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New York State Cattle Health Assurance Program


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Herd Health


The Veterinary-Client-Patient-Relationship (VCPR)**

NEW YORK STATE:
A valid VCPR is a prerequisite to offering veterinary service in NYS. Veterinarians who are licensed and practice in NYS follow VCPR guidelines outlined by New York’s Bureau of Veterinary Medicine, as follows (October 2015):

A VCPR exists when all of the following are satisfied:

A. The veterinarian has assumed the responsibility for making medical judgments regarding the health of the patient with the assent of the owner of the animal or their duly authorized agent.
B. The veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient. This means that the veterinarian is personally acquainted with the keeping and care of the patient by virtue of:

i. a timely examination of the patient by the veterinarian, or
ii. medically appropriate and timely visits by the veterinarian to the operation where the patient is managed, or
iii. medically appropriate and timely visits by the patient to the veterinary facility where the veterinarian is working.


C. The veterinarian is readily available for follow-up evaluation and oversight of treatment and outcomes, or has arranged for appropriate continuing care and treatment.
D. Patient records are maintained.


FEDERAL
New York’s guidelines, and US-FDA’s definition of a valid VCPR are very similar in meaning, however, since New York’s VCPR is not written in law, for US FDA’s purposes (as applies to writing a VFD or administering or prescribing drugs under AMDUCA) NY veterinarians defer to US FDA’s definition, noted below:

(1) A veterinarian has assumed the responsibility for making medical judgments regarding the health of (an)animal(s) and the need for medical treatment, and the client (the owner of the animal or animals or other caretaker) has agreed to follow the instructions of the veterinarian;

(2) There is sufficient knowledge of the animal(s) by the veterinarian to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s); and

(3) The practicing veterinarian is readily available for follow-up in case of adverse reactions or failure of the regimen of therapy. Such a relationship 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.


**
Veterinarians must meet the State definition of a valid VCPR, in conjunction with the US-FDA definition of a valid VCPR, in other words, if the State definition goes above and beyond the US-FDA definition both definitions must be followed.


VCPR KEY POINTS

  1. A VCPR is an inherent part of practicing veterinary medicine. It is in effect every time a veterinarian works with a client.
  2. Because it is inherent in practicing veterinary medicine daily, there is no requirement for it to be written between the vet and their client.
  3. There is no definition of timely visits which gives the veterinarian the discretion of what appropriate time limits are for each of their clients.
  4. The VCPR should be discussed between vet and client - especially when it comes to drug usage. A client’s drug usage can become the responsibility of their veterinarian even if the veterinarian is not aware of where or how their client is purchasing or using drugs. The relationship includes that the veterinarian is familiar with their client’s operation – that would include drug usage.
  5. Written agreements, especially in regards to drug inventories and drug usage, between the veterinarian and their clients is highly advisable. This would clarify what is happening on the operation and create responsibility/accountability for drug usage. An example of such an agreement is NYSCHAP’s Veterinary-Client Best Management Drug Usage Agreement form.
  6. These written agreements are NOT a COMPLETE VCPR in and of themselves, but rather, a subset of expectations under the broader definition of a VCPR; it includes responsibility and expectations between parties, as well as, documentation that “….the client (the owner of the animal or animals or other caretaker)” has agreed to follow the instructions of the veterinarian (stated in 21 CFR 530.3(i) )of the US FDA VCPR definition.


VETERINARY - CLIENT RECOMMENDATIONS

  1. CREATE WRITTEN AGREEMENTS between the veterinarian and the client. Include expectations between the two parties, outlines what the veterinarian’s responsible is for the operation (i.e. management area, drug usage, etc.), the client agrees to follow the protocols and accepts the oversight put forth by that veterinarian.
  2. CREATE FARM DRUG LISTS AND TREATMENT PROTOCOLS by the veterinarian for the client. This will set up the client to use drugs appropriately. Employee training on drug usage, treatments are completed by the herd veterinarian. Signed confirmation by both parties is recommended on protocols, training and oversight.
  3. REQUIRE FARMS TO KEEP WRITTEN/ELECTRONIC TREATMENT RECORDS for all groups of animals. Included in these records are: Date, ID, person administering treatment, indication for treatment, drug used, dosage, route given, withhold information for meat and milk.
  4. IDENTIFY RISKS FOR DRUG RESIDUES by reviewing the farm’s drug handling and usage, treatment records, number of individuals administering treatments, communication of these individuals, culling decisions, identification of all animals that have been treated – don’t forget young stock, storage and accessibility of drugs especially VFD drugs. Refer to NYSCHAP’s Drug Residue Risk Assessment under Residue Prevention Systems.
  5. ONGOING COMMUNICATION between veterinarian and client regarding other veterinarians/consultants that may be working with the client and any drug use changes. Review of written treatment protocols, drug usage, and treatment records by the veterinarian on a regular basis.


Frequently asked questions about the VCPR:


Does the VCPR have to be in writing?
No, but it is considered a “best practice” to have a written understandings of drug usage signed by all of the involved parties and to have a Veterinarian of Record for farm operations.  AABP has issued their recommended guidelines for establishing and maintaining a VCPR which is included in our resource section.

Does the VCPR mean the client can ONLY purchase drugs from the veterinarian?
No. The VCPR simply states that the client has agreed to follow the instructions of the veterinarian. It is not an exclusive contract for purchasing drugs.

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Does the VCPR include drugs that my client purchases over-the-counter and uses without my knowledge?
No. However, it is a good practice to discuss with the client ALL medications including OTC drugs to avoid errors in dosing and residues.

I signed a VCPR with my veterinarian for a period of one year. Does this mean that I don’t need to consult with him/her before I administer a prescription drug?
It depends on the drug and circumstances.  For example, if you have a written protocol for how and when a fresh cow is treated for metritis, and your veterinarian is familiar with and approves of this protocol, you may follow this protocol for the duration of the VCPR.  However, if you are suddenly noticing an increased incidence of metritis or you wish to change the protocol, then you should consult with your veterinarian.  Similarly, you may, for example, have calves that are treated for pneumonia with a certain antibiotic after being examined by your veterinarian.  If a few months later, the calves are once again showing symptoms, or if a different age calf is affected, or the symptoms are more severe, then you should consult with your veterinarian.

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What if the veterinarian sells or prescribes a particular drug to a client, and the client does not follow the veterinarian’s directions. Is the veterinarian liable?
Maybe.  The VCPR specifically states that the client has agreed to follow the instructions of the veterinarian.  The veterinarian must advise the client clearly on the proper usage of medications, if this does not happen, then responsibility may fall on the veterinarian.  If instructions are clearly given to the client and the client fails to follow these instructions, he/she is violating the terms of the VCPR.  To avoid misunderstandings, written and specific instructions for all medications must be provided.


Online references for the Veterinary-Client-Patient-Relationship

 

NYSVFRP Sections:       1     2      3      4