaning of Section 17556 of the Government Code and Section 6 of Article XIIIB of the California Constitution.
(a)No person or entity shall dispense or furnish, or cause to be dispensed or furnished, dangerous drugs or dangerous devices, as defined in Section 4022, on the internet for delivery to any person in this state without a prescription issued pursuant to a good faith prior examination of a human or animal for whom the prescription is meant if the person or entity either knew or reasonably should have known that the prescription was not issued pursuant to a good faith prior examination of a human or animal, or if the person or entity did not act in accordance with Section 1761 of Title 16 of the California Code of Regulations.
(b)Notwithstanding any other provision of law, a violation of this section may subject the person or entity that has committed the violation to either a fine of up to twenty-five thousand dollars ($25,000) per occurrence pursuant to a citation issued by the board or a civil penalty of twenty-five thousand dollars ($25,000) per occurrence.
(c)The Attorney General may bring an action to enforce this section and to collect the fines or civil penalties authorized by subdivision (b).
(d)For notifications made on and after January 1, 2002, the Franchise Tax Board, upon notification by the Attorney General or the board of a final judgment in an action brought under this section, shall subtract the amount of the fine or awarded civil penalties from any tax refunds or lottery winnings due to the person who is a defendant in the action using the offset authority under Section 12419.5 of the Government Code, as delegated by the Controller, and the processes as established by the Franchise Tax Board for this purpose. That amount shall be forwarded to the board for deposit in the Pharmacy Board Contingent Fund.
(e)Nothing in this section shall be construed to permit the unlicensed practice of pharmacy, or to limit the authority of the board to enforce any other provision of this chapter.
(f)For the purposes of this section, good faith prior examination includes the requirements for a physician and surgeon in Section 2242 and the requirements for a veterinarian in subdivision (f) of Section 4825.1.
SEC. 2.Section 4825.1 of the Business and Professions Code is amended to read:4825.1.These definitions shall govern the construction of this chapter as it applies to veterinary medicine.
(a)Client means an individual who represents to the veterinarian that they are the owner, or the agent of the owner, of an animal patient at the time that services are provided.
(b)Diagnosis means the act or process of identifying or determining the health status of an animal through examination and the opinion derived from that examination.
(c)Animal means any member of the animal kingdom other than humans, and includes fowl, fish, and reptiles, wild or domestic, whether living or dead.
(d)Food animal means any animal that is raised for the production of an edible product intended for consumption by humans. The edible product includes, but is not limited to, milk, meat, and eggs. Food animal includes, but is not limited to, cattle (beef or dairy), swine, sheep, poultry, fish, and amphibian species.
(e)Livestock includes all animals, poultry, aquatic and amphibian species that are raised, kept, or used for profit. It does not include those species that are usually kept as pets such as dogs, cats, and pet birds, or companion animals, including equines.
(f)(1)Veterinarian-client-patient relationship means a relationship that exists if all of the following conditions are met:
(A)The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgments regarding the health of the animal patient.
(B)The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in person or using real-time video communication, of the animal or of a group of animals of which the patient is a part, or through medically appropriate and timely visits to the premises where the animal, or the group of animals of which the patient is a part, is kept.
(C)The veterinarian is readily available or has provided for followup care in case of adverse reactions or failure of treatment.
(2)A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.
(g)Telehealth means the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, real-time video and audio communication; real-time, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
SEC. 3.Section 4826.6 is added to the Business and Professions Code, to read:4826.6.(a)(1)Except as provided in subdivision (f) or otherwise permitted by law, a person shall not practice veterinary medicine outside the context of a veterinarian-client-patient relationship.
(2)Real-time video communication is not required for the delivery of veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
(b)Only a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary medicine via telehealth. That practice shall be deemed to occur at the premises where the patient is located at the time that the veterinarian practices veterinary medicine.
(c)Before delivering veterinary medicine via telehealth, the veterinarian shall inform the client about the use of telehealth and obtain consent from the client to use telehealth, including acknowledgment of both of the following:
(1)The same standards of care apply to veterinary medicine services via telehealth and in-person veterinary medical services.
(2)The client has the option to choose an in-person visit from a veterinarian at any time.
(d)A veterinarian that practices veterinary medicine via telehealth shall do all of the following:
(1)Ensure that the technology, method, and equipment used to provide veterinary medicine services via telehealth comply with all current privacy protection laws.
(2)Have historical knowledge of the animal by obtaining and reviewing the patients relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
(3)Employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice.
(4)Be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client. client, and make available a summary of the patient record, as required by Section 4855.
(e)(1)Except as provided in paragraph (2), a veterinarian that practices veterinary medicine via telehealth may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant federal regulations.
(2)A veterinarian who established the required veterinarian-client-patient relationship using real-time video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the patient, either in person or using telehealth.
(f)A veterinarian is permitted to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.
SEC. 4.Section 4829.5 of the Business and Professions Code is amended to read:4829.5.(a)Each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug, as defined in Section 4022, to an animal patient in an outpatient setting, the veterinarian shall offer to provide, in person or through electronic means, to the client a consultation that includes the following information:
(1)The name and description of the dangerous drug.
(2)Route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug.
(3)Any special directions for proper use and storage.
(4)Actions to be taken in the event of a missed dose.
(5)If available, precautions and relevant warnings provided by the drugs manufacturer, including common severe adverse effects of the drug.
(b)If requested, a veterinarian shall provide drug documentation, if available.
(c)A veterinarian may delegate to a registered veterinary technician or veterinary assistant the task of providing the consultation and drug documentation required by this section.
(d)It shall be noted in the medical record of the animal patient if the consultation described in this section is provided or declined by the client.
SEC. 5.Section 4857 of the Business and Professions Code is amended to read:4857.(a)A veterinarian licensed under 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.
(2)Upon authorization received by electronic transmission when originated by 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 (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(5)If the care or service was for a horse that has participated in the previous year, or is intended to participate, in a licensed horse race. In these situations, the entire medical record for the horse shall be made available upon request to anyone responsible for the direct medical care of the horse, including the owner, trainer, or veterinarian, the California Horse Racing Board or any other state or local governmental entity, and the racing association or fair conducting the licensed horse race.
(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 veterinarians 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.
(e)Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians and facilities for the purpose of diagnosis or treatment of the animal that is the subject of the medical records.
SEC. 6.Section 4875.1 of the Business and Professions Code is amended to read:4875.1.(a)In order to ensure that its resources are maximized for the protection of the public, the board shall prioritize its investigative and prosecutorial resources to ensure that veterinarians and registered veterinary technicians representing the greatest threat of harm are identified and disciplined expeditiously. Cases involving any of the following allegations shall be handled on a priority basis, as follows, with the highest priority being given to cases in paragraph (1):
(1)Negligence or incompetence that involves death or serious bodily injury to an animal patient, such that the veterinarian or registered veterinary technician represents a danger to the public.
(2)Cruelty to animals.
(3)A conviction or convictions for a criminal charge or charges or being subject to a felony criminal proceeding without consideration of the outcome of the proceeding.
(4)Practicing veterinary medicine while under the influence of drugs or alcohol.
(5)Drug or alcohol abuse by a veterinarian or registered veterinary technician involving death or serious bodily injury to an animal patient or to the public.
(6)Self-prescribing of any dangerous drug, as defined in Section 4022, or any controlled substance, as defined in Section 4021.
(7)Repeated acts of excessive prescribing, furnishing, or administering of controlled substances, as defined in Section 4021, or repeated acts of prescribing, dispensing, or furnishing of controlled substances, as defined in Section 4021, without having first established a veterinarian-client-patient relationship pursuant to subdivision (f) of Section 4825.1.
(8)Extreme departures from minimum sanitary conditions such that there is a threat to an animal patient or the public and animal health and safety, only if the case has already been subject to Section 494 and board action.
(b)The board may prioritize cases involving an allegation of conduct that is not described in subdivision (a). Those cases prioritized shall not be assigned a priority equal to or higher than the priorities established in subdivision (a).
(c)The board shall annually report and make publicly available the number of disciplinary actions that are taken in each priority category specified in subdivisions (a) and (b).
SEC. 7.Section 14401 of the Food and Agricultural Code is amended to read:14401.Beginning January 1, 2018, a medically important antimicrobial drug shall not be administered to livestock unless ordered by a licensed veterinarian through a prescription or veterinary feed directive, pursuant to a veterinarian-client-patient relationship that meets the requirements of subdivision (f) of Section 4825.1 of the Business and Professions Code.
SEC. 8.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district are the result of a program for which legislative authority was requested by that local agency or school district, within the meaning of Section 17556 of the Government Code and Section 6 of Article XIIIB of the California Constitution.
(a)No person or entity shall dispense or furnish, or cause to be dispensed or furnished, dangerous drugs or dangerous devices, as defined in Section 4022, on the Internet internet for delivery to any person in this state without a prescription issued pursuant to a good faith prior examination of a human or animal for whom the prescription is meant if the person or entity either knew or reasonably should have known that the prescription was not issued pursuant to a good faith prior examination of a human or animal, or if the person or entity did not act in accordance with Section 1761 of Title 16 of the California Code of Regulations.
(b)Notwithstanding any other provision of law, a violation of this section may subject the person or entity that has committed the violation to either a fine of up to twenty-five thousand dollars ($25,000) per occurrence pursuant to a citation issued by the board or a civil penalty of twenty-five thousand dollars ($25,000) per occurrence.
(c)The Attorney General may bring an action to enforce this section and to collect the fines or civil penalties authorized by subdivision (b).
(d)For notifications made on and after January 1, 2002, the Franchise Tax Board, upon notification by the Attorney General or the board of a final judgment in an action brought under this section, shall subtract the amount of the fine or awarded civil penalties from any tax refunds or lottery winnings due to the person who is a defendant in the action using the offset authority under Section 12419.5 of the Government Code, as delegated by the Controller, and the processes as established by the Franchise Tax Board for this purpose. That amount shall be forwarded to the board for deposit in the Pharmacy Board Contingent Fund.
(e)Nothing in this section shall be construed to permit the unlicensed practice of pharmacy, or to limit the authority of the board to enforce any other provision of this chapter.
(f)For the purposes of this section, good faith prior examination includes the requirements for a physician and surgeon in Section 2242 and the requirements for a veterinarian in subdivision (f) of Section 4825.1.
SEC. 2.Section 4825.1 of the Business and Professions Code is amended to read:4825.1.These definitions shall govern the construction of this chapter as it applies to veterinary medicine.
(a)Client means an individual who represents to the veterinarian that they are the owner, or the agent of the owner, of an animal patient at the time that services are provided.
(b)Diagnosis means the act or process of identifying or determining the health status of an animal through examination and the opinion derived from that examination.
(c)Animal means any member of the animal kingdom other than humans, and includes fowl, fish, and reptiles, wild or domestic, whether living or dead.
(d)Food animal means any animal that is raised for the production of an edible product intended for consumption by humans. The edible product includes, but is not limited to, milk, meat, and eggs. Food animal includes, but is not limited to, cattle (beef or dairy), swine, sheep, poultry, fish, and amphibian species.
(e)Livestock includes all animals, poultry, aquatic and amphibian species that are raised, kept, or used for profit. It does not include those species that are usually kept as pets such as dogs, cats, and pet birds, or companion animals, including equines.
(f)(1)Veterinarian-client-patient relationship means a relationship that exists if all of the following conditions are met:
(A)The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgments regarding the health of the animal patient.
(B)The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in-person in person or using real-time video communication, of the animal or of a group of animals of which the patient is a part, or through medically appropriate and timely visits to the premises where the animal, or the group of animals of which the patient is a part, is kept.
(C)The veterinarian is readily available or has provided for followup care in case of adverse reactions or failure of treatment.
(2)A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.
(g)Veterinary telemedicine Telehealth means the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, real-time video and audio communication; real-time, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
SEC. 3.Section 4826.6 is added to the Business and Professions Code, to read:4826.6.(a)(1)Except as provided in subdivision (f) or otherwise permitted by law, a person shall not practice veterinary medicine outside the context of a veterinarian-client-patient relationship.
(2)Real-time video communication is not required for the delivery of care via veterinary telemedicine veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
(b)A Only a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary telemedicine. medicine via telehealth. That practice shall be deemed to occur at the premises where the patient is located at the time that the veterinarian practices veterinary medicine.
(c)Before delivering care via veterinary telemedicine, veterinary medicine via telehealth, the veterinarian shall inform the client about the use of veterinary telemedicine telehealth and obtain consent from the client to use veterinary telemedicine, telehealth, including acknowledgment of both of the following:
(1)The same standards of care apply to veterinary telemedicine medicine services via telehealth and in-person veterinary medical services.
(2)The client has the option to choose an in-person visit from a veterinarian at any time.
(d)A veterinarian that practices veterinary telemedicine medicine via telehealth shall do all of the following:
(1)Ensure that the technology, method, and equipment used to provide veterinary telemedicine medicine services via telehealth comply with all current privacy protection laws.
(2)Have historical knowledge of the animal by obtaining and reviewing the patients relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
(3)Employ sound professional judgment to determine whether using veterinary telemedicine telehealth is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice.
(4)Be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client.
(e)(1)Except as provided in paragraph (2), a veterinarian that practices veterinary telemedicine medicine via telehealth may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant federal regulations.
(2)A veterinarian who established the required veterinarian-client-patient relationship using real-time video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the patient, either in-person in person or using veterinary telemedicine. telehealth.
(f)A veterinarian is permitted to use veterinary telemedicine telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.
SEC. 4.Section 4829.5 of the Business and Professions Code is amended to read:4829.5.(a)Each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug, as defined in Section 4022, to an animal patient in an outpatient setting, the veterinarian shall offer to provide, in person or through electronic means, to the client a consultation that includes the following information:
(1)The name and description of the dangerous drug.
(2)Route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug.
(3)Any special directions for proper use and storage.
(4)Actions to be taken in the event of a missed dose.
(5)If available, precautions and relevant warnings provided by the drugs manufacturer, including common severe adverse effects of the drug.
(b)If requested, a veterinarian shall provide drug documentation, if available.
(c)A veterinarian may delegate to a registered veterinary technician or veterinary assistant the task of providing the consultation and drug documentation required by this section.
(d)It shall be noted in the medical record of the animal patient if the consultation described in this section is provided or declined by the client.
SEC. 5.Section 4857 of the Business and Professions Code is amended to read:4857.(a)A veterinarian licensed under 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.
(2)Upon authorization received by electronic transmission when originated by 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 (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(5)If the care or service was for a horse that has participated in the previous year, or is intended to participate, in a licensed horse race. In these situations, the entire medical record for the horse shall be made available upon request to anyone responsible for the direct medical care of the horse, including the owner, trainer, or veterinarian, the California Horse Racing Board or any other state or local governmental entity, and the racing association or fair conducting the licensed horse race.
(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 veterinarians 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.
(e)Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians and facilities for the purpose of diagnosis or treatment of the animal that is the subject of the medical records.
SEC. 6.Section 4875.1 of the Business and Professions Code is amended to read:4875.1.(a)In order to ensure that its resources are maximized for the protection of the public, the board shall prioritize its investigative and prosecutorial resources to ensure that veterinarians and registered veterinary technicians representing the greatest threat of harm are identified and disciplined expeditiously. Cases involving any of the following allegations shall be handled on a priority basis, as follows, with the highest priority being given to cases in paragraph (1):
(1)Negligence or incompetence that involves death or serious bodily injury to an animal patient, such that the veterinarian or registered veterinary technician represents a danger to the public.
(2)Cruelty to animals.
(3)A conviction or convictions for a criminal charge or charges or being subject to a felony criminal proceeding without consideration of the outcome of the proceeding.
(4)Practicing veterinary medicine while under the influence of drugs or alcohol.
(5)Drug or alcohol abuse by a veterinarian or registered veterinary technician involving death or serious bodily injury to an animal patient or to the public.
(6)Self-prescribing of any dangerous drug, as defined in Section 4022, or any controlled substance, as defined in Section 4021.
(7)Repeated acts of excessive prescribing, furnishing, or administering of controlled substances, as defined in Section 4021, or repeated acts of prescribing, dispensing, or furnishing of controlled substances, as defined in Section 4021, without having first established a veterinarian-client-patient relationship pursuant to subdivision (f) of Section 4825.1.
(8)Extreme departures from minimum sanitary conditions such that there is a threat to an animal patient or the public and animal health and safety, only if the case has already been subject to Section 494 and board action.
(b)The board may prioritize cases involving an allegation of conduct that is not described in subdivision (a). Those cases prioritized shall not be assigned a priority equal to or higher than the priorities established in subdivision (a).
(c)The board shall annually report and make publicly available the number of disciplinary actions that are taken in each priority category specified in subdivisions (a) and (b).
SEC. 7.Section 14401 of the Food and Agricultural Code is amended to read:14401.Beginning January 1, 2018, a medically important antimicrobial drug shall not be administered to livestock unless ordered by a licensed veterinarian through a prescription or veterinary feed directive, pursuant to a veterinarian-client-patient relationship that meets the requirements of subdivision (f) of Section 4825.1 of the Business and Professions Code.
SEC. 8.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district are the result of a program for which legislative authority was requested by that local agency or school district, within the meaning of Section 17556 of the Government Code and Section 6 of Article XIIIB of the California Constitution.
(a)No person or entity shall dispense or furnish, or cause to be dispensed or furnished, dangerous drugs or dangerous devices, as defined in Section 4022, on the Internet for delivery to any person in this state without a prescription issued pursuant to a good faith prior examination of a human or animal for whom the prescription is meant if the person or entity either knew or reasonably should have known that the prescription was not issued pursuant to a good faith prior examination of a human or animal, or if the person or entity did not act in accordance with Section 1761 of Title 16 of the California Code of Regulations.
(b)Notwithstanding any other provision of law, a violation of this section may subject the person or entity that has committed the violation to either a fine of up to twenty-five thousand dollars ($25,000) per occurrence pursuant to a citation issued by the board or a civil penalty of twenty-five thousand dollars ($25,000) per occurrence.
(c)The Attorney General may bring an action to enforce this section and to collect the fines or civil penalties authorized by subdivision (b).
(d)For notifications made on and after January 1, 2002, the Franchise Tax Board, upon notification by the Attorney General or the board of a final judgment in an action brought under this section, shall subtract the amount of the fine or awarded civil penalties from any tax refunds or lottery winnings due to the person who is a defendant in the action using the offset authority under Section 12419.5 of the Government Code, as delegated by the Controller, and the processes as established by the Franchise Tax Board for this purpose. That amount shall be forwarded to the board for deposit in the Pharmacy Board Contingent Fund.
(e)Nothing in this section shall be construed to permit the unlicensed practice of pharmacy, or to limit the authority of the board to enforce any other provision of this chapter.
(f)For the purposes of this section, good faith prior examination includes the requirements for a physician and surgeon in Section 2242 and the requirements for a veterinarian in Section 2032.1 of Title 16 of the California Code of Regulations. subdivision (f) of Section 4825.1.
SEC. 2.Section 4825.1 of the Business and Professions Code is amended to read:4825.1.These definitions shall govern the construction of this chapter as it applies to veterinary medicine.
(a)Client means an individual who represents to the veterinarian that they are the owner, or the agent of the owner, of an animal patient at the time that services are provided.
(a)(b)Diagnosis means the act or process of identifying or determining the health status of an animal through examination and the opinion derived from that examination.
(b)(c)Animal means any member of the animal kingdom other than humans, and includes fowl, fish, and reptiles, wild or domestic, whether living or dead.
(c)(d)Food animal means any animal that is raised for the production of an edible product intended for consumption by humans. The edible product includes, but is not limited to, milk, meat, and eggs. Food animal includes, but is not limited to, cattle (beef or dairy), swine, sheep, poultry, fish, and amphibian species.
(d)(e)Livestock includes all animals, poultry, aquatic and amphibian species that are raised, kept, or used for profit. It does not include those species that are usually kept as pets such as dogs, cats, and pet birds, or companion animals, including equines.
(f)(1)Veterinarian-client-patient relationship means a relationship that exists if all of the following conditions are met:
(A)The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgments regarding the health of the animal patient.
(B)The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in-person or using real-time video communication, of the animal or of a group of animals of which the patient is a part, or through medically appropriate and timely visits to the premises where the animal, or the group of animals of which the patient is a part, is kept.
(C)The veterinarian is readily available or has provided for followup care in case of adverse reactions or failure of treatment.
(2)A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.
(g)Veterinary telemedicine means the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, real-time video and audio communication; real-time, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
SEC. 3.Section 4826.6 is added to the Business and Professions Code, to read:4826.6.(a)(1)Except as provided in subdivision (f) or otherwise permitted by law, a person shall not practice veterinary medicine outside the context of a veterinarian-client-patient relationship.
(2)Real-time video communication is not required for the delivery of care via veterinary telemedicine after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
(b)A person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary telemedicine. That practice shall be deemed to occur at the premises where the patient is located at the time that the veterinarian practices veterinary medicine.
(c)Before delivering care via veterinary telemedicine, the veterinarian shall inform the client about the use of veterinary telemedicine and obtain consent from the client to use veterinary telemedicine, including acknowledgment of both of the following:
(1)The same standards of care apply to veterinary telemedicine services and in-person veterinary medical services.
(2)The client has the option to choose an in-person visit from a veterinarian at any time.
(d)A veterinarian that practices veterinary telemedicine shall do all of the following:
(1)Ensure that the technology, method, and equipment used to provide veterinary telemedicine services comply with all current privacy protection laws.
(2)Have historical knowledge of the animal by obtaining and reviewing the patients relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
(3)Employ sound professional judgment to determine whether using veterinary telemedicine is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice.
(4)Be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client.
(e)(1)Except as provided in paragraph (2), a veterinarian that practices veterinary telemedicine may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant federal regulations.
(2)A veterinarian who established the required veterinarian-client-patient relationship using real-time video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the patient, either in-person or using veterinary telemedicine.
(f)A veterinarian is permitted to use veterinary telemedicine without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.
SEC. 4.Section 4829.5 of the Business and Professions Code is amended to read:4829.5.(a)Each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug, as defined in Section 4022, to an animal patient in an outpatient setting, the veterinarian shall offer to provide, in person or through electronic means, to the client responsible for the animal, or his or her agent, a consultation that includes the following information:
(1)The name and description of the dangerous drug.
(2)Route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug.
(3)Any special directions for proper use and storage.
(4)Actions to be taken in the event of a missed dose.
(5)If available, precautions and relevant warnings provided by the drugs manufacturer, including common severe adverse effects of the drug.
(b)If requested, a veterinarian shall provide drug documentation, if available.
(c)A veterinarian may delegate to a registered veterinary technician or veterinary assistant the task of providing the consultation and drug documentation required by this section.
(d)It shall be noted in the medical record of the animal patient if the consultation described in this section is provided or declined by the client or his or her agent. client.
SEC. 5.Section 4857 of the Business and Professions Code is amended to read:4857.(a)A veterinarian licensed under 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 (Division 10 (commencing with Section 7920.000) 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 that is the subject of the medical records. (6)(5)If the care or service was for a horse that has participated in the previous year, or is intended to participate, in a licensed horse race. In these situations, the entire medical record for the horse shall be made available upon request to anyone responsible for the direct medical care of the horse, including the owner, trainer, or veterinarian, the California Horse Racing Board or any other state or local governmental entity, and the racing association or fair conducting the licensed horse race.
(7)(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 veterinarians 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.
(e)Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians and facilities for the purpose of diagnosis or treatment of the animal that is the subject of the medical records.
SEC. 6.Section 4875.1 of the Business and Professions Code is amended to read:4875.1.(a)In order to ensure that its resources are maximized for the protection of the public, the board shall prioritize its investigative and prosecutorial resources to ensure that veterinarians and registered veterinary technicians representing the greatest threat of harm are identified and disciplined expeditiously. Cases involving any of the following allegations shall be handled on a priority basis, as follows, with the highest priority being given to cases in paragraph (1):
(1)Negligence or incompetence that involves death or serious bodily injury to an animal patient, such that the veterinarian or registered veterinary technician represents a danger to the public.
(2)Cruelty to animals.
(3)A conviction or convictions for a criminal charge or charges or being subject to a felony criminal proceeding without consideration of the outcome of the proceeding.
(4)Practicing veterinary medicine while under the influence of drugs or alcohol.
(5)Drug or alcohol abuse by a veterinarian or registered veterinary technician involving death or serious bodily injury to an animal patient or to the public.
(6)Self-prescribing of any dangerous drug, as defined in Section 4022, or any controlled substance, as defined in Section 4021.
(7)Repeated acts of excessive prescribing, furnishing, or administering of controlled substances, as defined in Section 4021, or repeated acts of prescribing, dispensing, or furnishing of controlled substances, as defined in Section 4021, without having first established a veterinarian-client-patient relationship pursuant to Section 2032.1 of Title 16 of the California Code of Regulations. subdivision (f) of Section 4825.1.
(8)Extreme departures from minimum sanitary conditions such that there is a threat to an animal patient or the public and animal health and safety, only if the case has already been subject to Section 494 and board action.
(b)The board may prioritize cases involving an allegation of conduct that is not described in subdivision (a). Those cases prioritized shall not be assigned a priority equal to or higher than the priorities established in subdivision (a).
(c)The board shall annually report and make publicly available the number of disciplinary actions that are taken in each priority category specified in subdivisions (a) and (b).
SEC. 7.Section 14401 of the Food and Agricultural Code is amended to read:14401.Beginning January 1, 2018, a medically important antimicrobial drug shall not be administered to livestock unless ordered by a licensed veterinarian through a prescription or veterinary feed directive, pursuant to a veterinarian-client-patient relationship that meets the requirements of Section 2032.1 of Title 16 of the California Code of Regulations. subdivision (f) of Section 4825.1 of the Business and Professions Code.
SEC. 8.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district are the result of a program for which legislative authority was requested by that local agency or school district, within the meaning of Section 17556 of the Government Code and Section 6 of Article XIIIB of the California Constitution.
SECTION 1.Section 23002 of the Business and Professions Code is amended to read:23002.Unless the context otherwise requires, the definitions and general provisions of this chapter govern the construction of this division.Unless the context otherwise requires, the definitions and general provisions set forth in of this chapter govern the construction of this division.
|
Date
|
Status
|
|---|---|
| Oct 8, 2023 | Chaptered by Secretary of State - Chapter 475, Statutes of 2023. |
| Oct 8, 2023 | Approved by the Governor. |
| Sep 19, 2023 | Enrolled and presented to the Governor at 4 p.m. |
| Sep 12, 2023 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 79. Noes 0. Page 3304.). |
| Sep 12, 2023 | Assembly Rule 77 suspended. (Page 3228.) |
| Sep 11, 2023 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after September 13 pursuant to Assembly Rule 77. |
| Sep 11, 2023 | Read third time. Passed. Ordered to the Assembly. (Ayes 36. Noes 3. Page 2588.). |
| Sep 7, 2023 | Read second time. Ordered to third reading. |
| Sep 6, 2023 | Read third time and amended. Ordered to second reading. |
| Sep 5, 2023 | Read second time. Ordered to third reading. |
| Sep 1, 2023 | Read second time and amended. Ordered returned to second reading. |
| Sep 1, 2023 | From committee: Amend, and do pass as amended. (Ayes 7. Noes 0.) (September 1). |
| Aug 21, 2023 | In committee: Referred to APPR suspense file. |
| Jul 13, 2023 | Read second time and amended. Re-referred to Com. on APPR. |
| Jul 12, 2023 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0.) (July 10). |
| Jun 28, 2023 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on B., P. & E. D. |
| Jun 14, 2023 | Referred to Com. on B., P. & E. D. |
| Jun 1, 2023 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 31, 2023 | Read third time. Passed. Ordered to the Senate. (Ayes 76. Noes 0. Page 1957.) |
| May 25, 2023 | Read third time and amended. Ordered to third reading. (Page 1741.) |
| May 11, 2023 | Read second time. Ordered to third reading. |
| May 10, 2023 | From committee: Do pass. (Ayes 15. Noes 0.) (May 10). |
| Apr 20, 2023 | Re-referred to Com. on APPR. |
| Apr 19, 2023 | Read second time and amended. |
| Apr 18, 2023 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 16. Noes 0.) (April 18). |
| Mar 20, 2023 | Re-referred to Com. on B. & P. |
| Mar 16, 2023 | Referred to Com. on B. & P. |
| Mar 16, 2023 | From committee chair, with author's amendments: Amend, and re-refer to Com. on B. & P. Read second time and amended. |
| Feb 18, 2023 | From printer. May be heard in committee March 20. |
| Feb 17, 2023 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 12, 2023 | AB 1399 Friedman Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Sep 11, 2023 | Assembly 3rd Reading AB1399 Friedman et al. By Archuleta | Senate Floor |
Passed |
|
| Sep 1, 2023 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
|
| Aug 21, 2023 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jul 10, 2023 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Business, Professions and Economic Development |
Passed |
|
| May 31, 2023 | AB 1399 Friedman Assembly Third Reading | Assembly Floor |
Passed |
|
| May 10, 2023 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 18, 2023 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Business and Professions |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| American Society For The Prevention Of Cruelty To Animals | ** Support | |
| American Veterinary Medical Association | ** Support | Apr 18, 2023 |
| American Veterinary Medical Association | ** Against | Jul 10, 2023 |
| American Veterinary Medical Association | ** Against | Aug 21, 2023 |
| American Veterinary Medical Association | ** Against | |
| Best Friends Animal Society | * Support | Aug 21, 2023 |
| Cal Animals | * Support | Apr 18, 2023 |
| CalAnimals | * Support | Aug 21, 2023 |
| California Animal Welfare Association | ** Support | |
| California Veterinary Medical Association | * Against | Aug 21, 2023 |
| CFILC | * Support | Jul 10, 2023 |
| County of Riverside | ** Support | |
| Covetris | * Against | Jul 10, 2023 |
| Covetrus | ** Against | |
| Glendale Humane Society | * Support | Jul 10, 2023 |
| Humane Society Of The United States | ** Support | |
| Humane Society Veterinary Medical Association | ** Support | |
| Inland Valley Humane Society | * Support | Jul 10, 2023 |
| Inland Valley SPCA | * Support | Jul 10, 2023 |
| Lizzie Initiative for Pet Protection | * Support | Aug 21, 2023 |
| Lizzie Initiative for Pet Protection | * For If Amend | Jul 10, 2023 |
| Medicine for Modern Animal | ** Support | Apr 18, 2023 |
| Medicine for Modern Animal | * Support | Jul 10, 2023 |
| Medicine for Modern Animal | ** Support | Jul 10, 2023 |
| Michelson Center For Public Policy | ** Support | |
| Numerous individuals | ** Support | |
| Project Street Vet | ** Support | |
| San Diego Humane Society | ** Support | |
| San Francisco Spca | ** Support | |
| Shaw Yoder Antwih Schmelzer & Lange | * Support | Apr 18, 2023 |
| Social Compassion In Legislation | ** Support | |
| Solano County Democratic Central Committee | ** Support | |
| Southern California Veterinary Medical Association | ** Support | Apr 18, 2023 |
| UC Davis Shelter Medicine Program | * Support | Jul 10, 2023 |
| Veterinary Medical Board | ** Against | |
| Veterinary Virtual Care Association | ** Support | |
| Virtual Veterinary Care Association | * Support | Apr 18, 2023 |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 1399
Author:(Friedman and Lowenthal)
As Amended Ver:September 6, 2023
Majority vote
SUMMARY
Expands the authority of a licensed veterinarian to establish a veterinarian-client-patient relationship and practice veterinary medicine through the use of telehealth.
Senate Amendments
- Relocate the definitions of "veterinarian-client-patient relationship" and "telehealth" to a different code section and rearrange various other provisions of the bill.
- Define the term "synchronous" as a real-time interaction between a client and animal patient with a veterinarian who is licensed in this state and located at a distant site, and replace the term "real-time" with "synchronous" within the bill.
- Allow for a client to authorize an agent to act on the client's behalf.
- Require a veterinarian to specifically inform the client about the potential limitations of telehealth when obtaining informed consent prior to using telehealth, and requires that the client be advised how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate resulting from technological or equipment failure.
- Additionally require that a veterinarian using telehealth do all of the following:
- Be familiar with available medical resources, including emergency resources near the animal patient's location.
- Be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client.
- Keep, maintain, and make available a summary of the animal patient record.
- Provide the client with the veterinarian's name, contact information, and license number.
- Secure an alternative means of contacting the client if the electronic means is interrupted.
- Prohibit a veterinarian from ordering, prescribing, or making available a controlled substance, or xylazine, unless the veterinarian has performed an in-person physical examination of the patient or made medically appropriate and timely visits to the premises where the patient is kept, and requires the veterinarian to notify the client that some prescription drugs or medications may be available at a pharmacy and, if requested, requires the veterinarian to submit a prescription to a pharmacy that the client chooses.
- Prohibit a veterinarian from prescribing an antimicrobial drug to the animal patient for a period longer than 14 days of treatment without conducting an in-person examination.
- Prohibit a veterinarian from prescribing via telehealth any drug or medication for use on a horse engaged in racing or training at a facility under the jurisdiction of the California Horse Racing Board.
- Exempt the location where a veterinarian practices telehealth from current registration requirements if all of the following are satisfied:
- The veterinarian does not perform in-person examination or treatment of animal patients at the location.
- No veterinary drug, medicine, appliance, or medical equipment is kept at the location.
- The required veterinary medical records required are created, maintained, and stored so as to protect the veterinary medical records from access by unauthorized individuals, damage, or loss.
- Specified information about the veterinarian and the Veterinary Medical Board is provided on any electronic publication, including any internet website, through which the veterinarian provides or offers to provide veterinary medical services.
COMMENTS
The Veterinary Medicine Practice Act requires a veterinarian to establish and maintain a veterinarian-client-patient-relationship before providing care to an animal patient. Among other requirements, this relationship is established when the client has authorized the veterinarian to make medical judgements, and when the veterinarian has gained sufficient knowledge of the animal to make a diagnosis, generally through an in-person examination. The Veterinary Medical Board's regulations effectuating the relationship requirement state the following:
"(e) No person may practice veterinary medicine in this state except within the context of a veterinarian-client-patient relationship or as otherwise permitted by law. A veterinarian-client-patient relationship cannot be established solely by telephonic or electronic means."
This provision was added by the Board in 2019. During that rulemaking process, the Board acknowledged that it had been asked by various stakeholders including the University of California, Davis, School of Veterinary Medicine to expand the authority of veterinarians to practice through telehealth since 2011, the year the Telehealth Advancement Act was passed. However, while the Board considered presentations on potential alternative options to expand veterinary telemedicine, it ultimately chose to proceed with what stakeholders had characterized restrictive language. In its Final Statement of Reasons, the Board provided the following in response to one veterinarian's comment requesting that the Board delay its regulations until a more flexible approach could be negotiated:
"While telemedicine is proving to be an effective form of treatment in human health care, animals are fundamentally different and cannot benefit from telemedicine in the same aspects that humans can. Unlike people, animals are unable to communicate their sickness or symptoms. Communication is expressed solely by the animal owner, who likely has no veterinary training to properly diagnose or express a sickness or symptom of the animal. For these reasons, it is important that the VCPR [veterinarian-client-patient relationship] is developed in person and not based solely on telephonic or electronic means. Otherwise, the veterinarian would not be familiar with the animal's medical history and could not effectively provide the best level of care via telemedicine. For veterinary science to be effective, it is important that the VCPR be established in person, so a full physical examination can be performed, and the veterinarian can get to know the animal. It is only after this relationship has been established that telemedicine may be an effective method of the continuance of treatment."
Then Board's regulations prohibit the use of veterinary telemedicine in cases where a relationship has not already been established through an in-person examination. Additionally, it is understood that another in-person examination is required to reestablish the veterinarian-client-patient relationship prior to any subsequent diagnosis or treatment of a new medical condition for the animal. The regulations do authorize telemedicine to be conducted without a preexisting relationship in an emergency; however, that authority only extends to the length of time until the patient can be seen or transported to a veterinarian. The Board’s regulations on the delivery of veterinary care through telehealth are much stricter than the requirements of the Telehealth Advancement Act or requirements for other health care practitioners; however, the Act authorized each healing arts board to promulgate additional requirements through the adoption of regulations that are consistent with its governing practice act.
The Board's regulations were somewhat loosened during the State of Emergency declared in response to the COVID-19 pandemic. On March 30, 2020, Governor Newsom signed Executive Order N-39-20, which established a process under the Department of Consumer Affairs for regulatory boards to request a waiver of professional licensing requirements, including requirements related to the practice and permissible activities. On June 4, 2020, the Director of Consumer Affairs issued an order granting the Board's request to temporarily waive its regulations to the extent they required veterinarians to perform an in-person examination of the animal in order to diagnose a new or different medical condition. A number of additional extensions of the waiver were subsequently issued, with the final order extending the waiver until October 31, 2021, at which time it was allowed to expire.
During the Board's most recent sunset review in 2021, Issue #23 in the hearing background paper authored by the Assembly Committee on Business and Professions and the Senate Committee on Business, Professions, and Economic Development posed the following question: "Should existing law be amended to increase access to veterinary services via telehealth?" The background paper noted that Board's MDC had "acknowledged the need for clarity in statutes and regulations around the definitions of telehealth and telemedicine” and that a plan was underway to convene stakeholder discussions. The background paper recommended that the Board provide an update on those discussions “and advise if there are statutory changes that could facilitate increased access to services while maintaining high standards of veterinary care."
In the midst of these discussions, the San Francisco Society for the Prevention of Cruelty to Animals (SPCA) filed a lawsuit against the Board in the United States District Court for the Eastern District of California, challenging the constitutionality of the Board’s regulations restricting the practice of veterinary telemedicine. In their complaint, the plaintiffs argued that the Board’s regulations violated the First Amendment by unduly restricting a veterinarian’s right to exercise their freedom of speech by providing care and advice through telehealth. While the lawsuit was initially filed on May 3, 2021, the case was still pending as of April 4, 2023, when it was reassigned to a new district judge.
In January 2023, the Board voted to pursue a legislative proposal that would have amended the Veterinary Medicine Practice Act to statutorily recognize the use of veterinary telemedicine. This proposal would have largely codified the Board’s existing regulations in that it would still require an in-person examination to establish a veterinarian-client-patient relationship prior to providing care for an animal or diagnosing or treating a new medical condition. The proposal would have allowed for some expanded exceptions and codified the use of "teletriage" for life-threatening cases in an emergency. Ultimately, the proposal was not introduced as legislation.
Partly in response to the Board's efforts to codify its current veterinary telemedicine policy, the author and sponsors of this bill are now seeking to enact legislation that would preempt the Board’s regulations and allow for much more expansive use of veterinary telemedicine. This bill would expressly provide that a veterinarian-client-patient relationship may be established either in-person or using synchronous video communication, regardless of whether the veterinarian has examined the animal patient and regardless of whether it was for the same condition. Veterinary care provided after the veterinarian-client-patient relationship has been established would not require synchronous video communication, unless the veterinarian determines that it is necessary.
Additionally, this bill would enact requirements for veterinarians that practice via telehealth. First, the veterinarian is required to ensure that the technology, method, and equipment used to provide telehealth services comply with all current privacy protection laws. The veterinarian would also be required to have historical knowledge of the animal by obtaining and reviewing the patient’s relevant medical history and any available medical records. The veterinarian would be required to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice. Finally, the veterinarian would be required to be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client.
If enacted, this bill would significantly expand the use of telehealth technologies in the practice of veterinary medicine. The author and sponsors believe that this expansion would significantly improve access to care, particularly for animals and clients in rural communities. As with any legislation seeking to increase the use of new technologies in health care practice, discussion of this bill seeks to appropriately balance the goal of expanding access to care while continuing to protect the welfare of animal patients.
According to the Author
"During the pandemic, we saw how effective telemedicine can be for human healthcare, so why not apply this working model to veterinary care where there is a huge shortage? Telemedicine is a proven, safe means for delivering care. With this bill, we can prevent thousands of animals from needlessly suffering."
Arguments in Support
A coalition of animal welfare groups that includes the co-sponsors of this bill, the American Society for the Prevention of Cruelty to Animals (ASPCA) and the San Diego Humane Society, along with the California Animal Welfare Association, Social Compassion in Legislation, and Best Friends Animal Society, is in support of this bill. The coalition writes: "AB 1399 will expand the use of veterinary telemedicine for licensed California veterinarians and significantly reduce animal suffering, alleviate financial and logistical barriers to veterinary care, improve pet retention, and extend the capacity of animal shelters to serve animals and their communities." The coalition further argues that "AB 1399 offers a lifeline to pet owners who face financial, geographic, or logistical obstacles to accessing veterinary care. While finances are a primary obstacle for all pet owners seeking veterinary care, many people live in underserved urban or rural, remote areas with few or no veterinary services available. More flexible access to telemedicine can help address these challenges and others, such as preventing unnecessary time off work for pet owners and ameliorating the difficulty of bringing pets to the clinic by many Californians, including seniors, disabled individuals, and those without transportation or those with anxious, potentially aggressive, chronically ill, or large animals."
Arguments in Opposition
The Veterinary Medical Board (Board) opposes this bill unless amended. The Board writes: "Currently, a veterinarian only has to establish a VCPR to treat an animal patient. Part of establishing a VCPR requires examining the animal patient and diagnosing the condition to be treated. However, the way AB 1399 is drafted, a VCPR will be required to practice veterinary medicine, which includes examining or diagnosing the animal, not just to prescribe treatment. As such, AB 1399 goes far beyond the existing VCPR requirement and will prohibit any veterinarian from creating a VCPR, because they cannot examine or diagnose the animal to establish the VCPR – creating a Catch-22." The Board requested language to resolve this issue.
FISCAL COMMENTS
According to the Senate Committee on Appropriations, the Veterinary Medical Board reports a one-time cost of approximately $12,000 to update current regulations, which is anticipated to be absorbable within existing resources.
VOTES:
ASM BUSINESS AND PROFESSIONS: 16-0-2
YES: Berman, Flora, Alanis, Alvarez, Chen, Dixon, Gipson, Grayson, Irwin, Jackson, Lee, Lowenthal, McKinnor, Stephanie Nguyen, Joe Patterson, Ting
ABS, ABST OR NV: Bonta, McCarty
ASM APPROPRIATIONS: 15-0-1
YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Addis, Lowenthal, Papan, Pellerin, Robert Rivas, Sanchez, Weber, Wilson
ABS, ABST OR NV: Mathis
ASSEMBLY FLOOR: 76-0-4
YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon
ABS, ABST OR NV: Bains, Calderon, Muratsuchi, Schiavo
SENATE FLOOR: 36-3-1
YES: Allen, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener
NO: Alvarado-Gil, Hurtado, Wilk
ABS, ABST OR NV: Caballero
UPDATED
VERSION: September 6, 2023
CONSULTANT: Robert Sumner / B. & P. / (916) 319-3301 FN: 0002375
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB 1399 |
THIRD READING
Bill No: AB 1399
Author: Friedman (D) and Lowenthal (D), et al.
Amended: 9/6/23 in Senate
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 11-0, 7/10/23
AYES: Roth, Nguyen, Archuleta, Ashby, Becker, Dodd, Eggman, Glazer, Niello, Smallwood-Cuevas, Wahab
NO VOTE RECORDED: Alvarado-Gil, Wilk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 9/1/23
AYES: Portantino, Jones, Ashby, Bradford, Seyarto, Wahab, Wiener
ASSEMBLY FLOOR: 76-0, 5/31/23 - See last page for vote
SUBJECT: Veterinary medicine: veterinarian-client-patient relationship: telehealth
SOURCE: American Society for the Prevention of Cruelty to Animals
San Diego Humane Society
DIGEST:
This bill authorizes a veterinarian to establish a Veterinary Client Patient Relationship (VCPR) via telehealth, as defined.
Senate Floor Amendments of 9/6/23 exempt the location where a veterinarian practices telehealth from the requirement to obtain a premises permit from the Veterinary Medical Board (VMB) if specified conditions are met.
ANALYSIS:
Existing law:
- Establishes the VMB to license and regulate veterinarians, registered veterinary technicians (RVTs), to issue premises permits for veterinary hospitals, and to issue Veterinary Assistant Controlled Substances Permits (VACSPs). (BPC § 4800 et seq.)
- Requires all veterinarians actually engaged and employed, as veterinarians by the state, or a county, city, corporation, firm or individual, as specified, to secure a license from the VMB. (BPC § 4828)
This bill:
- Defines “client” for purposes of the veterinary practice act to mean the individual or individuals who represent to the veterinarian that they are the owner or owners of the animal patient at the time that the services are provided.
- Defines “synchronous” to mean a real-time interaction between a client and patient with a veterinarian located at a distant site.
- Defines “telehealth” to mean the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, synchronous video and audio communication, synchronous, two-way audio communication, and electronic transmission of images, diagnostics, data, and medical information.
- Prohibits a veterinarian from prescribing, dispensing, or administering a drug, medicine, application, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals unless a VCPR exists or otherwise permitted by law, except when the animal is a wild animal or the owner is unknown.
- Provides that VCPR exists if all of the following conditions are met:
- The client has authorized the veterinarian to assume responsibility for medical judgements regarding the health of an animal patient:
- The veterinarian possesses sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the animal patient’s medical condition; and,
- The veterinarian has assumed responsibility for making medical judgement, as specified.
- States that a veterinarian possesses sufficient knowledge of the animal patient if the veterinarian has recently seen, or is personally acquainted with the care of the animal by doing any of the following:
- Examining the animal patient in-person;
- Examining the animal patient by use of synchronous audio-video communication; or,
- Making medically appropriate and timely visits to the premises on which the animal is kept.
- Prohibits a VCPR relationship from being established solely by an audio-only communication or by means of a questionnaire.
- States that synchronous video communication is not required for the delivery of veterinary medicine via telehealth after a VCPR has been established unless the veterinarian determines that it is necessary, as specified.
- Authorizes only a person licensed in California to practice veterinary medicine via telehealth on an animal patient located in California.
- Requires a veterinarian before delivering veterinary medicine via telehealth to inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth including acknowledgment that the same standards of care apply to veterinary medicine services via telehealth and in-person veterinary medical care; the client has the option to choose an in-person visit from a veterinarian at any time; and, the client has been advised how to receive follow-up care or assistance in the event of an adverse reaction or an inability to communicate resulting from technological or equipment failure.
- Requires a veterinarian that practices veterinary medicine via telehealth to ensure the technology, method, and equipment used to provide veterinary medicine services vis telehealth comply with all current privacy protection laws; have historical knowledge of the animal by obtaining and reviewing the patient’s relevant medical history, and, if available, medical records. Provides that, if medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data to the veterinarian electronically; employ sound professional judgement to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient consistent with prevailing veterinary medical practices; be familiar with available medical resources, including emergency resources near the patient’s location, be able to refer the client to a nearby veterinarian who may be able to see the patient in person upon the request of the client, and make available a summary of the animal patient record as required under current law; provide the client with the veterinarians name, license number and contact information; and, secure alternatives means of contacting the client if the electronic means is interrupted.
- Prohibits a veterinarian from prescribing a drug for a duration of time that is inconsistent with the medical condition of the animal patient or the type of drug prescribed.
- Prohibits a veterinarian who established the required VCPR by examining the animal patient in person or by making medically appropriate and timely visits to the premises on which the animal patient is kept from prescribing a drug for a duration of time longer than one year from the date that the veterinarian examined the animal patient in person or visited the premises and prescribed the drug.
- Authorizes a veterinarian that practices via telehealth to order, prescribe, or make available drugs in accordance with all federal regulations.
- Prohibits a veterinarian who established the required VCPR using synchronous video communication from prescribing an antimicrobial drug to the animal patient for more than 14 days of treatment and may not issue any further antimicrobial drug prescription, including a refill, to treat the condition of the animal patient unless the veterinarian has conducted an in-person examination of the animal patient.
- Prohibits the veterinarian from issuing another prescription to the animal patient for the same drug unless they have conducted another examination of the patient, either in person or using telehealth.
- Prohibits a veterinarian from ordering, prescribing, or making available a controlled substance, as defined, or xylazine unless the veterinarian has performed an in-person physical examination of the animal patient or made medically appropriate and timely visits to the premises where the animal patient is kept.
- Prohibits a veterinarian from prescribing, via telehealth, any drug or medication for use on a horse engaged in racing or training at a facility under the jurisdiction of the California Horse Racing Board, as specified.
- Requires a veterinarian to notify a client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian will submit a prescription to a pharmacy that the client chooses.
- Permits a veterinarian to use telehealth without establishing a VCPR in order to provide advice in an emergency.
- Exempts the location where a veterinarian is practicing telehealth from the requirement to obtain a premises permit if all of the following are satisfied:
- The veterinarian does not perform in-person examination or treatment of animal patients at the location;
- No veterinary drug, medicine, appliance, or medical equipment is kept at the location; and,
- Information is provided on any electronic publication, including internet website, including the veterinarian’s name, contact information, and license number, contact information and instruction for obtaining a copy of the animal patient’s medical records, and a statement that the client may contact the VMB if the client has any questions or complaints regarding the veterinarian.
- Authorizes livestock treatment via telehealth, and makes other technical and clarifying chances.
Background
To practice veterinary medicine in California, an applicant must graduate from a degree program offered by an accredited postsecondary institution or institutions approved by the VMB, pass a national veterinarian examination, and pass an examination provided by the VMB to test the knowledge of the laws and regulations related to the practice of veterinary medicine in California.
According to the VMB’s current regulations (Title 16, California Code of Regulations § 2032.1), 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 VCPR with the animal patient, except where the patient is a wild animal or the owner is unknown. Current regulations related to the establishment of a VCPR require the animal patient be seen in person by a veterinarian. A VCPR cannot be established solely by telephonic or electronic means and further, telemedicine can only be conducted within an existing VCPR, with the exception for advice given in an “emergency,” until that patient(s) can be seen by or transported to a veterinarian.
This bill revises the parameters of the VCPR by permitting a veterinarian to establish a VCPR through telehealth. This bill specifies that the VCPR can only be established by use of video communication and that the client is not required to utilize telehealth and can see a veterinarian in person if requested. Veterinary care provided after the VCPR has been established would not require real-time video communication, unless the veterinarian determines that it is necessary.
Currently, veterinarians utilize telehealth as part of their practice. However, current law prohibits a veterinarian from using telehealth without an established VCPR and further limits how telehealth may be utilized to treat the animal patient with respect to that VCPR. As currently noted by the author, a VCPR must be established or re-established for each new medical condition. Essentially allowing for telehealth to help assist with follow up care for the initial condition. The VCPR must be established prior to administering, prescribing dispensing or furnishing a drug or providing a treatment to the animal patient. This bill limits the prescription timeframe for specified antimicrobial drugs to 14 days. For any additional prescriptions, the animal patient must be seen by a veterinarian in-person. This bill specifies that only a California licensed veterinarian is authorized to establish the VCPR through telehealth.
In order for the VCPR to be established, regardless of telehealth or in a licensed premise, this bill codifies parts of the VMB’s existing regulations pertaining to the VCPR.
Additionally, this bill enacts several requirements for veterinarians that practice veterinary telemedicine. First, the veterinarian is required to ensure that the technology, method, and equipment used to provide veterinary telemedicine services comply with all current privacy protection laws, although this bill is not specific as to what those laws are. The veterinarian would also be required to have historical knowledge of the animal by obtaining and reviewing the patient’s relevant medical history and any available medical records. The veterinarian would be required to employ sound professional judgment to determine whether using veterinary telemedicine is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice. As currently drafted, this bill is silent on what treatment or services may be best suited for animal healthcare via telehealth. Finally, the veterinarian would be required to be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client.
This bill provides an exemption for a veterinarian practicing telehealth to have a premises permit as long as there is no in-person examination or treatment, there are not veterinary drugs, medicine or medical equipment kept at the location where the telehealth is being providing and the veterinarian complies with record retention requirements. In addition, the veterinarian would be required to disclose specified information through electronic publications, including the veterinarian’s name, license number, contact information, instructions for obtaining a copy of the animal patient’s medical records, and a statement that informs the client they may contact the VMB if they have any questions or complaints regarding the veterinarian.
This bill allows for the continual care of an animal through telehealth, as there is no requirement that a veterinarian see an animal patient in-person.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes
According to the Senate Appropriations Committee, VMB reports a one-time cost of approximately $12,000 to update current regulations, which is anticipated to be absorbable within existing resources. The VMB does not anticipate an increase in complaints and subsequent enforcement workload to be significant, as violations would be discovered and addressed through the normal course of enforcement review and complaint process. The VMB received approximately 1,800 complaints last year. It is unknown how many of these complaints were related to veterinary care delivered through telehealth, as the VMB does not track the modality of practice (i.e. in person visits versus care received via telehealth) for complaints. To the extent that there is a significant increase in complaints related to a reduction in the standard of care of animals receiving veterinary medical services via telehealth, there may be a corresponding increase in enforcement workload. Actual costs to the VMB related to enforcement workload will depend on the number of complaints received and the complexity of any subs.
SUPPORT: (Verified 9/6/23)
American Society for The Prevention of Cruelty to Animals (co-source)
San Diego Humane Society (co-source)
County of Riverside
Humane Society of the United States
Humane Society Veterinary Medical Association
San Francisco SPCA
Social Compassion in Legislation
Solano County Democratic Central Committee
Veterinary Virtual Care Association
Numerous individuals
OPPOSITION: (Verified 9/6/23)
American Veterinary Medical Association
Covetrus
ARGUMENTS IN SUPPORT: Supporters note generally that increased access to telehealth services and establishing the VCPR through synchronous real time video communication would significantly improve access to care, particularly for animals and clients in rural communities.
ARGUMENTS IN OPPOSITION: Opponents note generally that relying solely on telehealth could place animal health and welfare, food safety, and public health at significant risk.
ASSEMBLY FLOOR: 76-0, 5/31/23
AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon
NO VOTE RECORDED: Bains, Calderon, Muratsuchi, Schiavo
Prepared by: Elissa Silva / B., P. & E.D. / 916-651-4104
9/7/23 11:08:18
**** END ****
SENATE COMMITTEE ON APPROPRIATIONS
Senator Anthony Portantino, Chair
2023 - 2024 Regular Session
AB 1399 (Friedman) - Veterinary medicine: veterinarian-client-patient relationship: telehealth
Version: July 13, 2023 | Policy Vote: B., P. & E.D. 11 - 0 |
Urgency: No | Mandate: Yes |
Hearing Date: September 1, 2023 | Consultant: Janelle Miyashiro |
Bill Summary:
AB 1399 authorizes licensed veterinarians to establish a veterinarian-client-patient-relationship (VCPR) through electronic communication technologies and practice veterinary medicine via telehealth, as specified.
*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on September 1, 2023
Fiscal Impact:
The Veterinary Medical Board (VMB) reports a one-time cost of approximately $12,000 to update current regulations, which is anticipated to be absorbable within existing resources (VMB Contingent Fund).
The VMB does not anticipate an increase in complaints and subsequent enforcement workload to be significant, as violations would be discovered and addressed through the normal course of enforcement review and complaint process. The VMB received approximately 1,800 complaints last year. It is unknown how many of these complaints were related to veterinary care delivered through telehealth, as the VMB does not track the modality of practice (i.e. in person visits versus care received via telehealth) for complaints.
To the extent that there is a significant increase in complaints related to a reduction in the standard of care of animals receiving veterinary medical services via telehealth, there may be a corresponding increase in enforcement workload. Actual costs to the VMB related to enforcement workload will depend on the number of complaints received and the complexity of any subsequent investigations. However, this fiscal impact is indeterminate at this time.
Author Amendments:
- Revise provisions related to establishing a VCPR and the practice of veterinary medicine via telehealth.
- Impose certain limitations on the prescribing of drugs to an animal patient, specifically:
- Prohibit a veterinarian from prescribing a drug for a duration of time that is inconsistent with the medical condition of the animal patient or the type of drug prescribed.
- Prohibit a veterinarian who established a VCPR in person or by visiting the premises the animal patient is kept at from prescribing a drug for a period of time longer than one year from the date the veterinarian examined the animal patient in person or visited the premises where that drug was prescribed.
- Prohibit a veterinarian who established a VCPR using synchronous audio-video communication from prescribing an antimicrobial drug to an animal patient for a period of time longer than 14 days. Prohibit a veterinarian from issuing a refill of an antimicrobial drug prescription unless the veterinarian conducts an in-person examination of that animal patient.
- Prohibit a veterinarian from prescribing via telehealth any drug or medication for use on a horse engaging in racing or training at a California Horse Racing board facility.
- Make technical, clarifying, and conforming changes.
-- END --
SENATE COMMITTEE ON APPROPRIATIONS
Senator Anthony Portantino, Chair
2023 - 2024 Regular Session
AB 1399 (Friedman) - Veterinary medicine: veterinarian-client-patient relationship: telehealth
Version: July 13, 2023 | Policy Vote: B., P. & E.D. 11 - 0 |
Urgency: No | Mandate: Yes |
Hearing Date: August 21, 2023 | Consultant: Janelle Miyashiro |
Bill Summary:
AB 1399 authorizes licensed veterinarians to establish a veterinarian-client-patient-relationship (VCPR) through electronic communication technologies and practice veterinary medicine via telehealth, as specified.
Fiscal Impact:
The Veterinary Medical Board (VMB) reports a one-time cost of approximately $12,000 to update current regulations, which is anticipated to be absorbable within existing resources (VMB Contingent Fund).
The VMB does not anticipate an increase in complaints and subsequent enforcement workload to be significant, as violations would be discovered and addressed through the normal course of enforcement review and complaint process. The VMB received approximately 1,800 complaints last year. It is unknown how many of these complaints were related to veterinary care delivered through telehealth, as the VMB does not track the modality of practice (i.e. in person visits versus care received via telehealth) for complaints.
To the extent that there is a significant increase in complaints related to a reduction in the standard of care of animals receiving veterinary medical services via telehealth, there may be a corresponding increase in enforcement workload. Actual costs to the VMB related to enforcement workload will depend on the number of complaints received and the complexity of any subsequent investigations. However, this fiscal impact is indeterminate at this time.
Background:
According to the VMB’s current regulations (Title 16, California Code of Regulations § 2032.1), 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 VCPR with the animal patient except where the patient is a wild animal or the owner is unknown. The regulations specify that the VCPR is established by all of the following:
- 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.
- The veterinarian has sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis of the medical condition of the animal. This means that the veterinarian is personally acquainted with the care of the animal by virtue of an examination of the animal or by medically appropriate and timely visits to the premises where the animals are kept.
- 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.
In addition, the regulations specify that a drug may not be prescribed for a duration inconsistent with the medical condition of the animal(s) or type of drug prescribed. A veterinarian is also prohibited from prescribing a drug for a duration longer than one year from the date the veterinarian examined the animal(s) and prescribed the drug.
In regards to telemedicine, the regulations require telehealth be conducted within an existing VCPR, and specifies that a VCPR cannot be established solely by telephonic or electronic means (with the exception for advice given in an “emergency,” until that patient(s) can be seen by or transported to a veterinarian).
So while veterinarians currently utilize telehealth as part of their practice, current law prohibits a veterinarian from using telehealth without an established VCPR and further limits how telehealth may be utilized to treat an animal patient with respect to that VCPR.
Proposed Law:
- Prohibits a person from practicing veterinary medicine outside the context of a VCPR.
- Defines a “veterinarian-client-patient-relationship” (VCPR) as a relationship that exists if all of the following conditions are met:
- The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgements regarding the health of the animal patient.
- The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in person or using synchronous video communication of the animal or group of animals of which the patient is a part, or through medically appropriate and timely visits to the premises where the animal or the group of animals in which the patient is a part, is kept.
- The veterinarian is readily available or has provided for follow up care in case of adverse reactions or failure of treatment.
- Specifies a VCPR cannot be established solely by audio-only communication or by means of a questionnaire.
- Defines “client” as the individual or individuals who represent to the veterinarian that they are the owner or owners of the animal patient at the time that the services are provided. Provides that a client may authorize an agent to act on the client’s behalf.
- Defines “synchronous” as a real-time interaction between a client and patient with a California-licensed veterinarian located at a distant site.
- Defines “telehealth” as the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, synchronous video and audio communication, synchronous, two-way audio communication, and electronic transmission of images, diagnostics, data, and medical information.
- Defines a “veterinarian-client-patient-relationship” (VCPR) as a relationship that exists if all of the following conditions are met:
- States that synchronous video communication is not required for the delivery of veterinary medicine via telehealth after a VCPR has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
- Authorizes only California-licensed veterinarians to practice veterinary medicine via telehealth.
- Before providing veterinary medicine services via telehealth, requires a veterinarian to inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth with specified acknowledgments.
- Requires a veterinarian practicing via telehealth to do all of the following:
- Ensure that the technology, method, and equipment used to provide veterinary medicine services via telehealth comply with all current privacy protection laws.
- Have historical knowledge of the animal by obtaining and reviewing the patient’s relevant medical history, and, if available, medical records. Provides that medical records or diagnostic data from a previous in-person visit that are available to a client may be transmitted to the veterinarian electronically by the client.
- Employ sound professional judgement to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practices.
- Be familiar with available medical resources, including emergency resources near the patient’s location, be able to provide the client with a list of nearby veterinarians who may be able to see the patient in person upon the request of the client, and keep, maintain, and make available a summary of the patient record.
- Provide the client with the veterinarian’s name, license number and contact information.
- Secure an alternative means of contacting the client if the electronic means is interrupted.
- Authorizes a veterinarian that practices via telehealth to order, prescribe, or make available drugs in accordance with all state and federal regulations, with exceptions:
- Prohibits a veterinarian who established the required VCPR using synchronous video communication from prescribing a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the patient or prescribed the drug.
- Prohibits a veterinarian from issuing another prescription to the animal patient for the same drug unless they have conducted another patient examination either in person or via telehealth.
- Prohibits a veterinarian from ordering, prescribing, or making available a controlled substance, as defined, or xylazine unless the veterinarian has performed an in-person physical examination of the patient or made medically appropriate and timely visits to the premises where the patient is kept.
- Requires a veterinarian to notify a client that some prescription drugs or medications may be available at a pharmacy and, if requested, requires the veterinarian submit a prescription to a pharmacy that the client chooses.
- Permits a veterinarian to use telehealth without establishing a VCPR in order to provide advice in an emergency.
- Authorizes the treatment of livestock via telehealth.
- Makes other technical and conforming chances.
Staff Comments:
The boards and bureaus within the Department of Consumer Affairs are special fund agencies whose activities are funded by regulatory and license fees and generally receive no support from the General Fund. New legislative mandates, even those modest in scope, may in totality create new cost pressures and impact the entity’s operating costs, future budget requests, or license fees.
-- END --
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Richard Roth, Chair
2023 - 2024 Regular
Bill No: Hearing Date: July 10, 2023
Author: | |||
Version: | June 28, 2023 | ||
Urgency: | No | Fiscal: | Yes |
Consultant: | Elissa Silva | ||
Subject:
SUMMARY:
Authorizes a veterinarian to establish a Veterinary Client Patient Relationship (VCPR) via telehealth, as defined.
Existing law:
- Establishes the Veterinary Medical Board (VMB) under the Department of Consumer Affairs (DCA), to license and regulate veterinarians, registered veterinary technicians (RVTs), to issue premises permits for veterinary hospitals, and to issue Veterinary Assistant Controlled Substances Permits (VACSPs). (BPC § 4800 et seq.)
- Authorizes the VMB, at any time, to inspect the premises in which veterinary medicine, veterinary dentistry, or veterinary surgery is practiced, and specifies that the VMB’s inspection authority does not extend to premises that are not registered with the VMB. (BPC § 4809.5)
- Requires all veterinarians actually engaged and employed, as veterinarians by the state, or a county, city, corporation, firm or individual are practicing veterinary medicine must secure a license by the VMB. (BPC § 4828)
- Exempts the following from the veterinary practice act (Act):
- Practicing veterinary medicine as a bona fide owner of one’s own animals and applies to the owner’s bona fide employees, and any person assisting the owner, provided that the practice is performed gratuitously;
- Lay testing of poultry by the whole blood agglutination test, as specified;
- Making any determination as to the status of pregnancy, sterility, or infertility upon livestock, equine, or food animals at the time an animal is being inseminated, providing no charge is made for this determination;
- Administering sodium pentobarbital for euthanasia of sick, injured, homeless, or surrendered domestic pets or animals without the presence of a veterinarian when the person is an employee of an animal control shelter and its agencies or humane society.
- Providing the following care to animals lawfully deposited with or impounded by a shelter not registered with the board pursuant to Section 4853:
- Administering preventative or prophylactic nonprescription vaccinations to the animal pursuant to protocols written by a veterinarian licensed in this state for the purposes of preventing the spread of communicable diseases, without the presence of a veterinarian when the person has received proper training in the administration of the nonprescription preventative or prophylactic vaccinations.
- Administering nonprescription medications to the animal pursuant to protocols written by a veterinarian licensed in this state, for the control or eradication of apparent or anticipated internal or external parasites, including, but not limited to, fleas, ticks, or worms, without the presence of a veterinarian when the person has received proper training in the administration of the nonprescription medications for the control or eradication of those internal or external parasites. A person’s decision to administer these medications shall not be construed to mean the person has made a diagnosis of the animal’s medical condition.
- Administering medications prescribed by a veterinarian licensed in the state to the animal without the presence of a veterinarian when the shelter has received a written treatment plan from the licensed veterinarian for that specific animal and has a dispensing protocol in place for the tracking of dispensed prescribed medications and when the person has received proper training in the administration of prescription medications. (BPC § 4827)
- Requires a veterinarian to 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. Specifies that the minimum amount of information included in written records and summaries is established by the VMB along with the minimum duration of time for which a licensed premise must retain the written record or a complete copy of the written record. (BPC § 4855)
- States that a person practices “veterinary medicine” when the person does any of the following:
- Represents oneself as engaged in the practice of veterinary medicine;
- Diagnoses or prescribes a drug, medicine, appliance, application, or treatment of whatever nature for the prevention, cure, or relief of a wound or fracture, bodily injury or disease of animals;
- Administers a drug, medicine, appliance, application, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals, except where the medicine, appliance, application, or treatment is administered by a RVT or a veterinary assistant at the direction of, and under the direct supervision of a licensed veterinarian, as specified. However, no person, other than a licensed veterinarian, may induce anesthesia unless authorized by regulation of the board;
- Performs a surgical or dental operation on an animal;
- Performs any manual procedure for the diagnosis of pregnancy, sterility, or infertility upon livestock or Equidae;
- Collects blood from an animal for the purpose of transferring or selling that blood and blood component products to a licensed veterinarian at a registered premises, except where the blood is collected by a RVT or veterinary assistant at the direction of, and under the direct supervision of, a licensed veterinarian, as specified; or,
- Uses any words, letters, or titles in such connection or under such circumstances as to induce the belief that the person using them is engaged in the practice of veterinary medicine, veterinary surgery, or veterinary dentistry. (BPC § 4826)
- Defines “telehealth” to mean the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers. (BPC § 2290.5(6))
This bill:
- Defines “client” for purposes of the veterinary practice act to mean the individual or individuals who represent to the veterinarian that they are the owner or owners of the animal patient at the time that the services are provided and the client may authorize an agent to act on the client’s behalf.
- Defines “synchronous” to mean a real-time interaction between a client and patient with a veterinarian located at a distant site.
- Defines a “veterinarian-client-patient-relationship” (VCPR) to mean a relationship that exists if all of the following conditions are met:
- The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgements regarding the health of the animal patient;
- The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in person or using synchronous video communication of the animal or group of animals of which the patient is a part, or through medically appropriate and timely visits to the premises where the animal or the group of animals in which the patient is a part, is kept;
- The veterinarian is readily available or has provided for follow up care in case of adverse reactions or failure of treatment;
- A VCPR cannot be established solely by audio-only communication or by means of a questionnaire.
- Defines “telehealth” to mean the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, synchronous video and audio communication, synchronous, two-way audio communication, and electronic transmission of images, diagnostics, data, and medical information.
- Prohibits a person from practicing veterinary medicine outside the context of a VCPR unless otherwise permitted by law, or via synchronous communication, as defined.
- States that synchronous video communication is not required for the delivery of veterinary medicine via telehealth after a VCPR has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
- Authorizes only a person who is licensed to practice veterinary medicine in this state to practice veterinary medicine via telehealth, and that practice must occur at the premises where the patient is located at the time that the veterinarian practices veterinary medicine.
- Requires a veterinarian before delivering veterinary medicine via telehealth, to inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth including acknowledgment of all of the following:
- The same standards of care apply to veterinary medicine services via telehealth and in-person veterinary medical care;
- The client has the option to choose an in-person visit from a veterinarian at any time;
- The client has been advised how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate resulting from technological or equipment failure.
- Requires a veterinarian that practices veterinary medicine via telehealth to do all of the following:
- Ensure that the technology, method, and equipment used to provide veterinary medicine services vis telehealth comply with all current privacy protection laws;
- Have historical knowledge of the animal by obtaining and reviewing the patient’s relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data to the veterinarian electronically;
- Employ sound professional judgement to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practices;
- Be familiar with available medical resources, including emergency resources near the patient’s location, be able to refer the client to a nearby veterinarian who may be able to see the patient in person upon the request of the client, and make available a summary of the patient record as required under current law;
- Provide the client with the veterinarians name, license number and contact information; and,
- Secure an alternative means of contacting the client if the electronic means is interrupted.
- Authorizes a veterinarian that practices via telehealth to order, prescribe, or make available drugs in accordance with all federal regulations.
- Prohibits a veterinarian who established the required VCPR using synchronous video communication from prescribing a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the patient or prescribed the drug.
- Prohibits the veterinarian from issuing another prescription to the animal patient for the same drug unless they have conducted another examination of the patient, either in person or using telehealth.
- Prohibits a veterinarian from ordering, prescribing, or making available a controlled substance, as defined, or xylazine unless the veterinarian has performed an in-person physical examination of the patient or made medically appropriate and timely visits to the premises where the patient is kept.
- Requires a veterinarian to notify a client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian will submit a prescription to a pharmacy that the client chooses.
- Permits a veterinarian to use telehealth without establishing a VCPR in order to provide advice in an emergency.
- Authorizes livestock treatment via telehealth.
- Makes other technical and clarifying chances.
FISCAL EFFECT:
According to the Assembly Committee on Appropriations: “VMB states this bill will require an update to current regulations with a total estimated cost of $12,000, which is absorbable within existing resources. The Board also anticipates some violations of the new provisions; however, violations would be discovered through the normal course of enforcement review of the complaint process, and the Board does not expect this bill to increase complaints significantly.”
COMMENTS:
- Purpose. The American Society for the Prevention of Cruelty to Animals and the San Diego Humane Society are the sponsors of this bill. According to the author, “California regulations unreasonably prohibit veterinarians from giving simple advice and direction to pet owners over telemedicine unless the owners can bring their animals into the veterinary hospital. Pet owners are forced to wait weeks and sometimes months for a hard-to-get appointment so that veterinarians can perform an in-person physical examination as a prerequisite to giving almost any advice or recommendations. The law requires veterinarians to conduct a new in-person examination each time that an animal (even a regular patient of the vet) has a problem, even minor and extremely common ailments and problems such as skin issues or fleas, or for routine prescriptions. This is because the law requires the establishment of a veterinarian/client/patient relationship (VCPR) for every new medical condition or patient. [CCR, tit. 16, § 2032.1].
These unnecessary, outdated regulations block licensed veterinarians from using their professional discretion to treat animals, and further hinder access to veterinary care for at least a third of pet owners whose pets do not regularly see a veterinarian.
Access to veterinary care is a growing problem in California. The veterinary industry has a critical shortage of professionals in the workforce, and California families, animal shelters, and local governments are struggling to access care for pets.”
- Background.
Veterinarians. The veterinary medical profession provides health care to livestock, poultry, and pets from birds, fish, rabbits, hamsters, and snakes to dogs, cats, goats, pigs, horses, and llamas. Currently there are 36 recognized specialties in veterinary medicine such as surgery, internal medicine, pathology, and ophthalmology. To practice veterinary medicine in California, an applicant must graduate from a degree program offered by an accredited postsecondary institution or institutions approved by the VMB, pass a national veterinarian examination, and pass an examination provided by the VMB to test the knowledge of the laws and regulations related to the practice of veterinary medicine in California.
BPC § 4827 outlines specific exemptions to the practice of veterinary medicine, including: practicing veterinary medicine on one’s own animals; specified poultry testing; determining the status of pregnancy, sterility, or infertility in livestock or food animals; and administering sodium pentobarbital to euthanize sick, injured, homeless, or surrendered animals without the presence of a veterinarian when the person is an employee of an animal control shelter and has received proper training. Additional exemptions include certain treatments provided by shelter personnel or volunteers to animals that have been impounded or taken in. There are close to 15,000 licensed veterinarians and 4,200 registered veterinary premises in California.
Veterinary Client Patient Relationship (VCPR). According to the VMB’s current regulations (Title 16, California Code of Regulations § 2032.1), 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 VCPR with the animal patient except where the patient is a wild animal or the owner is unknown.
The regulations additionally specify that the VCPR is established by the following:
(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 to initiate at least a general or preliminary diagnosis of the medical condition of the animal. This means that the veterinarian is personally acquainted with the care of the animal 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, a few other provisions.
In addition, the regulations specify that a drug may 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.
Moreover, that no person may practice veterinary medicine in this state except within the context of a VCPR or as otherwise permitted by law. A VCPR cannot be established solely by telephonic or electronic means.
Telemedicine shall be conducted within an existing VCPR, with the exception for advice given in an “emergency,” until that patient(s) can be seen by or transported to a veterinarian.
This bill will change how the VCPR may be established by permitting a veterinarian to establish a VCPR through the use of telehealth. This bill does specify that for purposes of establishing the initial VCPR via telehealth, it must be done through video-conferencing and not solely through a phone call or other electronic means. After the VCPR has been established, this bill would permit the use of telehealth without the requirement for a video-conference.
The Act and the Veterinary Medical Board. The VMB is the regulatory entity responsible for the licensure and regulation of veterinarians, RVT, schools and programs along with veterinary premises and hospitals through the enforcement of the California Veterinary Medicine Practice Act (Act). The VMB develops and enforces the standards for examinations, licensing, and hospital and school inspections. Additionally, the VMB is provided with enforcement authority to take actions against both licensed and unlicensed persons for any violation of the Act, including unlicensed practice.
The practice of veterinary medicine is specified in statute (BPC § 4826) and includes actions such as diagnosing or prescribing a drug, medicine, appliance, application, treatment of whatever nature, for the cure or relief of a wound, fracture, bodily injury or disease of animals (including those actions of an RVT or a veterinary assistant under the supervision of a licensed veterinarian). Further, the law requires that any premises where veterinary medicine, dentistry, or surgery is being practiced is required to obtain a premises permit from the VMB. A premises includes any building, kennel, mobile unit or vehicle (BPC § 4853). This bill would permit the use of telehealth to establish a VCPR; however, it does not subject the veterinarian practicing to be located at a licensed premise.
Telehealth. Telehealth services are an important tool to help ensure that patients are able to access needed care swiftly when necessary. As defined in the Medical Practice Act, (BPC § 2290.5) “Telehealth” to mean “the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.”
Currently, veterinarians utilize telehealth as part of their practice. However, current law prohibits a veterinarian from using telehealth without an established VCPR and further limits how telehealth may be utilized to treat the animal patient with respect to that VCPR. As currently noted by the author, a VCPR must be established or re-established for each new medical condition. Essentially allowing for telehealth to help assist with follow up care for the initial condition. The VCPR must be established prior to administering, prescribing dispensing or furnishing a drug or providing a treatment to the animal patient. The author and sponsor note the following with respect to the establishment of the VCPR for each new condition “…outdated regulations block licensed veterinarians from using their professional discretion to treat animals, and further hinder access to veterinary care for at least a third of pet owners whose pets do not regularly see a veterinarian.”
The establishment of a VCPR for purposes of treating animal patients is not unique to California and is a consistent part of veterinary care, nationally. A majority of states require the VCPR be established in person in order for the veterinarian to treat the patient or prescribe medication—consistent with what that practice in California. The American Veterinary Medical Association’s (AVMA) Principles of Veterinary Medical Ethics also specifies a VCPR for a veterinarian to prescribe medication or otherwise treat an animal. This is echoed in the AVMA’s Model Veterinary Practice Act. As noted on the AVMA’s website:
“A Veterinarian-Client-Patient Relationship, or VCPR for short, exists when your veterinarian knows your pet well enough to be able to diagnose and treat any medical conditions your animal develops. Your part of the VCPR is allowing your veterinarian to take responsibility for making clinical judgments about your pet's health, asking questions to make sure you understand, and following your veterinarian's instructions. Your veterinarian's part of the VCPR involves making those judgments; accepting the responsibility for providing your pet with medical care; keeping a written record of your pet's medical care; advising you about the benefits and risks of different treatment options; providing oversight of treatment, compliance (your follow-through on their recommendations) and outcome; and helping you know how to get emergency care for your pet if the need should arise.”
…” A VCPR is established only when your veterinarian examines your animal in person (except in a very few states where a relationship can be established electronically), and is maintained by regular veterinary visits as needed to monitor your animal's health…”
There are a handful of other states that permit the VCPR be established through electronic means including Arizona, Idaho, New Jersey, Vermont and Virginia. Arizona is the most recent state to authorize the establishment of the VCPR through electronic means. Information provided by the AVMA note that Arizona and Virginia’s authorization most closely resemble the authorization proposed by this bill.
It is important to note that current practice in California already authorizes a veterinarian to provide telehealth services to animal patients. However, that is only after the VCPR has been established. This bill authorizes telehealth, even for the initial visit to establish the VCPR.
History on the use of telehealth in California related to the VCPR, veterinary medicine and the VMB. During the Board’s most recent joint legislative sunset review in 2021, the issue of telehealth was raised in the Committee staff background paper. In that paper, it was noted: Existing laws and regulations provide that a VCPR must be established before care can be provided remotely via telehealth. It is also generally understood that VCPR must be re-established for any subsequent diagnosis and treatment of a new medical condition. In practice, this means a veterinarian will request to examine an animal in-person again if diagnosing or treating a new condition, even if the animal was receiving care via telemedicine on a prior medical condition.
…DCA issued a VCPR waiver on June 4, 2020 authorizing a veterinarian to use telemedicine to diagnose and treat an animal patient for a new or different medical condition, if a veterinarian-client-patient relationship was previously established. At the request of various stakeholders, the Board directed the MDC to evaluate the telemedicine waiver and determine if it should be made permanent. In its preliminary discussions, the MDC acknowledged the need for clarity in statutes and regulations around the definitions of telehealth and telemedicine.
Ultimately, the staff recommendation in that background paper included the following: “The Board should provide the Committees with an update on its discussions around telehealth and telemedicine, and advise if there are statutory changes that could facilitate increased access to services while maintaining high standards of veterinary care.” In response, the VMB created an Access to Veterinary Care Committee to further explore ways to expand access throughout California. That Committee did convene two meetings and discussed a variety of issues pertaining to access to care including barriers to licensure and education.
In the midst of these discussions, the San Francisco Society for the Prevention of Cruelty to Animals filed a lawsuit against the VMB in the United States District Court for the Eastern District of California, challenging the constitutionality of the VMB’s regulations restricting the practice of veterinary telemedicine. In their complaint, the plaintiffs argued that the VMB’s regulations violated the First Amendment by unduly restricting a veterinarian’s right to exercise their freedom of speech by providing care and advice through telehealth. The case is currently pending.
In January of this year, the VMB discussed a legislative proposal to address specific issues pertaining to the VCPR and telemedicine, and in 2021, the VMB considered an additional legislative proposal to address the issue of electronic veterinary health services by adding definitions pertaining the various branches of electronic health care. Ultimately, neither of the VMB’s legislative proposals were considered in legislation.
This bill would authorize a veterinarian, who is licensed in this state, to establish the VCPR through the use of telehealth which, in this bill, will be defined as: the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, synchronous video and audio communication; synchronous, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information. The bill specifies that the VCPR can only be established through the use of video communication and that the client is not required to utilize telehealth and can see a veterinarian in person if requested. Veterinary care provided after the VCPR has been established would not require real-time video communication, unless the veterinarian determines that it is necessary.
In order for the VCPR to be established, regardless of telehealth or in a licensed premise, this bill would codify parts of the VMB’s existing regulations pertaining to the VCPR. This bill would additionally require as part of the VCPR process that a veterinarian is readily available or has provided follow up care in the event of an adverse reaction. It is unclear as this bill is currently drafted, how a veterinarian who is providing telehealth at a very remote site (like in another state) would be able to comply.
Additionally, this bill would enact several requirements for veterinarians that practice veterinary telemedicine. First, the veterinarian is required to ensure that the technology, method, and equipment used to provide veterinary telemedicine services comply with all current privacy protection laws, although the bill is not specific as to what those laws are. The veterinarian would also be required to have historical knowledge of the animal by obtaining and reviewing the patient’s relevant medical history and any available medical records. The veterinarian would be required to employ sound professional judgment to determine whether using veterinary telemedicine is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice. As currently drafted, this bill silent on what treatment or services may be best suited for animal healthcare via telehealth. Finally, the veterinarian would be required to be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client.
This bill allows for the continual care of an animal through telehealth, as there is no requirement that a veterinarian see an animal patient in-person. The author and sponsors contend that increased access to telehealth services and establishing the VCPR through synchronous real time video communication would significantly improve access to care, particularly for animals and clients in rural communities.
- Related Legislation. SB 669 (Cortese of 2023) authorizes a Registered Veterinary Technician (RVT) to establish a veterinarian client patient relationship (VCPR) under the direct supervision of a veterinarian for purposes of administering preventive or prophylactic vaccines or medications for the control or eradication of apparent or anticipated internal or external parasites, viruses or bacteria, as specified. (Status: This bill is pending in the Assembly Committee on Appropriations).
AB 1535 (Committee on Business and Professions, Chapter 631, Statutes of 2021) enacts various changes to the regulation of veterinarians, RVTs, Veterinary Assistant Controlled Substances Permit (VACSP) holders, veterinary schools, and veterinary premises, stemming from the joint sunset review oversight of the Veterinary Medical Board (Board) by the Assembly Committee on Business and Professions and the Senate Committee on Business, Professions, and Economic Development.
SB 1347 (Galgiani of 2020) expands exemptions to the practice of veterinary medicine, and allows an animal shelter employee or volunteer who has obtained training to perform specified veterinary tasks. (Status: This bill died in Assembly Appropriations).
- Arguments in Support. ASPCA, San Diego Humane Society, California Animal Welfare Association, Project Street Vet, Social Compassion in Legislation, and Best Friends Animal Society write in support and note, “AB 1399 offers a lifeline to pet owners who face financial, geographic, or logistical obstacles to accessing veterinary care. While finances are a primary obstacle for all pet owners seeking veterinary care, many people live in underserved urban or rural, remote areas with few or no veterinary services available. More flexible access to telemedicine can help address these challenges and others, such as preventing unnecessary time off work for pet owners and ameliorating the difficulty of bringing pets to the clinic by many Californians, including seniors, disabled individuals, and those without transportation or those with anxious, potentially aggressive, chronically ill, or large animals.”
The San Francisco SPCA writes in support and notes, “At a time when Californians are experiencing a significant and worsening shortage of veterinary professionals, telehealth provides an excellent vehicle to help redress the impacts of that shortage.”
The Solano County Democratic Central Committee notes, “AB 1399 lowers barriers to access for veterinary services by leveraging the benefits of modern technology.”
The Humane Society of the United States and the Humane Society Veterinary Medical Association writes in support and notes, “Communities across the state are struggling to access veterinary resources, and the low availability, lack of accessibility and affordability of basic pet wellness services are particularly impacting low-income families. Based on the federal poverty line, about 13% or 5.1 Californians live in poverty.”
- Arguments in Opposition. The American Veterinary Medical Association writes in opposition and notes, “The AVMA strongly embraces technology, including but not limited to tools of telehealth, which encompasses some areas that do not require a VCPR to be established, such as teletriage, teleadvice, and tele-education. However, responsible implementation of telehealth requires that the health and safety of our patients are protected and that the trust of our clients is preserved. A properly established and maintained VCPR is one of the greatest safeguards we have available to protect animal health, the safety of the food supply, and public health. During an in-person encounter the veterinarian collects information about the patient (and the facilities and personnel where the animals are kept in the case of a premise visit for groups of animals), and the owner/caretaker—what their relationship is with the patient, whether they can comfortably and confidently handle the animal, and what type of care they are able to deliver.”
The California Veterinary Medical Association is oppose unless amended and notes, “It is critical to note that the CVMA fully supports the appropriate use of telemedicine in veterinary practice, and thus strongly favors California’s current law permitting its use for follow-up consultation after the in-person establishment of a veterinarian-client-patient relationship (VCPR) and critical case triage (teletriage does not require the establishment of a VCPR). However, because AB 1399 proposes completely eliminating the requirement for an initial in-person examination, the bill foreshadows an additional and exclusive reliance on telemedicine that places animal health and welfare, food safety, and public health at significant risk.
Animals—unlike people—cannot speak to express what they are feeling, and in fact instinctively hide pain and illness. Pet owners, despite their best intentions, very often miss or misinterpret signs and symptoms of trouble in their animals. Relying on pet owners to provide the information that a veterinarian would otherwise collect when examining a pet in person—especially when facing a new medical condition—can result in inaccurate diagnoses and erroneously prescribed treatments, risking adverse consequences for the animal patient.”
Covetrus is oppose unless amended and notes, “Put simply, the primary use of telemedicine will produce higher incidences of inaccurate diagnoses and ineffective treatment plans, higher rates of unnecessary prescriptions, and delays in diagnosis and treatment. These circumstances in turn can lead to prolonged patient suffering, greater expense and confusion for the client, and diminished trust in the veterinarian.”
The Veterinary Medical Board is opposed unless amended and notes concerns with the current section of the bill pertaining to prescribing a drug, and requests the section be revised as follows “Prescriptions based on an examination performed via telehealth may be initially issued for not more than 14 days and may not be renewed for more than 14 days without an additional examination via telehealth or an in-person examination.”
- Policy Considerations and Suggested Amendments.
California Licensed Veterinarians. The author and sponsor note that the intent of this this bill is applicable only to those veterinarians that are licensed to practice in California only. However, in the proposed definition of synchronous: a real-time interaction between a client and patient, with a veterinarian at a distance site, it could be interpreted to include veterinarians licensed in another state. In order to clarify the author and sponsor’s intent that the provisions of this bill only be applicable to California licensed veterinarians, the author should amend the bill to conform to existing telehealth provisions that specify the provider be licensed in this state.
Referral to in-person services. As currently drafted, this bill requires a veterinarian that practices via telehealth to be familiar with available medical resources near the patient’s location and be able to refer the client to a nearby veterinarian. However, using the common reference, “refer” might imply that the veterinarian would be prepared to see the patient or has knowledge of the referring veterinarian, which may not always be the case depending on the location of the telehealth provider. In an effort to clarify this, and to ensure that all current record requirements for the veterinarians apply to telehealth, the author should amend the bill as follows:
4826.6(d)(4) Be familiar with available medical resources, including emergency resources near the patient’s location, be able to provide the client with a list of nearby veterinarians to refer the client to a nearby veterinarian who may be able to see the patient in person upon the request of the client, and keep, maintain and make available a summary of the patient record, as specified in required by Section 4855.
Technical issues: To address various technical issues, the author should amend the bill as follows:
- Amend BPC 4067 (f):
For the purposes of this section, “good faith prior examination” includes the requirements for a physician and surgeon in Section 2242 and the requirements for a veterinarian in Section 2032.1 of Title 16 of the California Code of Regulations. subdivision (f) (g) of Section 4825.1.
- Amend 14401 Food and Agricultural Code as follows:
Beginning January 1, 2018, a medically important antimicrobial drug shall not be administered to livestock unless ordered by a licensed veterinarian through a prescription or veterinary feed directive, pursuant to a veterinarian-client-patient relationship that meets the requirements of Section 2032.1 of Title 16 of the California Code of Regulations. subdivision (f) (g) of Section 4825.1 of the Business and Professions Code.
- Amend 4826.6(2)(e)(1) as follows:
(e) (1) Except as provided in paragraphs (2) to (4), inclusive, a veterinarian that practices veterinary medicine via telehealth may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant state and federal regulations.
What does readily available mean for purposes of telehealth? As currently drafted, this bill requires, in order to establish the VCPR, that a veterinarian be readily available or has provided for follow up care in case of adverse reactions or failure or treatment. It is unclear how this provision would be implemented and what readily available consists of for purposes of utilizing or providing telehealth services. The author should continue to work with stakeholders to address this issue.
Is there any type of veterinary care that is not suited for telehealth? Although telehealth is an important component for patient access, there may be certain practices under veterinary care that are not well suited for telehealth. Without some guardrails in this space, consumers could unknowingly schedule telehealth appointments that are not appropriate for telehealth care, and could result in a consumer paying for two separate appointments, when a single office visit would always have been most appropriate. The author should continue working with the stakeholders to assess if there are any areas of veterinary care that may not be appropriate for telehealth treatment.
Should consumers be notified about the licensee prior to initiating a telehealth appointment? Should the veterinarian providing telehealth services to establish the VCPR be required to provide licensee information such as name, telephone number, practice address and California license number prior to providing services? This could be valuable information for a consumer, should they have questions about the veterinarian, would like to see the veterinarian in person, need to request or obtain animal patient records, among others. The author may wish to continue working with stakeholders and the VMB to assess appropriate consumer disclosure information.
Prescription Limitations-too long or not long enough? This bill sets standards for veterinarians to prescribe medications through telehealth. The limits proposed by this bill may not be within the best standard of care for the animal patient, as shorter or longer period of time may be necessary, including the need for an in-person examination. The author should continue to work with stakeholders to ensure that telehealth standards do not deviate from current standards of care and practice.
SUPPORT AND OPPOSITION:
Support:
San Diego Humane Society
California Animal Welfare Association
Project Street Vet
Social Compassion in Legislation
Best Friends Animal Society
ASPCA
Veterinary Virtual Care Association
Numerous individuals
Opposition:
American Veterinary Medical Association
California Veterinary Medical Association
Covetrus
Veterinary Medical Board
-- END --
ASSEMBLY THIRD READING
ATR Bill Id:AB 1399
Author:(Friedman and Lowenthal)
As Amended Ver:May 25, 2023
Majority vote
SUMMARY
Expands the authority of a licensed veterinarian to establish a veterinarian-client-patient relationship and practice veterinary medicine through the use of telehealth.
Major Provisions
- Prohibits a person from practicing veterinary medicine outside the context of a veterinarian-client-patient relationship, except to provide advice in an emergency.
- Defines "veterinarian-client-patient relationship" as a relationship in which all of the following conditions are met:
- The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgments regarding the health of the animal patient;
- The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in-person or using real-time video communication, or through medically appropriate and timely visits to the premises where the animal is kept;
- The veterinarian is readily available or has provided for followup care in case of adverse reactions or failure of treatment.
- Prohibits a veterinarian-client-patient relationship from being established solely by audio-only communication or by means of a questionnaire.
- Defines "telehealth" as the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, real-time video and audio communication; real-time, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
- Provides that real-time video communication is not required for the delivery of veterinary care via telehealth after a veterinarian-client-patient relationship has been established, unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
- Provides that only a person who holds a current license to practice veterinary medicine in California is authorized to practice via telehealth, and that practice shall be deemed to occur at the premises where the patient is located at the time that the veterinarian practices.
- Requires a veterinarian to obtain informed consent from the client prior to delivering veterinary care via telehealth, including acknowledgment that the same standards of care will apply as in-person veterinary medical services and the client has the option to choose an in-person visit from a veterinarian at any time.
- Requires a veterinarian who practices veterinary medicine to do all of the following:
- Ensure that the technology, method, and equipment used to provide telehealth services comply with all current privacy protection laws.
- Have historical knowledge of the animal by obtaining and reviewing the patient's relevant medical history, and records.
- Employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice.
- Be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client and make available a summary of the patient record.
- Authorizes a veterinarian that practices veterinary medicine via telehealth to order, prescribe, or make available drugs for up to six months following each examination.
- Allows for a veterinarian to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency.
COMMENTS
The Veterinary Medicine Practice Act requires a veterinarian to establish and maintain a veterinarian-client-patient-relationship before providing care to an animal patient. Among other requirements, this relationship is established when the client has authorized the veterinarian to make medical judgements, and when the veterinarian has gained sufficient knowledge of the animal to make a diagnosis, generally through an in-person examination. The Board's regulations effectuating the relationship requirement state the following:
"(e) No person may practice veterinary medicine in this state except within the context of a veterinarian-client-patient relationship or as otherwise permitted by law. A veterinarian-client-patient relationship cannot be established solely by telephonic or electronic means."
This provision was added by the Board in 2019. During that rulemaking process, the Board acknowledged that it had been asked by various stakeholders including the University of California, Davis, School of Veterinary Medicine to expand the authority of veterinarians to practice through telehealth since 2011, the year the Telehealth Advancement Act was passed. However, while the Board considered presentations on potential alternative options to expand veterinary telemedicine, it ultimately chose to proceed with what stakeholders had characterized restrictive language. In its Final Statement of Reasons, the Board provided the following in response to one veterinarian's comment requesting that the Board delay its regulations until a more flexible approach could be negotiated:
"While telemedicine is proving to be an effective form of treatment in human health care, animals are fundamentally different and cannot benefit from telemedicine in the same aspects that humans can. Unlike people, animals are unable to communicate their sickness or symptoms. Communication is expressed solely by the animal owner, who likely has no veterinary training to properly diagnose or express a sickness or symptom of the animal. For these reasons, it is important that the VCPR [veterinarian-client-patient relationship] is developed in person and not based solely on telephonic or electronic means. Otherwise, the veterinarian would not be familiar with the animal's medical history and could not effectively provide the best level of care via telemedicine. For veterinary science to be effective, it is important that the VCPR be established in person, so a full physical examination can be performed, and the veterinarian can get to know the animal. It is only after this relationship has been established that telemedicine may be an effective method of the continuance of treatment."
Then Board's regulations prohibit the use of veterinary telemedicine in cases where a relationship has not already been established through an in-person examination. Additionally, it is understood that another in-person examination is required to reestablish the veterinarian-client-patient relationship prior to any subsequent diagnosis or treatment of a new medical condition for the animal. The regulations do authorize telemedicine to be conducted without a preexisting relationship in an emergency; however, that authority only extends to the length of time until the patient can be seen or transported to a veterinarian. The Board's regulations on the delivery of veterinary care through telehealth are much stricter than the requirements of the Telehealth Advancement Act or requirements for other health care practitioners; however, the Act authorized each healing arts board to promulgate additional requirements through the adoption of regulations that are consistent with its governing practice act.
The Board's regulations were somewhat loosened during the State of Emergency declared in response to the COVID-19 pandemic. On March 30, 2020, Governor Newsom signed Executive Order N-39-20, which established a process under the Department of Consumer Affairs for regulatory boards to request a waiver of professional licensing requirements, including requirements related to the practice and permissible activities. On June 4, 2020, the Director of Consumer Affairs issued an order granting the Board's request to temporarily waive its regulations to the extent they required veterinarians to perform an in-person examination of the animal in order to diagnose a new or different medical condition. A number of additional extensions of the waiver were subsequently issued, with the final order extending the waiver until October 31, 2021, at which time it was allowed to expire.
During the Board's most recent sunset review in 2021, Issue #23 in the hearing background paper authored by the Assembly Committee on Business and Professions and the Senate Committee on Business, Professions, and Economic Development posed the following question: "Should existing law be amended to increase access to veterinary services via telehealth?" The background paper noted that Board's MDC had "acknowledged the need for clarity in statutes and regulations around the definitions of telehealth and telemedicine" and that a plan was underway to convene stakeholder discussions. The background paper recommended that the Board provide an update on those discussions "and advise if there are statutory changes that could facilitate increased access to services while maintaining high standards of veterinary care."
In the midst of these discussions, the San Francisco Society for the Prevention of Cruelty to Animals (SPCA) filed a lawsuit against the Board in the United States District Court for the Eastern District of California, challenging the constitutionality of the Board's regulations restricting the practice of veterinary telemedicine. In their complaint, the plaintiffs argued that the Board's regulations violated the First Amendment by unduly restricting a veterinarian's right to exercise their freedom of speech by providing care and advice through telehealth. While the lawsuit was initially filed on May 3, 2021, the case was still pending as of April 4, 2023, when it was reassigned to a new district judge.
In January 2023, the Board voted to pursue a legislative proposal that would have amended the Veterinary Medicine Practice Act to statutorily recognize the use of veterinary telemedicine. This proposal would have largely codified the Board's existing regulations in that it would still require an in-person examination to establish a veterinarian-client-patient relationship prior to providing care for an animal or diagnosing or treating a new medical condition. The proposal would have allowed for some expanded exceptions and codified the use of "teletriage" for life-threatening cases in an emergency. Ultimately, the proposal was not introduced as legislation.
Partly in response to the Board's efforts to codify its current veterinary telemedicine policy, the author and sponsors of this bill are now seeking to enact legislation that would preempt the Board's regulations and allow for much more expansive use of veterinary telemedicine. This bill would expressly provide that a veterinarian-client-patient relationship may be established either in-person or using real-time video communication, regardless of whether the veterinarian has examined the animal patient and regardless of whether it was for the same condition. Veterinary care provided after the veterinarian-client-patient relationship has been established would not require real-time video communication, unless the veterinarian determines that it is necessary.
Additionally, this bill would enact requirements for veterinarians that practice via telehealth. First, the veterinarian is required to ensure that the technology, method, and equipment used to provide telehealth services comply with all current privacy protection laws. The veterinarian would also be required to have historical knowledge of the animal by obtaining and reviewing the patient's relevant medical history and any available medical records. The veterinarian would be required to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice. Finally, the veterinarian would be required to be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client.
If enacted, this bill would significantly expand the use of telehealth technologies in the practice of veterinary medicine. The author and sponsors believe that this expansion would significantly improve access to care, particularly for animals and clients in rural communities. As with any legislation seeking to increase the use of new technologies in health care practice, discussion of this bill will include consideration of how to appropriately balance the goal of expanding access to care while continuing to protect the welfare of animal patients.
According to the Author
"During the pandemic, we saw how effective telemedicine can be for human healthcare, so why not apply this working model to veterinary care where there is a huge shortage? Telemedicine is a proven, safe means for delivering care. With this bill, we can prevent thousands of animals from needlessly suffering."
Arguments in Support
A coalition of animal welfare groups that includes the co-sponsors of this bill, the American Society for the Prevention of Cruelty to Animals (ASPCA) and the San Diego Humane Society, along with the California Animal Welfare Association, Social Compassion in Legislation, and Best Friends Animal Society, is in support of this bill. The coalition writes: "AB 1399 will expand the use of veterinary telemedicine for licensed California veterinarians and significantly reduce animal suffering, alleviate financial and logistical barriers to veterinary care, improve pet retention, and extend the capacity of animal shelters to serve animals and their communities." The coalition further argues that "AB 1399 offers a lifeline to pet owners who face financial, geographic, or logistical obstacles to accessing veterinary care. While finances are a primary obstacle for all pet owners seeking veterinary care, many people live in underserved urban or rural, remote areas with few or no veterinary services available. More flexible access to telemedicine can help address these challenges and others, such as preventing unnecessary time off work for pet owners and ameliorating the difficulty of bringing pets to the clinic by many Californians, including seniors, disabled individuals, and those without transportation or those with anxious, potentially aggressive, chronically ill, or large animals."
Arguments in Opposition
The California Veterinary Medical Association (CVMA) and the American Veterinary Medical Association (AVMA) write jointly in opposition to this legislation, stating: "The CVMA and AVMA believe that telemedicine has its place in veterinary medicine and supports California's current law, which permits its use to manage care of established patients through follow-up consultation, prescriptions, and triaging critical cases. However, this bill proposes completely eliminating the initial in-person examination or premise visit for an animal(s), which is deeply concerning. Our opposition to this measure is rooted in several critical areas. First and foremost, animals, unlike people, cannot speak to express what they are feeling, and in fact instinctively hide pain and illness. Pet owners, despite their best intentions, very often miss or misinterpret signs and symptoms of trouble in their animals. Thus, relying on pet owners to provide the information that a veterinarian would otherwise collect when examining a pet in-person – especially relative to new medical conditions – can result in inaccurate diagnoses and erroneously prescribed treatments, risking adverse consequences for the animal patient."
FISCAL COMMENTS
According to the Assembly Appropriations Committee, the Board states this bill will require an update to current regulations with a total estimated cost of $12,000, which is absorbable within existing resources.
VOTES
ASM BUSINESS AND PROFESSIONS: 16-0-2
YES: Berman, Flora, Alanis, Alvarez, Chen, Dixon, Gipson, Grayson, Irwin, Jackson, Lee, Lowenthal, McKinnor, Stephanie Nguyen, Joe Patterson, Ting
ABS, ABST OR NV: Bonta, McCarty
ASM APPROPRIATIONS: 15-0-1
YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Addis, Lowenthal, Papan, Pellerin, Robert Rivas, Sanchez, Weber, Wilson
ABS, ABST OR NV: Mathis
UPDATED
VERSION: May 25, 2023
CONSULTANT: Robert Sumner / B. & P. / (916) 319-3301 FN: 0001011
ASSEMBLY THIRD READING
ATR Bill Id:AB 1399
Author:(Friedman and Lowenthal)
As Amended Ver:April 19, 2023
Majority vote
SUMMARY
Expands the authority of a licensed veterinarian to establish a veterinarian-client-patient relationship and practice veterinary medicine through the use of telehealth.
Major Provisions
- Prohibits a person from practicing veterinary medicine outside the context of a veterinarian-client-patient relationship, except to provide advice in an emergency.
- Defines "veterinarian-client-patient relationship" as a relationship in which all of the following conditions are met:
- The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgments regarding the health of the animal patient;
- The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in-person or using real-time video communication, or through medically appropriate and timely visits to the premises where the animal is kept;
- The veterinarian is readily available or has provided for follow up care in case of adverse reactions or failure of treatment.
- Prohibits a veterinarian-client-patient relationship from being established solely by audio-only communication or by means of a questionnaire.
- Defines "telehealth" as the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, real-time video and audio communication; real-time, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
- Provides that real-time video communication is not required for the delivery of veterinary care via telehealth after a veterinarian-client-patient relationship has been established, unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
- Provides that only a person who holds a current license to practice veterinary medicine in California is authorized to practice via telehealth, and that practice shall be deemed to occur at the premises where the patient is located at the time that the veterinarian practices.
- Requires a veterinarian to obtain informed consent from the client prior to delivering veterinary care via telehealth, including acknowledgment that the same standards of care will apply as in-person veterinary medical services and the client has the option to choose an in-person visit from a veterinarian at any time.
- Requires a veterinarian who practices veterinary medicine to do all of the following:
- Ensure that the technology, method, and equipment used to provide telehealth services comply with all current privacy protection laws.
- Have historical knowledge of the animal by obtaining and reviewing the patient's relevant medical history, and records.
- Employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice.
- Be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client.
- Authorizes a veterinarian that practices veterinary medicine via telehealth to order, prescribe, or make available drugs for up to six months following each examination.
- Allows for a veterinarian to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency.
COMMENTS
The Veterinary Medicine Practice Act requires a veterinarian to establish and maintain a veterinarian-client-patient-relationship before providing care to an animal patient. Among other requirements, this relationship is established when the client has authorized the veterinarian to make medical judgements, and when the veterinarian has gained sufficient knowledge of the animal to make a diagnosis, generally through an in-person examination. The Board's regulations effectuating the relationship requirement state the following:
"(e) No person may practice veterinary medicine in this state except within the context of a veterinarian-client-patient relationship or as otherwise permitted by law. A veterinarian-client-patient relationship cannot be established solely by telephonic or electronic means."
This provision was added by the Board in 2019. During that rulemaking process, the Board acknowledged that it had been asked by various stakeholders including the University of California, Davis, School of Veterinary Medicine to expand the authority of veterinarians to practice through telehealth since 2011, the year the Telehealth Advancement Act was passed. However, while the Board considered presentations on potential alternative options to expand veterinary telemedicine, it ultimately chose to proceed with what stakeholders had characterized restrictive language. In its Final Statement of Reasons, the Board provided the following in response to one veterinarian's comment requesting that the Board delay its regulations until a more flexible approach could be negotiated:
"While telemedicine is proving to be an effective form of treatment in human health care, animals are fundamentally different and cannot benefit from telemedicine in the same aspects that humans can. Unlike people, animals are unable to communicate their sickness or symptoms. Communication is expressed solely by the animal owner, who likely has no veterinary training to properly diagnose or express a sickness or symptom of the animal. For these reasons, it is important that the veterinarian-client-patient relationship (VCPR) is developed in person and not based solely on telephonic or electronic means. Otherwise, the veterinarian would not be familiar with the animal's medical history and could not effectively provide the best level of care via telemedicine. For veterinary science to be effective, it is important that the VCPR be established in person, so a full physical examination can be performed, and the veterinarian can get to know the animal. It is only after this relationship has been established that telemedicine may be an effective method of the continuance of treatment."
Then Board's regulations prohibit the use of veterinary telemedicine in cases where a relationship has not already been established through an in-person examination. Additionally, it is understood that another in-person examination is required to reestablish the veterinarian-client-patient relationship prior to any subsequent diagnosis or treatment of a new medical condition for the animal. The regulations do authorize telemedicine to be conducted without a preexisting relationship in an emergency; however, that authority only extends to the length of time until the patient can be seen or transported to a veterinarian. The Board's regulations on the delivery of veterinary care through telehealth are much stricter than the requirements of the Telehealth Advancement Act or requirements for other health care practitioners; however, the Act authorized each healing arts board to promulgate additional requirements through the adoption of regulations that are consistent with its governing practice act.
The Board's regulations were somewhat loosened during the State of Emergency declared in response to the COVID-19 pandemic. On March 30, 2020, Governor Newsom signed Executive Order N-39-20, which established a process under the Department of Consumer Affairs for regulatory boards to request a waiver of professional licensing requirements, including requirements related to the practice and permissible activities. On June 4, 2020, the Director of Consumer Affairs issued an order granting the Board's request to temporarily waive its regulations to the extent they required veterinarians to perform an in-person examination of the animal in order to diagnose a new or different medical condition. A number of additional extensions of the waiver were subsequently issued, with the final order extending the waiver until October 31, 2021, at which time it was allowed to expire.
During the Board's most recent sunset review in 2021, Issue #23 in the hearing background paper authored by the Assembly Committee on Business and Professions and the Senate Committee on Business, Professions, and Economic Development posed the following question: "Should existing law be amended to increase access to veterinary services via telehealth?" The background paper noted that Board's MDC had "acknowledged the need for clarity in statutes and regulations around the definitions of telehealth and telemedicine" and that a plan was underway to convene stakeholder discussions. The background paper recommended that the Board provide an update on those discussions "and advise if there are statutory changes that could facilitate increased access to services while maintaining high standards of veterinary care."
In the midst of these discussions, the San Francisco Society for the Prevention of Cruelty to Animals (SPCA) filed a lawsuit against the Board in the United States District Court for the Eastern District of California, challenging the constitutionality of the Board's regulations restricting the practice of veterinary telemedicine. In their complaint, the plaintiffs argued that the Board's regulations violated the First Amendment by unduly restricting a veterinarian's right to exercise their freedom of speech by providing care and advice through telehealth. While the lawsuit was initially filed on May 3, 2021, the case was still pending as of April 4, 2023, when it was reassigned to a new district judge.
In January 2023, the Board voted to pursue a legislative proposal that would have amended the Veterinary Medicine Practice Act to statutorily recognize the use of veterinary telemedicine. This proposal would have largely codified the Board's existing regulations in that it would still require an in-person examination to establish a veterinarian-client-patient relationship prior to providing care for an animal or diagnosing or treating a new medical condition. The proposal would have allowed for some expanded exceptions and codified the use of "teletriage" for life-threatening cases in an emergency. Ultimately, the proposal was not introduced as legislation.
Partly in response to the Board's efforts to codify its current veterinary telemedicine policy, the author and sponsors of this bill are now seeking to enact legislation that would preempt the Board's regulations and allow for much more expansive use of veterinary telemedicine. This bill would expressly provide that a veterinarian-client-patient relationship may be established either in-person or using real-time video communication, regardless of whether the veterinarian has examined the animal patient and regardless of whether it was for the same condition. Veterinary care provided after the veterinarian-client-patient relationship has been established would not require real-time video communication, unless the veterinarian determines that it is necessary.
Additionally, this bill would enact requirements for veterinarians that practice via telehealth. First, the veterinarian is required to ensure that the technology, method, and equipment used to provide telehealth services comply with all current privacy protection laws. The veterinarian would also be required to have historical knowledge of the animal by obtaining and reviewing the patient's relevant medical history and any available medical records. The veterinarian would be required to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice. Finally, the veterinarian would be required to be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client.
If enacted, this bill would significantly expand the use of telehealth technologies in the practice of veterinary medicine. The author and sponsors believe that this expansion would significantly improve access to care, particularly for animals and clients in rural communities. As with any legislation seeking to increase the use of new technologies in health care practice, discussion of this bill will include consideration of how to appropriately balance the goal of expanding access to care while continuing to protect the welfare of animal patients.
According to the Author
"During the pandemic, we saw how effective telemedicine can be for human healthcare, so why not apply this working model to veterinary care where there is a huge shortage? Telemedicine is a proven, safe means for delivering care. With this bill, we can prevent thousands of animals from needlessly suffering."
Arguments in Support
A coalition of animal welfare groups that includes the co-sponsors of this bill, the American Society for the Prevention of Cruelty to Animals (ASPCA) and the San Diego Humane Society, along with the California Animal Welfare Association, Social Compassion in Legislation, and Best Friends Animal Society, is in support of this bill. The coalition writes: "AB 1399 will expand the use of veterinary telemedicine for licensed California veterinarians and significantly reduce animal suffering, alleviate financial and logistical barriers to veterinary care, improve pet retention, and extend the capacity of animal shelters to serve animals and their communities." The coalition further argues that "AB 1399 offers a lifeline to pet owners who face financial, geographic, or logistical obstacles to accessing veterinary care. While finances are a primary obstacle for all pet owners seeking veterinary care, many people live in underserved urban or rural, remote areas with few or no veterinary services available. More flexible access to telemedicine can help address these challenges and others, such as preventing unnecessary time off work for pet owners and ameliorating the difficulty of bringing pets to the clinic by many Californians, including seniors, disabled individuals, and those without transportation or those with anxious, potentially aggressive, chronically ill, or large animals."
Arguments in Opposition
The California Veterinary Medical Association (CVMA) and the American Veterinary Medical Association (AVMA) write jointly in opposition to this legislation, stating: "The CVMA and AVMA believe that telemedicine has its place in veterinary medicine and supports California's current law, which permits its use to manage care of established patients through follow-up consultation, prescriptions, and triaging critical cases. However, this bill proposes completely eliminating the initial in-person examination or premise visit for an animal(s), which is deeply concerning. Our opposition to this measure is rooted in several critical areas. First and foremost, animals, unlike people, cannot speak to express what they are feeling, and in fact instinctively hide pain and illness. Pet owners, despite their best intentions, very often miss or misinterpret signs and symptoms of trouble in their animals. Thus, relying on pet owners to provide the information that a veterinarian would otherwise collect when examining a pet in-person—especially relative to new medical conditions—can result in inaccurate diagnoses and erroneously prescribed treatments, risking adverse consequences for the animal patient."
FISCAL COMMENTS
According to the Assembly Committee on Appropriations, the Board states this bill will require an update to current regulations with a total estimated cost of $12,000, which is absorbable within existing resources.
VOTES
ASM BUSINESS AND PROFESSIONS: 16-0-2
YES: Berman, Flora, Alanis, Alvarez, Chen, Dixon, Gipson, Grayson, Irwin, Jackson, Lee, Lowenthal, McKinnor, Stephanie Nguyen, Joe Patterson, Ting
ABS, ABST OR NV: Bonta, McCarty
ASM APPROPRIATIONS: 15-0-1
YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Addis, Lowenthal, Papan, Pellerin, Robert Rivas, Sanchez, Weber, Wilson
ABS, ABST OR NV: Mathis
UPDATED
VERSION: April 19, 2023
CONSULTANT: Robert Sumner / B. & P. / (916) 319-3301 FN: 0000346
Date of Hearing: May 10, 2023
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Chris Holden, Chair
ABPCA Bill Id:AB 1399
Author:(Friedman) – As Amended Ver:April 19, 2023
Policy Committee: | Business and Professions | Vote: | 16 - 0 |
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Urgency: No State Mandated Local Program: Yes Reimbursable: No
SUMMARY:
This bill expands the authority of a licensed veterinarian to establish a veterinarian-client-patient relationship and practice veterinary medicine through the use of telehealth.
FISCAL EFFECT:
The Veterinary Medical Board (Board) states this bill will require an update to current regulations with a total estimated cost of $12,000, which is absorbable within existing resources. The Board also anticipates some violations of the new provisions; however, violations would be discovered through the normal course of enforcement review of the complaint process, and the Board does not expect this bill to increase complaints significantly.
COMMENTS:
- Purpose. This bill is co-sponsored by the American Society for the Prevention of Cruelty to Animals (ASPCA) and the San Diego Humane Society. According to the author:
As we have seen in the human healthcare field, telemedicine can help bridge gaps in care created by workforce shortages or other barriers to healthcare access. Doctors throughout the country in all 50 states establish new doctor-patient relationships using telemedicine, even for infants and other nonverbal people. Telemedicine is a proven, safe means for delivering care. AB 1399 empowers highly educated, licensed California veterinarians to establish a veterinarian-client-patient-relationship through video technology and assess when an animal needs to have an in-person examination as well as those situations when veterinary telemedicine would be a safe and satisfactory treatment decision. The bill makes veterinary care more accessible for all California pet-owners.
- Background. The Board’s regulations on the delivery of veterinary care through telehealth are generally substantially stricter than requirements specified for other health care practitioners. The regulations effectively prohibit the use of veterinary telemedicine in cases where the veterinarian-client-patient relationship has not already been established through an in-person examination. It is also generally understood that another in-person examination is required to reestablish the veterinarian-client-patient relationship prior to any subsequent diagnosis or treatment of a new medical condition for the animal. The regulations authorize telemedicine to be conducted without a preexisting relationship in an emergency; however, that authority only extends to the length of time until the patient can be seen or transported to a veterinarian.
The telehealth regulations were somewhat loosened during the state of emergency declared in response to the COVID-19 pandemic. On March 30, 2020, Governor Newsom signed Executive Order N-39-20, establishing a process for any regulatory board to request a waiver of professional licensing requirements, including requirements related to the practice and permissible activities. On June 4, 2020, the Director of Consumer Affairs granted the Board’s request to temporarily waive requirements for a veterinarian to perform an in-person examination of the animal to diagnose a new or different medical condition. After multiple extensions, the waiver expired October 31, 2021.
Partly in response to the Board’s efforts to codify its current veterinary telemedicine policy, the author and sponsors of this bill are now seeking to enact legislation that would preempt the Board’s regulations and allow for much more expansive use of veterinary telemedicine. This bill would expressly provide that a veterinarian-client-patient relationship may be established either in-person or using real-time video communication, regardless of whether the veterinarian has examined the animal patient and regardless of whether it was for the same condition. Veterinary care provided after the veterinarian-client-patient relationship has been established would not require real-time video communication, unless the veterinarian determines that it is necessary.
The author and sponsors believe this bill significantly expands access to care, particularly for animals and clients in rural communities.
The California Veterinary Medical Association (CVMA) and the American Veterinary Medical Association (AVMA) write jointly that they support California’s current law. CVMA and AVMA state that completely eliminating the initial in-person examination for an animal is deeply concerning, as animals cannot speak to express what they are feeling and, in fact, instinctively hide pain and illness. The opponents note that pet owners very often miss or misinterpret signs and symptoms of trouble in their animals. Thus, CVMA and AVMA conclude relying on pet owners to provide the information that a veterinarian would otherwise collect when examining a pet in-person—especially relative to new medical conditions—can result in inaccurate diagnoses and erroneously prescribed treatments.
Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081
Date of Hearing:
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Marc Berman, Chair
ABPCA Bill Id:AB 1399
Author:(Friedman) – As Amended Ver:March 16, 2023
SUBJECT: Veterinary medicine: veterinarian-client-patient relationship and veterinary telemedicine.
SUMMARY: Expands the authority of a licensed veterinarian to establish a veterinarian-client-patient relationship and practice veterinary medicine through the use of telehealth.
EXISTING LAW:
- Enacts the Veterinary Medicine Practice Act, outlining the licensure requirements, scope of practice, and responsibilities of individuals practicing veterinary medicine in California. (Business and Professions Code (BPC) §§ 4811 et seq.)
- Establishes the Veterinary Medical Board (Board) under the jurisdiction of the Department of Consumer Affairs, responsible for enforcing the provisions of the Veterinary Medicine Practice Act, and regulating veterinarians, registered veterinary technicians, veterinary assistant substance controlled permit holders, and veterinary premises. (BPC § 4800)
- Provides that protection of the public shall be the highest priority for the Board in exercising its licensing, regulatory, and disciplinary functions. (BPC § 4800.1)
- Declares that it is unlawful to practice veterinary medicine in California unless a person holds a valid, unexpired, and unrevoked license issued by the Board, with certain exceptions. (BPC § 4825)
- Defines “diagnosis” as the act or process of identifying or determining the health status of an animal through examination and the opinion derived from that examination. (BPC § 4825.1)
- Defines the practice of veterinary medicine, surgery, and dentistry when a person engages in various acts, including representing themselves as a veterinarian; diagnosing or prescribing a drug, medicine, appliance, application, or treatment; performing a surgical or dental operation or manual procedure for diagnosis; or collecting blood. (BPC § 4826)
- Requires a veterinarian who initially prescribes, dispenses, or furnishes a dangerous drug to an animal patient in an outpatient setting to offer a consultation containing specified information about that dangerous drug and its use. (BPC § 4829.5)
- Outlines the requirements for obtaining a veterinarian license, which includes passing three examinations: a licensing examination that is administered on a national basis; a California state board examination; and an examination on California statutes and regulations of the Veterinary Medicine Practice Act. (BPC § 4848)
- Requires all premises where veterinary medicine, dentistry and surgery is practiced to be registered with the Board; defines “premises” to include a building, kennel, mobile unit, or vehicle, and specifies that every registration of veterinary premises must include the name of the responsible licensee manager for the licensed premises. (BPC § 4853)
- Authorizes the Board to withhold, suspend or revoke the registration of veterinary premises when the licensee manager listed on the application ceases to become responsible for management of the registered premises and is not subsequently replaced, or the licensee manager has had their license revoked or suspended. (BPC § 4853.6)
- Prohibits a veterinarian from disclosing 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 specified circumstances. (BPC § 4857)
- Specifies a list of prohibited activities for individuals licensed under the Board, such as fraud, misleading advertising, and cruelty to animals; provides that the Board may deny, revoke, or suspend a license or registration, or assess a fine, if any a person under its jurisdiction is found to have engaged in prohibited activities. (BPC Section §§ 4883 et seq.)
- Authorizes healing arts licensees to provide services via telehealth in compliance with certain standardized requirements and definitions, their professional practice act, and the regulations adopted by their regulatory board pursuant to that practice act. (BPC § 686)
- Requires a veterinarian to order any medically important antimicrobial drug they administer through a prescription or veterinary feed directive, pursuant to a veterinarian-client-patient relationship. (Food and Agricultural Code § 14401)
THIS BILL:
- Prohibits a person from practicing veterinary medicine outside the context of a veterinarian-client-patient relationship, except to provide advice in an emergency.
- Defines “veterinarian-client-patient relationship” as a relationship in which all of the following conditions are met:
- The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgments regarding the health of the animal patient;
- The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in-person or using real-time video communication, or through medically appropriate and timely visits to the premises where the animal, or the group of animals of which the patient is a part, is kept;
- The veterinarian is readily available or has provided for followup care in case of adverse reactions or failure of treatment.
- Prohibits a veterinarian-client-patient relationship from being established solely by audio-only communication or by means of a questionnaire.
- Defines “veterinary telemedicine” as the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, real-time video and audio communication; real-time, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
- Provides that real-time video communication is not required for the delivery of care via veterinary telemedicine after a veterinarian-client-patient relationship has been established, unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
- Provides that any person who holds a current license to practice veterinary medicine in California is authorized to practice veterinary telemedicine, and that practice shall be deemed to occur at the premises where the patient is located at the time that the veterinarian practices veterinary medicine.
- Requires a veterinarian to obtain informed consent from the client prior to delivering care via veterinary telemedicine, including acknowledgment that the same standards of care will apply as in-person veterinary medical services and the client has the option to choose an in-person visit from a veterinarian at any time.
- Requires a veterinarian who practices veterinary medicine to do all of the following:
- Ensure that the technology, method, and equipment used to provide veterinary telemedicine services comply with all current privacy protection laws.
- Have historical knowledge of the animal by obtaining and reviewing the patient’s relevant medical history, and records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
- Employ sound professional judgment to determine whether using veterinary telemedicine is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice.
- Be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client.
- Authorizes a veterinarian that practices veterinary telemedicine to order, prescribe, or make available drugs for up to six months following each in-person or telemedicine examination.
- Allows for a veterinarian to use veterinary telemedicine without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency.
- Makes various conforming changes to the Veterinary Medicine Practice Act and other statutes to reflect that veterinarians may deliver care through veterinary telemedicine.
FISCAL EFFECT: Unknown; this bill is keyed fiscal by the Legislative Counsel.
COMMENTS:
Purpose. This bill is co-sponsored by the American Society for the Prevention of Cruelty to Animals and the San Diego Humane Society. According to the author:
“During the pandemic, we saw how effective telemedicine can be for human healthcare, so why not apply this working model to veterinary care where there is a huge shortage? Telemedicine is a proven, safe means for delivering care. With this bill, we can prevent thousands of animals from needlessly suffering.”
Background.
Telemedicine Generally. California first formally recognized the advent of new telehealth technologies in 1996 when the Legislature enacted SB 1665 (Thompson), the Telemedicine Development Act. This bill set standards for the use of what was then called “telemedicine” by health care practitioners and insurers. The bill prohibited health insurers from requiring face-to-face contact between a health care practitioner and patient for services appropriately provided through telemedicine. The bill also exempted out-of-state practitioners from the Medical Practice Act when consulting either within California or across state lines, with a licensed practitioner in California; however, it prohibited the out-of-state practitioner from having ultimate authority over the care or primary diagnosis of a patient in California.
Much of the Telemedicine Development Act was subsequently repealed and replaced in 2011 through the enactment of AB 415 (Logue), which established the Telehealth Advancement Act to revise and update existing law to facilitate the advancement of telehealth as a service delivery mode in managed care and the Medi-Cal Program. The vernacular shift from “telemedicine” to “telehealth” reflected a general consensus among policymakers that telehealth is not itself a form of medicine, but simply a tool to deliver health care outside a traditional office visit. In California there is no distinction between in-person care and telehealth in terms of either the standard of care or the expectations of a physician-patient relationship.
The following year in 2012, the author of the Telehealth Advancement Act introduced AB 1733 (Logue) to further effectuate the changes to the state’s telehealth laws. This bill updated a number of code sections to replace the term “telemedicine” with “telehealth” and expand the potential for the use of telehealth. AB 1733 also added a statute that expressly requiring any health care practitioner who provides services via telehealth to comply with the revised requirements and definitions set forth in the Telehealth Advancement Act, as well as any additional requirements contained in the practice act relating to the practitioner’s licensed profession and any regulations adopted by the practitioner’s licensing board pursuant to that practice act.
Veterinary Telemedicine. The Veterinary Medicine Practice Act requires a veterinarian to establish and maintain a veterinarian-client-patient-relationship before providing care to an animal patient. Among other requirements, this relationship is established when the client has authorized the veterinarian to make medical judgements, and when the veterinarian has gained sufficient knowledge of the animal to make a diagnosis, generally through an in-person examination. The Board’s regulations effectuating the veterinarian-client-patient-relationship requirement additionally state the following:
“(e) No person may practice veterinary medicine in this state except within the context of a veterinarian-client-patient relationship or as otherwise permitted by law. A veterinarian-client-patient relationship cannot be established solely by telephonic or electronic means.”
This provision was added by the Board in 2019. During that rulemaking process, the Board acknowledged that it had been asked by various stakeholders including the University of California, Davis, School of Veterinary Medicine to expand the authority of veterinarians to practice through telehealth since 2011, the year the Telehealth Advancement Act was passed. However, while the Board considered presentations on potential alternative options to expand veterinary telemedicine, it ultimately chose to proceed with what stakeholders had characterized restrictive language. In its Final Statement of Reasons, the Board provided the following in response to one veterinarian’s comment requesting that the Board delay its regulations until a more flexible approach could be negotiated:
“While telemedicine is proving to be an effective form of treatment in human health care, animals are fundamentally different and cannot benefit from telemedicine in the same aspects that humans can. Unlike people, animals are unable to communicate their sickness or symptoms. Communication is expressed solely by the animal owner, who likely has no veterinary training to properly diagnose or express a sickness or symptom of the animal. For these reasons, it is important that the VCPR [veterinarian-client-patient relationship] is developed in person and not based solely on telephonic or electronic means. Otherwise, the veterinarian would not be familiar with the animal’s medical history and could not effectively provide the best level of care via telemedicine. For veterinary science to be effective, it is important that the VCPR be established in person, so a full physical examination can be performed, and the veterinarian can get to know the animal. It is only after this relationship has been established that telemedicine may be an effective method of the continuance of treatment.”
Then Board’s regulations effectively prohibit the use of veterinary telemedicine in cases where the veterinarian-client-patient relationship has not already been established through an in-person examination. Additionally, it is generally understood that another in-person examination is required to reestablish the veterinarian-client-patient relationship prior to any subsequent diagnosis or treatment of a new medical condition for the animal. The regulations do authorize telemedicine to be conducted without a preexisting relationship in an emergency; however, that authority only extends to the length of time until the patient can be seen or transported to a veterinarian.
Generally speaking, the Board’s regulations on the delivery of veterinary care through telehealth are substantially stricter than the requirements of the Telehealth Advancement Act or requirements specified for other health care practitioners. However, AB 1733 made it clear that each healing arts board has the authority to promulgate additional requirements through the adoption of regulations that are consistent with its governing practice act. The author and sponsors of this bill further allege that California is one of the least flexible states in terms of how and when veterinary telemedicine may be practiced.
The Board’s regulations were somewhat loosened during the State of Emergency declared in response to the COVID-19 pandemic. On March 30, 2020, Governor Newsom signed Executive Order N-39-20, which established a process under the Department of Consumer Affairs for regulatory boards to request a waiver of professional licensing requirements, including requirements related to the practice and permissible activities. On June 4, 2020, the Director of Consumer Affairs issued an order granting the Board’s request to temporarily waive its regulations to the extent they required veterinarians to perform an in-person examination of the animal in order to diagnose a new or different medical condition. A number of additional extensions of the waiver were subsequently issued, with the final order extending the waiver until October 31, 2021, at which time it was allowed to expire.
During the Board’s most recent joint legislative sunset review in 2021, Issue #23 in the oversight hearing background paper authored by the Assembly Committee on Business and Professions and the Senate Committee on Business, Professions, and Economic Development posed the following question: “Should existing law be amended to increase access to veterinary services via telehealth?” The background paper noted that Board’s MDC had “acknowledged the need for clarity in statutes and regulations around the definitions of telehealth and telemedicine” and that a plan was underway to convene stakeholder discussions. The background paper recommended that the Board provide an update on those discussions “and advise if there are statutory changes that could facilitate increased access to services while maintaining high standards of veterinary care.”
In the midst of these discussions, the San Francisco Society for the Prevention of Cruelty to Animals (SPCA) filed a lawsuit against the Board in the United States District Court for the Eastern District of California, challenging the constitutionality of the Board’s regulations restricting the practice of veterinary telemedicine. In their complaint, the plaintiffs argued that the Board’s regulations violated the First Amendment by unduly restricting a veterinarian’s right to exercise their freedom of speech by providing care and advice through telehealth. While the lawsuit was initially filed on May 3, 2021, the case was still pending as of April 4, 2023, when it was reassigned to a new district judge.
In January 2023, the Board voted to pursue a legislative proposal that would have amended the Veterinary Medicine Practice Act to statutorily recognize the use of veterinary telemedicine. This proposal would have largely codified the Board’s existing regulations in that it would still require an in-person examination to establish a veterinarian-client-patient relationship prior to providing care for an animal or diagnosing or treating a new medical condition. The proposal would have allowed for some expanded exceptions and codified the use of “teletriage” for life-threatening cases in an emergency. Ultimately, the proposal was not introduced as legislation.
Partly in response to the Board’s efforts to codify its current veterinary telemedicine policy, the author and sponsors of this bill are now seeking to enact legislation that would preempt the Board’s regulations and allow for much more expansive use of veterinary telemedicine. This bill would expressly provide that a veterinarian-client-patient relationship may be established either in-person or using real-time video communication, regardless of whether the veterinarian has examined the animal patient and regardless of whether it was for the same condition. Veterinary care provided after the veterinarian-client-patient relationship has been established would not require real-time video communication, unless the veterinarian determines that it is necessary.
Additionally, this bill would enact several requirements for veterinarians that practice veterinary telemedicine. First, the veterinarian is required to ensure that the technology, method, and equipment used to provide veterinary telemedicine services comply with all current privacy protection laws. The veterinarian would also be required to have historical knowledge of the animal by obtaining and reviewing the patient’s relevant medical history and any available medical records. The veterinarian would be required to employ sound professional judgment to determine whether using veterinary telemedicine is an appropriate method for delivering medical advice or treatment to the patient and providing quality of care consistent with prevailing veterinary medical practice. Finally, the veterinarian would be required to be able to refer the client to a veterinarian who may be able to see the patient in person upon the request of the client.
If enacted, this bill would significantly expand the use of telehealth technologies in the practice of veterinary medicine. The author and sponsors believe that this expansion would significantly improve access to care, particularly for animals and clients in rural communities. As with any legislation seeking to increase the use of new technologies in health care practice, discussion of this bill will include consideration of how to appropriately balance the goal of expanding access to care while continuing to protect the welfare of animal patients.
Current Related Legislation. AB 814 (Lowenthal) would authorize a licensed physical therapist to be registered with the Veterinary Medical Board as an authorized animal physical therapist and to provide animal physical rehabilitation. This bill is pending in this committee.
AB 1369 (Bauer-Kahan) would authorize an eligible out-of-state physician and surgeon to practice medicine in California without a license if the practice is limited to delivering health care via telehealth to an eligible patient who has a disease or condition that is immediately life-threatening. This bill is pending in the Assembly Committee on Appropriations.
Prior Related Legislation. AB 1535 (Committee on Business and Professions, Chapter 631, Statutes of 2021) extended the sunset date for the Veterinary Medical Board and made additional changes resulting from the sunset review process.
AB 415 (Logue, Chapter 547, Statutes of 2011) enacted the Telehealth Advancement Act.
SB 1665 (Thompson, Chapter 864, Statutes of 1996) enacted the Telemedicine Development Act.
ARGUMENTS IN SUPPORT:
A coalition of animal welfare groups that includes the co-sponsors of this bill, the American Society for the Prevention of Cruelty to Animals (ASPCA) and the San Diego Humane Society, along with the California Animal Welfare Association, Social Compassion in Legislation, and Best Friends Animal Society, is in support of this bill. The coalition writes: “AB 1399 will expand the use of veterinary telemedicine for licensed California veterinarians and significantly reduce animal suffering, alleviate financial and logistical barriers to veterinary care, improve pet retention, and extend the capacity of animal shelters to serve animals and their communities.” The coalition further argues that “AB 1399 offers a lifeline to pet owners who face financial, geographic, or logistical obstacles to accessing veterinary care. While finances are a primary obstacle for all pet owners seeking veterinary care, many people live in underserved urban or rural, remote areas with few or no veterinary services available. More flexible access to telemedicine can help address these challenges and others, such as preventing unnecessary time off work for pet owners and ameliorating the difficulty of bringing pets to the clinic by many Californians, including seniors, disabled individuals, and those without transportation or those with anxious, potentially aggressive, chronically ill, or large animals.”
ARGUMENTS IN OPPOSITION:
The California Veterinary Medical Association (CVMA) and the American Veterinary Medical Association (AVMA) write jointly in opposition to this legislation, stating: “The CVMA and AVMA believe that telemedicine has its place in veterinary medicine and supports California’s current law, which permits its use to manage care of established patients through follow-up consultation, prescriptions, and triaging critical cases. However, this bill proposes completely eliminating the initial in-person examination or premise visit for an animal(s), which is deeply concerning. Our opposition to this measure is rooted in several critical areas. First and foremost, animals, unlike people, cannot speak to express what they are feeling, and in fact instinctively hide pain and illness. Pet owners, despite their best intentions, very often miss or misinterpret signs and symptoms of trouble in their animals. Thus, relying on pet owners to provide the information that a veterinarian would otherwise collect when examining a pet in-person—especially relative to new medical conditions—can result in inaccurate diagnoses and erroneously prescribed treatments, risking adverse consequences for the animal patient.”
POLICY ISSUE(S) FOR CONSIDERATION:
As discussed, the Telemedicine Development Act first set standards for the use of “telemedicine” in California in 1996. However, fifteen years later, the Telehealth Advancement Act made numerous changes to California law to reflect a more modern understanding of how communication technologies were expected to coexist with more traditional practice. One arguably technical yet still important change was the replacement of the term “telemedicine” with references to medicine being practiced “via telehealth.”
While much of this bill’s language references or borrows from provisions of law recast by the Telehealth Advancement Act, the term “veterinary telemedicine” is used throughout, in some instances suggesting that a different form of veterinary medicine is being practiced. It should be noted that the bill is clear that the same standards of care apply to veterinary telemedicine services and in-person veterinary medical services. However, it may still be appropriate to align the provisions of this bill with more recently accepting terminology used when describing the use of telehealth in providing care.
In addition, this bill currently states that “a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary telemedicine.” The bill then mirrors language found in the Telehealth Advancement Act by providing that the practice shall be deemed to occur at the premises where the patient is located at the time that the veterinarian practices veterinary medicine. However, the bill is not entirely clear that its intention is to require any veterinarian who provides care via telehealth to a patient who is located at the time in California to hold a license in California from the Board. The author may wish to clarify this provision.
AMENDMENTS:
- To align terminology used in the bill with the Telehealth Advancement Act, replace various references to “veterinary telemedicine” with “veterinary medicine via telehealth,” and make similar conforming changes.
- Clarify that only a veterinarian who holds a current license in California may provide veterinary care to an animal located in California.
REGISTERED SUPPORT:
American Society for the Prevention of Cruelty to Animals (Co-Sponsor)
San Diego Humane Society (Co-Sponsor)
Best Friends Animal Society
California Animal Welfare Association
Humane Society of the United States
Humane Society Veterinary Medical Association
Michelson Center for Public Policy (UNREG)
San Francisco SPCA
Social Compassion in Legislation
Veterinary Virtual Care Association
REGISTERED OPPOSITION:
American Veterinary Medical Association
California Veterinary Medical Association
Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301
Discussed in Hearing
49SEC
Assembly Floor
2MIN
Senate Floor
3MIN
Senate Standing Committee on Appropriations
38MIN
Senate Standing Committee on Business, Professions and Economic Development
2MIN
Assembly Floor
39SEC
Assembly Floor
13MIN
Assembly Standing Committee on Appropriations
18MIN
