If disciplinary actions of veterinarians were more easily accessed, it would not necessarily prevent compounding incidents such as Franck's, but it would make the public more aware of whether a veterinarian has previously been disciplined in relation to compound preparations. Aligus is an organization founded to advocate against veterinary malpractice, incompetence and negligence and to educate the public about how state veterinary boards handle citizens' complaints. The following article address some of the deficiencies in this area. The article can be found at www.ALIGUS.COM
Veterinary Boards
Each state veterinary board is responsible for licensing veterinarians and regulating the practice of veterinary medicine for the State.
Their mission is to safeguard against unqualified practitioners and to protect the public against veterinary malpractice, incompetence and negligence by carrying out their regulatory duties. State statutes and rules, generally called the Veterinary Practice Act, stipulate the regulation and enforcement of veterinary medicine.
Their mission is to safeguard against unqualified practitioners and to protect the public against veterinary malpractice, incompetence and negligence by carrying out their regulatory duties. State statutes and rules, generally called the Veterinary Practice Act, stipulate the regulation and enforcement of veterinary medicine.
A performance audit of the Arizona Veterinary Medical Examining Board conducted by The Office of the Auditor General pursuant to a May 29, 1995, resolution of the Joint Legislative Audit Committee detailed deficiencies so serious as to jeopardize the continued existence of the Board. The audit stated that if the Board did not rectify these problems after a five-year time period, the Legislature should consider other alternatives to ensure that the State's regulatory
Sources: http://www.auditorgen.state.az.us/PAD/97-7s.htm; http://www.auditorgen.state.az.us/Reports/State_Agencies/Agencies/Veterinary_Examining_State_Board_of/Performance/97-07/97-7.pdf
Sources: http://www.auditorgen.state.az.us/PAD/97-7s.htm; http://www.auditorgen.state.az.us/Reports/State_Agencies/Agencies/Veterinary_Examining_State_Board_of/Performance/97-07/97-7.pdf
THESE DEFICIENCIES RAISE QUESTIONS ABOUT ALL STATE BOARDS.
1. DO BOARDS DISCIPLINE WHEN WARRANTED?
In the Arizona audit, the dismissal rate of complaints had been as high as 90 percent. Veterinary consultants retained by the Auditor General of the State of Arizona reviewed complaints from fiscal year 1996 and found that as many as one out of every six complaints dismissed should have resulted in some discipline. The Board dismissed a complaint against a veterinarian who inserted a feeding tube into a cat's lungs instead of its stomach. The cat died when food was injected through the tube. The Board dismissed a complaint against a veterinarian who euthanized a dog without the proper consent. In a Board meeting, even though the veterinarian admitted making the error, the Board still dismissed the complaint.
Source: http://www.auditorgen.state.az.us/PAD/97-7s.htm.
Since January 1, 1998 more than half of the complaints before the Arizona Board were dismissed. In an average year, one license is revoked and usually this is for drug abuse by the DVM, not animal mistreatment. Most penalties are for failure to notify the board of an address change. Only two Tucson-area veterinarians faced probation or more serious discipline in the past five years for animal care or client interaction. The board's own records are incomplete, inconsistent and inaccurate
Source: http://www.azstarnet.com/star/sun/30629VETS2f2fdst-jmd.html, June 29, 2003
The Minnesota biennial report for 2004 - 2006 shows of the closed complaint cases 73% were dismissed for fiscal year 2005; 64% dismissed for 2006.
Source: www.asu.state.mn.us/LinkClick. aspx?link=26_Vet_Med.pdf&mid=2868
An August 1, 2005 article in the Ohio newspaper, Toledo Blade, states that the Ohio Veterinary Medical Licensing Board doesn't keep a running total of disciplinary actions. Disciplinary actions and the complaints that prompted them are only recorded in the files of veterinarians and complaints are removed from the files after two years. According to the article, a review of the Board’s online meeting minutes revealed 56 disciplinary actions and 479 complaints between January, 2002, and May, 2005. But a review of the individual files for Ohio's 2,378 veterinarians found that only 45 of them have ever had disciplinary action taken against them through a disciplinary order or a settlement involving a suspension or fine.
Source: http://www.toledoblade.com/apps/pbcs.dll/article?AID=/20050801/NEWS08/508010309
In Texas 8% or only 17 out of 212 of complaints received in 2006 resulted in discipline - 92% did not. The TVBME Strategic Plan, 2007-2011, states that the agency did not have sufficient funds for State Office of Administrative hearings in fiscal year 2006. The TVBME cites the results were having two cases that had to be postponed until funding could be acquired and that it was forced to settle several cases and reduce sanctions on other cases where it felt prosecuting them would be in the "best interest of the public".
Sources: http://cbs11tv.com/topstories/local_story_080203249.html;http://www.tbvme.state.tx.us/07-11%20Strat%20Plan.pdf
In North Carolina 52.8% of the 53 complaints considered were dismissed in 2009. Between 1995 to 2008 the dismissal rate ranged from 58 to 91%.
Source: Compilation of complaints from NCVMB Board Minutes, 1995 - 2009.
In California, 420 complaints were filed in 2000. The board issued fines and citations in only 53 cases. Six resulted in probationary measures, and four in license revocations. 85% of the complaints filed did not result in disciplinary actions. Most of the disciplinary actions involved police matters, such as drug abuse. Malpractice allegations are rarely disciplined.
Source: http://classic.sacbee.com/ourtown/pets/vets.html
In the State Board Report published by the Missouri Veterinary Medical Board September 2001, 39 official veterinary complaints were received, 11 investigations were initiated, 9 investigations were completed, 10 cases were referred to the Attorney General's office and 7 stipulation agreements were signed,
Source: http://www.ded.state.mo.us/regulatorylicensing/professionalregistration/vet/pdfs/vetvolume1iss4.pd
The Louisiana Board of Veterinary Medicine logged 24 complaints for July 2002 - June 2003. During that period 31 cases were considered and closed, with 2 cease and desist notices issued. There were two consent orders signed. There were 48 open complaints under investigation.
Source: http://www.lsbvm.org/news_02_12.htm#Complaint Statistics FY2003
In 2001 the Nevada State Board of Veterinary Medical Examiners dismissed 29 of 50 formal complaints filed (58%). There were 9 disciplinary settlement agreements. In 2002, 31 of 39 formal complaints filed were dismissed (79%). There were 6 disciplinary settlement agreements with 1 administrative hearing held/pending.
Source: http://vetboard.nv.gov/brdupd.htm
In Colorado the totals for 1/1/00 - 12/31/2001: Dismissed Cases = 115 (74%);
Letters of Admonition = 18; Cease & Desist Orders = 7; Stipulation/Final Agency Orders = 16.
Source: http://www.dora.state.co.us/veterinarians/images/PDFsUsedAsImages/VetNwsltr2001.pdf
The Rhode Island Board of Veterinary Examiners reports issuing ONLY A TOTAL OF EIGHT SANCTIONS (including simple reprimands) between 1993-2003.
Source: http://www.health.ri.gov/hsr/professions/vets.htm
"When disciplinary action is taken without following prescribed guidelines, the Board is perceived by some to be like the proverbial fox guarding the chicken coop if the sanction is deemed too lenient or otherwise inappropriate."
Source: http://www.state.oh.us/watchdog/investigations\vetbrd.pdf
Veterinary boards' records of weak disciplinary actions may be partly attributable to their failure to adequately investigate most consumer complaints. When a complaint is received, boards routinely request the medical records and a response from the veterinarian involved. However, despite most now having investigators, basic investigative steps such as interviewing the complainant and other involved parties, such as the doctor's staff, are generally not performed. In fact, a complainant was interviewed in only 3 of the 102 cases the Arizona performance audit.
Another problem with Board's complaint processes is that Boards often inappropriately limit the extent of the investigation performed on each complaint. In the Arizona performance audit, rather than allowing the Board's investigators to fully pursue each complaint and present the findings to the Board for adjudication, the Board heard each complaint in a public meeting and set limits on what the investigator should do. A review of the 22 complaints in fiscal year 1996 in which the Arizona Board directed the investigation found that the Board, on average, gave the investigator 2 directives per complaint. These directives involved limited actions, such as obtaining the names of the veterinarians who worked on a given day, or photographing a veterinary facility's sign.
Boards often expend only a small percentage of their budget on investigating complaints.
Source: http://www.auditorgen.state.az.us/PAD/97-7s.htm.
Since January 1, 1998 more than half of the complaints before the Arizona Board were dismissed. In an average year, one license is revoked and usually this is for drug abuse by the DVM, not animal mistreatment. Most penalties are for failure to notify the board of an address change. Only two Tucson-area veterinarians faced probation or more serious discipline in the past five years for animal care or client interaction. The board's own records are incomplete, inconsistent and inaccurate
Source: http://www.azstarnet.com/star/sun/30629VETS2f2fdst-jmd.html, June 29, 2003
The Minnesota biennial report for 2004 - 2006 shows of the closed complaint cases 73% were dismissed for fiscal year 2005; 64% dismissed for 2006.
Source: www.asu.state.mn.us/LinkClick. aspx?link=26_Vet_Med.pdf&mid=2868
An August 1, 2005 article in the Ohio newspaper, Toledo Blade, states that the Ohio Veterinary Medical Licensing Board doesn't keep a running total of disciplinary actions. Disciplinary actions and the complaints that prompted them are only recorded in the files of veterinarians and complaints are removed from the files after two years. According to the article, a review of the Board’s online meeting minutes revealed 56 disciplinary actions and 479 complaints between January, 2002, and May, 2005. But a review of the individual files for Ohio's 2,378 veterinarians found that only 45 of them have ever had disciplinary action taken against them through a disciplinary order or a settlement involving a suspension or fine.
Source: http://www.toledoblade.com/apps/pbcs.dll/article?AID=/20050801/NEWS08/508010309
In Texas 8% or only 17 out of 212 of complaints received in 2006 resulted in discipline - 92% did not. The TVBME Strategic Plan, 2007-2011, states that the agency did not have sufficient funds for State Office of Administrative hearings in fiscal year 2006. The TVBME cites the results were having two cases that had to be postponed until funding could be acquired and that it was forced to settle several cases and reduce sanctions on other cases where it felt prosecuting them would be in the "best interest of the public".
Sources: http://cbs11tv.com/topstories/local_story_080203249.html;http://www.tbvme.state.tx.us/07-11%20Strat%20Plan.pdf
In North Carolina 52.8% of the 53 complaints considered were dismissed in 2009. Between 1995 to 2008 the dismissal rate ranged from 58 to 91%.
Source: Compilation of complaints from NCVMB Board Minutes, 1995 - 2009.
In California, 420 complaints were filed in 2000. The board issued fines and citations in only 53 cases. Six resulted in probationary measures, and four in license revocations. 85% of the complaints filed did not result in disciplinary actions. Most of the disciplinary actions involved police matters, such as drug abuse. Malpractice allegations are rarely disciplined.
Source: http://classic.sacbee.com/ourtown/pets/vets.html
In the State Board Report published by the Missouri Veterinary Medical Board September 2001, 39 official veterinary complaints were received, 11 investigations were initiated, 9 investigations were completed, 10 cases were referred to the Attorney General's office and 7 stipulation agreements were signed,
Source: http://www.ded.state.mo.us/regulatorylicensing/professionalregistration/vet/pdfs/vetvolume1iss4.pd
The Louisiana Board of Veterinary Medicine logged 24 complaints for July 2002 - June 2003. During that period 31 cases were considered and closed, with 2 cease and desist notices issued. There were two consent orders signed. There were 48 open complaints under investigation.
Source: http://www.lsbvm.org/news_02_12.htm#Complaint Statistics FY2003
In 2001 the Nevada State Board of Veterinary Medical Examiners dismissed 29 of 50 formal complaints filed (58%). There were 9 disciplinary settlement agreements. In 2002, 31 of 39 formal complaints filed were dismissed (79%). There were 6 disciplinary settlement agreements with 1 administrative hearing held/pending.
Source: http://vetboard.nv.gov/brdupd.htm
In Colorado the totals for 1/1/00 - 12/31/2001: Dismissed Cases = 115 (74%);
Letters of Admonition = 18; Cease & Desist Orders = 7; Stipulation/Final Agency Orders = 16.
Source: http://www.dora.state.co.us/veterinarians/images/PDFsUsedAsImages/VetNwsltr2001.pdf
The Rhode Island Board of Veterinary Examiners reports issuing ONLY A TOTAL OF EIGHT SANCTIONS (including simple reprimands) between 1993-2003.
Source: http://www.health.ri.gov/hsr/professions/vets.htm
"When disciplinary action is taken without following prescribed guidelines, the Board is perceived by some to be like the proverbial fox guarding the chicken coop if the sanction is deemed too lenient or otherwise inappropriate."
Source: http://www.state.oh.us/watchdog/investigations\vetbrd.pdf
2. DO BOARDS ADEQUATELY INVESTIGATE MOST COMPLAINTS?
Veterinary boards' records of weak disciplinary actions may be partly attributable to their failure to adequately investigate most consumer complaints. When a complaint is received, boards routinely request the medical records and a response from the veterinarian involved. However, despite most now having investigators, basic investigative steps such as interviewing the complainant and other involved parties, such as the doctor's staff, are generally not performed. In fact, a complainant was interviewed in only 3 of the 102 cases the Arizona performance audit.Another problem with Board's complaint processes is that Boards often inappropriately limit the extent of the investigation performed on each complaint. In the Arizona performance audit, rather than allowing the Board's investigators to fully pursue each complaint and present the findings to the Board for adjudication, the Board heard each complaint in a public meeting and set limits on what the investigator should do. A review of the 22 complaints in fiscal year 1996 in which the Arizona Board directed the investigation found that the Board, on average, gave the investigator 2 directives per complaint. These directives involved limited actions, such as obtaining the names of the veterinarians who worked on a given day, or photographing a veterinary facility's sign.
Boards often expend only a small percentage of their budget on investigating complaints.
In the fiscal year 2002, Tennessee reported percentage of revenues expended as: Licensing 89.72%, Legal Services 2.54%, and Investigations 7.74%.
Source: http://www2.state.tn.us/health/Boards/Veterinary/funding.htm
Source: http://www2.state.tn.us/health/Boards/Veterinary/funding.htm
Between 1994 -2002, the NCVMB expended less than 1% of total revenues on investigations. In some years, there were no line item expenditures for investigations at all. North Carolina did not have a full time investigator until December 2001. Prior to that time "investigations" were conducted by the Executive Director and Board members with a private detective being engaged on a few rare occasions. Other percentages of revenues expended were: Examination expenses (for licensing) 10%; Legal. accounting and audit fees 15%; and Facilities inspections - travel 3%.
Sources: Minutes of the North Carolina Veterinary Medical Board 1995-2003;
1994-2002 Annual Financial Audits prepared by Shelton L. Hawley, C.P.A. for the NCVMB
Source: www.state.oh.us/watchdog/investigations\vetbrd.pdf
In North Carolina, 207 days elapsed between the NCVMB's vote to issue a Letter of Reprimand regarding a citizen's complaint and when it actually mailed the reprimand. Upon receipt, one of the veterinarians reprimanded requested an Administrative Hearing. Thereafter, 343 more days elapsed before the Notice of Hearing was actually mailed.
In North Carolina, 492 days elapsed between the NCVMB's vote to issue a Notice of Hearing and when the Notice was mailed in an NCVMB initiated complaint consolidated with a citizen's complaint. Attorneys for the NCVMB and the veterinarian jointly requested the Administrative Law Judge for three delays prolonging the start of the hearing an additional 91 days thus further contributing to the overall length of time to complete the adjudication process. The hearing never occurred. The NCVMB and the veterinarian entered into a negotiated discipline settlement, 36 days prior to the start of the hearing.
Sources: NCVMB Minutes and Other Public Records Documents of the NCVMB
Although the statutes and regulations between states are comparable, the discipline issued for similar violations often varies. As an example, in 2003 three Texas veterinarians failed to have valid DEA permits for handling controlled substances. Each was fined $250.00, issued a formal reprimand and required to take and pass the TBVME's Jurisprudence Examination. Although North Carolina has an equivalent law, in 2002 a North Carolina veterinarian found by DEA inspectors with controlled substances without a valid permit as documented to the NCVMB by the DEA was issued a Letter of Caution.
Sources: http://www.state.tx.us/tbvme/downloadables/03-2003BoardNotes.pdf; NCVMB Public Records files
In 2002, the Florida Veterinary Board, in reviewing a complaint, found that a veterinarian's medical records were unclear as to which anesthetic was used or how much IV fluids were used during the surgery. The Board's Stipulation imposed a $250.00 fine, costs of $849.88, and additional continuing education in record keeping. In North Carolina, the NCVMB found that medical records of a veterinarian were poor, that he billed for some things that were not in the record and did not provide adequate medical care following surgery and again that same night -- total discipline imposed was a Letter of Reprimand with no fine or continuing education requirements.
Sources: http://www.state.fl.us/dbpr/pro/vetm/meet/minutes/min_june.pdf; NCVMB Public Records files
Disparity can also exist between discipline issued to different respondents by the same Board. The North Carolina Veterinary Medical Board disciplined two veterinarians for practicing veterinary medicine in uninspected facilities without required prior approval of the practice name or requesting a required facility inspection. Both were disciplined via Consent Orders without administrative hearings and fined $5000.00. One veterinarian was given a 6 months suspension (3 months active) and 2 years probation; the other was given a 30 day suspension ( no days active) and 1 year probation even though his consent order stipulated an additional violation of practicing as an entity not permitted by state statute.
Source: NCVMB Public Records Files
In 1997, Ohio Inspector General Richard G. Ward released a 14 page report of investigation into allegations of wrongdoing involving the investigation of a Columbus veterinarian by the Ohio Veterinary Medical Board. While the OVMB investigation itself was found to be thorough, the Inspector General recommended that the board establish written policies and procedures to ensure that appropriate decisions are reached and are consistent with prior cases.
Source: http://www.state.oh.us/watchdog/oigpress/1997/121097.htm
In Michigan, it is mandated pursuant to the Michigan Public Health Code, P.A. 368 of 1978, as Amended, that the Department of Consumer & Industry Services is required to publish the names and addresses of disciplined individuals.
As a result of the April 2004 Sunset Commission recommendation that the Texas board should post information about disciplinary orders and sanctions on its web site in a format that consumers can easily access, the TVBME published an alphabetical list of disciplinary actions dating back to 1970. Included are the name of the practitioner, date of action, violation, summary and sanction
Sources:http://www.sunset.state.tx.us/79threports/sbvme/sbvme.pdf; http://www.tbvme.state.tx.us/Docket%20-%20website%20M-Z.pdf; http://www.tbvme.state.tx.us/Docket%20-%20website%20A-L.pdf
Although Tom Mickey, Executive Director of the North Carolina Veterinary Medical Board, stated that anyone looking for a new vet should find out about the vet's prior disciplinary record, as of 2010 the NCVMB still does not publish disciplinary actions on its web site, nor does it even have a veterinarian lookup so the public can verify a veterinarian's license. This is in contrast to the North Carolina Medical Board's web site that makes available to the public via lookup the doctor's age, address, educational background and disciplinary history. As a result of a new 2007 law, the Medical Board is now required to also publish felony convictions, hospital sanctions, malpractice payments and discipline by other state medical boards. Having been criticized for years about its lack of openness, the N.C. Medical Board supported the legislative changes that previously prohibited sharing information about malpractice suits and hospital discipline.
Sources: http://www.ncvmb.org; http://www.charlotte.com/162/story/253713.html; http://www.journalnow.com/servlet/Satellite?pagename=WSJ%2FHTML Page%2FWSJ_HTMLPage&c=HTMLPage&cid=1031769511726
California, Colorado, Georgia, Hawaii, Illinois, Maine, Michigan, Minnesota, Missouri, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, and Virginia are among state veterinary boards that publish disciplinary actions on their web sites - either as disciplinary lists, in Board Minutes, or as licensee lookup by name. Those that publish a compiled list, like Texas, rather than look-up by name or scattered among years of archived news letters or board minutes make this information most easily accessible to the public.
Accurate licensing AND disciplinary information should be easily available to the public. Disclosing license status (i.e., "active license") is inadequate and may be misleading. MANY ACTIVELY LICENSED VETERINARIANS HAVE HISTORIES OF SERIOUS COMPLAINTS AND DISCIPLINARY ACTIONS AND MAY EVEN BE UNDER CURRENT SANCTIONS.
According to a 1999 audit, Virginia's facility inspection program under the auspices of the Department of Health Professionals, failed to meet its goals for completing inspections of pharmacies, veterinary facilities, and funeral homes (although inspection standards were apparently met for the 9 other health professions). Many had not been inspected for over eight years. The audit also raised some drug law enforcement concerns, because a primary purpose of both pharmacy and veterinary inspections is to ensure that the distribution of drugs is properly controlled. The failure to meet these goals appeared to be due in part to the assumption by inspectors of some investigative responsibilities and to a shortage of inspector positions.
Source: Virginia, http://jlarc.state.va.us/Summary/Rpt233/health.htm
When the complainants in North Carolina complaint were told by the NCVMB that the veterinarian's practice facility had never been inspected, it was anticipated that the NCVMB would immediately inspect it to assure compliance with minimum standards. Instead nine months later the NCVMB issued a written complaint against the veterinarian which contained a cease and desist statement. The veterinarian responded by requesting an inspection of a different facility acquired subsequently. The Board inspector passed the newly acquired facility including certification that the veterinarian met all requirements for handling of controlled drugs. However, the veterinarian did not have a valid DEA controlled drug permit -- it had expired a year earlier and had been retired by the DEA.
Source: Public Records documents of the North Carolina Veterinary Medical Board
Source: http://www.vetbd.state.az.us/administrative.html.
Equally important as the numerical representation on a Board, is whether the public member, sometimes also known as the consumer representative, represents the interests of the consumer or serves in a token position. How Board members are selected is paramount.
In Mississippi, the governor appoints the veterinarian member from a written list of three recommendations submitted by the Mississippi State Veterinary Medical Association;
Source: http://www.mscode.com/free/statutes/69/015/0001.htm
In Oregon, the Governor may select appointments suggested by the Oregon Veterinary Medical Association (OVMA).
Source: http://www.ovmeb.state.or.us/board.htm.
Participants of the Federation of Associations of Regulatory Boards February 1999 forum drafted codes of conduct for board members. One code of conduct drafted was that Board members shall not hold an office in a professional or trade organization of the regulated profession. From one FARB member's Code of Ethics adopted April 17, 1999: "A board member should not serve as an officer or board member of a state professional trade association or state or provinicial professionally-related trade group.:
Source: http://www.fclb.org/ethics.pdf
Until 2007, the N. C. Medical Society (the group that lobbies on behalf of doctors) nominated seven of the 12 members to the N. C. Medical Board (the state board that licenses and disciplines doctors). The governor then ratified the nominations as appointments in a statutory practice that had been the target of criticism from patients that believed the board was more interested in protecting doctors that it was in protecting patients who raised claims of negligence or misconduct and raised the questions: (1) Is it proper for a trade group to stack the board that regulates its members, particularly where the mission is patient protection? (2) Do boards dominated by medical organization appointees aggressively police practitioners? and (3) Do close ties between medical organizations and regulatory boards result in lax punishments for problem practitioners? This changed in 2007 as response to a lawsuit filed by a doctor and three patients who claimed the state had given control of a public job to a private entity. A new statute now mandates that a nine-member review panel - with four Medical Society members - will recommend seven doctors and a physicians assistant or nurse practitioner to the board.
Sources: http://archives.newsbank.com (April 19, 2003, Record Number: hdk85089); The News and Observer, August 9, 2007, page 5B.
Source: http://www.usvet2005.com/pdf/107.pdf
Until AAVSB finished compiling the national disciplinary database in late 1994, there was no simple way for officials of one state to tell whether a vet who applied for licensing there had been disciplined by another state or even had his license revoked. In 1997 it was reported that while all 50 states participated voluntarily, it was up to each state to determine how many years of historical data to include. Charlotte Ronan, Executive Director of AAVSB, estimated that a quarter of the states provided fewer than five years of records for the database.
Source: http://www.smartmoney.com/consumer/index.cfm?Story=tenthings-may97
Between October 2002 and May 2003, the AAVSB received disciplinary reports from only about 29 jurisdictions. North Carolina was not one of them although the NCVMB had previously reported discipline to AAVSB. From the June 18, 2003 NCVMB Minutes, "Dr. Gordon [Board member Joseph K. Gordon, DVM] discussed with the Board the reporting of disciplinary actions to the American Association of Veterinary State Boards' (AAVSB). disciplinary database. Following the report from the Executive Director [Thomas M. Mickey] Dr. Marshall [Board member David T. Marshall] made a motion to not participate in the National Disciplinary Database until such time that the administrative issues within the office of the AAVSB are resolved. Dr. Lewis [Board member Amy J. Lewis, DVM] seconded the motion. The motion passed unanimously."
Sources: http://www.aasvb,org; Information obtained from AAVSB Program Administrator May 5-6, 2003; Minutes of the NCVMB June 2003 - November 2007
The August 5, 2009 Minutes of the North Carolina Veterinary Board state: "The Board discussed the history of the Board's relationship with the American Association of Veterinary State Boards (AASVB). Mr. Mickey [Thomas M. Mickey, Executive Director] reviewed recent administrative and other changes intended to improve the efficiency and accountability of AAVSB staff operations. The Board determined that is should confirm whether AAVSB had established sufficient security measures for confidential information and correct operational issues so as to justify this Board's resuming active participation in AAVSB. Following discussion, upon motion of Mrs. Robinson [Board member Nancy K. Robinson, RVT], seconded by Dr. Davidson [Board member Michael G. Davidson, DVM], the Board unanimously voted to authorize the necessary expenses for Mrs. Robinson and Mr. Mickey to travel to the AAVSB headquarters in Kansas City, Missouri to investigate administrative and staff changes and to report back to the Board."
Source: Minutes of the NCVMB November 5, 2009
The accuracy and validity of the AAVSB national discipline database as a resource to all State Boards is dependent upon ALL state members reporting disciplinary actions - censures, reprimands, fines, suspensions and revocations.
Source: http://www.aavsb.org/news/spring98.html
Sources: Minutes of the North Carolina Veterinary Medical Board 1995-2003;
1994-2002 Annual Financial Audits prepared by Shelton L. Hawley, C.P.A. for the NCVMB
3. ARE DISCIPLINARY HEARINGS CONDUCTED IN A TIMELY MANNER?
In 1997 the Ohio State Inspector General's Office investigated three allegations regarding the Ohio Veterinary Medical Board. Although the first two allegations were filed under a petition from the "Community at Large", allegation three, was the result of the Inspector General's own initiative. The findings were that although the Board's investigation of the given complaint against a veterinarian was completed within a reasonable time period, five unreasonable delays totaling 197 days contributed to the overall length of time needed to complete the adjudication process. One specific finding was that after completion of the investigation, too much time elapsed before the Notice of Opportunity for Hearing was mailed. -- 56 days had been allowed to elapse between the Board's initial vote to issue the Notice and when the Notice was actually mailed. The report also found these delays even more troublesome in light of the Board's disinclination to pursue injunctive relief pending final administration and found that such unreasonable delays feed the perception that government is overly bureaucratic and unresponsive to citizens.Source: www.state.oh.us/watchdog/investigations\vetbrd.pdf
In North Carolina, 207 days elapsed between the NCVMB's vote to issue a Letter of Reprimand regarding a citizen's complaint and when it actually mailed the reprimand. Upon receipt, one of the veterinarians reprimanded requested an Administrative Hearing. Thereafter, 343 more days elapsed before the Notice of Hearing was actually mailed.
In North Carolina, 492 days elapsed between the NCVMB's vote to issue a Notice of Hearing and when the Notice was mailed in an NCVMB initiated complaint consolidated with a citizen's complaint. Attorneys for the NCVMB and the veterinarian jointly requested the Administrative Law Judge for three delays prolonging the start of the hearing an additional 91 days thus further contributing to the overall length of time to complete the adjudication process. The hearing never occurred. The NCVMB and the veterinarian entered into a negotiated discipline settlement, 36 days prior to the start of the hearing.
Sources: NCVMB Minutes and Other Public Records Documents of the NCVMB
4. IS THERE A NEED FOR UNIFORM DISCIPLINARY ACTION GUIDELINES?
Although the statutes and regulations between states are comparable, the discipline issued for similar violations often varies. As an example, in 2003 three Texas veterinarians failed to have valid DEA permits for handling controlled substances. Each was fined $250.00, issued a formal reprimand and required to take and pass the TBVME's Jurisprudence Examination. Although North Carolina has an equivalent law, in 2002 a North Carolina veterinarian found by DEA inspectors with controlled substances without a valid permit as documented to the NCVMB by the DEA was issued a Letter of Caution. Sources: http://www.state.tx.us/tbvme/downloadables/03-2003BoardNotes.pdf; NCVMB Public Records files
In 2002, the Florida Veterinary Board, in reviewing a complaint, found that a veterinarian's medical records were unclear as to which anesthetic was used or how much IV fluids were used during the surgery. The Board's Stipulation imposed a $250.00 fine, costs of $849.88, and additional continuing education in record keeping. In North Carolina, the NCVMB found that medical records of a veterinarian were poor, that he billed for some things that were not in the record and did not provide adequate medical care following surgery and again that same night -- total discipline imposed was a Letter of Reprimand with no fine or continuing education requirements.
Sources: http://www.state.fl.us/dbpr/pro/vetm/meet/minutes/min_june.pdf; NCVMB Public Records files
Disparity can also exist between discipline issued to different respondents by the same Board. The North Carolina Veterinary Medical Board disciplined two veterinarians for practicing veterinary medicine in uninspected facilities without required prior approval of the practice name or requesting a required facility inspection. Both were disciplined via Consent Orders without administrative hearings and fined $5000.00. One veterinarian was given a 6 months suspension (3 months active) and 2 years probation; the other was given a 30 day suspension ( no days active) and 1 year probation even though his consent order stipulated an additional violation of practicing as an entity not permitted by state statute.
Source: NCVMB Public Records Files
In 1997, Ohio Inspector General Richard G. Ward released a 14 page report of investigation into allegations of wrongdoing involving the investigation of a Columbus veterinarian by the Ohio Veterinary Medical Board. While the OVMB investigation itself was found to be thorough, the Inspector General recommended that the board establish written policies and procedures to ensure that appropriate decisions are reached and are consistent with prior cases.
Source: http://www.state.oh.us/watchdog/oigpress/1997/121097.htm
5. DO VETERINARY BOARDS NEED TO INCREASE PUBLIC ACCESS TO INFORMATION?
According to the Arizona audit, the Board needs to do more to help ensure that the public has access to veterinarian licensing and complaint information. The public needs this information to make informed decisions when choosing medical care for their animals. Although the Board revised its public information policy in June 1996, it needed to ensure that the policy is carried out. Auditors acting as pet owners telephoned the Board on five occasions to test whether Board staff would provide information. In four of the phone calls, Board staff failed to provide complete information about complaints and previous disciplinary actions, including a license revocation. Currently, Arizona will give telephone verification of licensure and discipline actions. If disciplinary action has been taken, a copy will be mailed to the requester. The full disciplinary file is available for inspection or a copy may be obtained at $0.25 per page.In Michigan, it is mandated pursuant to the Michigan Public Health Code, P.A. 368 of 1978, as Amended, that the Department of Consumer & Industry Services is required to publish the names and addresses of disciplined individuals.
As a result of the April 2004 Sunset Commission recommendation that the Texas board should post information about disciplinary orders and sanctions on its web site in a format that consumers can easily access, the TVBME published an alphabetical list of disciplinary actions dating back to 1970. Included are the name of the practitioner, date of action, violation, summary and sanction
Sources:http://www.sunset.state.tx.us/79threports/sbvme/sbvme.pdf; http://www.tbvme.state.tx.us/Docket%20-%20website%20M-Z.pdf; http://www.tbvme.state.tx.us/Docket%20-%20website%20A-L.pdf
Although Tom Mickey, Executive Director of the North Carolina Veterinary Medical Board, stated that anyone looking for a new vet should find out about the vet's prior disciplinary record, as of 2010 the NCVMB still does not publish disciplinary actions on its web site, nor does it even have a veterinarian lookup so the public can verify a veterinarian's license. This is in contrast to the North Carolina Medical Board's web site that makes available to the public via lookup the doctor's age, address, educational background and disciplinary history. As a result of a new 2007 law, the Medical Board is now required to also publish felony convictions, hospital sanctions, malpractice payments and discipline by other state medical boards. Having been criticized for years about its lack of openness, the N.C. Medical Board supported the legislative changes that previously prohibited sharing information about malpractice suits and hospital discipline.
Sources: http://www.ncvmb.org; http://www.charlotte.com/162/story/253713.html; http://www.journalnow.com/servlet/Satellite?pagename=WSJ%2FHTML Page%2FWSJ_HTMLPage&c=HTMLPage&cid=1031769511726
California, Colorado, Georgia, Hawaii, Illinois, Maine, Michigan, Minnesota, Missouri, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, and Virginia are among state veterinary boards that publish disciplinary actions on their web sites - either as disciplinary lists, in Board Minutes, or as licensee lookup by name. Those that publish a compiled list, like Texas, rather than look-up by name or scattered among years of archived news letters or board minutes make this information most easily accessible to the public.
Accurate licensing AND disciplinary information should be easily available to the public. Disclosing license status (i.e., "active license") is inadequate and may be misleading. MANY ACTIVELY LICENSED VETERINARIANS HAVE HISTORIES OF SERIOUS COMPLAINTS AND DISCIPLINARY ACTIONS AND MAY EVEN BE UNDER CURRENT SANCTIONS.
6. DO BOARDS ADEQUATELY INSPECT VETERINARY FACILITIES?
The Arizona audit also presented findings recommending that the Board increase inspections of veterinary facilities. Performing routine inspections would help ensure a minimum standard of care at veterinary facilities.According to a 1999 audit, Virginia's facility inspection program under the auspices of the Department of Health Professionals, failed to meet its goals for completing inspections of pharmacies, veterinary facilities, and funeral homes (although inspection standards were apparently met for the 9 other health professions). Many had not been inspected for over eight years. The audit also raised some drug law enforcement concerns, because a primary purpose of both pharmacy and veterinary inspections is to ensure that the distribution of drugs is properly controlled. The failure to meet these goals appeared to be due in part to the assumption by inspectors of some investigative responsibilities and to a shortage of inspector positions.
Source: Virginia, http://jlarc.state.va.us/Summary/Rpt233/health.htm
When the complainants in North Carolina complaint were told by the NCVMB that the veterinarian's practice facility had never been inspected, it was anticipated that the NCVMB would immediately inspect it to assure compliance with minimum standards. Instead nine months later the NCVMB issued a written complaint against the veterinarian which contained a cease and desist statement. The veterinarian responded by requesting an inspection of a different facility acquired subsequently. The Board inspector passed the newly acquired facility including certification that the veterinarian met all requirements for handling of controlled drugs. However, the veterinarian did not have a valid DEA controlled drug permit -- it had expired a year earlier and had been retired by the DEA.
Source: Public Records documents of the North Carolina Veterinary Medical Board
7. IS THERE ADEQUATE PUBLIC REPRESENTATION?
The Arizona audit recommended that the Legislature increase public membership on the Board from three to four members. Changing a veterinarian position on the Board to a public member position would result in 50 percent public representation as recommended in the Auditor General's 1995 Special Study of Arizona's Health Regulatory System. In 2007 the Arizona Board had 4 public members and 5 veterinarians. A former president was a public member. As far as could be determined Arizona was the only state with near numerically equitable public membership in 2007.Source: http://www.vetbd.state.az.us/administrative.html.
Equally important as the numerical representation on a Board, is whether the public member, sometimes also known as the consumer representative, represents the interests of the consumer or serves in a token position. How Board members are selected is paramount.
8. WHAT IS THE INFLUENCE OF VETERINARY MEDICAL ASSOCIATIONS?
Most members of veterinary medical boards are appointed by the Governor or other elected state officials. In many instances, these appointments appear to have a political basis, whether in conjunction with the state veterinary medical association - the professional organization representing veterinarians - or otherwise.In Mississippi, the governor appoints the veterinarian member from a written list of three recommendations submitted by the Mississippi State Veterinary Medical Association;
Source: http://www.mscode.com/free/statutes/69/015/0001.htm
In Oregon, the Governor may select appointments suggested by the Oregon Veterinary Medical Association (OVMA).
Source: http://www.ovmeb.state.or.us/board.htm.
Participants of the Federation of Associations of Regulatory Boards February 1999 forum drafted codes of conduct for board members. One code of conduct drafted was that Board members shall not hold an office in a professional or trade organization of the regulated profession. From one FARB member's Code of Ethics adopted April 17, 1999: "A board member should not serve as an officer or board member of a state professional trade association or state or provinicial professionally-related trade group.:
Source: http://www.fclb.org/ethics.pdf
Until 2007, the N. C. Medical Society (the group that lobbies on behalf of doctors) nominated seven of the 12 members to the N. C. Medical Board (the state board that licenses and disciplines doctors). The governor then ratified the nominations as appointments in a statutory practice that had been the target of criticism from patients that believed the board was more interested in protecting doctors that it was in protecting patients who raised claims of negligence or misconduct and raised the questions: (1) Is it proper for a trade group to stack the board that regulates its members, particularly where the mission is patient protection? (2) Do boards dominated by medical organization appointees aggressively police practitioners? and (3) Do close ties between medical organizations and regulatory boards result in lax punishments for problem practitioners? This changed in 2007 as response to a lawsuit filed by a doctor and three patients who claimed the state had given control of a public job to a private entity. A new statute now mandates that a nine-member review panel - with four Medical Society members - will recommend seven doctors and a physicians assistant or nurse practitioner to the board.
Sources: http://archives.newsbank.com (April 19, 2003, Record Number: hdk85089); The News and Observer, August 9, 2007, page 5B.
9. ARE DISCIPLINARY ACTIONS REPORTED TO THE NATIONAL DATABASE?
The American Association of Veterinary State Boards maintains VIVA® (Veterinary Information Verifying Agency) as one of its services to its members that include 57 veterinary medical licensing boards in the U.S. and Canada. The VIVA® database, originally named the "Disciplinary Database" includes licensure and disciplinary information supplied by AAVSB Member Boards that is cross-referrenced because many veterinarians are licensed in more than one state.Source: http://www.usvet2005.com/pdf/107.pdf
Until AAVSB finished compiling the national disciplinary database in late 1994, there was no simple way for officials of one state to tell whether a vet who applied for licensing there had been disciplined by another state or even had his license revoked. In 1997 it was reported that while all 50 states participated voluntarily, it was up to each state to determine how many years of historical data to include. Charlotte Ronan, Executive Director of AAVSB, estimated that a quarter of the states provided fewer than five years of records for the database.
Source: http://www.smartmoney.com/consumer/index.cfm?Story=tenthings-may97
Between October 2002 and May 2003, the AAVSB received disciplinary reports from only about 29 jurisdictions. North Carolina was not one of them although the NCVMB had previously reported discipline to AAVSB. From the June 18, 2003 NCVMB Minutes, "Dr. Gordon [Board member Joseph K. Gordon, DVM] discussed with the Board the reporting of disciplinary actions to the American Association of Veterinary State Boards' (AAVSB). disciplinary database. Following the report from the Executive Director [Thomas M. Mickey] Dr. Marshall [Board member David T. Marshall] made a motion to not participate in the National Disciplinary Database until such time that the administrative issues within the office of the AAVSB are resolved. Dr. Lewis [Board member Amy J. Lewis, DVM] seconded the motion. The motion passed unanimously."
Sources: http://www.aasvb,org; Information obtained from AAVSB Program Administrator May 5-6, 2003; Minutes of the NCVMB June 2003 - November 2007
The August 5, 2009 Minutes of the North Carolina Veterinary Board state: "The Board discussed the history of the Board's relationship with the American Association of Veterinary State Boards (AASVB). Mr. Mickey [Thomas M. Mickey, Executive Director] reviewed recent administrative and other changes intended to improve the efficiency and accountability of AAVSB staff operations. The Board determined that is should confirm whether AAVSB had established sufficient security measures for confidential information and correct operational issues so as to justify this Board's resuming active participation in AAVSB. Following discussion, upon motion of Mrs. Robinson [Board member Nancy K. Robinson, RVT], seconded by Dr. Davidson [Board member Michael G. Davidson, DVM], the Board unanimously voted to authorize the necessary expenses for Mrs. Robinson and Mr. Mickey to travel to the AAVSB headquarters in Kansas City, Missouri to investigate administrative and staff changes and to report back to the Board."
Source: Minutes of the NCVMB November 5, 2009
The accuracy and validity of the AAVSB national discipline database as a resource to all State Boards is dependent upon ALL state members reporting disciplinary actions - censures, reprimands, fines, suspensions and revocations.
10. DO STATE PERFORMANCE AUDITS NEED CONDUCTED?
The Arizona audit clearly stated the need to remedy the identified deficiencies found against the Arizona Veterinary Medical Board. Louise Battaglia, administrator for the Arizona Board, reporting on their audit and Sunset Review, stressed that boards must be thorough in their record keeping. She suggested that boards conduct a self-audit annually to identify and correct any areas that may need improvement.Source: http://www.aavsb.org/news/spring98.html
The Texas State Board of Veterinary Medical Examiners last underwent Sunset Review during the 2004 79th Legislature — as part of a regular, cyclic event for all Texas occupational regulatory agencies. Some recommendations made and later enacted by law included:
- requiring at least two veterinarian members of the Board to review and decide whether a complaint should be dismissed or moved to an informal settlement conference. Staff would be permitted to resolve cases involving nontechnical and administrative violations, subject to review by the Board at its public meeting.
- requiring a public member to participate in all informal settlement conferences as opposed to only the Board Secretary, who is a veterinarian
- providing for restitution authority to allow a complainant to receive a refund for some or all of what was lost as a result of the act that caused the complaint
- making all enforcement information, such as final disciplinary actions and sanctions, readily available to the public on its web site.
Source: http://www.sunset.state.tx.us/79threports/sbvme/sbvme.pdfIn 2001, The Colorado State Board of Veterinary Medicine's statutes were reviewed through the Sunset process. Some of the notable changes were: increase the number of Board members; reflect the fact the veterinarians are required to take a national exam prior to becoming licensed for the first time; revised veterinarian recordkeeping requirements; granted immunity to veterinarians who report suspected incidents of animal cruelty in good faith; and permits the discipline of registrants for non-felony crimes. It was reported that most crimes coming before the Board involve alcohol or substance abuse that resulted in traffic tickets or complaints of impaired ability by consumers.
Source: http://www.dora.state.co.us/veterinarians/images/PDFsUsedAsImages/VetNwsltr2001.pdf
Source: http://www.dora.state.co.us/veterinarians/images/PDFsUsedAsImages/VetNwsltr2001.pdf
An inquiry to the North Carolina State Auditor's office for a copy of ANY audit - investigative, performance, or fiscal financial - of the North Carolina Veterinary Medical Board netted this reply:
"My check of our records indicate we have not done an audit of the Veterinary Medical Board, or at least one that is stored in our digital files. There was no record back at least 10 years. A lot of smaller agencies and nonprofit boards escape our notice on a regular basis".
The response from the Governor's office in 2002 for an investigation and full performance audit of the NCVMB was that the Governor did not have statutory authority.
Sources: N. C. State Auditor's Office, N.C. Governor's Office of Legal Affairs
North Carolina does not have any mechanism to regularly review the North Carolina Veterinary Medical Board's performance.Sources: N. C. State Auditor's Office, N.C. Governor's Office of Legal Affairs
It would seem that periodic performance audits, in some states known as Sunset Reviews - whether conducted as required by statute or as the result of an investigation - would help promote the accountability, integrity and reliability of veterinary medical boards.
If deficiencies of veterinary medical boards in regulating practitioners were remedied, perhaps there were be fewer incidents of veterinary malpractice, veterinary negligence, veterinary incompetence and veterinary abuse.