This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0849.RRS
DATE: 1/9/2024
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 849 Veterinary Practices
SPONSOR(S): Killebrew and others
TIED BILLS: IDEN./SIM. BILLS: SB 1040, SB 1162
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Regulatory Reform & Economic Development
Subcommittee
Thompson Anstead
2) Commerce Committee
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 (telehealth) is not addressed in the
practice act and is not specifically prohibited or authorized in Florida. However, medical doctors may practice
telehealth in Florida and may establish a patient relationship with a patient evaluation via telehealth under
certain circumstances.
The bill creates an act cited as the Providing Equity in Telehealth Services (PETS) Act, which establishes a
framework for the practice of veterinary telehealth as follows:
Authorizes a veterinarian practicing veterinary telehealth to order, prescribe, or make available
medicinal drugs or drugs as defined in s. 465.003, F.S., the Florida Pharmacy Act.
Limits a veterinarian’s authority to use telehealth to prescribe a controlled substance listed in Schedule
II of s. 893.03, F.S.
Allows veterinarians who are personally acquainted with the caring or keeping of an animal or group of
animals for food-producing animal operations, who have recently seen the animals or made medically
appropriate and timely visits to practice veterinary telehealth for these animals.
Specifies that only Florida licensed veterinarians may practice veterinary telehealth, and grants the
Board jurisdiction over the practice of veterinary telehealth.
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, 2024. STORAGE NAME: h0849.RRS PAGE: 2
DATE: 1/9/2024
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
Theriogenology is a branch of veterinary medicine concerned with veterinary obstetrics and with the diseases and physiology of
animal reproductive systems. See https://www.merriam-webster.com/medical/theriogenology (last visited Jan. 5, 2024).
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 Jan. 56, 2024).
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: h0849.RRS PAGE: 3
DATE: 1/9/2024
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 2021-2022, there were 12,360 actively licensed veterinarians in Florida. DBPR
received 568 complaints, which resulted in 26 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 2021-2022,
http://www.myfloridalicense.com/DBPR/os/documents/Division%20Annual%20Report%20FY%2021-22.pdf (last visited Jan. 5,
2024).
16
S. 474.202(8), F.S.
17
S. 474.202(12), F.S.
18
S. 465.003(8), F.S. STORAGE NAME: h0849.RRS PAGE: 4
DATE: 1/9/2024
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 (veterinary telemedicine) is not
addressed in the practice act and is not specifically prohibited or authorized for practitioners of
veterinary medicine in Florida.
21
According to research conducted by the American Veterinary Medical Association (AVMA), almost one-
third of all pets in the U.S. do not regularly see a veterinarian.
22
The reasons for this include cost of
veterinary care, logistical obstacles, and a shortage of licensed veterinarians.
23
Veterinary telemedicine has been found to “help pet owners avoid additional expenses related to
unnecessary time off work or transportation and may provide cost-effective options. Telemedicine can
also address problems with bringing pets to clinics that may be faced by many pet owners, such as
seniors, disabled individuals, those without transportation, and owners of fearful, large, or potentially
aggressive pets.”
24
“Interest in veterinary telemedicine has grown significantly in recent years, driven in part by a critical
shortage of veterinary professionals in the workforce and boosted by COVID-19 pandemic emergency
orders that temporarily suspended legal barriers to veterinary telemedicine.”
25
Expanding access to veterinary telemedicine may alleviate some of these problems, including, “industry
problems with workforce shortages of veterinary professionals, increased caseloads, and limited work-
life balance.”
26
In the human health setting, a 50 state survey conducted by the AVMA found that “all states allow a
physician to establish a relationship with a new patient over telemedicine.”
27
However, the same
approach does not appear to exist with veterinary medicine.
Opponents of veterinary telemedicine argue that animals cannot articulate symptoms like humans,
making physical examinations necessary to diagnose animal ailments. However, it has been found that
“while animals cannot verbally communicate, they provide behavioral signals, which can potentially be
more informative than seeing an animal in an unfamiliar place where the animal is not behaving as it
19
S. 893.02(4), F.S.
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
Malinda Larkin, New, Old Challenges Beg for Radical Change in Veterinary Profession, JAVMA News (Dec. 3, 2020),
https://www.avma.org/javma-news/2020-12-15/new-old-challenges-beg-radical-change-veterinary-profession (last visited Jan. 9,
2024).
23
The Veterinary Care Accessibility Project, Veterinary Care Accessibility Score, https://www.accesstovetcare.org/ (last visited Jan.
9, 2024).
24
Camille DeClementi, Jennifer Hobgood, and Diana Ferguson, IN THE CARDS: BETTING ON VETERINARY TELEMEDICINE
LEGAL REFORM, Florida Bar Journal, (Dec. 2022), https://www.floridabar.org/the-florida-bar-journal/in-the-cards-betting-on-
veterinary-telemedicine-legal-reform/ (last visited Jan. 9, 2024).
25
Id.
26
Id.
27
American Medical Association, 50-State Survey: Establishment of a Patient-Physician Relationship Via Telemedicine,
https://www.ama-assn.org/system/files/2018-10/ama-chart-telemedicine-patient-physician-relationship.pdf (last visited Jan. 9, 2024). STORAGE NAME: h0849.RRS PAGE: 5
DATE: 1/9/2024
customarily would. In a clinic setting, dogs and cats may become extremely fearful and withdrawn, and,
in a situation that they perceive as threatening, animals may mask their pain as a survival
mechanism.”
28
Historically, physicians resisted expansion of telemedicine in human medicine for similar reasons. By
the 1990s, resistance in the medical community had largely subsided.
29
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
30
and
Veterinary Feed Directive Drugs.
31
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.
32
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.”
33
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.
34
The FDA withdrew its temporary guidance suspending the enforcement of the animal examination and
premises visit VCPR requirements on February 21, 2023.
35
DBPR’s emergency order allowing Florida-licensed veterinarians to practice telemedicine ended with
the expiration of Florida’s COVID-19 state of emergency (EO 20-52) on Saturday June 26, 2021.
36
Veterinary Telemedicine in Other States
The use of telemedicine by veterinarians varies by state. Some states allow telemedicine to be used at
28
Mark Epstein, et al., 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats, American Animal Hospital Association
(2015), https://www.aaha.org/globalassets/02-guidelines/pain-
management/2015_aaha_aafp_pain_management_guidelines_for_dogs_and_cats.pdf (Iast visited Jan. 9, 2024).
29
Mary Ann Liebert, History of Telemedicine 15-16 (NY 2009).
30
21 C.F.R. part 530.
31
21 C.F.R. s. 558.6.
32
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 Jan. 5, 2024).
33
.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 Jan. 5, 2024).
34
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 Jan. 5, 2024).
35
87 C.F.R. 78111.
36
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. STORAGE NAME: h0849.RRS PAGE: 6
DATE: 1/9/2024
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: 25 states and the District of Columbia require the provider
to have “seen” or become “acquainted with” the animal; 10 states require a physical examination for a
VCPR; 5 states allow telemedicine to create a VCPR; 1 state allows telemedicine to create a VCPR
except for prescriptions; 1 state does not reference and therefore does not define or use the term
VCPR; and 9 states expressly prohibit using telemedicine to establish a VCPR.
37
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.”
38
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.”
39
The state of Oklahoma only allows a veterinarian to prescribe drugs via telemedicine under the
following conditions:
“The veterinarian assumes responsibility for making medical judgments regarding the
health of the animal based on a current thorough medical knowledge of the animal, such
knowledge is gained by recently seeing or being personally acquainted with the keeping
and care of the animal to the extent necessary to properly make appropriate medical
decisions.”
40
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.”
41
37
Veterinary Virtual Care Association, Veterinary Telemedicine Regulatory Map, https://vvca.org/telemedicine-map/ (last visited Jan.
5, 2024).
38
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 Jan. 5, 2024).
39
Idaho Board of Veterinary Medicine, Policy Number 2018-02 Telemedicine (Oct. 15, 2021), https://dopl.idaho.gov/wp-
content/uploads/2023/07/Telemed-Policy-6-8-18-with-Revision-10-15-21.pdf (last visited Jan. 5, 2024).
40
Oklahoma State Board of Veterinary Medical Examiners, Veterinarian-Client-Patient-Relationship-VCPR,
https://www.okvetboard.com/veterinarian-faq/95-board-telemedicine-telehealth-position-statement (last visited Mar. 6, 2023).
41
Wash. Rev. Code § 246-933-200(2). STORAGE NAME: h0849.RRS PAGE: 7
DATE: 1/9/2024
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.
42
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:
43
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 e-mail messages, or facsimile transmission under Florida law.
44
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,
45
or a registered out-of-state-health care provider.
46
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;
47
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;
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;
48
and
Prominently display a link to the DOH website, described below, which provides public
information on registered telehealth providers.
49
42
Mich. Gen. R. 338.4901a.
43
S. 456.47(1)(a), F.S.
44
Id.
45
Florida is a member of the Nurse Licensure Compact. See s. 464.0095, F.S.
46
S. 456.47(4), F.S.
47
The bill requires DOH to consult the National Practitioner Data Bank to verify whether adverse information is available for the
registrant.
48
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.).
49
S. 456.47(4), F.S. STORAGE NAME: h0849.RRS PAGE: 8
DATE: 1/9/2024
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.
50
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.
51
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.
52
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.
50
S. 456.47(2), F.S.
51
U.S. Department of Health & Human Services, Determination that a Public Health Emergency Exists, (Jan. 31, 2020)
https://aspr.hhs.gov/legal/PHE/Pages/2019-
nCoV.aspx#:~:text=A zar%20II%2C%20Secretary%20of%20Health,January%2027%2C%202020%2C%20nationwide. (last visited
Jan. 5, 2024).
52
U.S. Drug Enforcement Administration, DEA’s response to COVID-19, https://www.dea.gov/press-releases/2020/03/20/deas-
response-covid-19 (last visited Jan. 5, 2024); 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 Jan. 5, 2024). STORAGE NAME: h0849.RRS PAGE: 9
DATE: 1/9/2024
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
53
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:
54
The substance’s actual or relative potential for abuse;
Scientific evidence of the substance’s pharmacological effect, if known;
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
The FDA regulations governing Extralabel Drug Use in Animals and Veterinary Feed Directives, limited
in application to circumstances where a veterinarian is using a drug in a manner other than the purpose
for which it was approved or in feed directives, require a valid VCPR, which “can exist only when the
veterinarian has recently seen and is personally acquainted with the keeping and care of the animal(s)
by virtue of examination of the animal(s), and/or by medically appropriate and timely visits to the
premises where the animal(s) are kept.”
55
“However, the corresponding regulation in the Florida Administrative Code blocks veterinarians from
prescribing unless they have “recent contact” with the animal.
56
Since the Florida statute contains no
“recent contact” requirement for a VCPR or for prescribing, the Board may have exceeded its statutory
authority
57
to “carry out the provisions of” F.S. Ch. 474, Veterinary Medical Practice.”
58
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),
59
signed into
law in October 2008
60
created a pathway for telehealth practitioners to dispense controlled substances
via telehealth.
53
21 U.S.C. s. 812.
54
21 U.S.C. s. 811(c).
55
21 C.F.R. §530.1 & §530.3(i)(3).
56
Rule 61G18-30.001 (2)(y), F.S.
57
S. 474.204(1), F.S.
58
Camille DeClementi, Jennifer Hobgood, and Diana Ferguson, IN THE CARDS: BETTING ON VETERINARY TELEMEDICINE
LEGAL REFORM, Florida Bar Journal, (Dec. 2022), https://www.floridabar.org/the-florida-bar-journal/in-the-cards-betting-on-
veterinary-telemedicine-legal-reform/ (last visited Jan. 9, 2024).
59
Ryan Haight Online Consumer Protection Act of 2008, Public Law 110-425 (H.R. 6353).
60
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. STORAGE NAME: h0849.RRS PAGE: 10
DATE: 1/9/2024
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.
61
Florida law currently prohibits a telehealth provider (human) from using telehealth services to prescribe
a 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.
62
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.
63
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.
64
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.
65
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
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.
66
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.
67
Rabies Vaccinations
According to the World Health Organization, “rabies is a vaccine-preventable viral disease which
occurs in more than 150 countries and territories. Once clinical symptoms appear, rabies is virtually
100 percent fatal. In up to 99 percent of cases, domestic dogs are responsible for rabies virus
transmission to humans. Rabies can be prevented through vaccination of dogs and prevention of dog
bites.”
68
61
Id.
62
S. 456.47(2)(c), F.S.
63
Thomas Vickory, PhD, DEA REGULATION OF CONTROLLED DRUGS, https://www.vetfolio.com/learn/article/florida-drug-
laws-update-2013 (last visited Jan. 5, 2024).
64
Thomas, supra note 63.
65
Thomas, supra note 63.
66
Thomas, supra note 63.
67
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 Jan. 5, 2024).
68
World Health Organization, Rabies, Sep. 20, 2023, https://www.who.int/news-room/fact-sheets/detail/rabies (last visited Jan. 5,
2024). STORAGE NAME: h0849.RRS PAGE: 11
DATE: 1/9/2024
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.
69
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 by a penalty of up to $500.
70
A dog, cat, or ferret is exempt from vaccination against rabies if a licensed veterinarian has examined
the animal and has certified in writing that the vaccination would endanger the animal’s health because
of its age, infirmity, disability, illness, or other medical considerations. An exempt animal must be
vaccinated against rabies as soon as its health permits.
71
Upon vaccination, the licensed veterinarian is required to provide the animal’s owner and the animal
control authority with a rabies vaccination certificate.
72
The veterinarian who administers the rabies
vaccine to an animal as required under this section may affix his or her signature stamp in lieu of an
actual signature.
73
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.
74
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.
75
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.
76
Effect of the Bill
The bill allows licensed veterinarians to practice veterinary telehealth on a limited basis, and indirectly
supervise rabies vaccinations of impounded animals.
Regarding veterinary telemedicine, the bill:
Allows a veterinarian who holds a current license to practice veterinary medicine in this state to
practice veterinary telehealth.
Defines “telehealth” to have the same meaning as the human telehealth definition in s.
456.47(1), F.S.:
69
S. 828.30(1), F.S.
70
See s. 828.27(2), F.S
71
S. 828.30(2), F.S.
72
Each animal control authority and veterinarian shall use the “Rabies Vaccination Certificate” of the National Association of State
Public Health Veterinarians (NASPHV) or an equivalent form approved by the local government that contains all the information
required by the NASPHV Rabies Vaccination Certificate.
73
S. 828.30(3), F.S.
74
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.
75
R. 61G18-17.005, F.A.C.
76
R. 61G18-17.006, F.A.C. STORAGE NAME: h0849.RRS PAGE: 12
DATE: 1/9/2024
o “the use of synchronous or asynchronous telecommunications technology by a
telehealth provider to provide health care services, including, but not limited to,
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. The term does not include e-mail messages or facsimile
transmissions.”
Gives the Board of Veterinary Medicine jurisdiction over a veterinarian practicing veterinary
telehealth, regardless of where the veterinarian's physical office is located.
Deems the practice of veterinary to occur at the premises where the patient is located at the
time the veterinarian practices veterinary telehealth.
Prohibits practicing veterinary telehealth unless it is within the context of a
veterinarian/client/patient relationship.
Requires the practice of telehealth to be in a manner consistent with the scope of practice and
the prevailing professional standard of practice for a veterinarian who provides in-person
veterinary services to patients in this state.
Authorizes veterinarians practicing telehealth to perform a patient evaluation, and specifies that
if a veterinarian practicing telehealth conducts a patient evaluation sufficient to diagnose and
treat the patient, the veterinarian is not required to research a patient's medical history or
conduct a physical examination of the patient before using veterinary telehealth to provide a
veterinary health care service to the patient.
Requires veterinarians practicing telehealth to prescribe all drugs and medications in
accordance with all federal and state laws.
o Authorizes a veterinarian practicing veterinary telehealth to order, prescribe, or make
available medicinal drugs or drugs as defined in s. 465.003, F.S.
o Prohibits a veterinarian from using telehealth to prescribe a controlled substance listed in
Schedule II of s. 893.03, 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 pursuant to s. 193.461, F.S., 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 telehealth for animals on such operations.
Regarding rabies vaccinations, the bill:
Allows an employee, an agent, or a contractor of a county or municipal animal control authority,
or sheriff, acting under the indirect supervision of a veterinarian, to administer rabies
vaccinations to impounded dogs, cats, and ferrets that will be transferred, rescued, fostered,
adopted, or reclaimed by the owner.
Provides that the supervising veterinarian assumes responsibility for any person vaccinating
animals at his or her direction or under his or her direct or indirect supervision.
Defines "indirect supervision," to mean the supervising veterinarian is required to be available
for consultation through telecommunications but is not required to be physically present during
such consultation.
Authorizes veterinarians who supervise the administration of the rabies vaccination to affix his
or her signature stamp in lieu of an actual signature to the rabies vaccination certificate.
B. SECTION DIRECTORY:
Section 1: Creates s. 474.2021, F.S., relating to veterinary telehealth.
Section 2: Amends s. 474.2165, F.S., conforming provisions relating to ownership and control of
veterinary medical patient records; report or copies of records to be furnished.
Section 3: Amends s. 828.30, F.S., relating to rabies vaccination of dogs, cats, and ferrets.
Section 4: Amends s. 474.203, F.S., conforming provisions relating to exemptions.
STORAGE NAME: h0849.RRS PAGE: 13
DATE: 1/9/2024
Section 5: Amends s. 767.16, F.S., conforming provisions relating to police canine or service dog;
exemption.
Section 6: Amends s. 828.29, F.S., conforming provisions relating to dogs and cats transported or
offered for sale; health requirements; consumer guarantee.
Section 7: Provides an effective date of July 1, 2024.
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 SEC TOR:
Licensed veterinarians will be permitted to practice veterinary telehealth, 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: h0849.RRS PAGE: 14
DATE: 1/9/2024
Current law appears to grant the Board sufficient authority to adopt rules to implement the provisions of
this bill.
77
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
77
S. 474.206, F.S.