Bill Text: CA AB1399 | 2023-2024 | Regular Session | Chaptered
Bill Title: Veterinary medicine: veterinarian-client-patient relationship: telehealth.
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Passed) 2023-10-08 - Chaptered by Secretary of State - Chapter 475, Statutes of 2023. [AB1399 Detail]
Download: California-2023-AB1399-Chaptered.html
Assembly Bill
No. 1399
CHAPTER 475
An act to amend Sections 4067, 4825.1, 4829.5, 4853, 4857, and 4875.1 of, and to add Section 4826.6 to, the Business and Professions Code, and to amend Section 14401 of the Food and Agricultural Code, relating to veterinary medicine.
[
Approved by
Governor
October 08, 2023.
Filed with
Secretary of State
October 08, 2023.
]
LEGISLATIVE COUNSEL'S DIGEST
AB 1399, Friedman.
Veterinary medicine: veterinarian-client-patient relationship: telehealth.
Existing law, the Veterinary Medicine Practice Act, establishes the Veterinary Medical Board within the Department of Consumer Affairs for the licensure and regulation of veterinarians and the practice of veterinary medicine. Existing law specifies that a violation of the act is a crime. The act prohibits any person from practicing veterinary medicine, as defined, without a license. The act authorizes the board to deny, revoke, or suspend a license or registration or assess a fine for, among other things, violation of a regulation adopted by the board and unprofessional conduct, as specified.
A regulation adopted by the board makes it unprofessional conduct to provide specified treatment of an animal without having first established a veterinarian-client-patient relationship, as specified. That regulation also prohibits a person from practicing
veterinary medicine in this state outside the context of a veterinarian-client-patient relationship or as otherwise permitted by law.
This bill similarly would prohibit the practice of veterinary medicine outside the context of a veterinarian-client-patient relationship, as defined, except as specified.
Existing administrative law requires telemedicine to be conducted within an existing veterinarian-client-patient relationship, with the exception for advice given in an emergency, as specified, and defines “telemedicine” to mean the mode of delivering animal health care services via communication technologies to facilitate consultation, treatment, and care management of the patient.
This bill similarly would authorize a licensee to practice veterinary medicine via telehealth, as prescribed. The bill would require a veterinarian who practices veterinary medicine via telehealth, among
other things, to employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient and providing quality of care consistent with prevailing veterinary medical practice, be familiar with available medical resources, be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client, keep, maintain, and make an animal patient record summary available, provide the client with information about the veterinarian, and secure an alternative means of contacting the client if the electronic means is interrupted, as specified.
The bill would also define the term “client” for purposes of the act and make other conforming changes.
Existing law requires all veterinary premises to be registered with the board. Existing law defines “premises” for these purposes
as inclusive of mobile units or vehicles, but exempts them from independent registration with the board if they are operated from a building or facility that is the licensee manager’s principal place of business, the building is registered with the board, and the registration identifies and declares the use of the mobile unit or vehicle. Existing law specifies that the registration of veterinary premises is nontransferable and requires that, in the event of change of an owner or operator of the premises, the premises registration holder notify the board within 30 days after the change.
This bill would exempt the location where a veterinarian practices telehealth from the requirement that it be registered if specified conditions are met, including, among other things, that the veterinarian does not perform any in-person examination or treatment of animal patients at that location.
Because the bill would impose new
requirements and prohibitions under the Veterinary Medicine Practice Act, the violation of which is a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 4067 of the Business and Professions Code is amended to read:4067.
(a) No person or entity shall dispense or furnish, or cause to be dispensed or furnished, dangerous drugs or dangerous devices, as defined in Section 4022, on the internet for delivery to any person in this state without a prescription issued pursuant to a good faith prior examination of a human or animal for whom the prescription is meant if the person or entity either knew or reasonably should have known that the prescription was not issued pursuant to a good faith prior examination of a human or animal, or if the person or entity did not act in accordance with Section 1761 of Title 16 of the California Code of Regulations.(b) Notwithstanding any other provision of law, a violation of this section may subject the person or
entity that has committed the violation to either a fine of up to twenty-five thousand dollars ($25,000) per occurrence pursuant to a citation issued by the board or a civil penalty of twenty-five thousand dollars ($25,000) per occurrence.
(c) The Attorney General may bring an action to enforce this section and to collect the fines or civil penalties authorized by subdivision (b).
(d) For notifications made on and after January 1, 2002, the Franchise Tax Board, upon notification by the Attorney General or the board of a final judgment in an action brought under this section, shall subtract the amount of the fine or awarded civil penalties from any tax refunds or lottery winnings due to the person who is a defendant in the action using the offset authority under Section 12419.5 of the Government Code, as delegated by the Controller, and the processes as established by the Franchise
Tax Board for this purpose. That amount shall be forwarded to the board for deposit in the Pharmacy Board Contingent Fund.
(e) Nothing in this section shall be construed to permit the unlicensed practice of pharmacy, or to limit the authority of the board to enforce any other provision of this chapter.
(f) For the purposes of this section, “good faith prior examination” includes the requirements for a physician and surgeon in Section 2242 and the requirements for a veterinarian in Section 4826.6.
SEC. 2.
Section 4825.1 of the Business and Professions Code is amended to read:4825.1.
These definitions shall govern the construction of this chapter as it applies to veterinary medicine.(a) “Client” means the individual or individuals who represent to the veterinarian that they are the owner or owners of the animal patient at the time that the services are provided.
(b) “Diagnosis” means the act or process of identifying or determining the health status of an animal patient through examination and the opinion derived from that examination.
(c) “Animal” means any member of the animal kingdom other than humans, and includes fowl, fish, and reptiles, wild or domestic, whether living or dead.
(d) “Food animal” means any animal that is raised for the production of an edible product intended for consumption by humans. The edible product includes, but is not limited to, milk, meat, and eggs. Food animal includes, but is not limited to, cattle (beef or dairy), swine, sheep, poultry, fish, and amphibian species.
(e) “Livestock” includes all animals, poultry, aquatic and amphibian species that are raised, kept, or used for profit. It does not include those species that are usually kept as pets such as dogs, cats, and pet birds, or companion animals, including equines.
(f) “Synchronous” means a real-time interaction between a client and animal patient with a veterinarian who is licensed in this state and located at a distant site.
(g) “Telehealth”
means the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, synchronous video and audio communication; synchronous, two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.
SEC. 3.
Section 4826.6 is added to the Business and Professions Code, to read:4826.6.
(a) A veterinarian shall not prescribe, dispense, or administer a drug, medicine, application, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals unless a veterinarian-client-patient relationship exists or as otherwise permitted by law, except when the animal patient is a wild animal or the owner of the animal patient is unknown. A veterinarian-client-patient relationship exists if all of the following conditions are met:(1) The client has authorized the veterinarian to assume responsibility for medical judgments regarding the health of the animal patient.
(2) The veterinarian possesses sufficient
knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the animal patient’s medical condition.
(3) The veterinarian has assumed responsibility for making medical judgments regarding the health of the animal patient and has communicated with the client a medical, treatment, diagnostic, or therapeutic plan appropriate to the circumstances.
(b) A veterinarian possesses sufficient knowledge of the animal patient for purposes of paragraph (2) of subdivision (a) if the veterinarian has recently seen, or is personally acquainted with, the care of the animal patient by doing any of the following:
(1) Examining the animal patient in person.
(2) Examining the animal patient by use of synchronous audio-video communication.
(3) Making medically appropriate and timely visits to the premises on which the animal patient is kept.
(c) For purposes of paragraphs (1) and (3) of subdivision (a), the client may authorize an agent to act on the client’s behalf.
(d) Synchronous audio-video communication is not required for the delivery of veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.
(e) A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.
(f) Only
a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary medicine via telehealth on an animal patient located in this state.
(g) Before delivering veterinary medicine via telehealth, the veterinarian shall inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth, including acknowledgment of all of the following:
(1) The same standards of care apply to veterinary medicine services via telehealth and in-person veterinary medical services.
(2) The client has the option to choose an in-person visit from a veterinarian at any time.
(3) The client has been advised how to receive follow-up care or assistance in the event of an
adverse reaction to the treatment or in the event of an inability to communicate resulting from technological or equipment failure.
(h) A veterinarian who practices veterinary medicine via telehealth shall do all of the following:
(1) Ensure that the technology, method, and equipment used to provide veterinary medicine services via telehealth comply with all current privacy protection laws.
(2) Have historical knowledge of the animal patient by obtaining and reviewing the animal patient’s relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
(3) Employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient and providing quality of care consistent with prevailing veterinary medical practice.
(4) Be familiar with available medical resources, including emergency resources near the animal patient’s location, be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client, and keep, maintain, and make available a summary of the animal patient record, as specified in Section 4855.
(5) Provide the client with the veterinarian’s name, contact information, and license number.
(6) Secure an alternative means of contacting the client if the electronic means is
interrupted.
(i) (1) A veterinarian shall not prescribe a drug for a duration of time that is inconsistent with the medical condition of the animal patient or the type of drug prescribed.
(2) A veterinarian who established the required veterinarian-client-patient relationship by examining the animal patient in person or by making medically appropriate and timely visits to the premises on which the animal patient is kept shall not prescribe a drug for a duration of time that is longer than one year from the date that the veterinarian examined the animal patient in person or visited the premises and prescribed the drug.
(3) Except as provided in paragraphs (4) to (8), inclusive, a veterinarian who practices veterinary medicine via telehealth may order, prescribe, or make available drugs, as
defined in Section 11014 of the Health and Safety Code, in accordance with all relevant state and federal regulations.
(4) A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the animal patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the animal patient, either in person or using telehealth.
(5) A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe an antimicrobial drug to the animal patient for a period longer than 14 days of treatment. The
veterinarian shall not issue any further antimicrobial drug prescription, including a refill, to treat the condition of the animal patient unless the veterinarian has conducted an in-person examination of the animal patient.
(6) The veterinarian shall not order, prescribe, or make available a controlled substance, as defined in Section 4021, or xylazine, unless the veterinarian has performed an in-person physical examination of the animal patient or made medically appropriate and timely visits to the premises where the animal patient is kept.
(7) The veterinarian shall notify the client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian shall submit a prescription to a pharmacy that the client chooses.
(8) A veterinarian shall not prescribe via telehealth
any drug or medication for use on a horse engaged in racing or training at a facility under the jurisdiction of the California Horse Racing Board pursuant to Chapter 4 (commencing with Section 19400) of Division 8.
(j) As used in this section, “drug” means any controlled substance, as defined in Section 4021, or any dangerous drug, as defined in Section 4022.
(k) A veterinarian is permitted to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.
SEC. 4.
Section 4829.5 of the Business and Professions Code is amended to read:4829.5.
(a) Each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug, as defined in Section 4022, to an animal patient in an outpatient setting, the veterinarian shall offer to provide, verbally, in writing, or by email to the client, a consultation that includes the following information:(1) The name and description of the dangerous drug.
(2) Route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug.
(3) Any special directions for proper use and storage.
(4) Actions to be taken in the event of a missed dose.
(5) If available, precautions and relevant warnings provided by the drug’s manufacturer, including common severe adverse effects of the drug.
(b) If requested, a veterinarian shall provide drug documentation, if available.
(c) A veterinarian may delegate to a registered veterinary technician or veterinary assistant the task of providing the consultation and drug documentation required by this section.
(d) It shall be noted in the medical record of the animal patient if the consultation described in this section is provided or declined by the client.
SEC. 5.
Section 4853 of the Business and Professions Code is amended to read:4853.
(a) All veterinary premises shall be registered with the board. The certificate of registration shall be on a form prescribed in accordance with Section 164.(b) “Premises” for the purpose of this chapter shall mean the location of operation where veterinary medicine, veterinary dentistry, veterinary surgery, and the various branches thereof is being practiced and shall include a building, kennel, mobile unit, or vehicle. Mobile units and vehicles shall be exempted from independent registration with the board if they are operated from a building or facility that is the licensee manager’s principal place of business and the building is registered with the board, and the registration identifies and declares the use of the mobile unit or vehicle.
(c) The owner or operator of a veterinary premises shall submit a premises registration application to the board. The application shall set forth the name of each owner or operator of the premises, including the type of corporate entity, if applicable, the name of the premises, and the name of the responsible licensee manager who is to act for and on behalf of the registered premises. Substitution of the responsible licensee manager may be accomplished by application to the board if the following conditions are met:
(1) The person substituted qualifies by presenting satisfactory evidence that the person possesses a valid, unexpired, and unrevoked license as provided by this chapter and that the license is not currently under suspension.
(2) No circumvention of the law is contemplated by the substitution.
(d) If the owner or operator of a veterinary premises is a veterinary corporation practicing pursuant to Article 6 (commencing with Section 4910), the application shall set forth the names and titles of each officer, director, or shareholder. Any changes in the officers, directors, or shareholders shall be reported to the board within 30 days.
(e) If the owner or operator of a veterinary premises is a corporation or other artificial legal entity other than a veterinary corporation as provided under subdivision (d), the application shall set forth the names and titles of all owners, officers, general partners, if any, and the agent for service of process. Any changes in the owners, officers, general partners, or agent for service of process shall be reported to the board within 30 days.
(f) The premises registration is
nontransferable. In the event of change of an owner or operator of the premises, the premises registration holder shall notify the board of the change within 30 days after the change.
(g) This section does not authorize any person, corporation, or artificial legal entity, other than a California-licensed veterinarian or a veterinary corporation practicing pursuant to Article 6 (commencing with Section 4910) and the Moscone-Knox Professional Corporation Act (Part 4 (commencing with Section 13400) of Division 3 of Title 1 of the Corporations Code), to furnish to any person or animal patient any veterinary services, diagnosis, or treatment within the scope of California veterinarian licensure under this chapter. This section does not authorize any person, other than a California-licensed veterinarian within the scope of their license, to engage directly or indirectly in the practice of veterinary medicine, veterinary surgery, veterinary dentistry,
and the various branches thereof in accordance with Section 4826. This section does not regulate, govern, or affect in any manner the practice of veterinary medicine, veterinary surgery, or veterinary dentistry by any person duly licensed to engage in such practice.
(h) The location where a veterinarian practices telehealth shall be exempt from the requirement that it be registered pursuant to this section if all of the following requirements are satisfied:
(1) The veterinarian does not perform in-person examination or treatment of animal patients at the location.
(2) No veterinary drug, medicine, appliance, or medical equipment is kept at the location.
(3) The veterinary medical records required pursuant to Sections 4855 and 4856 are created,
maintained, and stored so as to protect the veterinary medical records from access by unauthorized individuals, damage, or loss.
(4) The following information shall be provided on any electronic publication, including any internet website, through which the veterinarian provides or offers to provide veterinary medical services:
(A) The veterinarian’s name, contact information, and California veterinarian license number, prominently displayed.
(B) Contact information and instruction for obtaining a copy of the animal patient’s medical records.
(C) A statement that a client may contact the Veterinary Medical Board if the client has any questions or complaints regarding the veterinarian.
SEC. 6.
Section 4857 of the Business and Professions Code is amended to read:4857.
(a) A veterinarian licensed under this chapter shall not disclose any information concerning an animal patient receiving veterinary services, the client responsible for the animal patient receiving veterinary services, or the veterinary care provided to an animal patient, except under any one of the following circumstances:(1) Upon written or witnessed oral authorization by knowing and informed consent of the client.
(2) Upon authorization received by electronic transmission when originated by the client.
(3) In response to a valid court order or subpoena.
(4) As may be
required to ensure compliance with any federal, state, county, or city law or regulation, including, but not limited to, the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(5) If the care or service was for a horse that has participated in the previous year, or is intended to participate, in a licensed horse race. In these situations, the entire medical record for the horse shall be made available upon request to anyone responsible for the direct medical care of the horse, including the owner, trainer, or veterinarian, the California Horse Racing Board or any other state or local governmental entity, and the racing association or fair conducting the licensed horse race.
(6) As otherwise provided in this section.
(b) This section shall not apply to
the extent that the client responsible for an animal patient or an authorized agent of the client responsible for the animal patient has filed or caused to be filed a civil or criminal complaint that places the veterinarian’s care and treatment of the animal patient or the nature and extent of the injuries to the animal patient at issue, or when the veterinarian is acting to comply with federal, state, county, or city laws or regulations.
(c) A veterinarian shall be subject to the criminal penalties set forth in Section 4831 or any other provision of this code for a violation of this section. In addition, any veterinarian who negligently releases confidential information shall be liable in a civil action for any damages caused by the release of that information.
(d) Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians
and peace officers, humane society officers, or animal control officers who are acting to protect the welfare of animals.
(e) Nothing in this section is intended to prevent the sharing of veterinary medical information between veterinarians and facilities for the purpose of diagnosis or treatment of the animal patient that is the subject of the medical records.
SEC. 7.
Section 4875.1 of the Business and Professions Code is amended to read:4875.1.
(a) In order to ensure that its resources are maximized for the protection of the public, the board shall prioritize its investigative and prosecutorial resources to ensure that veterinarians and registered veterinary technicians representing the greatest threat of harm are identified and disciplined expeditiously. Cases involving any of the following allegations shall be handled on a priority basis, as follows, with the highest priority being given to cases in paragraph (1):(1) Negligence or incompetence that involves death or serious bodily injury to an animal patient, such that the veterinarian or registered veterinary technician represents a danger to the public.
(2) Cruelty to animals.
(3) A conviction or convictions for a criminal charge or charges or being subject to a felony criminal proceeding without consideration of the outcome of the proceeding.
(4) Practicing veterinary medicine while under the influence of drugs or alcohol.
(5) Drug or alcohol abuse by a veterinarian or registered veterinary technician involving death or serious bodily injury to an animal patient or to the public.
(6) Self-prescribing of any dangerous drug, as defined in Section 4022, or any controlled substance, as defined in Section 4021.
(7) Repeated acts of excessive prescribing, furnishing, or administering
of controlled substances, as defined in Section 4021, or repeated acts of prescribing, dispensing, or furnishing of controlled substances, as defined in Section 4021, without having first established a veterinarian-client-patient relationship pursuant to Section 4826.6.
(8) Extreme departures from minimum sanitary conditions such that there is a threat to an animal patient or the public and animal health and safety, only if the case has already been subject to Section 494 and board action.
(b) The board may prioritize cases involving an allegation of conduct that is not described in subdivision (a). Those cases prioritized shall not be assigned a priority equal to or higher than the priorities established in subdivision (a).
(c) The board shall annually report and make publicly available the number of disciplinary
actions that are taken in each priority category specified in subdivisions (a) and (b).
