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I am getting a steady stream of requests from IACUC members for the
OC Fact Sheet and the OC Position Statement on thoracic compression.
As I've replied, I've taken the time to check the laws of the state
where the requester is located so they will know if it is legal for
the veterinarian to prescribe or provide isoflurane in the absence
of a veterinary-client-patient relationship. I will start posting
those here. Be advised that some veterinarians have told me that
they will prescribe or provide it to wildlife biologists in the
absence of an express prohibition, i.e., if the restriction is
merely a guideline or a reiteration of the AVMA ethical guidelines
(which is the source of the appearance of this otherwise laudable
concept in so many state laws).<br>
<br>
That isn't to say that there are no practical problems with the use
of isoflurane. There are. <br>
<br>
If your IACUC refuses to approve thoracic compression, or requires
you to use isoflurane, please contact me and I'll report back to you
on the laws in your state. Many (all?) IACUCs don't realize that
these legal restrictions/prohibitions exist.<br>
<br>
Ellen<br>
<pre class="moz-signature" cols="72">--
Ellen Paul
Executive Director
The Ornithological Council
Email: <a class="moz-txt-link-abbreviated" href="mailto:ellen.paul@verizon.net">ellen.paul@verizon.net</a>
"Providing Scientific Information about Birds<a class="moz-txt-link-rfc2396E" href="http://www.nmnh.si.edu/BIRDNET">"
http://www.nmnh.si.edu/BIRDNET"</a>
</pre>
<b>California law on the veterinary-client-patient relationship
exempts wild animals:</b><b><br>
</b><b> </b><br>
<br>
CALIFORNIA CODE OF REGULATIONS<br>
TITLE 16. PROFESSIONAL AND VOCATIONAL REGULATIONS<br>
DIVISION 20. VETERINARY MEDICAL BOARD<br>
ARTICLE 4. PRACTICE<br>
This database is current through 09/08/06, Register 2006, No. 36<br>
<br>
s 2032.1. Veterinary-Client-Patient Relationship.<br>
<br>
(a) Except where the patient is a wild animal or its owner is
unknown, it <br>
shall constitute unprofessional conduct for a veterinarian to
administer <br>
or prescribe a drug, medicine, appliance, or application or
treatment of <br>
whatever nature for the prevention, cure, or relief of a wound,
fracture <br>
or bodily injury or disease of an animal without having first
established <br>
a veterinarian-client-patient relationship with the animal patient
or <br>
patients and the client. It shall also constitute unprofessional
conduct <br>
for a veterinarian to prescribe, dispense, or furnish either a
veterinary <br>
drug, as defined by Section 1747.1, Title 16, California Code of <br>
Regulations, or a dangerous drug, as defined by Section 4022 of the
code, <br>
without having first established a veterinarian-client-patient <br>
relationship with the animal patient or patients and the client.<br>
<br>
<b>Therefore, the use of isoflurane is possible in California in
that (unlike at least a dozen other states), a veterinarian is not
legally prohibited from prescribing it in the absence of a
veterinary-client-patient relationship.</b> It does, however,
violate the AVMA Code of Ethics. <br>
<br>
<br>
<font size="+1"><b>Kansas</b></font><br>
<br>
Kansas is one of the many states that requires a "veterinary client
patient relationship."<br>
<br>
(1) All prescription drugs to be dispensed for use by a companion
animal may be dispensed only on the order <br>
of a licensed veterinarian who has an existing veterinary
client-patient relationship as defined by the Kansas veterinary
practice act. <br>
<br>
<a class="moz-txt-link-freetext"
href="http://www.kansas.gov/veterinary/KS_Administrative_Regulations.pdf">http://www.kansas.gov/veterinary/KS_Administrative_Regulations.pdf</a><br>
<br>
Here is the definition:<br>
<br>
(n) "Veterinary-client-patient relationship" means: <br>
(1) The veterinarian has assumed the responsibility for making
medical judgments regarding the health of the <br>
animal or animals and the need for medical treatment, and the
client, owner or other caretaker has agreed to follow <br>
the instruction of the veterinarian; <br>
(2) there is sufficient knowledge of the animal or animals by the
veterinarian to initiate at least a general or <br>
preliminary diagnosis of the medical condition of the animal or
animals. This means that the veterinarian has recently <br>
seen or is personally acquainted with the keeping and care of the
animal or animals by virtue of an examination of <br>
the animal or animals, or by medically appropriate and timely visits
to the premises where the animal or animals are <br>
kept, or both; and <br>
(3) the practicing veterinarian is readily available for followup
in case of adverse reactions or failure of the <br>
regimen of therapy. <br>
<br>
<a class="moz-txt-link-freetext"
href="http://www.kansas.gov/veterinary/KS_Practice_Act2.pdf">http://www.kansas.gov/veterinary/KS_Practice_Act2.pdf</a><br>
<br>
<b>As this virtually never exists in the context of wildlife biology
conducted in the field, it would appear that isoflurane is not an
alternative in Kansas.</b><br>
<font size="+1"><b><br>
</b><b>Massachusetts</b></font><br>
<br>
Massachusetts law on the provision of drugs by a veterinarian in the
absence of a veterinary client patient relationship. The law in your
state not only requires a veterinary client patient relationship:<br>
<br>
<br>
<a class="moz-txt-link-freetext"
href="http://www.mass.gov/ocabr/licensee/dpl-boards/vt/regulations/rules-and-regs/256-cmr-700.html">http://www.mass.gov/ocabr/licensee/dpl-boards/vt/regulations/rules-and-regs/256-cmr-700.html</a><br>
<br>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word; color: rgb(34, 34, 34); font-family: sans-serif;
font-size: 12.800000190734863px; font-style: normal; font-variant:
normal; font-weight: normal; letter-spacing: normal; line-height:
19.5px; orphans: auto; text-align: start; text-indent: 0px;
text-transform: none; white-space: normal; widows: auto;
word-spacing: 0px; -webkit-text-stroke-width: 0px;
background-color: rgb(255, 255, 255);">(1) A licensee's practice
shall conform to currently-accepted professional and scientific
standards in the profession of veterinary medicine such as but not
limited to the AVMA Principles.</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word; color: rgb(34, 34, 34); font-family: sans-serif;
font-size: 12.800000190734863px; font-style: normal; font-variant:
normal; font-weight: normal; letter-spacing: normal; line-height:
19.5px; orphans: auto; text-align: start; text-indent: 0px;
text-transform: none; white-space: normal; widows: auto;
word-spacing: 0px; -webkit-text-stroke-width: 0px;
background-color: rgb(255, 255, 255);">(2) A licensee shall:</p>
<br>
<br>
<span style="color: rgb(34, 34, 34); font-family: sans-serif;
font-size: 12.800000190734863px; font-style: normal; font-variant:
normal; font-weight: normal; letter-spacing: normal; line-height:
19.5px; orphans: auto; text-align: start; text-indent: 0px;
text-transform: none; white-space: normal; widows: auto;
word-spacing: 0px; -webkit-text-stroke-width: 0px;
background-color: rgb(255, 255, 255); display: inline !important;
float: none;">(e) Dispense or prescribe controlled substances only
in the course of his or her professional practice after
establishing a genuine veterinarian-client patient relationship;</span><br>
<br>
<br>
but also states:<br>
<br>
<h3 style="box-sizing: border-box; font-size: 1.2em; margin: 0px 0px
0.8em; font-family: Tahoma, Verdana, Geneva, sans-serif;
line-height: 1.2; color: rgb(34, 34, 34); font-style: normal;
font-variant: normal; letter-spacing: normal; orphans: auto;
text-align: start; text-indent: 0px; text-transform: none;
white-space: normal; widows: auto; word-spacing: 0px;
-webkit-text-stroke-width: 0px; background-color: rgb(255, 255,
255);"><a id="5.02" name="5.02" style="box-sizing: border-box;
overflow: hidden;">5.02</a>: Drugs and Medications</h3>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word; color: rgb(34, 34, 34); font-family: sans-serif;
font-size: 12.800000190734863px; font-style: normal; font-variant:
normal; font-weight: normal; letter-spacing: normal; line-height:
19.5px; orphans: auto; text-align: start; text-indent: 0px;
text-transform: none; white-space: normal; widows: auto;
word-spacing: 0px; -webkit-text-stroke-width: 0px;
background-color: rgb(255, 255, 255);">(1) A licensee shall
dispense or prescribe drugs and medications only for specific
animals and for specific medical problems. When treating the
animals as a group, a licensee shall judiciously dispense or
prescribe drugs and medications on a per client basis only for
specific medical problems and only in accordance with 256 CMR
7.01(2)(e).</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word; color: rgb(34, 34, 34); font-family: sans-serif;
font-size: 12.800000190734863px; font-style: normal; font-variant:
normal; font-weight: normal; letter-spacing: normal; line-height:
19.5px; orphans: auto; text-align: start; text-indent: 0px;
text-transform: none; white-space: normal; widows: auto;
word-spacing: 0px; -webkit-text-stroke-width: 0px;
background-color: rgb(255, 255, 255);">(2) When dispensing
medication, a licensee shall accurately type or print the
following information on a label permanently affixed to the
container:</p>
<blockquote style="box-sizing: border-box; margin: 1em 0.5em 1em
1.2em; color: rgb(34, 34, 34); font-family: sans-serif; font-size:
12.800000190734863px; font-style: normal; font-variant: normal;
font-weight: normal; letter-spacing: normal; line-height: 19.5px;
orphans: auto; text-align: start; text-indent: 0px;
text-transform: none; white-space: normal; widows: auto;
word-spacing: 0px; -webkit-text-stroke-width: 0px;
background-color: rgb(255, 255, 255);">
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word;">(a) client's name;</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word;">(b) animal's name;</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word;">(c) date;</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word;">(d) usage directions including route of
administration;</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word;">(e) name of the drug;</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word;">(f) quantity dispensed;</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word;">(h) hospital's name, address and telephone number;</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word;">(i) the name of the licensee dispensing the drug;</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word;">(j) expiration date if appropriate;</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word;">(k) any appropriate warning labels; and</p>
<p style="box-sizing: border-box; margin: 0px 0px 1em; word-wrap:
break-word;">(l) the number of refills if any.</p>
</blockquote>
<br>
<b>It would thus appear that isoflurance is not an alternative in
Massachusetts.</b><br>
<br>
<br>
<big><b>New York</b></big><br>
<br>
NY State guidelines and the AVMA ethical standards<br>
<br>
<a class="moz-txt-link-freetext"
href="http://www.op.nysed.gov/prof/vetmed/vetpg5.htm">http://www.op.nysed.gov/prof/vetmed/vetpg5.htm</a><br>
<br>
<br>
<div class="moz-cite-prefix"><dt class="bold" style="font-weight:
bold; color: rgb(0, 0, 0); font-family: Verdana, Arial,
Helvetica, sans-serif; font-size: 11.818181991577148px;
font-style: normal; font-variant: normal; letter-spacing:
normal; line-height: 17.315340042114258px; orphans: auto;
text-align: start; text-indent: 0px; text-transform: none;
white-space: normal; widows: auto; word-spacing: 0px;
-webkit-text-stroke-width: 0px; background-color: rgb(255, 255,
255);"><a id="five11" name="five11">5.11</a></dt>
<dd style="color: rgb(0, 0, 0); font-family: Verdana, Arial,
Helvetica, sans-serif; font-size: 11.818181991577148px;
font-style: normal; font-variant: normal; font-weight: normal;
letter-spacing: normal; line-height: 17.315340042114258px;
orphans: auto; text-align: start; text-indent: 0px;
text-transform: none; white-space: normal; widows: auto;
word-spacing: 0px; -webkit-text-stroke-width: 0px;
background-color: rgb(255, 255, 255);">establish a veterinary
client/patient relationship, "VCPR," except when the client is
unavailable. The VCPR exists when:<span
class="Apple-converted-space"> </span><br>
<ol type="A">
<li>you have sufficient knowledge of the animal to initiate at
least a general or preliminary diagnosis of the medical
condition of the animal. This means that you have recently
seen and are personally acquainted with the care of the
animal by a physical examination of the animal and/or by
medically appropriate and timely visits with the animal; and<br>
</li>
<li>you are readily available or have arranged for emergency
coverage for follow-up evaluations in the event of adverse
reactions or the failure of the treatment regimen.</li>
</ol>
<p> </p>
</dd>
<dt class="bold" style="font-weight: bold; color: rgb(0, 0, 0);
font-family: Verdana, Arial, Helvetica, sans-serif; font-size:
11.818181991577148px; font-style: normal; font-variant: normal;
letter-spacing: normal; line-height: 17.315340042114258px;
orphans: auto; text-align: start; text-indent: 0px;
text-transform: none; white-space: normal; widows: auto;
word-spacing: 0px; -webkit-text-stroke-width: 0px;
background-color: rgb(255, 255, 255);">5.12</dt>
<dd style="color: rgb(0, 0, 0); font-family: Verdana, Arial,
Helvetica, sans-serif; font-size: 11.818181991577148px;
font-style: normal; font-variant: normal; font-weight: normal;
letter-spacing: normal; line-height: 17.315340042114258px;
orphans: auto; text-align: start; text-indent: 0px;
text-transform: none; white-space: normal; widows: auto;
word-spacing: 0px; -webkit-text-stroke-width: 0px;
background-color: rgb(255, 255, 255);">only prescribe, deliver,
or have delivered prescription drugs when a VCPR has been
established and you have determined that the prescription drug
is therapeutically indicated for the health and/or well being of
the animal. You cannot fill prescriptions from other
veterinarians.
<ol type="A">
<li>Written prescriptions can be filled at a pharmacy of the
client's choice. A written prescription for a drug must be
provided upon request if a valid VCPR has been established.
All written prescriptions should include the following
information:<span class="Apple-converted-space"> </span><br>
<ol>
<li>the name, address, telephone number, license number
and signature of the prescribing veterinarian;</li>
<li>the name and address of the client;</li>
<li>the species and name, number or other identifying
information for the animal;</li>
<li>the name, strength and quantity of the drug(s);</li>
<li>directions for use including, if applicable,
withdrawal time;</li>
<li>date of issue;</li>
<li>number of refills; and</li>
<li>Dispense as Written box.</li>
</ol>
</li>
<li>Drugs dispensed from a veterinary pharmacy should be
labeled with the following information:<span
class="Apple-converted-space"> </span><br>
<ol>
<li>name, address and telephone number of the facility;</li>
<li>client's name;</li>
<li>the species and name, number, or other identifying
information for the animal;</li>
<li>date dispensed;</li>
<li>directions for use, including withdrawal time and
precautionary information, if applicable;</li>
<li>the manufacturer's trade name of the drug or the
generic name, strength (if more than one dosage form
exists), quantity of drug and the expiration date when
established by the manufacturer; and</li>
<li>name of prescribing veterinarian.</li>
</ol>
</li>
<li>Drugs should not be prescribed for a duration that is
inconsistent with the patient's medical condition. The drug
should not be prescribed for a period of more than one year
from the date that you have examined the patient and
prescribed the drug, unless you have conducted a subsequent
examination of the patient and determined that there is a
continued need for the prescribed drug.</li>
<li>Childproof containers should be used unless otherwise
requested by the client (an exception would be a drug that
is prepackaged, for example, and dispensed with appropriate
labeling).</li>
</ol>
</dd>
</div>
<br>
<b>It would thus appear that isoflurane is not an alternative in New
York.</b><br>
<br>
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