Veterinarian Compliance with DEA and SUPPORT Act

Recently, DEA announced the launch of the Suspicious Orders Report System (SORS) Online, a new centralized database [https://deadiversion.usdoj.gov/sors/index.html], where DEA registrants, including veterinarians, must report suspicious orders of controlled substances. Reporting by practitioner registrants and creation of the database by DEA was required when Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) last year. The DEA indicates that reporting a suspicious order to SORS Online constitutes compliance with the reporting requirement.

The reporting requirement applies to all DEA registrants, including veterinarians. This is why veterinarians who are DEA registrants have been receiving communication from the DEA on the SUPPORT Act.
The circumstances under which it will impact veterinarians should be extremely limited, but the Act does apply to them.
All DEA registrants, including veterinarians, are required to design and operate a system to identify suspicious orders for the registrant and to report suspicious orders to the DEA. The DEA advised that the plan should be in writing and could be requested during an inspection.
- Suspicious orders are defined as including requests for controlled substances of unusual size, deviating substantially from a normal pattern and orders of unusual frequency.
- The DEA also said the definition is not inclusive and a veterinarian should report anytime there is something that makes the veterinarian suspicious.
- The AVMA is looking to develop a brief model plan that can be utilized.
The reporting requirement applies anytime a registrant, including a veterinarian, is requested to distribute/provide a controlled substance to another registrant under circumstances identified by the registrant as suspicious. The example provided by DEA was where a veterinarian at one clinic asks to obtain a controlled substance from another veterinarian at a different clinic, such as seeking to obtain ketamine from a nearby clinic due to low inventory. A veterinarian who receives a request to provide a controlled substance to another practitioner must be aware of the requirement to report the ‘order’ if the circumstances raise any suspicion to believe that the controlled substance will go for an illegal or diversionary purpose.
The reporting requirement and SORS Online database are solely for reporting transfers of a controlled substance from one DEA registrant to another DEA registrant that seem suspicious. Veterinarians are not to report to the SORS Online reporting system anything related to the administration, prescribing or dispensing of controlled substances that occur in the ordinary course of veterinary practice. The SORS Online database is also not to be used for reporting suspicious or drug-seeking behavior of clients.
If a veterinarian believes a request from another practitioner is suspicious, the veterinarian should not supply the controlled substance. The veterinarian should register for the program on the DEA website and report the order to the electronic database (SORS Online). A veterinarian only needs to register for the database at the time of the need to file a report of a suspicious order.
The DEA will be promulgating rules that will be published in the Federal Register. AVMA will review the rules and respond as appropriate.

Download the AVMA guidance and draft “system” for veterinarians here.

AVMA Update – Jan 2020

The AVMA House of Delegates (HOD) conducted association business, considered policies, discussed topics of interest to members, deliberated and presented action items at the winter session held January 10-11 in Chicago. The Winter session for the House of Delegates was held at the same time as the Veterinary Leadership Conference.

The Volunteer Leaders are committed to representing member interests with this years passionate discussion around AVMA’s Resolution: Policy on Declawing of Domestic Cats. The revised policy states that declawing should not be considered a routine procedure and emphasizes the importance of professional judgment and client education in making decisions that best protect the health and welfare of the patient: “The AVMA discourages the declawing (onychectomy) of cats as an elective procedure and supports non-surgical alternatives to the procedure. The AVMA respects the veterinarian’s right to use professional judgment when deciding how to best protect their individual patients’ health and welfare. Therefore, it is incumbent upon the veterinarian to counsel the owner about the natural scratching behavior of cats, the alternatives to surgery, as well as the details of the procedure itself and subsequent potential complications. Onychectomy is a surgical amputation and if performed, multi-modal perioperative pain management must be utilized.”

Other Resolutions discussed and were approved by the HOD:
Resolution 1: AVMA Policy on Use of Technology in Veterinary Medicine, which states, in part: “The AVMA affirms and encourages the responsible and ethical development and use of technology for a variety of applications in veterinary medicine that can benefit and protect public health, animal health and welfare, and environmental health.”
Resolution 2: AVMA Policy on Cribbing in Horses, which states, in part: “The AVMA condemns the use of hog rings or other devices placed around the teeth to prevent cribbing in horses. These devices are detrimental to the welfare and health of the horse due to the potential to cause persistent pain, damage to the gingiva, periodontal disease and abrasive wear to adjacent teeth. The AVMA encourages research to understand and address the underlying causes of cribbing.”
Resolution 4: Revised Policy on Microchips, which states, in part: “The AVMA endorses the implantation of electronic identification in companion animals and equids and supports standardization in materials, procedures, equipment, and registries. Veterinary healthcare teams are thereby encouraged to recommend the implantation of electronic identification of animals to their clients.”

Membership

The AVMA membership is stronger than ever, with the association’s membership at more than 95,300. Three out of every four veterinarians are members of the AVMA. HOD members also heard updates on the AVMA’s member-focused initiatives: digital education platform, AVMA Axon; our Direct Connect practice resource; our wellbeing and recent graduate initiatives; and efforts related to advocacy and public policy.

The Veterinary Information Forum

Three topics were discussed during the HOD’s Veterinary Information Forum:
Student extern/practice volunteer: Veterinary work experience prior to and during clinical time in colleges of veterinary medicine is valuable. These experiences are part of the non-academic evaluation; give an understanding of our profession; provide to the students and volunteers a degree of comfort with animals in the clinical setting; and provide some basic technical skills and insight into the veterinary working world. These experiences come with the concern of risk, particularly in the case of injury and determination of liability. The action item for this topic is the AVMA Board of Directors develop a toolkit, including potential forms and an awareness campaign, for the protection of practitioners, students and other
members of the veterinary health care team.
Telehealth: An update on AVMA activities in 2019 included support for state veterinary medical associations to engage with regulators; communication and collaboration with industry; and further development of member-focused resources, including continuing education and online resources. The AVMA will continue its work to develop guidelines on telehealth and
connected care.
Cannabis and cannabis-derived products: While the House made no specific recommendations related to cannabis, the AVMA remains committed in 2020 to advocacy for regulatory clarity and the development of additional member-focused resources and education.

Other topics discussed during the Veterinary Information Forum were updates on sexual harassment in the workplace and the utilization of veterinary technicians. During the 2019 annual meeting a resolution was passed recognizing that sexual harassment in the workplace is a serious issue and asked the AVMA Board of Directors to develop supporting resources and report back to the House. The AVMA will work in 2020 to update the AVMA web site to include additional resources on the prevention of sexual harassment in the workplace, as well as include sexual harassment education in AVMA continuing education programs. In addition, the AVMA will explore identifying specific workplace harassment training programs to recommend to veterinary practices.

The AVMA Task Force on Veterinary Technician Utilization report was also shared with House members. The focus of the report was on veterinary technician education, licensing and regulation, economics, supply and attrition, and wellness.

Public Service Loan Forgiveness Program

The AVMA continues to advocate to protect and enhance the Public Service Loan Forgiveness Program, which has been under scrutiny due to the incredibly low acceptance rate to date and concerns about overall costs. The AVMA’s past efforts include:
– Leading 127 animal health organizations in sending a letter to Congress underscoring the program’s importance to the industry and asking lawmakers to protect Public Service Loan Forgiveness.
– Joining a broad coalition of organizations in sending a letter to Education Department officials expressing concern about the loan forgiveness denials.
– The AVMA is continuing to communicate members’ concerns about the program’s administration to Congress and the U.S. Department of Education.

If you were denied forgiveness through PSLF or have experienced issues with the program, please share your story using the AVMA’s online advocacy tools.

Leianne Lee Loy, Hawaii Delegate
Carolyn Naun, Hawaii Alternate Delegate

AVMA Report Summer 2019

Aloha HVMA Colleagues and Happy Summer!

We are preparing for the American Veterinary Medical Association (AVMA) Summer Session for the House of Delegates which will begin prior to the AVMA Convention – “A Monumental Experience.”

Here are the highlights for our session beginning on Thursday August 1, 2019 in Washington DC:

2019 D.C. Hill Visits: Because we are in DC, we are planning on visiting our legislators to discuss the issues that are important to the AVMA and the veterinary profession. With over 200 individual meetings, this will be the largest veterinary event on Capitol Hill ever conducted by the AVMA!

We are scheduled to meet with Hawaii’s Members of Congress or their staff – Senators Mazie Hirono and Brian Schatz; Representatives Ed Case and Tulsi Gabbard. We will be focusing on three issues for the visits: Veterinary Medicine Loan Repayment Enhancement Act (VMLRPEA); Fairness to Pet Owners Act (FTPOA) and Association Health Plans Act (AHP).

Resolutions to be discussed and voted by the House of Delegates:
a) Model Veterinary Practice Act: The AVMA adopt the revised policy Model Veterinary Practice Act
b) Revised Policy on Judicious Therapeutic Use of Antimicrobials
c) Revised joint AABP-AVMA Policy on Judicious Therapeutic Use of Antimicrobials in Cattle
d) Sexual Harassment Awareness
e) Revised Policy on Pet Heath Insurance
f) Revised Policy on Veterinary Dentistry

Proposed Bylaws Amendment:
a) Council on Research – Responsibility
b) Board of Directors – Qualifications
c) Board of Directors – Composition

AVMA Elections:
There are multiple positions that will be voted on by the House of Delegates:
a) President-Elect
b) House Advisory Committee
c) 6 Council Positions

Congratulations to Carolyn Naun who will be a speaker at this year’s AVMA Convention!

If you need to contact us with comments about the topics we mentioned, here is our email: AVMA_Delegate_HI@avma.org

Aloha!
Leianne K. Lee Loy
Hawaii Delegate

Carolyn Naun
Hawaii Alternate Delegate

Hawaii Rabies Quarantine Changes

Rule amendments to Chapter 4-29, HAR recently received final approval from the Governor and will become effective on August 31, 2018. A summary of the more significant changes follows. The complete Chapter 4-29, HAR with amendments is located on the Hawaii Department of Agriculture’s website at: http://hdoa.hawaii.gov/ under the Administrative Rules tab. The Animal Quarantine information page (access by clicking on the Animal Quarantine tab) has been updated and new checklists added to assist with preparing a dog or cat for the 5 Day or Less program and Direct Airport Release.

Exact Changes Made:

A. Section 4-29-2 Definitions
The definition “Service Animal” is added and the definitions of “Service Dog” and “User” are amended to reflect the definition of service animals under current Federal ADA language.

The definition “Eligibility Date” or “Eligible Date” is added for clarification of terminology and means the date determined by the State that an animal may qualify for five day or less quarantine by meeting all the specified requirements.

“Qualification date” is added for clarification and means the date determined by the state that an animal may be released from quarantine by meeting all the specified requirements under Chapter 4-29, HAR.
The definition “Safeguard” is added and means to confine and handle animals so that the animals shall not come into physical contact with any other animal, or cause a potential human exposure, at any time. The location and method of confinement and handling shall be approved by the state.

“Veterinary Hospital” is added for clarification and means an office or building designated for the sole purpose of providing veterinary examinations, diagnostics, and medical and surgical treatments of animals operated by a veterinarian licensed to practice in Hawaii.

B. Section 4-29-8.1 Other requirements
Changes are made to: Reduce the minimum time required from the most recently administered rabies vaccine before arrival in Hawaii from 90 days to 30 days;

Modify the minimum time required from a successful OIE-RVA test by reducing the period from the test before arrival in Hawaii from 120 to 30 days; and

Another amendment is added that owners are required to register their pet’s microchip number with the local county humane society or local animal welfare organization. Other changes are made throughout the section for clarification.

C. Section 4-29-8.3 Movement of dogs and cats requiring urgent diagnostic, medical or surgical procedures not available in Hawaii
A new subsection (b) is made to establish requirements for the importation of cloned animals derived from donor tissue originating in Hawaii into the state without quarantine. This provision allows application of advances in science and technology to qualify as a low risk category for import. Requirements for the cloning facility, veterinary management, brood stock, clone animal preparation, transportation and procedures are included.

J. Section 4-29-11 State animal quarantine station
Changes add that admission to the station may be denied to anyone that is not listed as an owner, co-owner, registered handler or authorized visitor on the record of an animal quarantined in the quarantine station. This change will increase biosecurity and minimize the potential of introducing diseases into the station.

An amendment is added to clarify that station veterinarians are authorized to refer an animal to a veterinary facility for diagnostics and treatment not available at the Station with or without prior owner authorization or approval. This is for situations when owners are not available and/or referral is in the best interest of the animal.

K. Section 4-29-17 Fees at the animal quarantine station.
Changes are made to fees for Five-day or less quarantine, Direct airport release, Neighbor Island Inspection Permit (NIIP) and Re-entry fee with direct airport release and ground transportation on Oahu are made. The total new fees for Fiveday or less quarantine being $244 (currently $224); Direct airport release total fee of $185 (currently $165); NIIP fee of $165 (currently $145), and Reentry fee with direct airport release of $98 (currently $78).

L. Throughout Chapter 4-29, HAR, the term “service dog” is changed to “service animal” to reflect current Federal ADA language.

Read full press release here

RVT in Hawaii FAQs

WHAT DOES THIS LAW DO?
This is a title protection law only. Meaning that, as of July 1, 2018, only people who have registered with the state of Hawaii can use the title veterinary technician, vet tech, CVT, LVT, or RVT.

This includes on name tags, websites, business cards, etc. All staff members can perform the same tasks, but in order to use the title “veterinary technician”, he or she must be an RVT in the state of Hawaii.
Visit https://hvta.org/rvt-in-hi-faq/ for more details.

I AM A VETERINARIAN. WHAT DOES THIS LAW MEAN FOR ME?
For eligible employees to grandfather in, you’ll check off skills and hours on the Hawaii Experience Verification form and have it notarized. Eligible employees will need 5 years practical experience in Hawaii to sit for the Vet Tech National Exam.

Your employees can still do all the skills and tasks that they’ve been performing, but until they register in Hawaii, they cannot use the title “vet tech” or “veterinary technician”.

WANT TO HELP YOUR STAFF BECOME RVTs?
Awesome! The VTNE is a challenging exam, and you can help prepare them. Quiz them, ask them to do drug & fluid calculations, include them in your complicated cases, help pay their fees, and encourage them to attend HVTA’s study sessions.
Visit https://hvta.org/study-sessions-vtne-prep/ for more info.

THREE PATHS TO RVT
1. If already credentialed in another state: transfer VTNE scores, send license verification to DCCA.
2. If graduate of an AVMA accredited vet tech program: pass the VTNE with HI as your state.
3. Alternate Path (aka “grandfathering”): available now through July 2021 for on-the-job-trained technicians with 5+ years of experience in Hawaii, need notarized form from veterinarian, pass the VTNE with HI as your state.

For more information, see the Department of Commerce and Consumer Affairs (DCCA) Vet Tech page.

Sam Geiling, RVT

President, HVTA

Windward Community College

Kaneohe, HI

RVT Applications Now Available Online

Applications for licensing registration as a RVT in Hawaii are available online here.

Senate Bill 2671 passed in 2016 which set the following requirements to qualify as a veterinary technician in Hawaii:

Be at least 18 years of age
Have successfully passed the Veterinary Technican National Examination
Meets at least ONE of the following conditions:
1. Has successfully completed a course of study at a program for veterinary technology accredited by the AVMA committee on Veterinary Technician Education and Activities;
2. Be licensed, certified, or registered veterinary technician in good standing in another state having standards for registration comparable to those in this State; or
3. Prior to July 1, 2021, submits a notarized document from an employer who is a licensed veterinarian and who certifies that applicant has five or more years of practical experience in Hawaii; provided that no reciprocity shall be given for practical experience gained outside of the State.

Information for licensing in Hawaii can be found on the Department of Commerce and Consumer Affairs Professional and Vocational Licensing website. Additional information can be found at the HVTA website. Information about the VTNE can be found here.

2018 Legislative Session

Legislative Update 2018 Session

Bill	Summary	Status
HB2498	Establishes and appropriates funds for one full-time equivalent permanent veterinary medical officer position within the Department of Health. HVMA SUPPORTS.	Failed in Senate
HB1823	Defines emotional support animals and makes it a misdemeanor to knowingly make a misrepresentation regarding a service dog or emotional support animal.	Failed in House
HB2060	Removes the word “Examiners” from the names of the State Board of Chiropractic Examiners, Board of Dental Examiners, Board of Examiners in Optometry, and Board of Veterinary Examiners. Renames the boards with titles that more accurately reflect their scope and duties. HVMA defers to BVE stance.	Failed in Conference Committee
HB2081 SB2566	Appropriates funds to the Department of Land and Natural Resources to provide assistance and supplemental funding to the National Wildlife Research Center of the U.S. Department of Agriculture to conduct pilot field studies to evaluate control tools and develop a management plan to reduce the rose-ringed parakeet population on Kauai.	Passed; Sent to Governor
HB2270 SB2501	Requires the Department of Human Services to establish ohana zones where homeless persons may reside. Appropriates funds.	Failed
SB2014	Requires persons convicted of animal cruelty to register with the attorney general. Requires animal shelters, animal breeders, and pet stores to check whether an individual has been convicted of animal abuse when the individual applies to work or volunteer, or purchases or adopts an animal. Establishes penalties. Prevents persons convicted of animal cruelty from possessing, owning, or working in close proximity to animals. Requires police officers to be trained in identifying and investigating animal abuse.	Failed in Senate
SB2289	Establishes the offense of sexual assault of an animal. Provides for impoundment and forfeiture of a sexually assaulted animal.	Not heard
SB2435 HB2593	Requires the Department of Health to contract with a nonprofit animal rescue group to oversee caretakers of feral cats. Exempts registered caretakers of feral cats from state laws and county ordinances relating to the feeding and confinement of cats. Establishes a trap-sterilize-return process.	Failed
SB2461	Establishes the offense of “misrepresentation of a service animal”. Changes the term “service dog” to “service animal” and amends the definition of that term to conform with the Americans with Disabilities Act of 1990	Passed; Signed into law by Governor
SB2929	Establishes the Hawaii spay/neuter council to be administratively attached to the department of Commerce and Consumer Affairs. Establishes the Hawaii spay/neuter special fund. Imposes a fee on pet food to support the Hawaii spay/neuter grant program to spay and neuter dogs and cats. Makes an appropriation.	Not heard
HB2072	Prohibits certain restraints and tethers that endanger, or deny sustenance, to a dog. Adjusted penalties.	Failed in Conference Committee
SB2260	Requires veterinarians, upon request of the owner of an animal, to make available a copy of any prescription that the veterinarian has previously prescribed the animal free of charge. HVMA OPPOSED.	Deferred by Senate

Updated May 2018

2018 Legislative Update

HVMA Opposes SB2260

SB2260 requires veterinarians, upon request of the owner of an animal, to make available a copy of any prescription that the veterinarian has previously prescribed the animal free of charge. This bill will have a public hearing on Tuesday February 20, 2018 at 9:00AM at the Hawaii State Capitol conference room 229 by the Senate Committee on Commerce, Consumer Protection, and Health. Read the complete bill text (brief) here.

Please send in written testimony opposing this bill via the Hawaii State Legislature website (steps detailed below) by Monday Feb 19th 9am and consider testifying in person at Tuesday’s hearing.

HVMA opposes SB2260 because it places unnecessary legislative burden on veterinarians and is of questionable value to the public. According to Hawaii Revised Statutes 471-10, licensed veterinarians in Hawaii are required to practice by “the recognized principles of medical ethics of the veterinary profession as adopted by the Hawaii Veterinary Medical Association and the American Veterinary Medical Association”. According to the AVMA Principles of Veterinary Medical Ethics Section V.b.iii., “Veterinarians are obligated to provide copies or summaries of medical records when requested by the client.” Prior prescription information is already contained within a patient’s medical record and available upon request by the client (owner of the animal). In regards to current prescriptions, Section VII.f.iii. states: “Veterinarians are entitled to charge fees for their professional services: A veterinarian shall honor a client’s request for a prescription or veterinary feed directive in lieu of dispensing, but may charge a fee for this service.” AVMA’s Policy on Client Requests for Prescriptions states: “Veterinarians shall honor client requests to prescribe rather than dispense a drug (AVMA Principles of Veterinary Medical Ethics). The client has the option of filling a prescription at any pharmacy.”

Please make the voice of veterinarians heard and submit your testimony today:
1. Go to the Hawaii State Legislature website.
2. In the upper right hand corner, either “Sign In” to your account or “Register” if you do not have an account.
3. Once signed in, click on “Submit Testimony” (first orange button in the middle of the page).
4. Under “Enter Bill or Measure” enter SB2260 and click “Get Hearing”.
5. Complete your testimony submission (you may upload a document or enter your testimony directly on the webpage) and click “Submit”.
6. Feel good about participating in the legislative process and shaping the practice of veterinary medicine in Hawaii!

The Hawaii State Capitol is located at 415 South Beretania Street in downtown Honolulu. If you have never testified in person before and have questions about the process, please feel free to email us at contact@hawaiivetmed.org.

Other Current Pending Legislation

HB2498 – Establishes and appropriates funds for one full-time equivalent permanent veterinary medical officer position within the Department of Health. HVMA SUPPORTS.

HB1823 – Defines emotional support animals and makes it a misdemeanor to knowingly make a misrepresentation regarding a service dog or emotional support animal.

HB2060 – Removes the word “Examiners” from the names of the State Board of Chiropractic Examiners, Board of Dental Examiners, Board of Examiners in Optometry, and Board of Veterinary Examiners. Renames the boards with titles that more accurately reflect their scope and duties. HVMA defers to BVE stance.

HB2072 – Prohibits certain restraints and tethers that endanger or deny sustenance to a dog. Specifies penalties.

HB2081/SB2566 – Appropriates funds to the Department of Land and Natural Resources to provide assistance and supplemental funding to the National Wildlife Research Center of the U.S. Department of Agriculture to conduct pilot field studies to evaluate control tools and develop a management plan to reduce the rose-ringed parakeet population on Kauai.

HB2270/SB2501 – Requires the Department of Human Services to establish ohana zones where homeless persons may reside. Appropriates funds.

SB2014 – Requires persons convicted of animal cruelty to register with the attorney general. Requires animal shelters, animal breeders, and pet stores to check whether an individual has been convicted of animal abuse when the individual applies to work or volunteer, or purchases or adopts an animal. Establishes penalties. Prevents persons convicted of animal cruelty from possessing, owning, or working in close proximity to animals. Requires police officers to be trained in identifying and investigating animal abuse.

SB2289 – Establishes the offense of sexual assault of an animal. Provides for impoundment and forfeiture of a sexually assaulted animal.

SB2435 – Requires the Department of Health to contract with a nonprofit animal rescue group to oversee caretakers of feral cats. Exempts registered caretakers of feral cats from state laws and county ordinances relating to the feeding and confinement of cats. Establishes a trap-sterilize-return process.

SB2461 – Establishes the offense of “misrepresentation of a service animal”. Changes the term “service dog” to “service animal” and amends the definition of that term to conform with the Americans with Disabilities Act of 1990

SB2929 – Establishes the Hawaii spay/neuter council to be administratively attached to the department of Commerce and Consumer Affairs. Establishes the Hawaii spay/neuter special fund. Imposes a fee on pet food to support the Hawaii spay/neuter grant program to spay and neuter dogs and cats. Makes an appropriation.