Can veterinarians comply with state and federal requirements for the Veterinary Client Patient Relationship and practice via telemedicine?
Nearly, if not all states, have some requirements regarding the establishment and maintenance of a veterinarian-client-patient relationships (VCPR) before the veterinarian can treat an animal owned by a client. In New Jersey, for example, the regulations (not statute) defines the VCPR as
- i) The veterinarian has undertaken to make medical judgments regarding the health of an animal or animals, herd or flock being treated and the need for medical treatment;
- ii) The client has retained the services of the veterinarian;
iii) The veterinarian has sufficient knowledge of the animal or animals, herd or flock to initiate at least a general or preliminary diagnosis of the medical condition of the animal or animals, herd or flock;
- iv) The veterinarian is available for follow-up treatment; and
- v) The veterinarian maintains records on the animal or animals, herd or flock in accordance with N.J.A.C. 13:44-4.9.
N.J.A.C. 13:44-4.1 (b)(1).
FDA requires veterinarians issuing a Veterinary Feed Directive (VFD) (essentially a prescription for treatment of livestock and poultry) to:
(i) Be licensed to practice veterinary medicine; and
(ii) Be operating in the course of the veterinarian’s professional practice and in compliance with all applicable veterinary licensing and practice requirements, including issuing the VFD in the context of a veterinarian-client patient relationship (VCPR) as defined by the State. If applicable VCPR requirements as defined by such State do not include the key elements of a valid VCPR as defined in § 530.3(i) of this chapter, the veterinarian must issue the VFD in the context of a valid VCPR as defined in § 530.3(i) of this chapter.
21 CFR § 558.6(b)(1).
FDA has identified states that do not define the VCPR in the same way that FDA does, and has mandated that veterinarians writing VFD’s must comply with federal standards. See FDA’s guidance.
Consider the continued contemporaneous evolution of three veterinary concerns regarding the proper care of livestock and poultry in the United States:
- The decreasing number of food animal veterinary practitioners, particularly in rural states;
- The state licensure requirements for each veterinarian practitioner; and
- The FDA requirements regarding the establishment of a VCPR prior to issuance of a VFD.
The decreasing number of food animal practitioners may have to be licensed in multiple states and be compliant with state and federal laws (which in the case of the VCPR may be inconsistent) to provide care to their patients, including medications pursuant to a VFD. One viable solution to assist these veterinarians and the animals they treat, is telemedicine. In many situations, veterinarians can comprehensively evaluate the needs of a herd or flock without visiting in person. While there should be an initial in-person visit, veterinarians, like physicians, should be able to communicate, diagnose and prescribe for remote herds and flocks without a required in-person visit. State licensing laws may have to be relaxed as a decreasing number of veterinarians engage in large anima/food animal practice.
Arizona has recently relaxed its laws, permitting out of state professionals moving to the state to engage in licensed practice without completing the previously required rigorous state licensing testing. Historically, states have permitted limited consultation from out of state veterinarians. Farmers and ranchers would certainly benefit if they could access veterinarians from other states that specialize in food animal medicine, without requiring a physical presence and in-person examination in each state.