This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1117c.COM
DATE: 3/27/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 1117 Medical Treatment of Animals
SPONSOR(S): Buchanan
TIED BILLS: IDEN./SIM. BILLS: SB 554, SB 1600
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Regulatory Reform & Economic Development
Subcommittee
9 Y, 1 N Thompson Anstead
2) Commerce Committee 19 Y, 0 N Thompson Hamon
SUMMARY ANALYSIS
In Florida, the practice of “veterinary medicine” means the diagnosis of medical conditions of animals, and the
prescribing or administering of medicine and treatment to animals for the prevention, cure, or relief of a wound,
fracture, bodily injury, or disease. Veterinarians are regulated by the Board of Veterinary Medicine (Board) in
the Department of Business and Professional Regulation (DBPR) pursuant to ch. 474, F.S., relating to
veterinary medical practice (practice act). The purpose of the practice act is to ensure that every veterinarian
practicing in this state meets minimum requirements for safe practice to protect public health and safety.
Current law defines a “veterinarian/client/patient relationship” (VCPR) as one in which a veterinarian has
assumed responsibility for making medical judgments about the health of an animal and its need for medical
treatment. Veterinarians are permitted to prescribe drugs in the course of veterinary practice; however, the
veterinarian must be either personally acquainted with the keeping and caring of the animal and have recently
seen the animal, or have made medically appropriate and timely visits to the premises where the animal is kept
before prescribing drugs in the course of practice.
The use of electronic communications to facilitate patient health care (telemedicine) is not addressed in the
practice act and is not specifically prohibited or authorized in Florida. However, medical doctors may practice
telemedicine in Florida and may establish a patient relationship with a patient evaluation via telemedicine
under certain circumstances.
The bill creates an act cited as the Providing Equity in Telemedicine Services (PETS) Act, which establishes a
framework for the practice of veterinary telemedicine as follows:
Authorizes a veterinarian practicing veterinary telemedicine to order, prescribe, or make available
medicinal drugs or drugs defined in ch. 465, F.S., the Florida Pharmacy Act.
Limits a veterinarian’s authority to prescribe controlled substances while practicing telemedicine to
situations where the veterinarian has previously performed an in-person physical examination or made
medically appropriate and timely visits to the premises where the animal is kept.
Allows veterinarians who are personally acquainted with the caring or keeping of an animal or group of
animals for food-producing animal operations, who has recently seen the animal(s) or has made
medically appropriate and timely visits to practice telemedicine for these animal(s).
Specifies that only Florida licensed veterinarians may practice veterinary telemedicine, and grants the
Board jurisdiction over the practice of veterinary telemedicine.
Allows an animal control authority under the “indirect supervision” of a veterinarian to administer rabies
vaccinations.
The bill is not expected to have a fiscal impact on state or local government, and may have a positive fiscal
impact on the private sector.
The bill provides an effective date of July 1, 2023. STORAGE NAME: h1117c.COM PAGE: 2
DATE: 3/27/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Current Situation
Practice of Veterinary Medicine
The Board of Veterinary Medicine (Board) in the Department of Business and Professional Regulation
(DBPR) implements the provisions of ch. 474, F.S., relating to veterinary medical practice (practice
act). The purpose of the practice act is to ensure that every veterinarian practicing in this state meets
minimum requirements for safe practices to protect public health and safety.
1
A “veterinarian” is a health care practitioner licensed by the Board to engage in the practice of
veterinary medicine in Florida
2
and they are subject to disciplinary action from the Board for various
violations of the practice act.
3
The practice of “veterinary medicine” is the diagnosis of medical conditions of animals, and the
prescribing or administering of medicine and treatment to animals for the prevention, cure, or relief of a
wound, fracture, bodily injury, or disease, or holding oneself out as performing any of these functions.
4
Veterinary medicine includes, with respect to animals:
5
Surgery;
Acupuncture;
Obstetrics;
Dentistry;
Physical therapy;
Radiology;
Theriogenology (reproductive medicine);
6
and
Other branches or specialties of veterinary medicine.
The practice act does not apply to the following categories of persons:
Veterinary aides, nurses, laboratory technicians, preceptors,
7
or other employees of a licensed
veterinarian, who administer medication or provide help or support under the responsible
supervision
8
of a licensed veterinarian;
Certain non-Florida licensed veterinarians who are consulting upon request of a Florida-licensed
veterinarian on the treatment of a specific animal or on the treatment on a specific case of the
animals of a single owner.
Faculty veterinarians when they have assigned teaching duties at accredited
9
institutions;
1
S. 474.201, F.S.
2
S. 474.202(11), F.S.
3
Ss. 474.213 & 474.214, F.S.
4
See s. 474.202(9), F.S. Also included is the determination of the health, fitness, or soundness of an animal, and the performance of
any manual procedure for the diagnosis or treatment of pregnancy or fertility or infertility of animals.
5
See s. 474.202(13), F.S. S. 474.202(1), F.S., defines “animal” as “any mammal other than a human being or any bird, amphibian,
fish, or reptile, wild or domestic, living or dead.”
6
The Society for Theriogenology, established in 1954, is composed of veterinarians dedicated to standards of excellence in animal
reproduction. See https://www.therio.org/ (last visited Mar. 6, 2023).
7
A preceptor is a skilled practitioner or faculty member who directs, teaches, supervises, and evaluates students in a clinical setting to
allow practical experience with patients. See also https://www.merriam-webster.com/dictionary/preceptor#medicalDictionary (last
visited Mar. 6, 2023).
8
The term “responsible supervision” is defined in s. 474.202(10), F.S., as the “control, direction, and regulation by a licensed doctor
of veterinary medicine of the duties involving veterinary services” delegated to unlicensed personnel.
9
Ss. 474.203(1) and (2), F.S., provide that accreditation of a school or college must be granted by the American Veterinary Medical
Association (AVMA) Council on Education, or the AVMA Commission for Foreign Veterinary Graduates. STORAGE NAME: h1117c.COM PAGE: 3
DATE: 3/27/2023
Certain graduated intern/resident veterinarians of accredited institutions;
Certain students in a school or college of veterinary medicine who perform assigned duties by
an instructor or work as preceptors;
Certain doctors of veterinary medicine employed by a state agency or the United States
Government;
Persons or their employees caring for the persons’ own animals, as well as certain part-time or
temporary employees, or independent contractors, who are hired by an owner to help with herd
management and animal husbandry tasks; and
Certain entities or persons
10
that conduct experiments and scientific research on animals as part
of the development of pharmaceuticals, biologicals, serums, or treatment methods of treatment
or techniques to diagnose or treatment of human ailments, or in the study and development of
methods and techniques applicable to the practice of veterinary medicine.
11
Any permanent or mobile establishment where a licensed veterinarian practices must have a premises
permit issued by DBPR.
12
Each person to whom a veterinary license or premises permit is issued must
conspicuously display such document in her or his office, place of business, or place of employment in
a permanent or mobile veterinary establishment or clinic.
13
By virtue of accepting a license to practice veterinary medicine in Florida, a veterinarian consents to:
Render a handwriting sample to an agent of the department and, further, to have waived any
objections to its use as evidence against her or him.
Waive the confidentiality and authorize the preparation and release of medical reports
pertaining to the mental or physical condition of the licensee when the department has reason
to believe that a violation of this chapter has occurred and when the department issues an
order, based on the need for additional information, to produce such medical reports for the time
period relevant to the complaint.
14
For Fiscal Year 2020-2021, there were 12,156 actively licensed veterinarians in Florida. DBPR
received 472 complaints, which resulted in 17 disciplinary actions.
15
Veterinarian/Client/Patient Relationship
The practice act defines a “patient” as any animal for which the veterinarian practices veterinary
medicine.
16
The practice act defines a “veterinarian/client/patient relationship” (VCPR) as one in which a
veterinarian has assumed responsibility for making medical judgments about the health of an animal
and its need for medical treatment.
17
Veterinarians are permitted to prescribe drugs in the course of veterinary practice, but may be
disciplined by the Board for certain related violations, including ordering, prescribing, or making
available medicinal drugs or drugs
18
or controlled substances
19
for use other than for the specific
treatment of animal patients for which there is a documented VCPR and without:
10
See s. 474.203(6), F.S., which states that the exemption applies to “[s]tate agencies, accredited schools, institutions, foundations,
business corporations or associations, physicians licensed to practice medicine and surgery in all its branches, graduate doctors of
veterinary medicine, or persons under the direct supervision thereof ....”
11
See s. 474.203, F.S.
12
S. 474.215(1), F.S.
13
S. 474.216, F.S.
14
S. 474.2185, F.S.
15
Department of Business and Professional Regulation, Division of Professions Annual Report Fiscal Year 2020-2021,
http://www.myfloridalicense.com/DBPR/os/documents/DivisionAnnualReport_FY2021.pdf (last visited Mar. 6, 2023).
16
S. 474.202(8), F.S.
17
S. 474.202(12), F.S.
18
S. 465.003(8), F.S.
19
S. 893.02(4), F.S. STORAGE NAME: h1117c.COM PAGE: 4
DATE: 3/27/2023
Having sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis
of the medical condition of the animal, which means that the veterinarian is personally
acquainted with the keeping and caring of the animal and has recently seen the animal or has
made medically appropriate and timely visits to the premises where the animal is kept;
Being available to provide for follow-up care and treatment in case of adverse reactions or
failure of the regimen of therapy; and
Maintaining records which document patient visits, diagnosis, treatment, and other relevant
information required under the practice act.
20
Veterinary Telemedicine
The use of electronic communications to facilitate patient health care (telemedicine) is not addressed in
the practice act and is not specifically prohibited or authorized for practitioners of veterinary medicine in
Florida.
21
Veterinary Telemedicine During the Pandemic
On March 24, 2020, the U.S. Food and Drug Administration (FDA) announced that it would temporarily
suspend enforcement of certain prescription limitations in order to allow veterinarians to better utilize
telemedicine to address animal health needs during the COVID-19 pandemic. Specifically, the FDA
provided guidance related to suspending the enforcement of the animal examination and premises visit
VCPR requirements relevant to FDA regulations governing Extra-label Drug Use in Animals
22
and
Veterinary Feed Directive Drugs.
23
This allowed veterinarians to prescribe or authorize the use of
drugs without direct examination or making visits to patients, in an effort to limit human-to-human
interaction and potential spread of COVID-19 in the community.
24
According to the FDA, veterinarians are licensed by their state veterinary licensing board and must
meet the requirements of the licensing board to practice in that state. FDA regulates the devices and
drugs that veterinarians use, and the conditions under which veterinarians may prescribe drugs for
extra-label uses. When an approved drug is used in a manner other than what is stated on the label, it
is an extra-label use. This is commonly called an “off-label” use because the drug is used in a way that
is “off the label.”
25
On March 27, 2020, DBPR issued emergency order EO 2020-04, which suspended any restriction of
ch. 474, F.S., or ch. 61G-18, F.A.C., which would prohibit an active Florida-licensed veterinarian from
practicing telemedicine on a patient. The order specified that attending veterinarians must be
comfortable assessing the patient remotely and feel able to exercise good clinical judgment to assist
the patient.
26
The FDA withdrew its temporary guidance suspending the enforcement of the animal examination and
premises visit VCPR requirements on February 21, 2023.
27
DBPR’s emergency order allowing Florida-licensed veterinarians to practice telemedicine ended with
20
S. 474.214(1)(y)., F.S.
21
R. 64B8-9.0141, F.A.C. Currently, medical doctors may practice telemedicine in Florida in a patient relationship with a patient
evaluation, under certain circumstances.
22
21 C.F.R. part 530.
23
21 C.F.R. s. 558.6.
24
U.S. Food and Drug Administration, Coronavirus (COVID-19) Update: FDA Helps Facilitate Veterinary Telemedicine During
Pandemic, https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-helps-facilitate-veterinary-
telemedicine-during-pandemic (last visited Mar. 6, 2023).
25
.S. Food and Drug Administration, What FDA Does and Does Not Regulate, https://www.fda.gov/animal-veterinary/animal-health-
literacy/what-fda-does-and-does-not-regulate#top (last visited Mar. 6, 2023).
26
Department of Business and Professional Regulation, Emergency Order EO 2020-04, Mar. 27, 2020,
http://www.myfloridalicense.com/dbpr/os/documents/EO_2020-04.pdf (last visited Mar. 6, 2023).
27
87 C.F.R. 78111. STORAGE NAME: h1117c.COM PAGE: 5
DATE: 3/27/2023
the expiration of Florida’s COVID-19 state of emergency (EO 20-52) on Saturday June 26, 2021.
28
Veterinary Telemedicine in Other States
The use of telemedicine by veterinarians varies by state. Some states allow telemedicine to be used at
the veterinarian’s discretion, others allow it after the establishment of a VCPR, some do not allow it at
all, and others limit telemedicine for purposes of prescribing medication or controlled substances.
According to the Veterinary Virtual Care Association, state laws relating to veterinary telemedicine
generally fall within the following categories: six states either enable vets to use telemedicine to
establish a VCPR or have no VCPR; seven states require the provider to have “recently seen” or
become “acquainted with” the animal; 25 states require an examination or a physical examination for a
VCPR; and 10 states expressly prohibit using telemedicine to establish a VCPR. Florida is not included
among these categories.
29
Virginia allows veterinarians to practice telemedicine. In addition, it allows a veterinarian who performs
or has performed an appropriate examination of a patient to prescribe certain controlled substances to
a patient via the practice of telemedicine. The Virginia Board of Veterinary Medicine adopted guidance
effective September 17, 2020, for telehealth in the practice of veterinary medicine, which indicates that:
“Using telehealth technologies in veterinary practice is considered a method of service
delivery. The current, applicable regulations apply to all methods of service delivery,
including telehealth. The licensee is responsible for using professional judgment to
determine if the type of service can be delivered via telehealth at the same standard of care
as in-person service.”
30
The Idaho Board of Veterinary Medicine provides the following guidance on telehealth:
“The veterinarian must employ sound profession judgment to determine whether using
Telehealth is appropriate in particular circumstances each and every time animal care is
provided and only provide medical advice or treatment via Telehealth to the extent that it is
possible without a hands on examination. A veterinarian using Telehealth must take
appropriate steps to obtain Informed Consent, establish the VCPR and conduct all
appropriate evaluations and history of the patient consistent with traditional standards of
care for the particular patient presentation. As such, some situations and patient
presentations are appropriate for the utilization of Telehealth as a component of, or in lieu
of, hands on medical care, while others are not.”
31
The state of Oklahoma only allows a veterinarian to prescribe drugs via telemedicine under the
following conditions:
“The veterinarian accepts that he or she cannot prescribe drugs when practicing via
telehealth alone, unless the veterinarian has sufficient knowledge of the animal or group of
animals by virtue of a history and inquiry, and either physical examination or medically
28
On March 9, 2020, Governor DeSantis issued Executive Order 20-52 which declared a state of emergency for the entire state due to
COVID-19. The Executive Order was extended several times. Executive Order 21-94 extended the state of emergency for sixty days
from April 27, 2021. The sixtieth day was Saturday June 26, 2021, and the order was not renewed by the Governor.
29
Veterinary Virtual Care Association, Veterinary Telemedicine Regulatory Map, https://vvca.org/telemedicine-map/ (last visited
Mar. 19, 2023).
30
Virginia Board of Veterinary Medicine, Guidance for Telehealth in the Practice of Veterinary Medicine, Guidance Document: 150-
25, https://www.dhp.virginia.gov/media/dhpweb/docs/vet/guidance/150-25.pdf (last visited Mar. 6, 2023).
31
Idaho Veterinary Medical Association, State specific questions for Idaho – Essential services, taxes, telehealth, IDAHO BOARD OF
VETERINARY MEDICINE – TELEMEDICINE STATEMENT , https://www.ivma.org/2020/03/26/idaho-essential-services-extended-
tax-filing-deadline/ (last visited Mar. 6, 2023). STORAGE NAME: h1117c.COM PAGE: 6
DATE: 3/27/2023
appropriate and timely visits to the premises where the animal or group of animals is
kept.”
32
The state of Washington only allows telemedicine after a VCPR has been established:
“The veterinarian shall not establish a veterinary-client-patient relationship solely by
telephonic or other electronic means. However, once established, a veterinary-client-patient
relationship may be maintained between medically necessary examinations via telephone
or other types of consultations.”
33
Michigan recently repealed the need for an in-person exam prior to practicing telemedicine. Effective
April 15, 2021, a veterinarian providing a “telehealth service” is required to have sufficient knowledge of
the animal patient by having recently examined the animal patient in person or obtained current
knowledge of the animal patient through the use of instrumentation and diagnostic equipment through
which images and medical records may be transmitted electronically, or have conducted medically
appropriate and timely visits to the premises where the group of animal patients is kept.
34
Telehealth for Medical Doctors
Current law broadly defines “telehealth” as the use of synchronous or asynchronous
telecommunications technology by a telehealth provider to provide health care services, including, but
not limited to:
35
Assessment, diagnosis, consultation, treatment, and monitoring of a patient;
Transfer of medical data;
Patient and professional health-related education;
Public health services; and
Health administration.
Telehealth does not include audio-only telephone calls, e-mail messages, or facsimile transmission
under Florida law.
36
No express authority is needed to communicate using these methods.
Health care services may be provided via telehealth by a Florida-licensed health care practitioner, a
practitioner licensed under a multistate health care licensure compact of which Florida is a member,
37
or a registered out-of-state-health care provider.
38
Out-of-state telehealth providers must register biennially with the Department of Health (DOH) or the
applicable board to provide telehealth services, within the relevant scope of practice established by
Florida law and rule, to patients in this state. To register or renew registration as an out-of-state
telehealth provider, the health care professional must:
Hold an active and unencumbered license, which is substantially similar to a license issued to a
Florida practitioner in the same profession, in a U.S. state or jurisdiction and
Not have been subject to licensure disciplinary action during the five years before submission of
the registration application;
39
Not be subject to a pending licensure disciplinary investigation or action;
Not have had license revoked in any state or jurisdiction;
Designate a registered agent in this state for the service of process;
32
Oklahoma State Board of Veterinary Medical Examiners, Board Telemedicine/Telehealth Position Statement,
https://www.okvetboard.com/veterinarian-faq/95-board-telemedicine-telehealth-position-statement (last visited Mar. 6, 2023).
33
Wash. Rev. Code § 246-933-200(2).
34
Mich. Gen. R. 338.4901a.
35
36
S. 456.47(1), F.S.
37
Florida is a member of the Nurse Licensure Compact. See s. 464.0095, F.S.
38
S. 456.47(4), F.S.
39
The bill requires DOH to consult the National Practitioner Data Bank to verify whether adverse information is available for the
registrant. STORAGE NAME: h1117c.COM PAGE: 7
DATE: 3/27/2023
Maintain professional liability coverage or financial responsibility, which covers services
provided to patients not located in the provider’s home state, in the same amount as required for
Florida-licensed practitioners;
40
and
Prominently display a link to the DOH website, described below, which provides public
information on registered telehealth providers.
41
Telehealth Standards of Practice
Current law sets the standard of care for telehealth providers at the same level as the standard of care
for health care practitioners or health care providers providing in-person health care services to patients
in this state. This ensures that a patient receives the same standard of care irrespective of the modality
used by the health care professional to deliver the services. A patient receiving telehealth services may
be in any location at the time services are rendered and a telehealth provider may be in any location
when providing telehealth services to a patient.
42
Practitioners may perform a patient evaluation using telehealth. A practitioner using telehealth is not
required to research a patient’s medical history or conduct a physical examination of the patient before
providing telehealth services to the patient if the telehealth provider is capable of conducting a patient
evaluation in a manner consistent with the applicable standard of care sufficient to diagnose and treat
the patient when using telehealth.
Emergency Orders
On January 31, 2020, the U.S. Secretary of HHS issued a public health emergency.
43
On March 16,
2020, the DEA published a COVID-19 Information page on the Diversion Control Division website,
authorizing DEA-registered practitioners to issue prescriptions for all Schedule II-V controlled
substances to patients without first conducting an in-person medical evaluation, provided all of the
following conditions are met:
The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual
course of his/her professional practice.
The evaluation is conducted using an audio-visual, real-time, two-way interactive
communication system.
The practitioner is acting in accordance with applicable federal and state law.
44
On March 16, 2020, Surgeon General Scott Rivkees executed DOH Emergency Order 20-002
authorizing certain out-of-state physicians, osteopathic physicians, physician assistants, and advanced
practice registered nurses to provide telehealth in Florida without the need to register as a telehealth
40
Florida law requires physicians, acupuncturists, chiropractic physicians, dentists, anesthesiologist assistants, advanced practice
registered nurses, and licensed midwives to demonstrate $100,000 per claim and an annual aggregate of $300,000 of professional
responsibility (see ss. 458.320 and 459.0085, F.S.; r. 64B1-12.001. F.A.C; r. 64B2-17.009, F.A.C.; 64B5-17.0105, F.A.C.; r. 64B8-
31.006 and 64B15-7.006, F.A.C.; r. 64B9-4.002, F.A.C.; and r. 64B24-7.013, F.A.C.; respectively). Podiatric physicians must
demonstrate professional responsibility in the amount of $100,000 (see r. 64B18-14.0072, F.A.C.).
41
S. 456.47(4), F.S.
42
S. 456.47(2), F.S.
43
Determination that a Public Health Emergency Exists, Alex M. Azar II, Secretary of U.S. Department of Health and Human
Services (January 31, 2020) https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx (last visited Mar. 6,
2023).
44
Diversion Control Division, U.S. Department of Justice Drug Enforcement Administration, COVID-19 Information Page,
https://www.deadiversion.usdoj.gov/coronavirus.html (last visited Jan. 5, 2022); Letter from Thomas Prevoznik, Deputy Assistant
Administrator, Diversion Control Division, U.S. Department of Justice Drug Enforcement Administration, to DEA Qualifying
Practitioners and Other Practitioners, (Mar. 31, 2020) https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-
022)(DEA068)%20DEA%20SAMHSA%20buprenorphine%20telemedicine%20%20(Final)%20+Esign.pdf (last visited Mar. 6,
2023). STORAGE NAME: h1117c.COM PAGE: 8
DATE: 3/27/2023
provider under s. 456.47(4), F.S.
45
This emergency order ended with the expiration of Florida’s COVID-
19 state of emergency (EO 20-52) on June 26, 2021.
46
The Surgeon General also executed DOH Emergency Order 20-003
47
authorizing certain out-of-state
clinical social workers, marriage and family therapists, mental health counselors, and psychologists to
provide telehealth in Florida without the need to register as a telehealth provider under s. 456.47(4),
F.S. This emergency order also ended on June 26, 2021.
48
Controlled Substances – Florida Law
Chapter 893, F.S., sets forth the Florida Comprehensive Drug Abuse Prevention and Control Act. This
chapter classifies controlled substances into five schedules in order to regulate the manufacture,
distribution, preparation, and dispensing of the substances. The scheduling of substances in Florida
law is generally consistent with the federal scheduling of substances under 21 U.S.C. s. 812:
A Schedule I substance has a high potential for abuse and no currently accepted medical use in
treatment in the United States and its use under medical supervision does not meet accepted
safety standards. Examples include heroin and lysergic acid diethylamide (LSD).
A Schedule II substance has a high potential for abuse, a currently accepted but severely
restricted medical use in treatment in the United States, and abuse may lead to severe
psychological or physical dependence. Examples include cocaine and morphine.
A Schedule III substance has a potential for abuse less than the substances contained in
Schedules I and II, a currently accepted medical use in treatment in the United States, and
abuse may lead to moderate or low physical dependence or high psychological dependence or,
in the case of anabolic steroids, may lead to physical damage. Examples include lysergic acid;
ketamine; and some anabolic steroids.
A Schedule IV substance has a low potential for abuse relative to the substances in
Schedule III, a currently accepted medical use in treatment in the United States, and abuse may
lead to limited physical or psychological dependence relative to the substances in Schedule III.
Examples include alprazolam, diazepam, and phenobarbital.
A Schedule V substance has a low potential for abuse relative to the substances in
Schedule IV, a currently accepted medical use in treatment in the United States, and abuse
may lead to limited physical or psychological dependence relative to the substances in
Schedule IV. Examples include low dosage levels of codeine, certain stimulants, and certain
narcotic compounds.
Controlled Substances – Federal Law
The Federal Controlled Substances Act
49
also classifies controlled substances into schedules based on
the potential for abuse and whether there is a currently accepted medical use for the substance. The
Drug Enforcement Administration (DEA) is required to consider the following when determining where
to schedule a substance:
50
The substance’s actual or relative potential for abuse;
Scientific evidence of the substance’s pharmacological effect, if known;
45
Department of Health, State of Florida, Emergency Order DOH No. 20-002 (Mar. 16, 2020) http://floridahealthcovid19.gov/wp-
content/uploads/2020/03/filed-eo-doh-no.-20-002-medical-professionals-03.16.2020.pdf (last visited Mar. 6, 2023).
46
On March 9, 2020, Governor DeSantis issued Executive Order 20-52 which declared a state of emergency for the entire state due to
COVID-19. The Executive Order was extended several times. Executive Order 21-94 extended the state of emergency for sixty days
from April 27, 2021. The sixtieth day was Saturday June 26, 2021, and the order was not renewed by the Governor.
47
Department of Health, State of Florida, Emergency Order DOH No. 20-003 (Mar. 21, 2020) https://s33330.pcdn.co/wp-
content/uploads/2020/03/DOH-EO-20-003-3.21.2020.pdf (last visited Mar. 6, 2023).
48
On March 9, 2020, Governor DeSantis issued Executive Order 20-52 which declared a state of emergency for the entire state due to
COVID-19. The Executive Order was extended several times. Executive Order 21-94 extended the state of emergency for sixty days
from April 27, 2021. The sixtieth day was Saturday June 26, 2021, and the order was not renewed by the Governor.
49
21 U.S.C. s. 812.
50
21 U.S.C. s. 811(c). STORAGE NAME: h1117c.COM PAGE: 9
DATE: 3/27/2023
The state of current scientific knowledge regarding the substance;
The substance’s history and current pattern of abuse;
The scope, duration, and significance of abuse;
What, if any, risk there is to public health;
The substance’s psychic or physiological dependence liability; and
Whether the substance is an immediate precursor of a substance already controlled.
Telehealth Prescribing of Controlled Substances
Federal law specifically prohibits prescribing controlled substances via the Internet without an in-person
evaluation, but the Ryan Haight Online Pharmacy Consumer Protection Act (Haight Act),
51
signed into
law in October 2008
52
created a pathway for telehealth practitioners to dispense controlled substances
via telehealth. The practitioner is still subject to the requirement that all controlled substance
prescriptions be issued for a legitimate purpose by a practitioner acting in the usual course of
professional practice. But, once an in-person evaluation of the patient has occurred, the
practitioner may provide future prescriptions for controlled substances for that patient using telehealth
services.
53
Florida law currently prohibits a telehealth provider (human) from using telehealth services to prescribe
a Schedule II controlled substance except when treating a psychiatric disorder, an inpatient at a
licensed hospital, a patient receiving hospice services, or a resident of a nursing home facility.
However, providers are allowed to prescribe Schedule III, IV, and V controlled substances using
telehealth services without limitation.
54
Prescription Drug Law for Veterinarians
In order to purchase, prescribe, administer or dispense controlled substances in Florida, veterinarians
must obtain a license from the U.S. Drug Enforcement Administration (DEA). Florida does not require
any additional licensure for veterinarians to purchase and prescribe controlled drugs.
55
The DEA is a division within the U.S. Department of Justice and reports to the U.S. Attorney General.
In consultation with the U.S. Secretary of the federal Department of Health and Human Services (HHS)
and others, the Attorney General oversees the listing of substances on five schedules (Classes I, II, III,
IV or V) of controlled agents as described in Title 21 United States Code (USC) of the Controlled
Substances Act. The central mission of the DEA is to enforce controlled substances laws and
regulations.
56
With respect to veterinarians and other health professionals, the major focus of the DEA is to prevent
illegal diversion of controlled prescription drugs for the purpose of illicit or non-medical uses. In order to
legally purchase, dispense or prescribe controlled prescription drugs, a veterinarian must be licensed
by the DEA. Prescription drugs that are regulated or controlled by the DEA include many important
drugs that are used routinely by veterinarians. DEA-controlled drugs are tightly controlled at all aspects
of manufacturing, distribution, ordering, storage, use and disposition.
57
While veterinarians are allowed to write prescriptions for controlled drugs, they cannot order controlled
drugs from their local pharmacy for “in-house” use nor for secondary re-sale. Like any other
prescription, controlled drug prescriptions must be written for a specific patient and cannot be for
51
Ryan Haight Online Consumer Protection Act of 2008, Public Law 110-425 (H.R. 6353).
52
21 CFR s. 829, the in-person medical evaluation requires that the patient be in the physical presence of the provider without regard
to the presence or conduct of other professionals.
53
Id.
54
S. 456.47(2)(c), F.S.
55
Thomas Vickory, PhD, DEA REGULATION OF CONTROLLED DRUGS, https://www.vetfolio.com/learn/article/florida-drug-
laws-update-2013 (last visited Mar. 6, 2023).
56
Thomas, supra note 46.
57
Thomas, supra note 46. STORAGE NAME: h1117c.COM PAGE: 10
DATE: 3/27/2023
general use. As a licensed DEA registrant, veterinarians are expected to create and maintain a system
that provides strong safeguards against theft or diversion of controlled drugs in their practice.
58
Two opioids are approved and marketed for use in animals, butorphanol and buprenorphine. Due to the
limited number of approved and marketed veterinary opioids, veterinarians who need to use opioids to
control pain in their patients generally use products approved for use in people.
59
Rabies Vaccinations
All dogs, cats, and ferrets four months of age or older must be vaccinated by a licensed veterinarian
against rabies with a vaccine that is licensed by the U.S. Department of Agriculture (USDA) for use in
those species. The owner must have the animal revaccinated 12 months after the initial vaccination,
and subsequent vaccinations must conform to the vaccine manufacturer’s directions. The cost of
vaccination must be borne by the animal’s owner. Violations of this requirement are a civil infraction,
punishable as provided in s. 828.27(2), F.S.
60
Currently, Florida law does not appear to allow anyone other than the veterinarian to administer the
rabies vaccine. The law allows certain vaccines, anesthesia and tranquilization to be administered by a
veterinary aide, nurse, laboratory technician, intern, or other employee of a licensed veterinarian while
under the “immediate supervision” of a licensed veterinarian.
61
In addition, the following tasks may be
performed without the licensed veterinarian on the premises:
The administration of medication and treatment, excluding vaccinations, as directed by the
licensed veterinarian; and
The obtaining of samples and the performance of those diagnostic tests, including radiographs,
directed by the licensed veterinarian.
62
The Board has recognized that the following diseases are communicable to humans and are of public
health significance, and as a result, only a veterinarian is authorized to immunize or treat an animal
for these diseases. The diseases include:
Brucellosis.
Tuberculosis.
Rabies.
Equine Encephalomyelitis.
63
Effect of the Bill
The bill allows licensed veterinarians to practice veterinary telemedicine on a limited basis, and
indirectly supervise rabies vaccinations of impounded animals.
Regarding veterinary telemedicine, the bill:
Defines “veterinary telemedicine” to mean the practice of veterinary medicine using
synchronous, audiovisual, interactive telecommunications technology.
Requires veterinarians to be currently licensed in order to practice veterinary telemedicine.
Deems the practice to occur at the premises where the patient is located at the time a
veterinarian practices veterinary telemedicine.
Gives the Board jurisdiction over a veterinarian practicing veterinary telemedicine in this state,
regardless of the location of the veterinarian's physical office.
Requires veterinarians practicing telemedicine to provide the client with a statement containing:
58
Thomas, supra note 46.
59
U.S. FDA, The Opioid Epidemic: What Veterinarians Need to Know, https://www.fda.gov/animal-veterinary/resources-you/opioid-
epidemic-what-veterinarians-need-know (last visited Mar. 6, 2023).
60
S. 828.30(1), F.S.
61
S. 474.202(5), F.S., defines “immediate supervision” or words of similar purport to mean a licensed doctor of veterinary medicine is
on the premises whenever veterinary services are being provided.
62
R. 61G18-17.005, F.A.C.
63
R. 61G18-17.006, F.A.C. STORAGE NAME: h1117c.COM PAGE: 11
DATE: 3/27/2023
o The veterinarian’s identity, license number, and contact information;
o The contact for at least one physical veterinary clinic in the vicinity of the pet's location; and
o Instructions for how to receive patient follow-up care or assistance if the veterinarian and
client are unable to communicate because of a technological or equipment failure or if there
is an adverse reaction to treatment.
Requires the veterinarian to obtain from the client a signed and dated statement indicating the
client has received the required information from the client statement.
Authorizes a veterinarian practicing veterinary telemedicine to order, prescribe, or make
available medicinal drugs.
Limits a veterinarian’s authority to order, prescribe, or make available controlled substances
while practicing telemedicine to situations where the veterinarian has previously performed an
in-person physical examination or made medically appropriate and timely visits to the premises
where the patient is kept.
Revises the requirement that a veterinarian have “seen the animal” in order to prescribe
medicinal drugs and controlled substances, to instead require the veterinarian to have recently
performed an examination of the patient either:
o In person; or
o By the use of veterinary telemedicine in compliance with s. 474.2021, F.S.
Authorizes veterinarians who are personally acquainted with the caring and keeping of an
animal or group of animals on food-producing animal operations on land classified as
agricultural who has recently seen the animal or group of animals or has made medically
appropriate and timely visits to the premises where the animal or group of animals is kept to
practice veterinary telemedicine for animals on such operations in compliance with this section
and applicable federal law.
Requires veterinarians practicing telemedicine to employ sound, professional judgment to
determine whether using veterinary telemedicine is an appropriate method for delivering
medical advice or treatment to the patient and providing quality of care consistent with prevailing
veterinary medical practice.
Specifies that the practice of veterinary telemedicine in compliance with these provisions is not
a quality-of-care violation, and a veterinarian may not be disciplined solely for practicing
veterinary telemedicine.
Regarding rabies vaccinations, the bill:
Allows an employee, agent, or contractor of an animal control authority acting under the indirect
supervision of a veterinarian to administer rabies vaccinations to impounded animals that will be
transferred, rescued, fostered, adopted, or reclaimed by the owner.
Defines "indirect supervision," to mean the supervising veterinarian must be available for
consultation through telecommunications but is not required to be on the premises during such
consultation.
o The supervising veterinarian assumes responsibility for the veterinary care given to the
animal by any person working under or at his or her direction and supervision.
Authorizes veterinarians who supervise an employee, agent, or contractor of an animal control
authority administering the rabies vaccination to an animal to affix his or her signature stamp in
lieu of an actual signature.
B. SECTION DIRECTORY:
Section 1: Titles the act the “Providing Equity in Telemedicine Services (PETS) Act.”
Section 2: Amends s. 474.202, F.S., relating to definitions.
Section 3: Creates s. 474.2021, F.S., relating to veterinary telemedicine.
Section 4: Amends s. 474.203, F.S., relating to exemptions.
Section 5: Amends s. 474.214, F.S., relating to disciplinary proceedings.
STORAGE NAME: h1117c.COM PAGE: 12
DATE: 3/27/2023
Section 6: Amends s. 474.2165, F.S., relating to ownership and control of veterinary medical
patient records; report or copies of records to be furnished.
Section 7: Amends s. 828.30, F.S., relating to rabies vaccination of dogs, cats, and ferrets.
Section 8: Provides an effective date of July 1, 2023.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
Indeterminate. Animal control authorities will be able to administer rabies vaccinations of
impounded animals without a veterinarian having to be physically present. This may create a
savings for local animal control authorities to the extent they are incurring extra veterinary costs
associated with veterinarians being required to be onsite to administer rabies vaccinations.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Licensed veterinarians will be permitted to practice veterinary telemedicine, including limited
prescription authority, thus giving them more flexibility in their practice. This will move them further
toward equal footing with licensed health care providers in the state who are already allowed to practice
telehealth.
Animal owners may have greater access to veterinarians and may feel more comfortable, especially
during a state of emergency. Visitors and tourists with pets may be able to obtain veterinarian care
while on vacation in Florida without the need for locating and transporting their animal to a
veterinarian’s office.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
3. Other:
None.
B. RULE-MAKING AUTHORITY: STORAGE NAME: h1117c.COM PAGE: 13
DATE: 3/27/2023
Current law appears to grant the Board sufficient authority to adopt rules to implement the provisions of
this bill.
64
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
64
S. 474.206, F.S.