Original Notice.

     Preproposal statement of inquiry was filed as WSR 08-05-119.

     Title of Rule and Other Identifying Information: WAC 246-935-010 Definitions, 246-935-040 Responsibilities of veterinarian supervising a veterinary technician or an unregistered assistant, and 246-935-050 Animal health care tasks.

     Hearing Location(s): Department of Health, Conference Room One, 20435 72nd South, Kent, WA 98032, on June 1, 2009, at 10:00 a.m.

     Date of Intended Adoption: June 1, 2009.

     Submit Written Comments to: Judy Haenke, Program Manager, P.O. Box 47870, Olympia, WA 98504-7870, web site http://www3.doh.wa.gov/policyreview/, fax (360) 586-4359, by May 20, 2009.

     Assistance for Persons with Disabilities: Contact Judy Haenke by June 1, 2009, TTY (800) 833-6388 or 711.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rules simplify and clarify both the tasks that may be performed by licensed veterinary technicians and unregistered assistants and under what level of supervision the tasks may be performed. The proposed rules also more effectively describe the roles and responsibilities of the supervising veterinarian, the licensed veterinary technician and the unregistered assistant. The supervising veterinarian is responsible for the health, safety and welfare of the animal patient and must examine the animal patient prior to delegation of any animal health care task. The supervising veterinarian may delegate an animal health care task only if the licensed veterinary technician or unregistered assistant is qualified to perform the task. The licensed veterinary technician or unregistered assistant are responsible for refusing to perform duties they are not legally or technically able to perform.

     Reasons Supporting Proposal: The current rules are vague and not in a format that is easily understood. By clarifying the tasks that may be performed by either a licensed veterinary technician or an unregistered assistant, and the required level of supervision, the supervising veterinarian has a clear guideline to follow when delegating tasks for the care of the animal patient. The proposed amendment will allow the supervising veterinarian to limit the number of unregistered assistants under his/her supervision to that which is appropriate for the circumstances.

     Statutory Authority for Adoption: RCW 18.92.030, 18.92.125.

     Statute Being Implemented: RCW 18.92.030.

     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: Judy Haenke, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-4947.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rule would not impose more than minor costs on businesses in an industry. A copy of the statement may be obtained by contacting Judy Haenke, P.O. Box 47868, Olympia, WA 98504-7868, phone (360) 236-4947, fax (360) 586-4359, e-mail judy.haenke@doh.wa.gobv[gov].

     A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Judy Haenke, P.O. Box 47868, Olympia, WA 98504-7868, phone (360) 236-4947, fax 3586-4359 [(360) 586-4359], e-mail judy.haenke@doh.wa.gov.

Harmon A. Rogers, DVM, Chair

Veterinary Board of Governors

OTS-2051.4

AMENDATORY SECTION(Amending WSR 08-11-099, filed 5/20/08, effective 6/20/08)

WAC 246-935-010   Definitions.   (1) (("Veterinary technician" means any person who has met the requirements of RCW 18.92.015 and who is licensed as required by chapter 18.92 RCW.

     (2))) "Anesthesia maintenance" means maintaining adequate depth of anesthesia through control of the amount and type of drug(s) delivered to the animal patient.

     (2) "Anesthesia monitoring" means measuring, reporting, and recording vital signs.

     (3) "Direct supervision" means the veterinary supervisor is on the premises, is quickly and easily available and the animal patient has been examined by a veterinarian at such times as acceptable veterinary medical practice requires, consistent with the particular delegated animal health care task.

     (((3))) (4) "Emergency" means that the animal patient has ((been placed in)) a life-threatening condition where immediate treatment is necessary to sustain life or avoid significant injury and morbidity.

     (((4))) (5) "Immediate supervision" means the supervisor is in audible and visual range of the animal patient and the person treating the patient.

     (((5))) (6) "Indirect supervision" means the supervisor is not on the premises, but has given either written or oral instructions for treatment of the animal patient and the animal patient has been examined by a veterinarian at such times as acceptable veterinary medical practice requires, consistent with the particular delegated animal health care task and the animal patient is not anesthetized.

     (((6))) (7) "Licensed veterinary technician" means any person who has met the requirements of RCW 18.92.015 and who is licensed as required by chapter 18.92 RCW.

     (8) "Supervisor" means a veterinarian or((, if a task so provides,)) a licensed veterinary technician.

     (((7))) (9) "Unregistered assistant" means any individual who is not a veterinary technician or veterinarian.

     (((8))) (10) "Veterinarian" means a person authorized by chapter 18.92 RCW to practice veterinary medicine in the state of Washington.

     (((9))) (11) "Veterinary medical facility" is ((as defined by WAC 246-933-310)) any premises, unit, structure or vehicle where any animal patient is received and/or confined, in order to provide veterinary medicine, surgery, or dentistry as defined in RCW 18.92.010.

[Statutory Authority: RCW 18.92.030 and 2007 c 235. 08-11-099, § 246-935-010, filed 5/20/08, effective 6/20/08. Statutory Authority: RCW 18.92.030. 02-10-135, § 246-935-010, filed 5/1/02, effective 6/1/02; 91-24-098 (Order 221B), § 246-935-010, filed 12/4/91, effective 1/4/92; 91-02-060 (Order 108B), recodified as § 246-935-010, filed 12/28/90, effective 1/31/91. Statutory Authority: RCW 18.92.015 and 18.92.030. 83-19-055 (Order PL 445), § 308-156-010, filed 9/19/83. Statutory Authority: RCW 18.92.030. 80-01-069 (Order PL 332), § 308-156-010, filed 12/21/79.]

     (a) ((Permit)) To any licensed veterinary technician ((in his/her employ to perform)) the performance of any animal health care services not authorized by WAC 246-935-040 or 246-935-050.

     (b) ((Permit)) To any unregistered assistant ((to perform)) the performance of any animal health care services not authorized by WAC 246-935-040 or 246-935-050.

     (2) The supervising veterinarian shall:

     (a) Have legal responsibility for the health, safety and welfare of the animal patient which the licensed veterinary technician or unregistered assistant serves.

     (b) Delegate animal health care tasks only if the licensed veterinary technician or unregistered assistant is qualified to perform the task, and the task is not precluded by the medical condition of the animal patient.

     (c) Use the level of supervision required for a specific task.

     (d) Make all decisions relating to the diagnosis, treatment, management, and future disposition of an animal patient.

     (e) Limit the number of unregistered assistants under indirect supervision to ((two at any single time)) that which is appropriate for the circumstances.

     (f) Allow licensed veterinary technicians and unregistered assistants the right and responsibility to refuse to perform duties they are not legally or technically able to perform.

     (3) A supervising veterinarian shall examine the animal patient prior to the delegation of any animal health care task to either a licensed veterinary technician or unregistered assistant. The examination of the animal patient must be conducted at the times and in the manner consistent with veterinary medicine practice, and the particular delegated animal health care task.

     (4) If a licensed veterinary technician is authorized((,)) to provide supervision for an unregistered assistant performing a specified health care task, the licensed veterinary technician shall be under the same degree of supervision by the veterinarian, as if the licensed veterinary technician were performing the task.

     (((5) Unless specifically allowed by regulation, a veterinarian shall not authorize a veterinary technician or an unregistered assistant to perform the following functions:

     (a) Surgery, other than outlined in WAC 246-935-050 (1)(a);

     (b) Diagnosis and prognosis of animal disease;

     (c) Prescribing of drugs, medicines and appliances.))

[Statutory Authority: RCW 18.92.030. 02-02-046, § 246-935-040, filed 12/27/01, effective 1/27/02; 92-02-057 (Order 233B), § 246-935-040, filed 12/30/91, effective 1/30/92; 91-24-098 (Order 221B), § 246-935-040, filed 12/4/91, effective 1/4/92; 91-02-060 (Order 108B), recodified as § 246-935-040, filed 12/28/90, effective 1/31/91. Statutory Authority: RCW 18.92.015 and 18.92.030. 83-19-055 (Order PL 445), § 308-156-045, filed 9/19/83.]

     No individual, other than a licensed veterinary technician, may advertise or offer her/his services in a manner calculated to lead others to believe that she/he is a trained or licensed veterinary technician.

     (1) Licensed veterinary technicians and unregistered assistants are prohibited from performing the following activities:

     (a) Surgery except as outlined below;

     (b) Diagnosis and prognosis;

     (c) Prescribing drugs, medication or appliances;

     (d) Initiation of treatment without prior instruction by a veterinarian except as outlined under emergency animal care.

     (((a))) (2) Immediate supervision. Unregistered assistants are not authorized to perform the tasks in this section. A licensed veterinary technician may perform the following tasks only under the immediate supervision of a veterinarian:

     (((i) Assist veterinarian in surgery by tissue handling;

     (ii) Assist veterinarian in surgery by instrument handling;

     (iii) Dental extractions.

     (b) Direct supervision. A veterinary technician may perform the following tasks under the direct supervision of a veterinarian:

     (i) Endotracheal intubation;

     (ii) Blood administration;

     (iii) Fluid aspiration, including cystocentesis;

     (iv) Intraperitoneal injections;

     (v) Monitoring of vital signs of anesthetized patient;

     (vi) Application of splints;

     (vii) Induce anesthesia by intravenous, intramuscular, or subcutaneous injection or by inhalation;

     (viii) Administration of immunological agents including rabies vaccination;

     (ix) Catheterization of the unobstructed bladder;

     (x) Ophthalmological procedure including:

     (A) Tear production testing

     (B) Topical anesthetic application

     (C) Fluorescein staining of the cornea

     (D) Tonometry;

     (xi) Teeth cleaning, provided an oral examination of the anesthetized patient has been conducted by the veterinarian;

     (xii) Microchip implantation;

     (xiii) Floating teeth;

     (xiv) Removal of partially exposed foxtails and porcupine quills;

     (xv) Provide massage;

     (xvi) Suturing. The use of a needle, cutting or tapered, and suture material, staples, wound clips or tissue glue to close a skin or gingival incision or prepared wound as directed by the attending licensed veterinarian under direct supervision. Suturing may include the use of needle holders, thumb forceps, tissue forceps, retractors and comparable instruments for gentle handling of the tissues to be repaired/closed by such suturing. Suturing does not include the use of cutting instruments such as scalpels, scissors, electrosurgical equipment or other instruments to remove skin or other tissues from the animal patient.

     (c) Indirect supervision. A veterinary technician may perform the following tasks under the indirect supervision of a veterinarian. If the animal is anesthetized, these tasks require the direct supervision of a veterinarian:

     (i) Enema;

     (ii) Electrocardiography;

     (iii) Application of bandages;

     (iv) Gavage;

     (v) Ear flush;

     (vi) Radiology;

     (A) Patient positioning;

     (B) Operation of radiograph machines;

     (C) Oral and rectal administration of radio-opaque materials;

     (vii) Placement and securing of an intravenous catheter;

     (viii) Injections of medications not otherwise prohibited:

     (A) Intramuscular, excluding immunological agents

     (B) Subcutaneous, excluding immunological agents

     (C) Intravenous, including giving medication through an established intravenous catheter;

     (ix) Oral medications;

     (x) Topical medications;

     (xi) Laboratory (specimen collections):

     (A) Collection of tissue during or after a veterinarian has performed a necropsy

     (B) Urine, except cystocentesis

     (C) Blood

     (D) Parasitology

     (E) Exfoliative cytology

     (F) Microbiology

     (G) Fecal material

     (xii) Laboratory (specimen testing):

     (A) Urinalysis

     (B) Hematology

     (C) Serology

     (D) Chemistries

     (E) Endocrinology

     (F) Parasitology

     (G) Exfoliative cytology

     (H) Microbiology

     (I) Fecal analysis;

     (xiii) Administration of preanesthetic drugs;

     (xiv) Oxygen therapy;

     (xv) Euthanasia in all circumstances as otherwise allowed by law;

     (xvi) Removal of sutures;

     (xvii) Indirect blood pressure measurement;

     (xviii) Obtaining a general history from a client of a patient and the client's concerns regarding that patient;

     (xix) Preliminary physical examination including temperature, pulse and respiration;

     (xx) Behavioral consultation with clients;

     (xxi) Dietary consultation with clients.

     (2) Unregistered assistants.

     Induction of anesthesia by any method is prohibited.

     (a) Immediate supervision by veterinarian. An unregistered assistant may perform the following tasks only under the immediate supervision of a veterinarian:

     (i) Assist veterinarian in surgery by tissue handling;

     (ii) Assist veterinarian in surgery by instrument handling.

     (b) Immediate supervision by veterinarian or veterinary technician. An unregistered assistant may perform the following tasks only under the immediate supervision of either a veterinarian or veterinary technician:

     (i) Blood administration;

     (ii) Laboratory (specimen collections):

     (A) Hematology

     (B) Exfoliative cytology, including skin scraping

     (C) Microbiology

     (D) Serology;

     (iii) Placement and securing of an intravenous catheter.

     (c) Direct supervision by veterinarian. An unregistered assistant may perform the following tasks only under the direct supervision of a veterinarian:

     (i) Monitor vital signs of anesthetized patient;

     (ii) Euthanasia in all circumstances as otherwise allowed by law;

     (iii) Removal of sutures;

     (iv) Teeth cleaning, provided an oral examination of the anesthetized patient has been conducted by the veterinarian;

     (v) Provide massage;

     (vi) Administration of immunological agents including rabies vaccination;

     (vii) Microchip implantation;

     (viii) Enema;

     (ix) Removal of partially exposed foxtails and porcupine quills from skin and feet.

     (d) Direct supervision by veterinarian or veterinary technician. An unregistered assistant may perform the following tasks under direct supervision of either a veterinarian or veterinary technician. If the animal is anesthetized, these tasks require immediate supervision of a veterinarian or a veterinary technician:

     (i) Application of bandages;

     (ii) Ear flush;

     (iii) Electrocardiography;

     (iv) Intramuscular or subcutaneous injections of medications not otherwise prohibited;

     (v) Laboratory (test preparation, not evaluation):

     (A) Parasitology

     (B) Serology

     (C) Urinalysis;

     (vi) Preliminary physical examination including temperature, pulse and respiration;

     (vii) Radiology:

     (A) Patient positioning

     (B) Operation of radiograph machines

     (C) Rectal and oral administration of radio-opaque materials.

     (e) Indirect supervision. An unregistered assistant may perform the following tasks under the indirect supervision of a veterinarian. If the animal is anesthetized, these tasks require the direct supervision of a veterinarian:

     (i) Oral medications;

     (ii) Topical medications;

     (iii) Laboratory (specimen collection):

     Collecting of voided urine and fecal material;

     (iv) Oxygen therapy;

     (v) Obtaining a general history from a client of a patient and the client's concerns;

     (vi) Behavioral consultation with clients;

     (vii) Dietary consultation with clients.

     (3) Emergency animal care.

     (a) Under conditions of an emergency, a veterinary technician and unregistered assistant may render certain life saving aid to an animal. A veterinary technician may:

     (i) Apply tourniquets and/or pressure bandages to control hemorrhage;

     (ii) Administer pharmacologic agents to prevent or control shock. Placement of an intravenous catheter and administering parenteral fluids, must only be performed after direct communication with a veterinarian, and only if the veterinarian is either present or immediately en route to the location of the distressed animal;

     (iii) Administer resuscitative oxygen procedures;

     (iv) Establish open airways including the use of intubation appliances, but excluding surgery;

     (v) Administer external cardiac resuscitation;

     (vi) Apply temporary splints or bandages to prevent further injury to bones or soft tissues;

     (vii) Apply appropriate wound dressings and external supportive treatment in severe burn cases;

     (viii) Apply external supportive treatment to stabilize body temperature.

     (b) An unregistered assistant may:

     (i) Apply tourniquets and/or pressure bandages to control hemorrhage;

     (ii) Administer resuscitative oxygen procedures;

     (iii) Establish open airways including intubation appliances, but excluding surgery;

     (iv) Apply external supportive treatment to stabilize body temperature.)) Dental extractions.

     (3) Direct supervision. Unregistered assistants are not authorized to perform the tasks in this section. A licensed veterinary technician may perform the following tasks only under the direct supervision of a veterinarian:

     (a) Anesthesia:

     (i) Induction, including preanesthesia;

     (ii) Maintenance;

     (iii) Monitoring.

     (b) Application of casts and splints;

     (c) Floating teeth;

     (d) Intraperitoneal injections;

     (e) Blood administration;

     (f) Closure, including suturing, of prepared skin wound or gingival incision;

     (g) Arterial and central venous catheters.

     (4) Indirect supervision. Unregistered assistants are not authorized to perform the tasks in this section. A licensed veterinary technician may perform the following tasks only under the indirect supervision of a veterinarian:

     (a) Intravenous injections into uncatheterized vein;

     (b) Centesis, including fine needle aspirates;

     (c) Unobstructed bladder catheter;

     (d) Diagnostic procedures:

     (i) Fecal analysis;

     (ii) Electrocardiograms;

     (iii) Blood pressure;

     (iv) Cytology analysis, including urinalysis and hematology;

     (v) Microbiology.

     (e) Placement and use of nasogastric and orogastric tubes for gavage, lavage, or reflux;

     (f) Ophthalmological procedures:

     (i) Tear production testing;

     (ii) Topical anesthetic application;

     (iii) Fluorescein staining of the cornea;

     (iv) Tonometry.

     (g) Tasks authorized to be performed under immediate or direct supervision for unregistered assistants, may be performed by licensed veterinary technicians under indirect supervision unless otherwise restricted.

     (5) Immediate supervision for unregistered assistants. An unregistered assistant may perform the following tasks only under the immediate supervision of a veterinarian or licensed veterinary technician:

     (a) Place and secure an intravenous catheter;

     (b) Monitor vital signs of an anesthetized patient;

     (c) Dental prophy.

     (6) Direct supervision for unregistered assistant. An unregistered assistant may perform the following tasks only under the direct supervision of a veterinarian or licensed veterinary technician:

     (a) Intravenous injection into catheterized vein;

     (b) Biologics injections (vaccines) with the veterinarian's verification signature on appropriate certificate;

     (c) Imaging procedures;

     (d) Removal of sutures, drain tubes and staples;

     (e) Bandaging;

     (f) Removal of exposed foreign bodies;

     (g) Lab sample collection and test preparation (not evaluation) to include:

     (i) Venipuncture;

     (ii) Skin scraping.

     (h) Microchip implantation;

     (i) Enema;

     (j) Ear flush;

     (k) Perform electrocardiogram and blood pressure measurements;

     (l) Intramuscular and subcutaneous injection;

     (m) Massage except where regulated.

     (7) Indirect supervision for unregistered assistants. An unregistered assistant must always be under the indirect supervision of a veterinarian or licensed veterinary technician, except as listed in subsections (5) and (6) of this section. Tasks not specifically listed or otherwise restricted may be performed by a licensed veterinary technician or unregistered assistant under the indirect supervision of a veterinarian.

     (8) To be authorized to dispense pharmaceuticals, unregistered assistants must be registered as a veterinary medication clerk under chapter 246-937 WAC.

     (9) Emergency animal care. Under conditions of an emergency, a licensed veterinary technician and unregistered assistant may render certain life saving aid to an animal patient.

     (a) A licensed veterinary technician may:

     (i) Apply emergency cardiopulmonary resuscitation and first aid procedures and all tasks as listed in subsections (3), (4), (5), and (6) of this section;

     (ii) Administer pharmacologic agents and parenteral fluids only after communication with a veterinarian.

     (b) An unregistered assistant may:

     (i) Apply noninvasive cardiopulmonary resuscitation and basic first aid procedures;

     (ii) Provide other aid upon the order of a licensed veterinarian as outlined in this section.

[Statutory Authority: RCW 18.92.030 and 2007 c 235. 08-11-099, § 246-935-050, filed 5/20/08, effective 6/20/08. Statutory Authority: RCW 18.92.030. 07-17-169, § 246-935-050, filed 8/22/07, effective 9/22/07; 02-02-046, § 246-935-050, filed 12/27/01, effective 1/27/02; 91-02-060 (Order 108B), recodified as § 246-935-050, filed 12/28/90, effective 1/31/91. Statutory Authority: RCW 18.92.015 and 18.92.030. 83-19-055 (Order PL 445), § 308-156-050, filed 9/19/83.]

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