Florida Laws and Rules Governingthe Practice of Veterinary Medicine

Presented by: Bryan W. Reynolds, Esquire

Link to Florida Rules & Laws - Reference Booklethttp://rpslaw.net/seminarsces.html

Bryan W. Reynolds8950 Dr. M. L. King Jr. St. N, Ste 220

St. Petersburg, FL 33702Phone: 727-570-4660

Email: breynolds@rpslaw.net

Education: Shippensburg University of Pennsylvania (B.S.B.A., 1984);Stetson University (J.D., 1986). Beta Gama Sigma; Kappa Delta Pi

Experience: During his attendance at Stetson College of Law and before his admission to the Florida Bar, Mr. Reynolds was employed as a clerk for Fox & Grove, Florida Partnership. Mr. Reynolds became an associate with Fox & Grove, Florida Partnership upon his admission to the Florida Bar in 1987. Mr. Reynolds became a partner at Fox, Grove, Abbey, Adams, Reynolds, Byelick and Kiernan on April 1, 1991. As of November 1, 1995 Mr. Reynolds started the new firm of Reynolds & Stowell, P.A. (which has now become Reynolds Parrino Spano & Shadwick, P.A.).

Mr. Reynolds is experienced in the following areas of litigation: motor vehicle liability; uninsured motorist claims in both litigation and arbitration; PIP; coverage questions; premise liability; veterinary malpractice; DBPR licensing claims; multiple competing claims; and time demands. He has been counsel in approximately ninety-four jury trials and thirty appeals. Bryan Reynolds is a Board Certified Trial Attorney.

3 Types of Cases

A. Civil Cases

B. Criminal Cases

C. Administrative Law Cases

Civil Cases

• Burden of Proof• 2 year Statute of Limitations• Most cases Plaintiff needs Expert Witness• Do not need an Expert Witness Pre-suit• May demand a Jury Trial or a Bench Trial• Anyone may file as long as they have a filing fee

Criminal Cases

• Burden of Proof• State Attorney Prosecutes• 5th Amendment Right• If convicted, found guilty, plea-no contest or guilty,

regardless of adjudication, a crime in any jurisdiction. MUST REPORT within 30 days! 455.277(1)(t)

• Jury or bench trial

Administrative Law

• Burden of Proof• No Jury Trial – Administrative Law Judge

• Video Conferencing with Court Reporter• Rules of Evidence

• Licensing defense coverage

Your Actions can subject you to all three Areas at Once!

Look out!

Florida Rules & Laws:

Florida Rules & Laws governing the practice of Veterinary medicine in Florida

• Chapter 455 – DBPR: General Provisions• Chapter 465 – Pharmacy• Chapter 474 – Veterinary Medical Practice• Chapter 499 – Drug, Cosmetic, and Household Products• Chapter 585 – Animal Industry• Chapter 828 – Animals: Cruelty; Sales; Animal Enterprise Protection• Chapter 893 – Drug abuse Prevention and Control• Chapter 61G18 – Fl. Admin Code; Organization, Purpose, Meetings,

Probable Cause Panel, Procedures

Florida Rules & Laws:

Florida Statutes Chapter 455; Business and Professional Regulation

• 455.217 – Monitoring• 455.225 – Disciplinary Proceedings

• “Uniform Complaint”• Anyone allege facts and sign.• Anonymous?• Confidential Informant

• 455.228 – Unlicensed• 455.24 – Advertising

• “Free”• Discounted

Florida Rules & Laws:

Florida Statutes Chapter 455; Business and Professional Regulation (cont’d)

• 455.242 – Disposition of Records• 455.243 – Authority to Inspect • 455.275 – Address of Record

• Mailing• Email• Place of Practice• If any fail = Violation

Florida Rules & Laws:

Florida Statutes Chapter 474; Veterinary Medical Practice

• 474.213 - Prohibitions – Shall Not• 474.214 - Disciplinary proceedings • 474.2145 - Subpoenas for records –

• Includes names & addresses of some or ALL Clients!

Florida Rules & Laws:

Florida Statutes Chapter 474; Veterinary Medical Practice (cont’d)

• 474.2165 - Ownership of Records, control • Records Owner = generates medical record, employment contract• Actual Cost of Reproduction

• 474.2185 - Consent handwriting or Physical Exams • 474.221 - Impaired Practitioner

Florida Rules & Laws:

Florida Statutes Chapter 585; Animal Industry

Disease Inspection, Control and Eradication

• 585.09 – Procedures for condemnation of animals and property by department

• 585.18 – Duty to report diseased animals• 585.19 – Duty of practitioners of veterinary medicine

and owners of animals to report dangerous transmissible diseases or pests.

Florida Rules & Laws:

Florida Statutes Chapter 828; Animals; Cruelty; Sales; Animal Enterprise Protection

• 828.058 – Euthanasia of dogs and cats• 828.12 – Cruelty to animals• 828.126 – Sexual activities involving animals• 828.29 – Dogs and cats transported or offered for sale;

health requirements; consumer guarantee• 828.30 – Rabies vaccination of dogs, cats, and ferrets

Florida Rules & Laws:

A. Chapter 61G18 – Florida Administrative Code Rules• Section 15 - Permits – min stds – premises, mobile and

inspections. Limited – Service Veterinary & Records (Disclaimer)• Section 16 - Continuing Education and Euthanasia tech cert.• Section 17 - Exemptions & Exceptions – tasks requiring

immediate supervision and tasks only a Vet can do.• Section 18 - Medical Records – deceased – relocation/termination

and maintenance of Medical Records (amended Nov. 18, 2012)• Contemporaneous• Physical Examination (see Rule Changes)

Florida Rules & Laws:

Chapter 61G18 – 18.002 Maintenance of Medical Records (Pre 11/18/2012)(3) Medical records shall be contemporaneously written and include the date of each service performed. They shall contain the following information:

Name of Owner or agentPatient IdentificationRecords of any vaccination administeredComplaint or reason for provisions of servicesHistoryPhysical ExaminationAny present illness of injury notedProvisional diagnosis or health status determination

Florida Rules & Laws:

Chapter 61G18 – 18.002 Maintenance of Medical Records (Post 11/18/2012)(3) Medical records shall be created as treatment is provided or within 24 hours of the time of treatment and include date of each service performed. They shall contain the following information:

Name of Owner or agentPatient IdentificationRecords of any vaccination administeredComplaint or reason for provisions of servicesHistoryPhysical Examination to include but not limited to patient weight, temperature, pulse, and respiration or noted exceptions to the collection of said information. Any present illness of injury notedProvisional diagnosis or health status determination

Florida Rules & Laws:

Chapter 61G18 – 18.002 Maintenance of Medical Records (Pre 11/18/2012) (continued)(4) In addition, medical records shall contain the following information if these services are provided or occur during the examination or treatment of an animal or animals:

Clinical laboratory reportsRadiographs and their interpretationConsultationTreatment – medical, surgicalHospitalizationDrugs prescribed, administered, or dispensedTissue examination reportNecropsy findings

Florida Rules & Laws:

Chapter 61G18 – 18.002 Maintenance of Medical Records (Post 11/18/2012) (continued)(4) In addition, medical records shall contain the following information if these services are provided or occur during the examination or treatment of an animal or animals:

Clinical laboratory reportsRadiographs and their interpretationConsultationTreatment – medical, surgicalHospitalizationDrugs prescribed, administered, or dispensed along with the route, strength, and dosage of the drug and time said drug was administered if not otherwise discernable from the record.Tissue examination reportNecropsy findings

Florida Rules & Laws:

A. Chapter 61G18 – Florida Administrative Code Rules• Section 19 - Standard of Practice• Section 20 - Impaired Physicians• Section 21 - Advertising• Section 30 - Discipline – guidelines - do not have to follow to the

letter of the law – departure.

Florida Rules & Laws:

Criminal Self-Reporting Document

Client Complaint

Complaint by Client or DBPR

1. Uniform Complaint Served to you at address on record.

2. 20 days from date of receipt to respond.A. Options

I. IgnoreII. General DenialIII. Hire Bryan Reynolds/Serve Response = CV, Records + Your side.

B. Confidential at this timeC. License History

Client Complaint

Complaint by Client or DBPR

3. Wait 90-180 days4. Sent to Legal5. Sent to Probable Cause Committee

Case Study #1

COMPLAINT ALLEGATIONS

The Uniform Complaint alleges a violation of Chapter 474 against Dr. Do-Good.The specific allegation is a violation of F.S. 474.214(1)(R), incompetence ornegligence by failing to practice medicine with acceptable standard of care andFS 474.214(1)(EE) failing to keep contemporaneously written medical records asrequired by rule of the board.Specifically, Complainer brought her dog in with diarrhea; he eventuallystopped eating food and drinking water. On 4/15/15, blood work and x-rayswere done and he was given Metronidazole ½ tablet every 12 hours. The testsrevealed that his liver was enlarged and had an infection, possibly fromingesting something toxic. Complainer’s dog was left under Dr. Do-Good’s care.So Dr. Do-Good could administer him an IV for dehydration and an antibioticinjection. Complainer was unaware of a cerenia injection. Complainer’s dog wasgiven 3 medicines: same 1 every 24 hours, Baytril ½ tablets every 24 hours, andcerenia tablet of 16mg every 24 hours. Complainer’s dog’s bowels were blackand Dr. Do-Good told her to stop giving him the cerenia. Complainer’s petcouldn’t walk and later passed away. Complainer did some research on cereniaand it is not supposed to be administered to pet with liver problems, or smalldogs, and/or administered to pets that have possibly ingested something toxic.Complainer states that the records are incomplete and information was altered.NOTE the foregoing are the allegations of the Complainant and should not beinterpreted as agreed to by Dr. Do-Good.

RESPONSE TO THE ALLEGATIONS

Please refer to the medical records from Animal Hospital in conjunction with Dr.Do-Good’s response. First, the Complainer presented DOG for very sporadictreatment before April 15, 2015. When referring to the records, theComplainer brought DOG in only when there was a problem and not for regularcheckups or well care. On December 17, 2012, DOG got hurt jumping soveterinary care was sought. Then on September 10, 2013, when DOG tooth fellout she again sought out veterinary care.Next on April 15, 2015 Complainer brought her 15.5 year old, male neutered,DOG, to Dr. Do-Good’s office because DOG had diarrhea since Easter on April 5,2015. (Complainer allowed DOG to have diarrhea for approximately 10 daysbefore seeking out the services of a veterinary physician.) Complainer hadbeen feeding DOG chicken and brown rice. Initially there had been someimprovement, but then DOG began refusing to eat, and the diarrhea worsenedagain. DOG was also PU/PD (polyuria/polydipsia), which was consistent with anelevation of the BUN, creatine and phosphourus. The increases seen withAmylase and Lipase can be consistent with pancreatitis. Pancreatitis typicallyresults in vomiting, abdominal pain and subsequent abdominal splinting, thesesymptoms were not present at this time. Complainer was concerned that herapartment complex had possibly sprayed for bugs in her absence.

Case Study #1

A proper physical examination was performed, vitals recorded and the blood was collected for a CBC, Profile, and T4, the blood work charts are attached. Metronidazole 250 mg ½ tablet, BID was prescribed for the colitis. The tests revealed elevation of an enzyme Alkaline Phosphatase, this can be indicative of choleostatic liver disease as well as a number of non-hepatic diseases. Alkaline Phosphatase comes from a variety of tissues such as; kidney liver, bone, and intestine. It is a non liver specific enzyme. Additionally, exogenous corticosteroid administration and endogenous cortisol elevation i.e. Cushing’s Disease can also elevate Alkaline Phosphatase. Other increases of Alk Phos can occur as a result of primary liver disease ( hepatitis, neoplasia, and nodular hyperplasia) acute or chronic stress causing reactive hepatopathy or physiologic stress associated with acute or chronic stress (neoplasia, infection, inflammation, pancreatitis, GI disease, and bone related disease). A phone call to the office was made on April 17th informing the office that DOG was now vomiting. She was told to come into the office.On April 17, 2015 Complainer returned with DOG with the complaint that he had begun to vomit. She was syringe feeding him baby food and water and he was unresponsive. DOG had regurgitated the food and water multiple times that day. DOG was admitted to the hospital for administration of subcutaneous fluids and a radiograph. A physical examination was performed and again the vitals were recorded. The CBC from 4/15/15 revealed an elevated WBC and slightly toxic neutrophils.

A pathologist reviewed DOG’s platelets and determined the numbers were adequate. Cerenia was administered by injection and dispensed for at home use the next day; Baytril was also dispensed. A radiograph was taken revealing mild liver enlargement (slights rounding of the liver lobes). There was no further regurgitation while DOG was hospitalized and he was discharged to Complainer’s care in stable condition.Complainer called on Sunday, April 19, 2015 to report that DOG had vomited blood a few minutes after administering the oral Cerenia. Dr. Do-Good discussed with her that there was no way that the medication had been absorbed in that short of a timeframe, and that it had not caused the gastric bleeding. Dr. Do-Good called CVS for Sucralfate to coat any possible GI erosion of ulceration. On April 20, 2015, Complainer arrived at the hospital to inform Dr. Do-Good that DOG had passed away and requested his medical records. It is believed that no necropsy was performed and it is unknown what the cause of death was for DOG who was at an advanced age.

Case Study #2

COMPLAINT ALLEGATIONS

The Uniform Complaint alleges violation of Chapter 474 against Dr. Goodheart.The specific allegation is the violation of F.S. 474.214(1)(R), GrossNegligence/Incompetency. Specifically, on January 18th, 2015, Dr. Goodheartdiagnosed the Complainant’s cat, Fat Cat, with feline diabetes and begantreatment of insulin injections twice daily. On February 7th, 2015, Fat Catstopped eating and began to show signs of weakness and thirst. The next day,Fat Cat was taken to the Dr. Goodheart’s clinic, where they did a glucose curveand a snap pancreatic lipase test. Also, they gave him fluids for his dehydrationand sent home with anti-nausea medicine and appetite enhancing medicine totreat Fat Cat for dehydration. On February 9th, 2015, Complainant asked tohave Fat Cat tested for ketones. Dr. Goodheart confirmed that it wasketoacidosis and stated that there was nothing he could do, and to take Fat Catto Emergency Hospital. Fat Cat was transferred to Dr. Betterheart for care. FatCat was diagnosed with ketoacidosis and hepatic lipidosis. Complainant arguesthat Dr. Goodheart failed to diagnose Fat Cat and he did not run the necessarytests to diagnose or treat him causing Fat Cat pain. Fat Cat’s health andcondition had declined so much that he was euthanized. (NOTE: that the aboveallegations are per the Complainant and are NOT agreed to by Dr. Goodheartand should not be accepted as truthful.)

RESPONSE TO ALLEGATIONS

On January 17, 2015 there was an appointment scheduled as “New clientannual vaccine” but upon arrival the owner presented Fat Cat with multiplecomplaints and health issues all of which included vomiting, significant weightloss, trouble breathing the was described as “wheezing”. The owner wasconcerned about kitty asthma. Fat Cat also came in with black eye dischargeand possibly fleas. Fat Cat was not on any flea prevention and had not seen aveterinarian in over FIVE (5) years with NO vaccine history. The onlyveterinarian visit was in Selinsgrove, Pennsylvania when he was originallyadopted. The service included in the “annual vaccine” visit would be gettingthe vaccines and FeLv/Fiv test. The owner noted that Fat Cat was fractious andunfriendly with other people. When Fat Cat was taken back to get a weight andTPR, he immediately became irritated, stressed and fractious. It was decidedthat the best plan of action for Fat Cat was to prescribe gabapentin and sendhim home and have him come back the next day and be dropped off because hewould need a complete/full work up to include radiographs, blood work, andpossibly fluids along with an annual complete examination. The owner waspresented with an estimate that included all of this but the owner said thatthey could not afford the end price that was over $500.00.

Case Study #2

Dr. Goodheart spoke with his office manager, Mario, and Mario talked to theowner and it was agreed that the owner would come back in the morning as adrop off and the work would be done, but the charge would only be 50% of thecosts of the estimate and that the clinic would eat the rest. On the estimatefluids, medications to go home were not included. Owner said that they wouldpay for 40% of the cost of the bill and would be back the next morning. Theoption of going to an Emergency Hospital was also presented to the owner butthey stated that they felt like Fat Cat could wait till the next morning as thishas been going on for over a month’s duration.

On January 18th, Fat Cat was brought back to be seen by Dr. Goodheart. TheJanuary 18th visit consisted of a physical exam, history, radiographs, bloodwork, FeLv/FIV Snap test and medications/vaccinations.

On January 19th, Dr. Goodheart diagnosed Fat Cat with diabetes. There werephone communications that day wherein Dr. Goodheart talked with the ownerabout diabetes management and emergency situation. There was another callby the office to follow up to see how the patient was doing. It was reportedthat Fat Cat was doing well but was groggy from waking up from sedation.NONE of the phone calls were documented.

On January 24th the owner came in to pick up U-40 syringes but unable to doso because of financial concerns. Some canned food was picked up on February3rd.

On February 8th there was a phone call that Fat Cat was not getting any better,he stopped eating since yesterday and was just laying down and did nothing.Fat Cat was dropped off to be examined. Fat Cat had been vomiting for thepast 2 days. The owner had not given insulin in the past 2 days. A physicalexamination and some tests were done. However, some testing was not donedue to financial concerns with the owner. You can see the clientcommunication in reference to the financial concerns expressed in the records.Again the assessment of Fat Cat was that she had diabetes with glucose of 565.

On February 9, Dr. Goodheart spoke to the owner and recommended that FatCat be taken to a 24 hour clinic. The owner then took Fat Cat to see Dr.Betterheart, where he performed an exam and testing, and saw Fat Cat had notimproved and possibly was getting worse. Dr. Betterheart recommended thatthe best course would be hospitalization at a 24 hour hospital or humaneeuthanasia. Fat Cat needed 24 hour monitoring and Dr. Goodheart’s clinic wasnot equipped to do the same. The owner opted for euthanasia and it wascompleted.

Client Complaint

SETTLEMENT AGREEMENT

Patient Name: _______________________

I, _________________________, agree to release any and all claims, damages, costs, and any compensation whatsoever which has accrued on account of or in any way arising out of the care, treatment and/or evaluation of __________________________ by Dr. ______________, his/her staff or the veterinary facility.

It is understood and agreed that Dr. ___________has paid/ written off charges for the disputed claim as to the amount of $_________. This agreement, nor the payment of monies/monies written off, shall be construed as an admission of liability, and Dr. ____________, his/her staff and the veterinary facility denies any fault/negligence. It is agreed that the terms of this settlement is confidential and shall not be disclosed to any third party, person or entity, without a lawful subpoena. The terms of this settlement shall not be posted/discussed on any social/electronic media.

THE UNDERSIGNED HAS READ THE FOREGOING SETTLEMENT AGREEMENT AND FULLY UNDERSTANDS IT.

_____________________________ ________________________ ____________

Print Name/OWNER NAME Signature Date

__________________________ _____________________ ___________

Dr. Signature Date

I Didn’t Know That?!

Defenses1. Wrong Identity2. No Necropsy defense3. Battle of Experts4. Bad result ≠ Malpractice/Breach

of Standard of Care5. Proper Documentation per 61G18-

18.002 (3)(4)

Not a Defense(s)1. Way we always have done it2. They couldn’t afford better care3. Did it for FREE4. Technician did not write it down5. Owner was a pain6. Board does not like

a) Relief Vetsb) Homeopathic Vetsc) Limited Service Vets

7. Everybody does it that way

Penalties and Guidelines

Chapter 61G18-30 Discipline

Penalties

What can they do to you: reprimand, fine, restrict practice, probation, suspension, revocation, denial of application for licensure or own facility, retake exams.IF very minor Notice of Non Compliance

Aggravation/Mitigation – DepartureDanger to PublicLOT since violation# times disciplined by BoardLOT practicedActual damage, physical or otherwiseDeterrent effectEffect on Livelihood

Effort for rehabActual knowledge of violationAttempts to correct or stop violationRelated violationsActual NegligencePecuniary Benefit

Reference Material

Florida Rules & Laws - Reference Booklethttp://rpslaw.net/seminarsces.html

Bryan W. Reynolds, Esquire8950 Dr. M. L. King Jr. St. N., Ste 220

St. Petersburg, FL 33702Office: 727-570-4660

Cell: 727-422-9967Email: breynolds@rpslaw.net