-Adds language to clearly state license exemptions.
-Allows veterinarians to delegate additional veterinary medical acts to certified veterinary technicians and unlicensed assistants.
-Allows veterinarians to delegate the placement of intravenous catheters to unlicensed assistants under the direct supervision of the veterinarian present on the premises, per requests from stakeholders.
-Additional changes to the delegation of veterinary medical acts are included in the telehealth section of this summary.
-Makes changes for consistency and ease of use the places in which rule requirements repeat, or refer to requirements in statute.
-Modifies language regarding unprofessional conduct so that it also refers to Wis. Stat. s. 89.07 (1). -Modifies language regarding prescribing and dispensing a veterinary drug to refer to -Wis. Stat. s. 89.068 (1) (c) allows. -Makes a correction to the delegation of rabies vaccinations to reflect Wis. Stat. s. 95.21 (2) (a).
-Modifies terminology for clarity and consistency.
-Adds additional definitions and updates existing definitions language for clarity.
-Renames “temporary permit” to “temporary veterinary permit” and renamed “temporary consulting permit” to “veterinary consulting permit.”
-Changes language to use the word “dispense” rather than “sell” to be more consistent with statutory language and definitions to make the language clearer and easier to understand.
-Adds a note clarifying that the board accepts “veterinary nurse” as equivalent to “veterinary technician.”
Telehealth Changes
-Adds definitions related to telehealth.
-Adds definitions related to veterinary consulting and clarifies that a consulting veterinarian or other consultant may not do any of the following:
-Visit the patient or client or communicate directly with the client without the knowledge of the attending veterinarian.
-Take charge of a case or problem without the consent of the attending veterinarian and the client.
-Clarifies that the practice of veterinary medicine takes place where the animal is located at the time of practice, in alignment with Wis. Stat. ss. 89.05 (1) and 89.02 (6). -Clarifies that in order to practice veterinary medicine in Wisconsin a veterinarian must be licensed in Wisconsin and have an established veterinary-client-patient relationship (VCPR) with the client. A VCPR must be established via an in person physical exam, or timely medically appropriate visits to the premises on which the patient is kept. It may not be established by telehealth technologies.
-Clarifies that the VCPR, once established, extends to other veterinarians within the practice, or relief veterinarians within the practice, that have access to, and have reviewed, the medical history and records of the animal.
-Clarifies that records must be kept, regardless of the encounter type.
-Clarifies, in accordance with Wis. Stat. s. 89.02 (8) (c), that an animal owner must be able to easily seek follow-up care or information from the veterinarian who conducts an encounter while using telehealth technologies. -Expands the delegation of medical services to allow a veterinarian to delegate the following items to a certified veterinary technician (CVT) if the veterinarian is available to communicate via telehealth technologies within five minutes. Under current rules, these items may only be delegated to a CVT if the veterinarian is personally present on the premises.
-Performing diagnostic radiographic awake contrast studies not requiring general anesthesia.
-Sample collection via a cystocentesis procedure.
-Placement of intravenous catheters.
-Suturing of tubes and catheters.
-Fine needle aspirate of a mass.
Summary of, and Comparison with, Existing or Proposed Federal Statutes and Regulations
Pursuant to 9 CFR 160 to 162, a veterinarian must be specifically authorized by the United States Department of Agriculture – Animal and Plant Health Inspection Service to perform animal disease eradication and control functions under federal animal health laws. Licensure requirements to practice veterinary medicine are established by each state and should not be affected by federal requirements.
Comparison with Rules in Adjacent States
The structural changes and minor language changes in the proposed rule are unique to Wisconsin rules and make the rules clearer and easier to use. Veterinary telehealth regulations in Wisconsin, Illinois, Iowa, Michigan, and Minnesota are compared below. Regulatory recommendations by the American Association of Veterinary State Boards, the American Veterinary Medical Association, and the Wisconsin Veterinary Medical Association are also included for comparison.
Wisconsin
Under both the existing rule and the proposed rule, a veterinarian must be licensed in Wisconsin in order to practice veterinary medicine and have an established VCPR with the client. A VCPR must be established via an in-person physical exam, or timely medically appropriate visits to the premises on which the patient is kept. It may not be established by telehealth technologies.
The proposed rule clarifies items related to telehealth and also expands the delegation of medical services to allow a veterinarian to delegate the specific items to a CVT if the veterinarian is available to communicate via telehealth technologies within five minutes.
Illinois
In Illinois, a valid VCPR cannot be established solely by telephonic or electronic communications. No further information was provided regarding whether Illinois would allow telehealth to be used if a VCPR was previously established.
Iowa
In Iowa, a valid VCPR cannot be established solely by telephonic or electronic communications. No further information was provided regarding whether Illinois would allow telehealth to be used if a VCPR was previously established.
Michigan
Michigan recently promulgated a new rule related to the practice of veterinary medicine using telehealth technologies, which became effective April 15, 2021. The Michigan rules now require:
-Disclosure of the identity and contact information of the veterinarian providing telehealth services. Licensing information shall be provided upon request.
-Ensure that the technology method and equipment used to provide telehealth services complies with all current privacy-protection laws.
-Employ sound professional judgement to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient.
-Have sufficient knowledge of the animal patient to render telehealth services demonstrating by satisfying one of the following:
-Have recently examined the animal patient in-person or have obtained current knowledge of the animal patient through the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically.
-Have conducted medically appropriate and timely visits to the premises where the group of animal patients is kept.
-Act within the scope of practice.
-Exercise the same standard of care applicable to traditional, in-person veterinary care service.
-Be readily available to the animal patient for follow-up veterinary services or ensure there is another suitable provider available for follow-up care.
-Consent for medical advice and treatment shall be obtained before providing a telehealth service.
-Evidence of consent for medical advice and treatment must be maintained in the animal patient’s medical record.
-A veterinarian providing a telehealth service may prescribe a drug if the veterinarian is a prescriber acting within the scope of practice and in compliance.
Minnesota
Minnesota only allows patient-specific telemedicine within a VCPR. A VCPR cannot be established without an in-person examination. A veterinarian licensed in another state can serve as a consultant to the Minnesota veterinarian that holds the VCPR for that patient. The same standards of care apply to services rendered via telemedicine as to in-person visits.
American Association of Veterinary State Boards (AAVSB)
