Original Notice.

     Preproposal statement of inquiry was filed as WSR 02-13-057.

     Title of Rule: WAC 246-933-320 General requirements for all veterinary medical facilities, 246-933-501 Intent, 246-933-510 Definitions, 246-933-520 Registration, 246-933-530 Purchase and use of drugs, and 246-933-550 Investigations.

     Purpose: The proposal establishes that the veterinary board adopt rules to regulate entities that provide limited veterinary services to the low-income member of our communities.

     Statutory Authority for Adoption: RCW 18.92.030, chapter 157, Laws of 2002.

     Statute Being Implemented: RCW 18.92.260.

     Summary: To establish registration and renewal requirements for humane societies and animal control agencies (entities); define emergency, entity and low income household; govern the purchase and use of drugs for the authorized limited services; and rules to ensure that entities are in compliance with legislation.

     To amend the current recordkeeping rule that will apply to all veterinary facilities and entities.

     Reasons Supporting Proposal: This rule will allow low-income households access to veterinary care for their animals which may help improve the health of the pet population.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Karen Kelley, 1112 S.E. Quince Street, Olympia, WA 98504-7868, 236-4876.

     Name of Proponent: Department of Health, governmental.

     Rule is not necessitated by federal law, federal or state court decision.

     Explanation of Rule, its Purpose, and Anticipated Effects: New Rules:

     WAC 246-933-501 Intent, states the legislature's intent to allow qualified animal control agencies and humane societies to provide limited veterinary services to low income members of our communities.

     WAC 246-933-510 Definitions, this rule defines entity, emergency care and low-income household.

     WAC 246-933-520 Registration, this rule directs entities to chapter 246-12 WAC, Part 3 for registration requirements.

     WAC 246-933-530 Purchase and use of legend drugs and controlled substances, legend drugs and controlled substances are defined, and the responsibilities of veterinarians are clearly stated.

     WAC 246-933-550 Investigation, states that treatment records to include drug use will be made available to representatives of the veterinary board and the board of pharmacy.

Amended Rule:

     WAC 246-933-320 General requirements for all veterinary medical facilities, subsection (7) Records, language is added requiring documentation of low-income status, if applicable.

     These rules will provide the opportunity for entities to register to provide limited veterinary services to the low-income members of our communities.

     Access to these limited veterinary services will be improved for the pets of low-income households and help prevent the spread of disease and overpopulation.

     Proposal Changes the Following Existing Rules: WAC 246-933-320 will be amended to be clearer by adding items to be included in an animal's record, and require documentation of the low-income status for persons that seek the limited veterinary services provided by qualified animal care and control agencies and humane societies.

     A small business economic impact statement has been prepared under chapter 19.85 RCW.

     Purpose and Objectives: The Veterinary Board of Governors is proposing rule changes that will:

•     Add clarity to the existing definitions and rules, making it easier for all veterinary professionals, staff facilities and entities to understand the responsibilities, requirement and limitations in terms of providing necessary and appropriate services, treatment and documentation.

•     Add new language accounting for low-income persons receiving the limited veterinary services provided by qualified animal care and control agencies and humane societies.

     Rule-making Requirements of the Regulatory Fairness Act (chapter 19.85 RCW): The Regulatory Fairness Act, RCW 19.85.030 requires the department to conduct a small business economic impact statement (SBEIS) for proposed rules that have more than minor impact on small businesses. As defined in RCW 19.85.020 a small business is "any business entity, including a sole proprietorship, corporation, partnership, or other legal entity, that is owned and operated independently from all other businesses, that has the purpose of making a profit, and that has fifty or fewer employees."

     What do the proposed rule amendments do? The proposed rule changes provide a more clear, concise outline of standards for recordkeeping for all veterinary medical facilities in the state. The proposed amendment clarify and add new tasks to ensure consistent and appropriate documentation of all veterinary medical services provided in the state. These additional requirements apply to all veterinary professionals, entities, their staff and facilities, and specifically address the following areas:

•     Documenting the litter of animals.

•     Recording the author of medical record entries, to include veterinary professionals and staff.

•     Recording the weight of animals.

•     Providing sufficient information in the history and examination record to justify diagnosis and warrant treatment.

•     Recording sufficient information regarding diagnostic tests performed.

•     Documenting the dosage and route of medications administered, prescribed or dispensed.

•     Recording a description of surgery performed.

•     Providing sufficient refrigeration for the purpose of storing the bodies of deceased animals.

     A portion of these rules applies only to veterinary entities qualified to provide limited services to low-income pet owners. These specific rules address:

•     The identification, verification and documentation of low-income status of persons seeking the limited veterinary services provided by qualified animal care and control agencies and humane societies.

     Affected Industries/Disproportionate Impact: In preparing this small business economic impact statement (SBEIS), the Department of Health used the following SIC codes:

SIC	Description	MINOR IMPACT THRESHOLD
0741	Veterinary services for livestock	$66.10
0742	Veterinary services, specialties	$66.10

     These two SIC codes both indicate a minor impact threshold of $66.10. The estimated cost to veterinary professionals and staff for amending these rules is less that $66.10. Therefore, there is no disproportionate cost to small businesses.

     Because the rule changes do not require major personnel modifications and do not mandate the purchase of additional equipment, the estimated costs will be minimal and are expected to be below the minor impact threshold. Rather than imposing additional costs to businesses, the rule amendment allows for more efficient and effective methods for documentation, recordkeeping and treatment, reducing some investigative and regulatory burden of the state, and most importantly, improving health outcomes of pets and ultimately their owners - residents of the state of Washington.

     The largest burden that this rule imposes deals with the additional documentation of low-income status for persons whose pets receive the limited services of qualified animal care and control facilities and humane societies. Because animal care and control agencies are operated or contracted by city or county governments as defined in RCW 16.52.011, and nonprofit humane societies are qualified under section 501 (c)(3) of the Internal Revenue Code, these entities are not deemed small businesses as defined by RCW 19.85.020. Therefore, the additional requirement of documenting low-income status does not impose a disproportionate cost to small businesses.

     How the Department of Health will notify businesses: Upon adoption, these rules will be made available to businesses that involve veterinary professionals and facilities in a number of ways.

•     Available on the Internet.

•     Copy sent to all businesses that have asked to be placed on the interested persons mailing list.

•     Included in the next updated law book which is sent upon request to businesses and licensees.

•     Available at the front counter for businesses and licensees.

•     Copy of rule is available through the Code Reviser's Office, which is available to all businesses and licensees.

•     Printed in the WSVMA newsletter.

     How the Department of Health has involved businesses in the rule-making process: At the very beginning of the rules writing process in June 2002, notices were sent to all persons on the interested parties mailing list. This list included veterinary professionals, animal care and treatment facilities, and humane societies, as well as other interested individuals. Veterinary Board of Governors meetings were held on June 10, August 5, September 26, and December 9, 2002.

     Costs to the Department of Health to administer the regulation: There are no new additional costs to the Department of Health to administer these rules. No additional review time and no additional analyses are required as a result of the amendments.

     A copy of the statement may be obtained by writing to Karen Kelley, Program Manager, Veterinary Board of Governors, P.O. Box 47868, Olympia, WA 98504-7868, phone (360) 236-4786, fax (360) 664-9077.

     RCW 34.05.328 applies to this rule adoption. The rules establish registration and renewal requirements for humane societies and animal care and control agencies.

     Hearing Location: Department of Health, Creekside Three at CenterPoint, 20435 72nd Avenue South, Suite 200, Kent, WA 98032, (253) 395-7731, fax (253) 395-6759, on June 2, 2003, at 1:30 p.m.

     Assistance for Persons with Disabilities: Contact (360) 236-4841 by May 23, 2003, TDD (711).

     Submit Written Comments to: Karen Kelley, Program Manager, Veterinary Board of Governors, P.O. Box 47868, Olympia, WA 98504-7868, fax (360) 664-9077, by May 23, 2003.

     Date of Intended Adoption: June 2, 2003.

February 18, 2003

Karen Kelley

Program Manager

OTS-6163.1

AUTHORIZING ANIMAL CARE AND CONTROL AGENCIES AND NONPROFIT HUMANE SOCIETIES TO PROVIDE LIMITED VETERINARY SERVICES
NEW SECTION
WAC 246-933-501   Intent.   It is the intent of the legislature to allow qualified animal control agencies and humane societies to provide limited veterinary services to low-income members of our communities. It is not the intent of the legislature to allow these agencies to provide veterinary services to the public at large.

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     (1) "Entity" means animal care and control agencies as defined in RCW 16.52.011 and nonprofit humane societies, which have qualified under section 501 (c)(3) of the Internal Revenue Code.

     (2) "Emergency care" as referred to in RCW 18.92.260 (1)(b) means an unexpected, serious occurrence or situation which urgently requires prompt action in order to prevent an animal's death or permanent injury, unless defined otherwise by local ordinance.

     (3) "Low-income household" means a single person, family or unrelated persons living together whose adjusted family income is less than eighty percent of the median family income, adjusted for household size, for the county where the project is located (RCW 43.185A.010(5)).

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     (a) "Legend drugs" means any drugs that are required by state law or regulation of the state board of pharmacy to be dispensed on prescription only or are restricted to use by practitioners only.

     (b) "Controlled substances" means a drug, substance, or immediate precursor in Schedule I through V of Article II of chapter 69.50 RCW.

     (2) A licensed veterinarian shall be responsible for the policies and procedures regarding the ordering, purchasing, safe storage, dispensing and administration of all drugs used at an entity registered under RCW 18.92.260 in connection with surgical sterilization or emergency care. Entities are responsible for the ordering, purchasing, and safe storage of all drugs.

     (a) The veterinarian shall comply with the state board of pharmacy requirements for controlled substances in chapter 69.50 RCW, and legend drugs in chapter 69.41 RCW.

     (b) All drugs shall be stored in accordance with WAC 246-933-320.

     (c) All controlled substances shall be stored, maintained, administered, dispensed and prescribed in compliance with federal and Washington state laws.

     (d) All legend drugs shall be dispensed in accordance with RCW 18.92.012, 18.92.013, and WAC 246-933-340(5).

     (e) A record of all drugs administered and/or dispensed shall be kept in the individual animal's record.

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OTS-6164.1

AMENDATORY SECTION(Amending Order 299B, filed 8/19/92, effective 9/19/92)

WAC 246-933-320   General requirements for all veterinary medical facilities.   (1) Construction and maintenance: All facilities shall be so constructed and maintained as to provide comfort and safety for patients and clients. All areas of the premises shall be maintained in a clean and orderly condition, free of objectionable odors. All facilities shall comply with applicable state, county and municipal laws, ordinances and regulations.

     (2) Ventilation: Adequate heating and cooling shall be provided for the comfort of the animals, and the facility shall have sufficient ventilation in all areas.

     (3) Lighting: Proper lighting shall be provided in all rooms utilized for the practice of veterinary medicine. Outside lighting shall be adequate to identify the building and to assist the clients.

     (4) Water: Potable water shall be provided.

     (5) Basic sanitation: Any equipment, instruments or facilities used in the treatment of animals shall be clean and sanitary at all times to protect against the spread of diseases, parasites and infection.

     (6) Waste disposal: Covered waste containers, impermeable by water, shall be used for the removal and disposal of animal and food wastes, bedding, animal tissues, debris and other waste.

     Disposal facilities shall be so operated as to minimize insect or other vermin infestation, and to prevent odor and disease hazards or other nuisance conditions.

     The facility shall use refrigeration and employ a procedure for the prompt, sanitary and esthetic disposal of dead animals which complies with all applicable state, county and municipal laws, ordinances and regulations.

     (7) Records:

     (a) Every veterinarian shall keep daily written reports of the animals he or she treats. Separate records for companion animals shall be kept for each animal. The medical record for a litter may be recorded either on the dam's record or on a litter record until the individual animals are permanently placed or reach the age of three months. Records for food and fibre producing animals and animals kept in herds or flocks, etc., may be maintained on a group or client basis. ((These)) All records shall be legible, readily retrievable and shall be kept for a period of three years following the last treatment or examination. ((They)) The author of all medical record entries must be identified by code or employee number, or initials. The records shall include, but not be limited to, the following:

     (i) Name, address and telephone number of the owner.

     (ii) Name, number or other identification of the animal or group.

     (iii) Species, breed, age, sex, weight and color of the animal.

     (iv) Immunization record.

     (v) Beginning and ending dates of custody of the animal.

     (vi) Sufficient information in the history and examination portions of the record to justify the tentative diagnosis and to warrant the treatment. This would include, but not be limited to:

     (A) A short history of the animal's condition as it pertains to its medical status.

     (((vii))) (B) Physical examination findings and any laboratory ((data)) or other diagnostic tests performed and/or recommended.

     (((viii))) (vii) Provisional or final diagnosis.

     (((ix))) (viii) Treatment ((and medication administered, prescribed or dispensed.

     (x) Surgery and anesthesia.

     (xi) Progress of the case)) administered and/or recommended.

     (ix) Dosage and route of medications administered, prescribed or dispensed.

     (x) Anesthesia dosage and route of administration.

     (xi) Description of surgery performed.

     (xii) Progress of the case.

     (xiii) If applicable, documentation of the low-income status for persons that seek the limited veterinary services provided by qualified animal care and control agencies and humane societies.

     (b) Veterinary medical records and radiographs are the property of the veterinarian or the veterinary facility ((which)) that originally ordered their preparation. When requested by the client, copies of records will be made available as promptly as required under the circumstances, but no later than fifteen working days upon the client's request. The veterinarian may charge a reasonable copying fee, not to exceed the actual cost for providing the veterinary care information. A radiograph shall be released upon the request of another veterinarian who has the authorization of the owner of the animal to which it pertains. Such radiograph shall be returned to the originating veterinarian or veterinary facility within fifteen working days of receipt of a written request.

     (8) Storage: All supplies, including food and bedding, shall be stored in facilities which adequately protect such supplies against infestation, contamination or deterioration. Refrigeration shall be provided for all supplies that are of a perishable nature, including foods, drugs and biologicals.

     (9) Biologicals and drugs: Biologicals and other drugs shall be stored in such a manner as to prevent contamination and deterioration in accordance with the packaging and storage requirements of the current editions of the U.S. Pharmacopeia, 12601 Twinbrook Parkway, Rockville, Maryland 20852, and the National Formulary, Mack Publishing Company, 20th and Northampton Streets, Easton, Pennsylvania 18042 and/or manufacturers' recommendation.

     All controlled substances shall be maintained in a locked cabinet or other suitable secure container in accordance with federal and Washington state laws.

     Controlled substance records shall be readily retrievable, in accordance with federal and Washington state laws.

[Statutory Authority: RCW 18.92.030. 92-17-076 (Order 299B), § 246-933-320, filed 8/19/92, effective 9/19/92; 91-24-098 (Order 221B), § 246-933-320, filed 12/4/91, effective 1/4/92; 91-02-060 (Order 108B), recodified as § 246-933-320, filed 12/28/90, effective 1/31/91; 88-08-033 (Order PM 719), § 308-153-020, filed 4/1/88. Statutory Authority: RCW 18.92.030, 18.130.050 (1) and (12) and 1986 c 259 § 139. 86-13-070 (Order PM 600), § 308-153-020, filed 6/18/86; Order PL-236, § 308-153-020, filed 2/18/76.]

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