As you may be aware, the Pharmacy Boards of various states, including Louisiana, as well as the Louisiana Board of Veterinary Medicine, have been engaged in a legal conflict with a well known internet pharmacy regarding the filling of prescriptions for patients without the appropriate veterinarian-client-patient relationship being established.

The Board notified a well known internet pharmacy by certified mail, dated September 24, 2001, of violations of the Veterinary Practice Act and Rules and Regulations promulgated by the Board being committed in Louisiana.  More particularly, the internet pharmacy was dispensing prescription drugs to the owners of animals in Louisiana upon demand (1) without a license to practice veterinary medicine issued by the Board; (2) without a prescription issued by a person licensed to practice veterinary medicine in Louisiana; and (3) without the establishment of the veterinary-client-patient relationship.

It is the Board’s understanding that on or about April 16, 2002, a Consent Agreement was entered into by the internet pharmacy with the Florida Board of Pharmacy wherein it was disciplined and, more particularly, ordered to : (1) not knowingly fill, dispense, or distribute medication for prescriptions written by veterinarians who have not physically examined the animal for whom the prescription is written; and (2) immediately terminate the internet pharmacy’s alternate veterinarian program regarding veterinarians under contract or employed to write prescriptions for medication when the veterinarian has not physically examined the animal for whom the prescription is written.

Thereafter, a Consent Order was entered into by the same internet pharmacy and the Louisiana Board of Pharmacy, regarding the improper dispensing of veterinary medication to a client in violation of applicable laws and violations pertaining to the practice of pharmacy.  The internet pharmacy entered pleas of no lo contendere to cited violation in exchange for the Louisiana Board of Pharmacy dismissing any and all other complaints it received against the company as of March 6, 2002.

The substance of the Consent Agreements the internet pharmacy entered into with the Louisiana and Florida Boards of Pharmacy echo the legal authority set forth in the cease and desist letter forwarded by your Board referenced above, dated September 24, 2001.  It is the Board’s understanding that such illegal activities will cease due to recent decisions by the Louisiana and Florida Boards of Pharmacy which have primary jurisdiction over this internet pharmacy.

During the pendency of the conflict with the internet pharmacy, the Board received complaints and inquires from various sources, including clients, regarding a veterinarian’s legal obligation to provide a prescription.  The Board considered several legal authorities in forming its position on this issue.

Pursuant to Rule 705.G(3), “a veterinarian may refuse to write a prescription if it is not directly requested by a client with whom a veterinary-patient-client relationship exists.” (underscore added)  Furthermore, Rule 1014 provides that a licensed veterinarian shall not violate the confidential relationship between himself and his client.  For a veterinarian to provide a prescription to an internet pharmacy without a direct request from his client, also subjects the veterinarian to disciplinary action by the Board for violating the confidential relationship between himself and his client by sharing treatment information with a faceless third party by way of internet and/or facsimile.

Additionally, Rule 705.G(2) states that a veterinarian shall not be required to write a prescription for any medication that in his medical opinion is not appropriate for the patient’s medical care.  While the American Heartworm Society may have an opinion that suggests testing for heartworms every two (2) to three (3) years, if a veterinarian is of the medical opinion that his patient must be seen and/or tested on an earlier basis, such is within the scope of his professional judgement pursuant to the Veterinary Practice Act and the Board’s Rules.  Of course, a veterinarian must act in a reasonable manner and conform to the prevailing standard of veterinary medical practice regarding such issue.

You may also wish to note that pursuant to Rule 1001 the Board has adopted the Principles of Veterinary Medical Ethics of the American Veterinary Medical Association.  Principle VI.A(1) provides that attending veterinarians are entitled to charge a fee for their professional services.  In interpreting this Principle, the Board has ruled that a reasonable fee to review a patient’s file and write a prescription directly requested by the client is not a violation of the Veterinary Practice Act or Board’s Rules.

More recently, the Board has been asked whether a veterinarian can refuse to give a prescription to a paying customer if the drug is one he is prescribing and using on that customer’s animal.  The factual scenario at issue involves a veterinarian providing the annual examination and shots to a dog.  The veterinarian in the past provided Advantage and Heartguard to the client for administration to the patient.  However, in this particular instance the client directly requested the prescriptions so that she might “price shop”.  The veterinarian then refused to provide the prescriptions.

In applying Rules 705.G(2) and (3) to the factual scenario described, it is the Board’s opinion that the veterinarian can not legally refuse to provide the prescriptions requested directly by the client.  This opinion is based on the premise that these drugs would have been the same drugs that the veterinarian would provide and/or administer to the pet.

In concluding, with regards to the issue of providing prescriptions, please keep in mind your legal obligations, as well as your rights, so as to avoid any unnecessary and legal woes.  Also, the Board office and I are available to answer any questions you may have concerning the issue of prescriptions.