Specialty/ER Service Interruption

The Hawaii Board of Veterinary Medicine has recently reinterpreted Hawaii’s veterinary practice law and begun rejecting the practice of veterinary sponsorship. This practice previously allowed many out-of-state specialists to share their services with our clients on a short-term or intermittent basis. All of us have benefited from referring our clients to visiting dermatologists, radiologists, surgeons, as well as our few emergency care centers that operate 24/7. This interruption in veterinary sponsorship has limited service hours at emergency clinics and worsened the backlog of surgery cases in Hawaii.

If your clients are being affected, please encourage them to file a complaint with the DCCA and Board of Veterinary Medicine to insist that they must immediately return to honoring the practice of veterinary sponsorship in Hawaii as clearly allowed by HRS 471(2)-5.

Veterinarians as COVID-19 Vaccinators

Submitted by the American Veterinary Medical Association

The AVMA has been working hard for the past few months, as veterinarians have been increasingly discussed as needing to be among those able to assist in efforts to vaccinate people against COVID, to have veterinarians specifically included in the declarations under the federal Public Readiness and Emergency Preparedness Act (PREP Act), which authorizes the HHS Secretary to issue emergency public health declarations and provides limited immunity from liability to those covered under the act.

As of March 12, 2021, veterinarians and veterinary students are included in the PREP Act:

· It allows veterinarians who are licensed to practice under the law of any state to administer COVID vaccines in any jurisdiction in association with a COVID vaccination effort by a state, local, tribal, or territorial authority or by an institution in which the COVID vaccine is administered.

·        This also applies to veterinarians who have held an active license or certification under the law of any state within the last five years which is inactive, expired or lapsed, as well as veterinary students with appropriate training in administering vaccines. The intent is to include recently retired veterinarians who may want to help.

·        Today’s amendment preempts any state law that would otherwise prohibit veterinarians or veterinary students who are a “qualified person” under the PREP Act from prescribing, dispensing, or administering COVID vaccines or other covered COVID countermeasures.

·        Veterinarians and veterinary students will be afforded liability protections in accordance with the PREP Act and the terms of the amendment. However, specific conditions must be met in order for the authorization to administer the vaccines and the liability protections to apply. These liability protections apply from March 11, 2021, through October 1, 2024.

·        In order for the authorization and liability protections to apply, veterinarians and veterinary students must be participating in association with a COVID vaccination effort by a state, local, tribal, or territorial authority, or by an institution in which the COVID vaccine is administered. Additional specific requirements also must be met, such as having basic certification in CPR, completing the CDC COVID vaccination modules, an observation period, etc. There is a separate section of the declaration that applies to those in the uniformed services and for federal employees, contractors and volunteers when authorized to administer COVID vaccine.

·        While the liability outlined in the PREP Act is broad, it does not apply to willful misconduct, and the federal government does not provide a legal defense in the event that you are sued. Your state may have separate liability protections, along with separate requirements to qualify, and may or may not provide a legal defense. Veterinary malpractice will not likely respond to claims arising from a veterinarian intentionally vaccinating people against COVID.

More information on vaccination volunteer requirements

Sign up for Hawaii’s volunteer Medical Reserve Corps here

PREP Fact Sheet that Includes Veterinarians as Qualified Health Professionals

Federal Requirements for the Veterinarian-Client-Patient Relationship

The following guidance information has been provided by the AVMA

THE BASICS

The federal government regulates veterinary medicine and animal drugs very differently than it does human health care and drugs intended for human use. This is, in part, because veterinarians are key to maintaining a healthy, safe, and wholesome food supply and because they also play an important role in overseeing the judicious use of antimicrobials in animals. One important difference between human and veterinary medicine is that the U.S. Food and Drug Administration (FDA) has authority under the federal Food, Drug and Cosmetic Act (FDCA) over the use of animal drugs and human drugs by veterinarians, and the authority to define how a veterinarian-client-patient relationship (VCPR) is established for certain uses of animal and human drugs. [1]

For these uses, FDA has authority to require the keeping of veterinary medical records and to access them at any reasonable time to verify and copy them. [2] Use of animal and human drugs by veterinarians that violates the federal VCPR parameters set forth in the FDCA and its implementing regulations results in the drug being statutorily deemed unsafe for the use and, if in animal feed, the feed is statutorily deemed adulterated. [3] The USDA, which regulates veterinary biological products, also has promulgated rules defining a VCPR using the same language as the FDA. [4]

APPLICATION OF THE FEDERAL VCPR

The federal VCPR applies to any use of an FDA-approved human drug in animals, including over-the-counter (OTC) human drugs. [5] It applies to any use of an FDA-approved animal drug in any manner that differs from its approved labeling (Extra Label Drug Use [6]), such as a different frequency of administration, different dose, different medical indication for its use, different route of administration, or use in a different species. [7] It also applies to the use of compounded drugs by veterinarians [8] and a veterinarian’s authorization of a veterinary feed directive (VFD). [9] All of these are very common occurrences in the day-to-day practice of veterinary medicine.

Establishing the federal VCPR requires a physical examination of the animal or timely and medically appropriate visits to the premises where animals are kept. The FDA does not allow the VCPR to be established through electronic means. [10] FDA does allow the VCPR to be maintained electronically through telemedicine. [11] Veterinarians must comply with the federal VCPR in each of the circumstances in which it applies, irrespective of whether state law defines it differently.

The federal VCPR also applies in two important, but more limited, circumstances under USDA authorities. Veterinarians who manufacture biological products for use in their patients must do so within the context of the federal VCPR. [12] Veterinarians also must have established a federal VCPR when using prescription platform product biologics, which are a new category of biotechnology vaccines. [13]

CONFLICTING STATE AND FEDERAL VCPR DEFINITIONS AND TELEMEDICINE

• Conflicting state and federal VCPR definitions (e.g., states allowing the VCPR to be established electronically) would cause significant confusion. The FDA and USDA have used the same regulatory definition to avoid such confusion.
• Veterinarians must comply with the federal VCPR requirements where they apply, regardless whether state laws are more lax. Activities where the federal VCPR applies are extremely common in day-to-day veterinary practice.
• State law and regulations relating to the establishment of a VCPR that conflict with federal law would also cause telemedicine encounters to be frustrating for many veterinary clients. A veterinarian who has not already established a VCPR that complies with federal requirements (i.e., by conducting an in-person examination/visit) could not even recommend the use of an FDA-approved human OTC product for an animal without violating federal law.
• There are many valuable uses of telemedicine within the parameters of a federal VCPR.

  1. 21 USC 360b; 21 CFR Part 530
  2. 21 CFR 530.5
  3. 21 USC 360b(a)(1), (2), (4) & (5); 21 USC 342(a)
  4. 9 CFR 107.1(a)(1)
  5. 21 USC 360b(a)(5); 21 CFR 530.2; 21 CFR 530.3(a)
  6. https://www.fda.gov/animal-veterinary/resources-you/ins-and-outs-extra-label-drug-use-animals-resource-veterinarians
  7. 21 USC 360b(a)(4); 21 CFR 530.2; 21 CFR 530.3(a)
  8. https://www.fda.gov/animal-veterinary/resources-you/ins-and-outs-extra-label-drug-use-animals-resource-veterinarians#compounding; FDA Draft Guidance for Industry #256
  9. 21 CFR 558.6(b)
  10. FDA letter to the American Veterinary Medical Association, April 6, 2017 – “Therefore, for the purposes of the federal definition, a VCPR cannot be established solely through telemedicine (e.g., photos, videos, or other electronic means that do not involve examination of the animal(s) or timely visits to the premises).”; During the pandemic FDA announced they will temporarily suspend enforcement of the federal VCPR physical exam and premises visit requirements. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/cvm-gfi-269-enforcement-policy-regarding-federal-vcpr-requirements-facilitate-veterinary. In this announcement FDA reiterated that under normal circumstances – “Given that the Federal VCPR definition requires animal examination and/or medically appropriate and timely visits to the premises where the animal(s) are kept, the Federal VCPR definition cannot be met solely through telemedicine.”
  11. Id. “The regulations do not specifically address the use of telemedicine to maintain an established VCPR. However, based upon the language of the VCPR definition provided above, nothing would prohibit the use of telemedicine (e.g., use of photos, videos, or other electronic means that may be considered virtual) to allow the veterinarian to keep informed and able to make medical judgments regarding the health of the animal(s) and the need for medical treatment between periodic examinations of the animal(s) and/or timely visits to the premises where the animal(s) are being kept.”
  12. 9 CFR 107.1(a)
  13. USDA Veterinary Services Memorandum 800.214

2021 Membership Renewal

Welcome to the new year! The Hawaii Veterinary Medical Association is a not-for-profit organization that depends upon our member participation and dues. Your dues enable us to host regular CE, provide scholarships for veterinary and veterinary technician students, advocate on behalf of the veterinary profession in Hawaii, and give back to our community. Throughout the COVID-19 pandemic, the HVMA has fought for Hawaii veterinarians to be included as essential service providers, provided timely information on COVID-19 updates and resources, and helped to secure multiple pet food donations for affected families throughout Hawaii. We understand that this is a difficult time for many, but if it is within your budget, HVMA would greatly appreciate your continued support.

RENEW TODAY!

Meet A Board Member: Leilani Sim-Godbehere

Leilani Sim-Godbehere, DVM
Kauai County Representative

Dr. Leilani Sim-Godbehere is currently our longest-serving member on the HVMA Executive Board. She was first involved as an Oahu Delegate, then as President-Elect, followed by President, and currently as the Kauai Delegate.

Dr. Sim-Godbehere received her DVM degree from Kansas State University in 1983. She has been in small animal private practice since graduation – first in Visalia, CA and then on Oahu for 18 years. She also held a four-year stint as a Veterinary Medical Officer for the Department of Agriculture at the Animal Quarantine Station from 1986 to 1990.

She is currently working as a relief doctor on a regular basis at the Kapaa Animal Clinic on Kauai and serves as the main caregiver for her elderly mom. She has always enjoyed the camaraderie and the privilege of belonging to such a lofty yet humble profession. Being involved in organized veterinary medicine has allowed her to give a little back to her colleagues and profession.

Dr. Sim-Godbehere’s other passions include her family, her dogs, horse, tortoises, rabbit, cats, and garden. She loves walking, swimming, horseback riding, and skiing. She is thankful to God for all the blessings he has given her.

AVMA Update January 2021

AVMA held their first-ever virtual Veterinary Leadership Conference in January. If you are interested in honing your leadership skills, CE is still available on demand through March. 

AVMA House of Delegates also gathered virtually and held the Veterinary Information Form to discuss veterinary medicine during the COVID-19 pandemic and timing of canine spay/neuter. Action was taken on a number of AVMA resolutions and policies, which can be viewed here.

Hawaii’s AVMA House of Delegate representatives are Leianne Lee Loy, DVM (Delegate) and Carolyn Naun, DVM (Alternate Delegate). If you have any concerns regarding veterinary medicine and the AVMA, please contact them at avma_delegate@hawaiivetmed.org.

COVID-19 Vaccination Update

The state of Hawaii has indicated veterinarians and their staff are essential health care providers included in Tier 1b of the COVID-19 vaccination rollout. To receive more information, fill out the Department of Health survey. The Department of Health will directly contact you to follow up. You may also check their website for updates.

AVMA News

Veterinary Leadership Conference 2021

Registration for the AVMA Veterinary Leadership Conference (VLC) 2021 is now open. VLC 2021 will be held virtually January 7-9, 2021. HVMA is currently accepting nominations for the designated “Veterinary Leader” from Hawaii, due by November 28, 2020.

Past attendees include Drs. David Gans, Jenee Odani, Aleisha Swartz, and Katie Hancock Reed. Contact us for more information. Read more about the VLC here.

Volunteer Opportunities

We invite you to explore the Committee and Council positions available this year and in 2021.  Please visit the Volunteer Opportunities section of the AVMA website to learn more. As a volunteer, travel, lodging and meals are covered by the AVMA.

AVMA COVID-19 Resources

AVMA Webinars

2020 Membership Renewal

If you haven’t already done so, it’s not too late to renew your 2020 membership! The Hawaii Veterinary Medical Association is a not-for-profit organization that depends upon our member participation and dues. Your dues enable us to host regular CE, provide scholarships for veterinary and veterinary technician students, advocate on behalf of the veterinary profession in Hawaii, and give back to our community. During the onset of the COVID-19 pandemic, the HVMA immediately fought for Hawaii veterinarians to be included as essential service providers, provided timely information on COVID-19 updates and resources, and helped to secure multiple pet food donations for affected families throughout Hawaii. We understand that 2020 is a difficult year for many, but if it is within your budget, HVMA would greatly appreciate your continued support.

AVMA House of Delegates Updates

Submitted by HVMA HOD Representatives Leianne Lee Loy and Carolyn Naun

The first Virtual Annual House Of Delegate (HOD) Session was held on July 30 and 31, 2020. Regular Annual Meeting Agenda included: Veterinary Information Forum with open mic discussion, candidate introductions, officer speeches, Informational meeting (AVMF, PAC, PLIT, CVTEA, COE), Reference Committee, and the district caucuses.  

Highlights of the meeting:
Discussion, cases and stories of HOD COVID-19
Diversity and Inclusion in Veterinary Medicine
Two Resolutions Approved: Revised Policy on Antiparasitic Resistance and Transportation of Research Animals for the Purpose of Research, Testing, and Education

Election results:
AVMA President Elect 2020-2021: Jose Arce
AVMA Vice President 2020-2022: Sandra Faeh

Continuing Education Opportunity with AVMA

This summer, the AVMA’s first Virtual Convention will take place August 20-22. Take a step back from the day-to-day and rekindle your energy and passion for veterinary medicine—without leaving your home!
Tracks include:

  • Cannabis Symposium
  • Companion animal medicine
  • Food animal / equine
  • Practice management
  • Professional development
  • Public and corporate practice
  • Veterinary technology

Find out more and register here

Diversity and inclusion

As you know, diversity and inclusion has become a salient issue over the past several months. AVMA leadership has listened, and the HOD passed recommendations to the Board of Directors outlining some actionable steps. The Multicultural Veterinary Medical Organization released a thought provoking video that we recommend you watch if you have not seen it already: https://www.youtube.com/watch?v=j7Pl4YX_QNc

Given recent events in Washington involving a Member of Congress who is a veterinarian, we wanted to clear up one misunderstanding we have heard regarding the use of member dues. AVMA does take an active role in advocating for the profession and championing the legislative causes that affect us. This effort is nonpartisan in nature.  However, in accordance with federal law, your AVMA dues cannot be used toward political campaign contributions.

The AVMA’s Political Action Committee is a separate entity supported by individual contributions from members. AVMA PAC does support veterinarian Members of Congress, as they understand the challenges faced by our profession and the issues you care about, without regard to party affiliation. You can reach AVMA PAC to provide feedback or to make a contribution at avmapac.org

Here is a link to the statement from AVMA regarding the reported interaction between Rep. Ted Yoho and Rep. Alexandria Ocasio-Cortez: https://www.facebook.com/avmavets/posts/10163691028363990

Rep. Ted Yoho is retiring from Congress at the end of this year.