DEPARTMENT OF HEALTH

(Veterinary Board of Governors)

[Filed January 22, 2020, 8:49 a.m.]

Preproposal statement of inquiry was filed as WSR 18-12-090.

Title of Rule and Other Identifying Information: WAC 246-933-310 Definitions and new WAC 246-933-345 Client communication, the veterinary board of governors (board) is proposing to add a definition related to facilities and practice management standards and to create a new section to establish requirements for veterinarians when communicating with clients regarding evaluation and treatment.

Hearing Location(s): On March 2, 2020, at 10:00 a.m., at the Department of Health, Creekside Two at Center Point, 20425 72nd Avenue South, Room 307, Kent, WA 98032.

Date of Intended Adoption: March 2, 2020.

Submit Written Comments to: Loralei Walker, Department of Health, Veterinary Board of Governors, P.O. Box 47852, Olympia, WA 98504-7852, email https://fortress.wa.gov/doh/policyreview, fax 360-236-2901, by February 21, 2020.

Assistance for Persons with Disabilities: Contact Loralei Walker, phone 360-236-4947, TTY 360-833-6388 or 711, email loralei.walker@doh.wa.gov, by February 21, 2020.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The board is proposing to establish minimum requirements for information provided to clients when evaluating and treating animal patients. The board proposes to amend an existing rule and create a new rule in order to take a more holistic approach to requirements for client communication. The proposed rule includes expanded or new communication requirements for proposed diagnostic tests, possible and definitive diagnoses, common side effects or adverse outcomes of diagnostics and treatment, estimated cost, prognosis and treatment options, communication that is timely and prior to treatment (except during emergencies or when the client cannot be reached), communication that enables the clients to understand the problem and options, and written or verbal consent from the clients.

Reasons Supporting Proposal: This proposal is intended to ensure care provided promotes the health and safety of animal patients based on client decisions and emphasizes the importance of consultation with clients.

Statutory Authority for Adoption: RCW 18.92.030.

Statute Being Implemented: Chapter 18.92 RCW.

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

Name of Proponent: Department of health, veterinary board of governors, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Loralei Walker, Program Manager, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-4947.

A school district fiscal impact statement is not required under RCW 28A.305.135.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Loralei Walker, Department of Health, Veterinary Board of Governors, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-4947, fax 360-236-2901, TTY 360-833-6388 or 711, email loralei.walker@doh.wa.gov.

The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. License holders, not businesses, must meet the proposed rules.

Kirk Breuninger, VMD MPH DACVPM

Chair, Veterinary Board of Governors

AMENDATORY SECTION(Amending WSR 91-24-098, filed 12/4/91, effective 1/4/92)

WAC 246-933-310Definitions.

The definitions in this section apply in WAC 246-933-310 through 246-933-350 unless the context clearly requires otherwise.

(1) ((Veterinary medical facility: Any premise, unit, structure or vehicle where any animal is received and/or confined to be examined, diagnosed or treated medically, surgically or prophylactically, as defined in RCW 18.92.010.

(2) Mobile clinic: A vehicle, including a camper, motor home, trailer or mobile home, used as a veterinary medical facility. A mobile clinic is not required for house calls or farm calls.

(3) Aseptic surgery: Aseptic surgical technique exists when everything that comes in contact with the wound is sterile and precautions are taken to ensure such sterility during the procedure. These precautions include, but are not limited to, such things as the surgery room itself, sterilization procedures, scrubbing hands and arms, sterile gloves, caps and masks, sterile long-sleeved gowns, and sterile draping and operative techniques.

(4)))"Antiseptic surgery((: Antiseptic surgical))" means the technique ((exists))used when care is taken to avoid bacterial contamination but the precautions are not as thorough and extensive as in aseptic surgery. Surgeons and surgical assistants ((shall)) wear clean attire and sterile gloves, and the patient ((shall be))is appropriately draped. A separate sterile surgical pack shall be used for each animal.

(2) "Aseptic surgery" means the technique used when everything that comes in contact with the wound is sterile and precautions are taken to ensure such sterility during the procedure. These precautions include, but are not limited to, such things as the surgery room itself, sterilization procedures, scrubbing hands and arms, sterile gloves, caps and masks, sterile long-sleeved gowns, and sterile draping and operative techniques.

(3) "Client" means the patient's owner, owner's agent, or other person presenting the patient for care.

(4) "Mobile clinic" means a vehicle, including a camper, motor home, trailer or mobile home, used as a veterinary medical facility. A mobile clinic is not required for house calls or farm calls.

(5) "Treatment" means any action or procedure taken to impact an animal's physical, mental, or behavioral health in the pursuit of preventing or resolving disease, maintaining or improving quality of life, or providing end of life care. This includes, but is not limited to, the prescription, recommendation, issuance, or administration of any drug, veterinary feed directive, vitamins, minerals, or supplements.

(6) "Veterinary medical facility" means any premise, unit, structure or vehicle where any animal is either received or confined, or both, to be examined, diagnosed or treated medically, surgically or prophylactically, as defined in RCW 18.92.010.

WAC 246-933-345Client communication regarding evaluation and treatment.

(1) The veterinarian must communicate when appropriate to the client the following:

(a) Proposed diagnostic tests;

(b) Differential diagnoses;

(d) Proposed treatments;

(e) Common side effects or adverse outcomes from proposed diagnostic testing or treatment;

(f) Most likely side effects or adverse outcomes from proposed diagnostic testing or treatment based on patient signalment and disease status. Patient signalment may include, but is not limited to, species, breed, age, and sex;

(g) Estimated cost;

(h) Prognosis; and

(i) Alternate diagnostic and treatment options for the patient.

(2) Such communications must be timely and sufficient to enable the client to understand clearly the problem and the choices that must be made, and provide written or verbal consent for a proposed diagnostic and treatment plan. If other staff is involved in the communication process, it is the responsibility of the veterinarian to ensure that such communications are appropriate. All communications must be made prior to rendering treatment, except in cases of emergencies as described in WAC 246-933-050 or when a client cannot be reached for consultation within a reasonable time frame as dictated by the patient's condition.

(3) Client communication required in subsection (1) of this section must be documented in the patient medical record.