California Veterinary Law and Complementary Health Care

Complementary health care for animals is rapidly expanding it’s reach into the veterinary field. “A University of Florida survey in 1990 revealed that 34% of animal owners utilized some form of CAM. By 1997, survey results showed an increase to 42% but 60% of these people did not provide this information to their regular veterinarian.” The AVMA Guidelines for Complementary and Alternative Veterinary Medicine, identify these complementary medical modalities as CAVM. If you read their guidelines you will see that they “recognize the interest in and use of these modalities and is open to their consideration” but they require a demonstration of a substantial body of scientific knowledge in order to be recognized by the AVMA. Since we as human beings are animals by scientific classification and since most of the animals that CAVM practitioners treat are mammals like us and since there is plenty of scientific evidence for CAM practice and efficacy now the AVMA should start to look at these studies.  At the end of their guidelines they refer the DVM back to state laws regulating veterinary practice. Nowhere in their guidelines do they say that they are interested in educating their members on the possible benefits that the consumer obviously perceives. The AVMA seems to be trying to ignore this growing field it. The AVMA further states: “The foremost objective in veterinary medicine is patient welfare. Ideally, sound veterinary medicine is effective, safe, proven, and holistic in that it considers all aspects of the animal patient in the context of its environment.” If 42% of animal owners are trying these modalities and 60% of these owners are not discussing this with their DVM there is something seriously wrong with the AVMA’s position on CAVM. It also seems that the AVMA is out of touch with animal owners needs for CAVM treatments for their animals. The AVMA has done nothing to help animal owners and caretakers get access to CAVM treatments, in fact the AVMA has worked against CAVM practitioners to make sure that they can not practice legally in a vast majority of the states. If the patients welfare is the foremost objective in veterinary medicine and animal owners believe in the efficacy of these treatments then the AVMA should fund some studies on these modalities to prove or disprove their efficacy. I personally believe that the AVMA does care about the health of animals but their board of directors and members are mainly working towards blocking the avenues to these treatments for the customer just as the AMA blocked chiropractors from practicing for years.

California’s veterinary laws pretty much make it illegal for CAVM practitioners to practice unless they are a DVM in this state. As CAVM modality use is increasing, veterinary medical schools are starting to add programs to their curriculum to help veterinary students learn more about these modalities which they will certainly encounter in their practice. While there is still a lot of resistance by traditional DVM’s to these modalities I believe that this resistance is due to ignorance and protectionism. A must read book for both DVM’s and CAVM practitioners is Complementary and Alternative Veterinary Medicine by David W. Ramey DVM and Bernard E. Rollin PhD. These respected authors take a critical look at the CAVM field and have some very helpful insights to share. In the future I believe we will see a CAVM organization under the umbrella of the AVMA. Human medicine has already recognized complementary health care and the National Institute of Health has recognized and funded research in the CAM field through the NCCAM. IF the AVMA is serious about making sure that animals get the best health care possible it should follow the NCCAM model and start the process of scientific investigation of CAVM modalities so animal owners can find out which modalities might help or hurt their animal companions.

An important issue for CAVM practitioners is how to work within the law and with DVM’s and this is the subject that I promised to address in my last blog. Let me begin this part of the conversation by saying that I personally believe that the AVMA and its’ members should be in the lead in helping to determine which CAVM modalities and treatments are suitable for animal owners to use. DVM’s are very well trained in this country and have a vast body of knowledge at their disposal. All of the DVM’s I have known have proven to be very compassionate and knowledgeable practitioners and I have a great amount of respect for their dedication the the health of animals. CAVM practitioners need to learn how to work with DVM’s and the AVMA so we can both achieve our common goals which are to help animals become and stay healthy and free from pain and disease. So our number one goal at this point should be to establish and maintain good working relationships with the AVMA and DVM’s. Good communication and education are the best medicine to use. Patience and perseverance will also be very helpful in establishing a good rapport with other animal health care practitioners.

So, the number one thing we must do to practice CAVM legally in the state of California is to be under the supervision of a DVM. California DVM’s probably are the most open to CAVM modalities because a large amount of their clients are using CAVM practitioners on a regular basis. It should not be hard to find a DVM who is willing to supervise your practice. You should pay the DVM for their consulting time and refer clients to them on a regular basis. Under state guidelines and AVMA guidelines the supervising DVM should be consulted for any treatment and in fact it is my belief that if you can not prove efficacy of the treatment to the DVM the treatment should not be given. When under the supervision of the DVM you should maintain all records in a professional manner and forward these records to the supervising and primary DVM. It is illegal for any CAVM practitioner who is not a DVM to diagnose so please leave this to the DVM. You can give your opinion the the DVM based upon your expertise in the CAVM field you are practicing but you should not state this opinion to your client without the DVM’s permission and review.

Let’s get an example of this communication trail. Maybe you are a veterinary chiropractor, physical therapist or massage therapist who has an animals owner contact you for treatment. The first thing we would want to do is to find out who the animals primary DVM is. We would find out from the owner if the DVM referred them to us for treatment. If their primary DVM did not refer them to us for treatment and another DVM referred them for treatment we would still need to contact the primary DVM and have them supervise the treatment. If they found us through another referral source we would then ask the client if it was alright with them that we contact the primary DVM before any treatment so that they could supervise whatever treatment that we would give. Maybe the client doesn’t want us to contact the primary DVM because they thought that the primary DVM would not be receptive to the treatment that they wanted to get for the animal. In this case we should have a DVM who we regularly have supervise us examine the animal in question and have them supervise the treatment. If the animals caretaker doesn’t want to incur the expense of this option then by law we would not be able to give the treatment. Once we have done a thorough examination of the animal in question and if we have the approval to contact the primary DVM or our supervising DVM we would email then or call them and let them know what we have found in our examination, what type of treatment we would like to give to the animal, ask them if there is any contraindications to the treatment and ask the DVM if they would be willing to supervise us. It would also be helpful is we had all of the clients medical reports before treatment so we would ask the animals caretaker to allow the DVM to give us access to these records. Once we have the DVM’s recommendations we can proceed to treat the animal based upon the DVM’s recommendations, the clients goals and the animals needs. If we find during the treatment and examination for example that there are trigger points and indurated tissue in the gluteals and the dog has been limping on the side of the trigger points and induration and maybe we also found a dorsal displacement of L-4, what would we tell the client about this? We have two choices here, 1. We could tell the animals owner what we have found with a preface that they should always check with their DVM which would not truly be a legal approach because we would be diagnosing or 2. We could chart these findings and send them to the DVM for further examination and diagnoses and let the animals owner know that we have sent our findings to the DVM and the DVM will interpret these findings and will contact them about what type of treatment will be needed to treat the animal in the future if these findings are correct.

While all of this might seem to much to do for a CAVM practitioner consider the fact that any DVM who was not the animals primary DVM would do the same thing if the animal was referred to them from the primary DVM. Why should CAVM practitioners do anything differently?

This blog is already getting a little to long so in the next blog we will look at opportunities in the educational field for those CAVM practitioners, out of state DVM’s and DVM’s entering into the field from out of the country who wish to work with animals in this state or any state in the USA and who have been stymied by the veterinary laws from practicing veterinary medicine.