Regulations Pertaining to the Practice of Veterinary Medicine in the State of Maryland
These are the regulations applying to the practice of veterinary medicine in the State of Maryland as printed on the state website effective 2/24/2006. To check for updates, see http://www.dsd.state.md.us/comar/subtitle_chapters/15_Chapters.htm, and go to Subtitle 14.
15.14.01.00. Title 15 DEPARTMENT OF AGRICULTURE Subtitle 14 BOARD OF VETERINARY MEDICAL EXAMINERS Chapter 01 Standards of Practice and Code of Ethics for the Practice of Veterinary Medicine in the State Authority: Agriculture Article, §2-103, 2-304, and 2-310, Annotated Code of Maryland
15.14.01.01 Purpose and Authority.
The purpose of this chapter is to set forth standards of professional conduct and ethics for veterinarians and prescribe standards of practice of veterinary medicine in the State. The chapter also implements the laws of Maryland governing the practice of veterinary medicine in the State as set forth in the Agriculture Article, Annotated Code of Maryland, and is issued by the Board pursuant to that authority and approved by the Secretary in accordance with his authority in Title 2 of the Agriculture Article, Annotated Code of Maryland.
This chapter shall apply to all veterinarians licensed and registered in the State.
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Board" means the State Board of Veterinary Medical Examiners.
(2) "Controlled dangerous substance" means any drug, substance, or immediate precursor as listed in Criminal Law Article, §5-101, Annotated Code of Maryland.
(3) "Department" means the Department of Agriculture of Maryland.
(4) "Dispensing" means direct distribution of products by veterinarians to their clients for use in or on their animals.
(5) "Federal legend drug" or "veterinary prescription drug" means a drug labeled with the statement "Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian".
(6) "Prescribing" means transmitting an order that authorizes a licensed pharmacist or the equivalent to prepare and dispense specified pharmaceuticals to be used in or on animals in the manner directed by a veterinarian.
(7) "Secretary" means the Secretary of Agriculture.
(8) "Veterinarian" means an individual who is licensed and registered as a veterinarian to practice in the State.
(9) "Veterinary hospital" means a building or portion of a building which is regularly used for the treatment of animals by a veterinary practitioner.
(10) "Veterinarian-client-patient relationship" means that all of the following conditions exist:
(a) The veterinarian has assumed the responsibility for making clinical judgments regarding the health of the animal and the need for medical treatment, and the client has agreed to follow the veterinarian's instructions;
(b) The veterinarian has sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis of the medical condition of the animal because the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal through either:
(i) A physical examination; or
(ii) Medically appropriate and timely visits to the location where the animal is kept; and
(c) The veterinarian is readily available or has arranged for emergency coverage or follow-up evaluation in the event of adverse reactions or the failure of the treatment regimen.
15.14.01.04 Professional Conduct.
A. The principal objectives of the veterinary profession are to render service to society, to conserve our livestock resources, and to relieve suffering of animals. A veterinarian shall act in relation to the public, the veterinarian's colleagues, and their patients, and the allied professions so as to merit their full confidence and respect. Examples of conduct which are prohibited by this standard include, but are not limited to, the following:
(1) Using a college degree to which the veterinarian is not entitled or any degree or title granted by an institution declared unworthy by contemporary institutions of its class;
(2) Accepting a fee from the seller of an animal by a veterinarian employed by a buyer to inspect an animal for soundness which is prima facie evidence of fraud;
(3) Guaranteeing a cure;
(4) Performing or participating in surgery if it is known the surgery was requested with intent to deceive a third party;
(5) Promoting, selling, prescribing, or using any product, the ingredient formula of which has not been revealed to the veterinarian;
(6) Performing a surgical procedure to conceal or to correct genetic defects in animals to be shown, bred, or sold;
(7) Making payments to any person for referring, attempting to refer, or promising to refer animals to that veterinarian; and
(8) Prescribing or dispensing veterinary prescription drugs outside of a veterinarian-client-patient relationship.
B. A veterinarian may not act in an unprofessional or immoral manner in the practice of veterinary medicine.
15.14.01.05 Choice and Selection of Patients.
A veterinarian may choose whom he will serve. Once he has undertaken care of a patient he may not neglect him. In an emergency, however, he should render service to the best of his ability, but this does not require veterinarians to accept financial responsibility for the care and treatment of any animal.
A. A veterinarian may not prepare, cause to be prepared, use, or participate in the use of, any advertisement or other public communication containing information about the services of particular veterinarians or veterinary hospitals which:
(1) Contains a misstatement of fact;
(2) Is likely to mislead or deceive because in context it makes only a partial disclosure of relevant facts;
(3) Is intended or is likely to create false or unjustified expectations of favorable results;
(4) Contains any other statement that is intended or likely to cause a reasonable person to misunderstand or be deceived; or
(5) Constitutes, is part of, or is a device for carrying out, an otherwise unlawful act.
B. A veterinarian, or holder of a license to operate a veterinary hospital, who advertises the availability of a veterinarian to serve a 24-hour emergency veterinary hospital, shall state clearly in the advertisement whether a veterinarian is personally present at the hospital facility on a 24-hour basis, or is merely on call.
C. Veterinarians shall be personally responsible for compliance with the above requirements and shall be prepared to substantiate their compliance to the State Board of Veterinary Medical Examiners.
15.14.01.07 Professional Judgment and Practice.
A. A veterinarian, when caring for and treating a patient, shall conform to those minimal standards of care and treatment which are customary among veterinarians in this State.
B. If a veterinarian professes to the public or colleagues to be a specialist in a particular area of veterinary medicine, the veterinarian, when caring for and treating a patient, shall conform to the minimum standards of care and treatment which are customary among these specialists.
C. A veterinarian may not provide professional services while:
(1) Using any narcotic or controlled dangerous substance, as defined in Criminal Law Article, Annotated Code of Maryland; or
(2) Under the influence of alcohol or any drug that impairs that veterinarian's judgment or motor skills.
15.14.01.08 Professional Knowledge and Training.
A veterinarian should strive continually to improve veterinary knowledge and skill, making available to his colleagues the benefit of his professional attainments, and seeking, through consultation, assistance of others when it appears that the quality of a veterinary service may be enhanced by consultation.
15.14.01.09 Maintenance of Professional Standards and Reporting Requirements.
It shall be considered a violation of this regulation for any veterinarian to commit any of the following acts of omission or commission:
A. To fail to report promptly when required by law or regulations, any dangerous, infectious, or contagious disease known to the veterinarian;
B. To fail to report promptly the results of any tests when required to do so by law or regulation or to apply or report them fraudulently;
C. To willfully make any misrepresentation in the inspection of foodstuffs;
D. To issue or use fraudulently any health certificate, inspection certificate, vaccination certificate, test chart, or other blank form used in the practice of veterinary medicine, including signing these forms in their blank state and dispensing them as such to the client;
E. To conduct a practice in violation of the regulations prescribed by the Board for proper sanitary and hygienic methods in the care and treatment of animals.
15.14.01.10 Record Keeping.
A. For animals that a veterinarian treats, the veterinarian shall prepare a legibly written record that accurately and thoroughly reflects the treatment provided. At a minimum, the veterinarian's record shall include the following information, as applicable:
(1) If available, the name, address, and phone number of the animal's owner;
(2) If available, the name and identity of the animal;
(3) If available, the age, sex, and breed of the animal;
(4) The dates (beginning and ending) of custody of the animal;
(5) A short history of the animal's condition as it pertains to the animal's medical status;
(6) The animal's physical condition at the beginning of custody and the initial diagnosis, if any;
(7) The treatment provided the animal and if medication is given, the amount and frequency;
(8) The progress and disposition of the case; and
(9) The surgery log and anesthetic log, if any.
B. The veterinarian shall record the information referenced in §A of this regulation in a timely manner, that is, as soon as practicable after the veterinarian has seen the animal.
C. If the veterinarian discovers that the record is incomplete or in error, the veterinarian shall amend the record, being sure to date and initial the amendment.
D. A veterinarian shall label each radiograph with the patient's name, the owner's name, and the date the radiograph was taken.
E. Patient records shall be kept by a veterinarian for 3 years after a patient's last visit.
F. Patient Records.
(1) Patients' records are the property of the veterinary practice for whom the records were made.
(2) If requested by a patient's owner, the veterinarian shall release a copy of an animal's written record to the owner or a subsequent treating veterinarian. The veterinarian may require the owner to pay the reasonable cost of providing the records requested.
(3) If requested by a patient's owner, the veterinarian shall release temporarily to a subsequent treating veterinarian the original nonwritten record of the animal, such as, but not limited to, radiographs, photographs, electrocardiograms, and slides. The subsequent treating veterinarian shall return these original nonwritten records within 30 days of their receipt or such other time as agreed to by the parties.
(4) Upon request and if known, a veterinarian shall inform a boarding facility, including a veterinary hospital offering boarding services, which is boarding a veterinarian's patient, whether the animal's vaccinations are current.
G. The requirements of this regulation apply to companion pet animals only.
15.14.01.11 Annual Registration.
A. A licensee who practices veterinary medicine in the State shall:
(1) Register annually with the Board;
(2) Pay the Board a registration fee, as provided in COMAR 15.14.12.02;
(3) State on the registration form the licensee's:
(a) Primary practice address, if any,
(b) Business telephone number, if any,
(c) Home (street) address and mailing address if the mailing address is different from the licensee's home address; and
(4) Notify the Board in writing of any change in the licensee's name or address (home, mailing, and practice) within 60 days after the change.
B. Any veterinarian, who permits his license to become invalid by unpaid registration, shall submit to the Board satisfactory proof of his or her qualifications to practice veterinary medicine or take the examination again.
15.14.01.12 Controlled Dangerous Substances.
A. To prescribe or dispense controlled dangerous substances, a veterinarian shall have a current:
(1) Federal controlled substance registration certificate; and
(2) Maryland controlled dangerous substance registration.
B. A veterinarian shall ensure that all controlled dangerous substances are maintained, administered, prescribed, dispensed, and destroyed in compliance with all State and federal laws.
C. Schedule II drugs.
(1) Emergency Dispensing. A Schedule II drug may be dispensed upon oral prescription by a veterinarian if the following conditions are met:
(a) Immediate administration of the drug is necessary for proper treatment;
(b) Alternative treatment is not available; and
(c) It is not possible for the veterinarian to provide a written prescription for the drug at that time.
(2) If an oral prescription is issued under §C(1) of this regulation, the veterinarian shall:
(a) Specify the:
(i) Name of the drug;
(ii) Dose strength;
(iv) Instructions; and
(v) Warnings; and
(b) Prescribe only enough to treat the animal during the emergency period;
(c) State on the prescription "Authorization for Emergency Dispensing";
(d) Within 72 hours, write, sign, and send the prescription to the location that dispensed the drug; and
(e) Make a note of the issuance of an oral prescription in the animal's record.
(3) Except as provided in §C(4) of this regulation, a veterinarian shall maintain all Schedule II drugs under lock at all times, with access by veterinarians only.
(4) A registered veterinary technician may have access to a working stock of Schedule II drugs kept under separate lock.
D. Schedule III—V drugs. A veterinarian shall maintain all Schedule III—V drugs under lock when not in use.
(1) For all controlled dangerous substances, a veterinarian shall maintain complete and accurate records on the premises indicated by name on the federal controlled substance registration certificate or Maryland controlled dangerous substance registration. A veterinarian may delegate to an authorized employee the daily task of completing these records.
(2) A veterinarian or authorized employee shall include the following information in the dispensing record:
(a) Date of dispensation;
(b) Drug name, strength, and the amount dispensed, administered, or wasted;
(c) Client and animal identification; and
(d) Identification of the veterinarian authorizing the administration or dispensing of a drug.
F. Inventory. A veterinarian shall:
(1) Take inventory on the same date once every 2 years;
(2) Sign, date, and record the time inventory is taken;
(3) Maintain records of all Schedule II prescriptions for a period of 5 years, and maintain records of all Schedule III—V prescriptions for a period of 2 years.
G. Disposal. A veterinarian shall destroy all Schedule II—V drugs in accordance with United States Drug Enforcement Agency rules and regulations.
A. A veterinarian may issue a prescription only under the following conditions:
(1) A veterinarian-client-patient relationship exists; and
(2) The veterinarian is willing to dispense the drug for the patient.
B. A licensed veterinarian authorizing a pharmacist to dispense a veterinary prescription drug shall include the following in the prescription:
(1) The name, address, telephone number, and license number of the veterinarian;
(2) The name and address of the client;
(3) Identification of the animal, through either name or number;
(4) The species of the animal;
(5) The name, quantity, and strength of the drug;
(6) Directions for use;
(7) Cautionary statements including, if applicable, expiration date and withdrawal time for slaughter or milk withholding, or both;
(8) Date of issue;
(9) Number of refills; and
(10) The signature of the veterinarian.
C. When issuing a prescription or dispensing a drug to a client, a veterinarian shall inform the client of the most common known side effects of the drug.
D. A veterinarian or employee approved by a veterinarian may transmit prescriptions that are not controlled dangerous substances from the prescriber to a pharmacy chosen by a client, and note such action in the record of the animal belonging to the client. Acceptable methods of transmission include but are not limited to:
(1) Facsimile; or
(2) Encrypted computer transmission.
E. A veterinarian may renew a prescription issued by another veterinarian from the same hospital for a client of that hospital if the veterinarian issuing the prescription renewal is in agreement with the need to continue treatment.
F. A veterinarian may supply a veterinarian at a different veterinary hospital with a prescription drug to alleviate a shortage or supply a need, but may not fill a prescription for a client that has been written by a veterinarian who is not an employee of that hospital.
15.14.01.12-2 Dispensing of Federal Legend Drugs or Veterinary Prescription Drugs.
A. A veterinarian may dispense a prescription drug only if a veterinarian-client-patient relationship exists.
B. A veterinarian shall ensure that all federal legend drugs and veterinary prescription drugs are maintained, administered, prescribed, dispensed, and destroyed in compliance with all State and federal laws.
C. A veterinarian shall dispense prescription drugs only to the clients of the veterinarian or to clients of other veterinarians at the same hospital if there is an agreement with the need to continue treatment.
D. A veterinarian or authorized employee may not dispense a quantity of drug that is greater than that needed for the treatment of an animal, herd, or flock.
E. Nonprofessional staff may dispense prescription drugs only after specific instructions have been provided by a staff veterinarian.
F. A veterinarian or authorized employee shall include the following information on the labels of dispensed drugs:
(1) Hospital name, address, and telephone number;
(2) Name of prescribing veterinarian;
(3) Name of client and animal;
(4) Name, quantity, and strength of the drug;
(5) Directions for usage;
(6) Route of administration;
(7) Length of treatment;
(8) Appropriate cautionary statements including, if applicable, slaughter withdrawal or milk withholding times, or both;
(9) Date of dispensation; and
(10) Expiration date.
G. Returned Prescriptions.
(1) A veterinarian or authorized individual may not place a prescription returned by a client back into inventory unless:
(a) The prescription container is unopened;
(b) The prescription has not expired; and
(c) It can be readily determined that the drug was properly stored, labeled, and sealed to preserve strength, quality, purity, and identity during the time between sale of the drug and return to the veterinarian.
(2) A client may return any drug that does not meet the requirements of §G(1) to the veterinarian or veterinary hospital for proper disposal.
15.14.01.12-3 Expired Medications.
A. A veterinarian may not administer expired medications to an animal.
B. A veterinarian may not remove expiration dates from medications.
C. Until a veterinarian has disposed of an expired medication, the veterinarian shall package and keep it separate and apart from unexpired medications.
This chapter shall be enforced by the Board of Veterinary Medical Examiners. The Board may suspend or revoke the license and registration of any veterinarian or censure or place on probation any veterinarian for a violation of any provision of this chapter. Disciplinary actions instituted on the basis of this chapter shall be conducted in accordance with the hearing requirements established by the statutes relating to the practice of veterinary medicine in the State and the regulations promulgated under them. Hearings shall be conducted in accordance with procedures adopted by the Board and the Department of Agriculture and prescribed by the Administrative Procedures Act.
If any provision of this chapter or the application thereof to any person or circumstance is held invalid for any reason by a court of competent jurisdiction, the holding may not affect other provisions or applications of the regulation and, to this extent, the provisions of this regulation are severable.
15.14.01.15 Complying with Certain Requests of the Board.
A veterinarian shall comply with the following requests of the Board:
A. If summoned to appear before the Board, to appear on the date and at the time indicated in the summons; and
B. Within 15 days after receiving a Request for Production of Documents from the Board, to deliver to the Board all books, papers, records, and other documentary evidence which the Board has requested; and
C. If the veterinarian owns a veterinary hospital, to allow the Board's inspectors to inspect the facility during normal business hours.
15.14.01.16 Notice of Lack of 24-hour Supervision.
A veterinarian who has assumed the care and custody of an animal, but does not provide 24-hour supervision by an individual physically on the premises, shall provide the following written notification to the owner of the animal: "We Do Not Provide 24-Hour Supervision". This notice shall be provided either by:
A. Posting in a conspicuous location within the hospital that is readily accessible by the public, such as at or near a receptionist's desk; or
B. Hand delivery to the owner on a piece of paper when the animal is presented for treatment or boarding.
15.14.01.17 Direct Supervision Guidelines.
A. In this regulation, the following terms have the meanings indicated:
(1) "Registered veterinary technician" means an individual currently registered with the Board as a veterinary technician;
(2) "Responsible direct supervision" means competent, immediate, and active supervision;
(3) "Technician" means a nurse, attendant, or technician other than a registered veterinary technician, intern, or other employee of the veterinarian.
B. A veterinarian giving responsible direct supervision to the work of a technician or registered veterinary technician shall be:
(1) In the immediate vicinity of where the work is being performed; and
(2) Actively engaged in supervising this work throughout the entire period it is being performed, including:
(a) Providing clear and specific directions on what work is to be done,
(b) Being cognizant of how the assigned work is being performed, and
(c) Being immediately available to provide advice when the assigned work is being performed.
C. A veterinarian may not permit a technician to perform the following procedures on an animal while the animal is under that veterinarian's care:
(1) Anesthesia induction by inhalation or intravenous injection;
(2) Anesthesia induction by intramuscular injection;
(3) Application of casts and splints;
(4) Dental extractions; and
(5) Suturing of existing surgical skin incisions.
D. A veterinarian may permit a registered veterinary technician to perform the procedures referenced in §C of this regulation if, when these procedures are being performed:
(1) The individual is under the responsible direct supervision of the veterinarian; and
(2) For the procedure referenced in §C(1) of this regulation only, the veterinarian also is able to maintain direct visual contact of the technician's performance of this procedure.
E. A veterinarian may permit a technician to render auxiliary or supporting assistance or administer medication if, when rendering the assistance or administering medication, the employee is under the responsible direct supervision of the veterinarian.
F. In the case of an anesthetized animal, a veterinarian may permit a technician to monitor the animal's condition and provide other supporting assistance, including the animal's maintenance, once the animal is stabilized.
15.14.01.18 Animal Boarding by a Veterinarian.
A veterinarian who operates an animal boarding business in connection with a veterinary hospital is responsible for:
A. Caring for boarded animals;
B. Training staff on the care of boarded animals;
C. Instructing staff to report to the veterinarian on duty if a boarded animal is sick or injured; and
D. Arranging for the veterinary care of any sick or injured boarded animal.