ASPCA Statement of Support for Veterinary Telemedicine During the COVID-19 Pandemic

4/8/2020

Stay at home orders, limitation on activities to only those deemed “essential”, the need for social distancing and dire shortages of personal protective gear (PPE) are among the many challenges facing us all during the COVID-19 pandemic. For pet owners seeking care for their animals and for the veterinarians committed to providing that care, these constraints pose additional hurdles. Fortunately,  most of the executive orders issued to date in states around the country include veterinary medicine and animal sheltering as “essential services”  Many states have also relaxed their rules to allow more expansive use of “telemedicine”[1] so that veterinarians, where appropriate, can serve their clients remotely, without the risks of  close person-to-person contact.

Expand Telemedicine When Possible

Because ensuring that pets can access necessary care and remain safely at home with their families is more critical now than ever,  the ASPCA supports the broadest use of telemedicine allowed by applicable law by both private practitioners and shelter veterinarians and urges states that haven’t already done so to permit the use of this essential tool during times of disaster.

• Key Takeaway: During the COVID-19 pandemic, veterinarians should use telemedicine expansively whenever it is medically appropriate and permissible by law.

Consult State Veterinary Boards

State veterinary practice laws dictate the extent to which veterinarians may use telemedicine and these laws vary from state to state. The American Veterinary Medical Association (AVMA) has created a glossary of telemedicine terms and recommends that veterinary telemedicine should be conducted only “within an existing Veterinarian-Client-Patient Relationship (VCPR), with the exception for advice given in an emergency until that patient can be seen by a veterinarian.”  But in response to the national health crisis, some states have begun to make special accommodations to permit wider use of telemedicine than is normally allowed under the law.

For example, on April 1, the Governor of Arizona issued an executive order allowing veterinarians to use telemedicine to establish a VCPR so long as the veterinarian can gather sufficient information to initiate a preliminary diagnosis, and the Governor of Colorado issued an executive order temporarily suspending the requirement that a veterinarian needs to have recently seen and be personally acquainted with an animal to establish a VCPR.  Michigan has required veterinarians to postpone all in-person non-essential veterinary services until the declared emergency has ended and to provide all veterinary services—essential and non-essential—via telemedicine to the fullest extent possible during the declared emergency.  

Other states have not gone as far but have still relaxed the rules considerably when it comes to using telemedicine. For example, Minnesota has decided that, until January 1, 2021, the “timely visits” requirement for establishing a VCPR is met if the veterinarian has examined the patient or visited the premises where the animal is kept within the past 18 months.

These states have rightly recognized that even with the danger that COVID-19 presents to the public and the need to protect veterinary healthcare workers, veterinarians must still be able to provide animals with the care they urgently need. Permitting broader use of telemedicine allows this important work to continue, while ensuring the safeguards compelled by the current public health emergency.

• Key Takeaway: Veterinarians should consider whether their state may permit more expansive use of telemedicine due to COVID-19.
   

[1] The American Veterinary Medical Association (AVMA) defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications regarding a patient’s clinical health status.”  For additional defined telehealth terms, please refer to the glossary.

Prescribe Extralabel Drugs

While state practice laws govern veterinary practice, federal law governs extralabel drug use by veterinarians. The federal agency with regulatory authority, the U.S. Food and Drug Administration (FDA) announced on March 24th, that it will suspend temporarily the VCPR requirements imposed by the Animal Medicinal Drug Use Clarification Act of 1994 (AMDUCA) regulations relating to extralabel[1] usage of certain drugs.  Acknowledging the vital role that veterinarians play in protecting public health, the FDA recognized the need to provide veterinarians with “the latitude to expand the use of telemedicine in the care of animals.”  Moreover, on March 16, the U.S. Drug Enforcement Administration (DEA) permitted DEA-registered practitioners to issue prescriptions for all schedule II–V controlled substances to patients for whom they have not conducted an in-person medical evaluation so long as certain basic conditions are met, including that the prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his or her professional practice; that the telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system; and that the practitioner is acting in accordance with applicable federal and state laws.

• Key Takeaway: FDA and DEA allow vets to prescribe extralabel drugs via telemedicine due to COVID-19.

Employ Telemedicine When Appropriate

The ASPCA encourages veterinarians to use telemedicine whenever it is medically appropriate and legal to do so.  The dire shortage of personal protective equipment, including facemasks and shields, gowns, and gloves, has left doctors with limited options.  Yet the need for veterinary care for both animal health and human wellbeing is critical, more so in this stressful and uncertain time.  Limiting in-person veterinary visits will preserve valuable personal protective equipment so that it can be utilized by the medical professionals who are combatting this deadly pandemic.  Telemedicine also supports social distancing not only by restricting interactions between veterinarians and veterinary staff with clients but also by reducing interactions of staff members due to a decreased need for in-person veterinary services.

Just like private clients, shelters can use telemedicine to provide care for animals in their custody.  Even shelters with veterinarians on staff may face situations where these veterinarians cannot come to work during the pandemic but can still provide care by using telemedicine.  For shelters without veterinarians on staff, third-party veterinarians may be able to provide valuable services through telemedicine.    Veterinarians wishing to support shelters will find shelter veterinary medicine resources widely available, including through the ASPCA, Association of Shelter Veterinarians, and the University of Florida’s Maddie’s Shelter Medicine Program.

• Key Takeaway: Private and shelter veterinarians should fully leverage these more expansive opportunities to employ telemedicine to help animals and limit the risk to public health during the pandemic.

Relax Legal Impediments 

In this time of national crisis where social distancing is required to protect public health, personal protective equipment is scarce, and animals are in need, the ASPCA supports the reduction of legal limitations to telemedicine, something that has already happened in the human medical world.  The American Medical Association has even created a guide to help physicians practice telemedicine “[i]n an effort to keep … health care workers and patients safe amid the COVID-19 pandemic.”  While physical veterinary medical examinations are of course sometimes critical even during the pandemic, responsible use of telemedicine can bring essential care to animals in need while protecting people on the frontlines of the fight against this pandemic.

• Key Takeaway: Legal impediments to telemedicine should be relaxed during the COVID-19 pandemic.
   

[1] “Extralabel usage” is defined as “[a]ctual use or intended use of a drug in an animal in a manner that is not in accordance with the approved labeling.”   21 C.F.R. 530.3(a).