Performance audit, Veterinary Medical Examining Board

              State of Arizona
Office
of the
Auditor General
PERFORMANCE AUDIT
Report to the Arizona Legislature
By Douglas R. Norton
Auditor General
VETERINARY
MEDICAL
EXAMINING
BOARD
April 1997
Report No. 97-7
2910 NORTH 44th STREET • SUITE 410 • PHOENIX, ARIZONA 85018 • (602) 553-0333 • FAX (602) 553-0051
DOUGLAS R. NORTON, CPA
AUDITOR GENERAL
DEBRA K. DAVENPORT, CPA
DEPUTY AUDITOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
April 25, 1997
Members of the Arizona Legislature
The Honorable Fife Symington, Governor
Dr. Robert L. Hatch, Board Chairman
Veterinary Medical Examining Board
Transmitted herewith is a report of the Auditor General, A Performance Audit of the Veterinary
Medical Examining Board. This report is in response to a May 29, 1995, resolution of the Joint
Legislative Audit Committee. The performance audit was conducted as part of the Sunset
review set forth in A.R.S. ''41-2951 through 41-2957.
The report addresses the need for the Board to appropriately discipline veterinarians when
warranted. Veterinarian consultants retained by the Auditor General found as many as one out
of every six complaints dismissed by the Board in fiscal year 1996 should have resulted in some
discipline. The report also addressed the need for the Board to improve its complaint
investigation process by interviewing all complainants and allowing the Board investigators to
thoroughly and independently investigate complaints. We identify several areas to improve the
public=s access to information, and recommend that the Legislature consider increasing public
membership on the Board to 50 percent. Finally, the report addresses the need for the Board to
conduct more inspections of veterinary premises.
My staff and I will be pleased to discuss or clarify items in the report.
This report will be released to the public on April 28, 1997.
Sincerely,
Douglas R. Norton
Auditor General
Enclosure
SUMMARY
The Office of the Auditor General has conducted a performance audit and Sunset review
of the Veterinary Medical Examining Board, pursuant to a May 29, 1995, resolution of the
Joint Legislative Audit Committee. This audit was conducted as part of the Sunset review
set forth in Arizona Revised Statutes (A.R.S.) ''41-2951 through 41-2957.
According to A.R.S. Title 32, Chapter 21 (A.R.S. '32-2201 et seq), the Board is responsible
for licensing and regulation of veterinarians and veterinary facilities and certification and
regulation of veterinary technicians. The Board is comprised of 8 members, including 5
veterinarians and 3 public members, one of whom must represent the livestock industry.
As of June 1996, the Board licensed 1,375 veterinarians and certified 222 technicians, and
licensed 520 veterinary facilities. In fiscal year 1996, the Board resolved 102 medically
related complaints. The Board employs an executive director, one full-time investigator,
one part-time investigator as of September 1996, and a secretary, and is mainly funded by
license renewal fees.
Board Often Does Not
Discipline When Warranted
(See pages 5 through 10)
The Veterinary Board does not adequately discipline veterinarians. Without the Board
taking appropriate disciplinary action, the public will not be protected. In three of the past
four fiscal years, the Board dismissed more than 90 percent of consumer complaints.
Veterinary consultants retained by the Auditor General reviewed complaints from fiscal
year 1996 and found that as many as one out of every six complaints dismissed should
have resulted in some discipline. The consultants also reviewed the following two
dismissed complaints from fiscal years 1994 and 1995 and concluded that both
veterinarians should have been disciplined.
n The Board dismissed a complaint against a veterinarian who inserted a feeding tube
into a cat=s lungs instead of its stomach. The cat died when food was injected through
the tube.
n The Board dismissed a complaint against a veterinarian who euthanized a dog without
the proper consent. In a Board meeting, even though the veterinarian admitted making
the error, the Board still dismissed the complaint.
The Board needs to overcome its apparent reluctance to discipline veterinarians and
commit to carrying out its enforcement duties. In addition, other changes could also
augment enforcement. These include adopting minimum standards of practice,
disciplinary guidelines, and a cite-and-fine option in which a veterinarian could accept the
Board=s decision and pay the required fine without admitting guilt.
Board Does Not Adequately
Investigate Most Complaints
(See pages 11 through 15)
The Veterinary Board=s record of weak disciplinary actions may be partly attributable to
its failure to adequately investigate most consumer complaints. In fiscal year 1996, the
Board investigated only 22 of the 102 consumer complaints it resolved. When a complaint
is received, the Board routinely requests the medical records and a response from the
veterinarian involved. However, despite having 1.5 full-time investigators, basic
investigative steps such as interviewing the complainant and other involved parties, such
as the doctor=s staff, are generally not performed. In fact, a complainant was interviewed
in only 3 of the 102 cases.
Another problem with the Board=s complaint process is that the Board inappropriately
limits the extent of the investigation performed on each complaint. Rather than allowing
the Board=s investigators to fully pursue each complaint and present the findings to the
Board for adjudication, the Board hears each complaint in a public meeting and sets limits
on what the investigator should do. A review of the 22 complaints in fiscal year 1996 in
which the Board directed the investigation found that the Board, on average, gave the
investigator 2 directives per complaint. These directives involved limited actions, such as
obtaining the names of the veterinarians who worked on a given day, or photographing
a veterinary facility=s sign.
Further, Board staff need to forward all potential violations to the Board. While
investigating one complaint, the Board investigator also uncovered information that the
veterinarian in question was euthanizing animals with household bleach and other
cleaning chemicals, and disposing of the animals in plastic bags while they were still alive.
Although the investigator submitted a report regarding these allegations in December
1995, Board members were not made aware of this situation until it was brought to their
attention by auditors in November 1996. According to the Board, this is an active
investigation case. However, a review of the investigation file in April 1997 found no
evidence of investigative activity since December 1995.
To address complaint investigation problems, the Board needs to develop written policies
specifying an appropriate investigation process and provide training for its investigators.
The Veterinary Board Needs to
Improve Public Access to Information
(See pages 17 through 21)
The Board needs to do more to help ensure that the public has access to veterinarian
licensing and complaint information. The public needs this information to make informed
decisions when choosing medical care for their animals. Although the Board revised its
public information policy in June 1996, it needs to ensure that the policy is carried out.
Auditors acting as pet owners telephoned the Board on five occasions to test whether
Board staff would provide information. In four of the phone calls, Board staff failed to
provide complete information about complaints and previous disciplinary actions,
including a license revocation.
Other recommendations include retaining complaint files longer than four years to
maintain more complete veterinarian histories, and ensuring that a complaint is logged
against the appropriate veterinarian. Currently, Board staff log the complaint against the
name the complainant writes on the complaint form; however, complainants may use only
the clinic=s name or specify the wrong veterinarian.
Other Findings
(See pages 23 through 25)
This report also presents findings recommending that the Board increase inspections of
veterinary facilities, and that the Legislature increase public membership on the Board
from three to four members. Performing routine inspections would help ensure a
minimum standard of care at veterinary facilities. Changing a veterinarian position on the
Board to a public member position would result in 50 percent public representation as
recommended in the Auditor General=s 1995 Special Study of Arizona=s Health Regulatory
System.
Sunset Factors
(See pages 27 through 31)
This audit report also contains responses to the 12 Sunset Factor questions in accordance
with A.R.S. '41-2954. In response to the question addressing the Board=s continuation, this
Office recommends that the Legislature consider continuing the Board for a period of five
years. This will provide the Board sufficient opportunity to address the recommendations
made in this report, and provide sufficient time to assess the impact of the changes made.
Because the problems found during this audit relate directly to problems identified
previously in the 1994 Sunset review of the Board, a timely follow-up review is needed to
determine if the Board has rectified the deficiencies reported in this audit.
If the Board has not rectified these problems after the five-year time period, the Legislature
should consider other alternatives to ensure that the State=s regulatory responsibilities are
carried out and that the public is protected. The Legislature may wish to fundamentally
change the nature of the Board by making all, or a majority of, Board members Apublic
members.@ Another option would be to eliminate Board oversight and place this regulatory
function in another agency.
Table of Contents
Page
Introduction and Background........................................................... 1
Finding I: Board Often Does Not
Discipline When Warranted.......................................................... 5
Board Does Not
Take Disciplinary Action
As Often As Is Warranted..................................................................................... 5
Reluctance To Discipline
Must Be Overcome................................................................................................ 8
Additional Disciplinary
Guidelines and Options
Are Also Needed................................................................................................... 8
Recommendations................................................................................................. 10
Finding II: Board Does Not
Adequately Investigate
Most Complaints............................................................................ 11
Problems with Investigations............................................................................... 11
Board=s Extensive Involvement
in Directing Investigations Impairs
Its Role As Complaint Adjudicator ..................................................................... 13
Board Needs To Develop
Written Investigation Policies .............................................................................. 14
Recommendations................................................................................................. 15
Table of Contents (cont=d)
Finding III: The Veterinary
Board Needs To Improve
Public Access to Information....................................................... 17
The Veterinary Board
Needs To Ensure Adherence to
Its Public Information Policy................................................................................ 17
The Veterinary Board
Should Improve Complaint
File Processing and Retention.............................................................................. 19
The Veterinary Board
Should Consider Implementing
Additional Procedures To Improve
Access to Public Information ............................................................................... 20
Recommendations................................................................................................. 21
Finding IV: Veterinary Facility
Inspections Needed....................................................................... 23
Veterinary Facilities Not
Randomly Inspected............................................................................................. 23
Inspections Needed............................................................................................... 23
Sufficient Resources Available ............................................................................. 24
Recommendation .................................................................................................. 24
Finding V: Veterinary Board Needs
More Public Representation......................................................... 25
Public Representation Still
Below Recommended Standard........................................................................... 25
Recommendation .................................................................................................. 25
Table of Contents (concl=d)
Sunset Factors ................................................................................... 27
Agency Response
Tables
Table 1: Veterinary Medical Examining Board
Statement of Revenues, Expenditures,
and Changes in Fund Balances
Years Ended or Ending June 30, 1994 through 1997
(Unaudited) .......................................................................................... 2
Table 2: Veterinary Medical Examining Board
Disposition of Medical Complaints Resolved
Years Ended June 30, 1993 through 1996 ........................................... 6
INTRODUCTION AND BACKGROUND
The Office of the Auditor General has conducted a performance audit and Sunset review
of the Veterinary Medical Examining Board, pursuant to a May 29, 1995, resolution of the
Joint Legislative Audit Committee. This audit was conducted as part of the Sunset review
set forth in Arizona Revised Statutes (A.R.S.) ''41-2951 through 41-2957.
Board Responsibilities
The purpose of the Arizona State Veterinary Medical Examining Board is to:
AProvide for the licensure, certification and regulation of veterinarians and veterinary
technicians to protect and promote the public health, safety and welfare and to enhance the
veterinary medical profession.@1
The Board fulfills these responsibilities by examining and licensing veterinarians,
certifying veterinary technicians, licensing veterinary premises, and investigating and
adjudicating complaints filed against licensees. As of June 30, 1996, the Board reported
1,375 licensed veterinarians, 222 certified technicians, and 520 licensed premises. In fiscal
year 1996, the Board resolved 102 of the 112 complaints it received relating to medical
procedures performed by veterinarians. It dismissed 96 of them and found violations in
the remaining 6 complaints.
Staffing and Budget
The Board is comprised of 8 membersC5 veterinarians and 3 public members appointed
by the Governor for 5-year terms. One public member must represent the livestock
industry. For fiscal year 1997, the Board was authorized 3.5 full-time equivalent (FTE)
employeesCan executive director who oversees agency operations, 1.5 investigators, and
a secretary.
The Board receives its legislative appropriation from the Board of Veterinary Medical
Examiner=s Fund. This Fund contains revenues derived from the collection of license
application and renewal fees, examination fees, late renewal fees assessed against
licensees, and other fees. Ninety percent of the Board=s revenues are deposited into this
Fund and the remaining 10 percent into the General Fund. All civil penalties assessed
1 Laws 1995, Chapter 156, '4.
against licensees are deposited in the General Fund. The Board=s revenues and
expenditures are shown in Table 1 (see page 2).
Table 1
Veterinary Medical Examining Board
Statement of Revenues, Expenditures,
and Changes in Fund Balances
Years Ended or Ending June 30, 1994 through 1997
(Unaudited)
1994 1995 1996 1997
(Actual) (Actual) (Actual) (Estimated)
Revenues 1 (90% of
gross revenues)2 $ 52,848 $308,144 $ 73,066 $353,200
Expenditures
Personal services 93,409 101,451 104,137 125,300
Employee related 17,992 22,296 24,366 26,200
Professional and
outside services 20,194 36,853 38,645 39,600
Travel, in-state 8,316 6,301 4,773 11,100
Travel, out-of-state 941 2,544 2,491 2,600
Equipment 3,306 3,686 1,046
Other operating 10,091 14,759 11,343 12,300
Total Expenditures 154,249 187,890 186,801 217,100
Excess of revenues
over (under) expenditures (101,401) 120,254 (113,735) 136,100
Fund balance,
beginning of year 181,959 80,558 200,812 87,077
Fund balance,
end of year $ 80,558 $200,812 $ 87,077 $223,177
_______________
1 The disparity of annual revenue amounts is due to biennial license renewal.
2 As a 90/10 agency, the Veterinary Medical Examining Board remits 10 percent of its gross revenues to the
General Fund.
Source: The Uniform Statewide Accounting System Revenues and Expenditures by Fund, Program,
Organization, and Object reports for the years ended June 30, 1994 through 1996 and the
State of Arizona Appropriations Report for the year ending June 30, 1997.
Several 1994 Sunset Review
Concerns Continue
Although the Board has addressed some problems identified during the 1994 legislative
Sunset review of the Veterinary Board, serious concerns with complaint investigations and
Board discipline of veterinarians have not been addressed.
Legislative staff under the Committee of Reference=s guidance conducted a Sunset review
in 1994. That review disclosed the public=s concerns that the Board did not investigate
complaints, dismissed too many complaints, made it difficult to get information about
veterinarians, and other concerns. Because of these concerns, the Legislature continued the
Agency for only two years and directed the Auditor General to conduct another Sunset
review within that time frame.
The Board has addressed some problems since 1994. The Board has improved some aspects
of public access to information, including revising its public information policy in June
1996. The Board has also hired a part-time investigator to assist in complaint investigations
and other duties. Further, an Auditor General review of statistics contained in the Board=s
annual reports found that discrepancies were related to misunderstandings about correct
reporting procedures. Finally, the Legislature increased public membership on the Board
from two to three public members.
However, this current performance audit and Sunset review found that several problems
raised in the previous review still continue. Audit findings in this report address the
Board=s reluctance to discipline veterinarians, incomplete investigation of complaints,
continued problems with disclosing public information, the need for more inspections of
veterinary facilities, and the need for an additional public member on the Board.
Audit Scope
and Methodology
This performance audit report presents findings and recommendations in five areas:
n The need for the Board to take disciplinary action when warranted;
n The need for the Board to properly and adequately investigate complaints;
n The need for the Board to improve disclosure of public information about veterinarians;
n The need for the Board to conduct more inspections of veterinary premises; and
n The need for an additional public member on the Board.
Information was obtained and analyzed from a variety of sources, including interviews of
Board members, the Executive Director, and staff. To evaluate the Board=s compliance with
open meeting requirements and the complaint-handling process, 7 board meetings were
attended, and minutes and associated documentation from meetings since 1991 were
reviewed. Four hundred thirty complaints the Board resolved from fiscal year 1993
through fiscal year 1996 were reviewed to determine the types and disposition of these
complaints. A more detailed review of 81 of these complaints was conducted with the help
of two veterinarian consultants who were employed because of the medical complexity of
some complaints.1 Information was also gathered from 8 states identified by several
national veterinary experts as having innovative regulatory programs.2 Information was
gathered regarding complaint and investigatory processes, and public information policies.
However, since each state defines disciplinary action differently, a meaningful comparison
of disciplinary rates among states was not possible.
This audit was conducted in accordance with government auditing standards.
The Auditor General and staff express appreciation to the Board Chairman, Board
members, Executive Director, and staff of the Veterinary Medical Examining Board for
their cooperation and assistance throughout the audit.
1 Both consultants are veterinarians and have served on their states= Veterinary Boards. Dr. James Dalley has
taught veterinary medicine at Michigan State University for the past 37 years and served 2 terms on the
Michigan Board of Veterinary Medicine. He is currently national president of the American Association
of Veterinary State Boards. Dr. Arthur Hazarabedian has practiced veterinary medicine for 35 years and
served 2 terms on the California Board of Examiners in Veterinary Medicine. He was president of the
American Association of Veterinary State Boards for 2 years and served as the chairperson of the California
Veterinary Board=s Enforcement Committee for 8 years.
2 The states contacted were Alabama, California, Georgia, Massachusetts, Michigan, Montana, Texas, and
Washington.
FINDING I
BOARD OFTEN DOES NOT
DISCIPLINE WHEN WARRANTED
The Veterinary Board dismisses most complaints, even though as many as one out of every
six complaints appears to warrant disciplinary action. The Veterinary Board appears
reluctant to discipline veterinarians for various reasons; however, it must overcome this
reluctance. The Board could also augment discipline by establishing additional guidelines
and disciplinary options.
A common concern voiced about industry-dominated regulatory boards is that protecting
the profession may play a bigger role in decisions than protecting the public. For example,
in a 1995 report on regulation of the health care professions across the nation, the Pew
Health Professions Commission reported that the autonomy and independence associated
with industry regulation of a profession prompts the public=s concern that professional
self-interest takes priority over protection of the public. This perception has been evident
in past reviews of the Veterinary Board. At the Sunset hearing in 1994, many consumers
voiced concerns about the Board. Several said they believe the Veterinary Board dismisses
complaints that should not be dismissed, while others voiced their belief that the Board
protects incompetent veterinarians.
Board Does Not
Take Disciplinary Action
As Often As Is Warranted
The Board does not take disciplinary action as frequently as it should. The Board dismisses
most complaints with no disciplinary action. However, a review of complaints adjudicated
in fiscal year 1996 revealed that approximately 17 percent of the complaints were
dismissed inappropriately. Further, observations of Board meetings showed the Board
dismisses some complaints even after discussion that a violation has occurred.
Few complaints result in disciplinary actionCThe Board seldom takes disciplinary action
against veterinarians. The Board took disciplinary action in only 6 of 102 complaints filed
in fiscal year 1996, dismissing the remaining 96. This pattern is typical, in that the Board
has dismissed more than 90 percent of the complaints it has adjudicated in three of the last
four fiscal years. The one year that disciplinary actions significantly increased (fiscal year
1995) was the same year that the Legislature conducted a Sunset hearing of the Veterinary
Board (see Table 2).
Table 2
Veterinary Medical Examining Board
Disposition of Medical Complaints Resolved
Years Ended June 30, 1993 through 1996
Number of
Complaints Percentage Percentage
Year Resolved Dismissed Disciplined
1993 86 93% 7%
1994 81 93% 7%
1995 69 80% 20%
1996 102 94% 6%
Source: Office of the Auditor General review of complaint files for fiscal years 1993 through 1996.
Additional disciplinary action warrantedCWhile there may be legitimate reasons to
dismiss complaints, a review of complaints resolved in fiscal years 1993B1996 revealed that
some were dismissed inappropriately. At the request of the Office of the Auditor General,
2 veterinary consultants reviewed 79 complaints resolved in fiscal year 1996 to determine
if the Board took appropriate disciplinary action against veterinarians.1 The consultants
concluded that the Board did not take sufficient action in approximately 17 percent of the
cases they reviewed. One consultant reviewed 34 complaints and believed that the Board
inappropriately dismissed 5 of them; the other consultant reviewed 45 additional
complaints and believed that the Board inappropriately dismissed 9. Following is an
example of a complaint the Board dismissed that the consultant concluded would have
warranted disciplinary action.
1 The veterinary consultants randomly selected complaints from the 102 complaints resolved in fiscal year
1996, and reviewed as many as possible in the time allotted.
n A puppy was apparently attacked by dogs and taken to a veterinarian for examination,
during which the veterinarian noted various injuries, including breathing difficulties.
Without performing any diagnostic tests or treating the breathing difficulty, the
veterinarian sent the puppy home. The puppy died later that day. An autopsy revealed
that the puppy died from severe internal injuries that diagnostic tests could have
detected. The Board dismissed the complaint. The consultant who reviewed this case
said that the veterinarian=s failure to use essential diagnostic tests was negligent and
should have resulted in the suspension or revocation of this veterinarian=s license.
In addition, the consultants reviewed two dismissed complaints from fiscal years 1994 and
1995 and concluded that both would have warranted disciplinary action.
n A veterinarian who was treating a cat for lack of balance and inability to eat attempted
to insert a tube through the cat=s mouth into its stomach for feeding purposes.
Unfortunately, the veterinarian inserted the tube into the cat=s lungs, and the animal
died when the veterinarian subsequently injected food into the tube. The Board
dismissed the complaint. The consultant who reviewed this case said that although the
improper placement of the feeding tube appeared to be unintentional, it was a violation
and would justify a finding of negligence or incompetence.
n The Board received anonymous information that a veterinarian had allowed unlicensed
employees to unlawfully practice veterinary medicine and had provided the employees
with unsupervised access to drugs for euthanizing animals. The Board investigated the
allegations and confirmed that the veterinarian=s employees had access to euthanasia
drugs, and had euthanized a dog while the veterinarian was out of state. The Board
dismissed the complaint. The consultant who reviewed this complaint said the evidence
appeared serious enough to warrant revoking the veterinarian=s license.
Board members dismiss complaints after stating that a violation occurredCIn five cases,
auditors observed Board members state their belief that a violation had been committed
and then dismiss the complaint with no violation. In the following case, the Board
dismissed the complaint even though the veterinarian admitted negligence in euthanizing
a dog without the owner=s consent.
n Two unrelated families took their dogs, one two years old and the other four months
old, into an emergency animal hospital at approximately the same time. Hospital staff
took both dogs to an examination area while the dogs= owners remained in the waiting
room. After examining the two-year-old dog, the veterinarian spoke with the people
she believed were that dog=s owners, although they were actually the owners of the
four-month-old dog. These people, thinking the veterinarian was talking about their
four-month-old dog, requested that the dog be euthanized due to the cost of treatment.
The veterinarian, without asking them to confirm the description or identity of their
dog, euthanized the two-year-old dog instead. The veterinarian admitted to the Board
that she euthanized the dog without speaking to the owners or obtaining their
authorization. During the original discussion of the complaint, Board members stated
that the veterinarian=s failure to correctly identify the owner was Avery egregious,@
Anegligent,@ and Aa violation.@ Following an informal interview at which the
veterinarian expressed remorse for her actions, Board members commended the
veterinarian for her honesty and, with one member opposed, dismissed the complaint.
The consultant who reviewed this case said that euthanizing the dog without the
owner=s consent was negligent and the veterinarian should have been disciplined.
Reluctance To Discipline
Must Be Overcome
The Veterinary Board must overcome its reluctance to discipline veterinarians. Board
members appear hesitant to impose discipline for either serious violations or minor
offenses. Although the Board=s statutory duty is in part to Aprotect and promote the public
health, safety and welfare,@ two of the eight Board members indicated that they were
hesitant to revoke or suspend the license of small community veterinarians because
consumers would be left without a nearby veterinarian. In addition, these same two Board
members indicated they are hesitant to strongly discipline veterinarians because of the
impact the discipline may have on the veterinarian=s ability to practice and make a living.
Additional Disciplinary
Guidelines and Options
Are Also Needed
The Board could also improve discipline by establishing additional guidelines and
disciplinary options. To ensure that veterinarians are disciplined appropriately, the Board
needs to establish minimum standards of practice. Additionally, the Board should establish
disciplinary guidelines that include consideration of past violations. Finally, the Board
should establish a cite-and-fine provision to address minor offenses, and should issue
letters of concern more frequently.
Minimum practice standards are neededCTo ensure that veterinarians are disciplined
appropriately, the Board needs to establish minimum standards of practice. Arizona does
not have a set of minimum practice standards, a deficiency that appears to hinder the
Board=s ability to discipline veterinarians. For example:
n At one Board meeting, members discussed a complaint that involved the death of a
young dog while under anesthesia for teeth cleaning. A Board member noted that the
medical records contained no indication that the dog=s vital signs, including heart rate
and breathing, had been monitored. He stated that the Board should consider changing
its rules to establish minimum standards of practice, since currently there is no
requirement that veterinarians monitor anesthetized patients. The Board dismissed the
complaint with no violation.
California has minimum practice standards addressed in its rules and regulations.
California=s standards include that 1) veterinarians must examine all animals within 12
hours prior to surgery, and must provide continuous monitoring for all animals that are
under general anesthesia; 2) surgical packs must include drapes, gloves, sponges, and
proper instrumentation; and 3) a separate sterile surgical pack must be used for each
animal, and sterile gloves must be worn during surgical procedures.
The Board needs to establish disciplinary guidelines and consider past violationsCThe
Board currently does not have or use guidelines to determine what type of discipline to
impose for various violations. Washington and California use disciplinary guidelines that
consider the violation severity and the veterinarian=s disciplinary history. In addition,
California=s disciplinary guidelines establish minimum and maximum penalties for
different types of violations.
In addition, the Board needs to routinely consider prior violations when imposing
discipline after a violation has been found. The Board has occasionally considered past
violations when making disciplinary decisions in some serious cases. However, the Board
has not routinely consider past violations for all cases, despite advice to do so from its
Attorney General representative. Veterinarians who continue to commit violations should
receive progressively stronger disciplinary measures until problems are either resolved or
the veterinarian=s license is suspended or revoked to protect the public. Our consultants
also stressed the importance of the Board taking past violations into account, including
disciplinary actions that may have occurred in other states, when making disciplinary
decisions.
Additional options needed for minor offensesCThe Board needs a cite-and-fine
disciplinary option and needs to more frequently use its Aletter of concern@ option when
addressing less- serious situations. To provide meaningful discipline for minor violations,
both consultants recommended that the Board increase its use of civil penalties by
instituting a cite-and-fine provision. A veterinarian who is cited for a violation under such
a provision can accept the Board=s decision and pay the required fine without admitting
guilt. However, the citation documents the violation and can be considered in the future
if further disciplinary action becomes necessary. One consultant said the cite-and-fine
process is Aspeedy, admits no guilt, but straightens out many minor violators before the
violator becomes more of a problem.@ To do this, the Board should promulgate rules to
establish a cite-and-fine disciplinary option.
Both consultants also recommended that the Board make greater use of letters of concern
as another option to address specific problems and prevent them from worsening.
Although letters of concern are not disciplinary actions, they do allow the Board to
document its concerns about the activities that led to the complaint. A letter of concern
further notifies the veterinarian that while there is not sufficient evidence to support
disciplinary action, continuing the activities that led to the complaint being submitted may
result in action against the veterinarian=s license.
Recommendations
1. The Veterinary Board should take disciplinary action each time it is warranted.
2. The Veterinary Board should promulgate administrative rules to implement a cite-and-fine
program to sanction veterinarians who commit minor violations.
3. The Veterinary Board should establish minimum standards of practice for veterinarians
to follow.
4. The Veterinary Board should establish disciplinary guidelines that include
consideration of past violations, severity of violations, mitigating and aggravating
factors, and minimum and maximum penalties for different violations to ensure
appropriate discipline for each violation.
5. The Veterinary Board should make greater use of letters of concern to address specific
problems and prevent them from worsening.
FINDING II
BOARD DOES NOT ADEQUATELY
INVESTIGATE MOST COMPLAINTS
The Veterinary Board=s record of weak disciplinary actions may be partly attributable to
its failure to adequately investigate most consumer complaints. Although the Board
employs one full-time and one part-time investigator, basic investigative steps are not
performed. Further, the Board is unnecessarily directing and participating in
investigations. This puts the Board in the position of acting both as investigator and
adjudicatorCa confusion of roles that the Attorney General=s Arizona Agency Handbook
recommends against. The Board needs to develop policies to address these concerns.
Problems with
Investigations
The audit identified three concerns with complaint investigations: complaints are not
adequately investigated; additional potential violations are not followed up; and other
violations identified are not always provided to the Board.
Complaints not adequately investigatedCOverall, the Board investigated few complaints.
In fiscal year 1996, only 22 of the 102 complaints closed were investigated. In addition, the
investigator rarely interviewed complainants and other involved parties as part of the
investigation. The Board directed the investigator to interview the complainant in only 3
of the 102 complaints.1 Interviewing the complainant is a fundamental step that should
occur early in the investigation.
In addition, the Board has inappropriately restricted the thoroughness of complaint
investigations. Rather than allow the Board investigators to fully investigate complaints,
the Board screens all complaints and provides Adirectives@ or instructions to investigators
in the form of specific questions to which the investigators seek answers. Of the 22
complaints on which investigations were ordered in fiscal year 1996, the Board provided
an average of 2 directives per complaint. Examples of these directives include obtaining
1 The Board also interviewed 11 complainants. However, as discussed on page 14, the Attorney General
recommends that Boards be removed from the investigative process due to concerns that it may impact the
impartiality of Boards when adjudicating complaints.
records and narrative from the veterinarian, obtaining the names of the veterinarians who
worked on certain days, and photographing the veterinary facility=s sign. In contrast, an
investigator working without constraints could perform other investigatory activities, such
as interviewing witnesses or reviewing previous complaints against the veterinarian in
question.
Further, one of the veterinary consultants retained for the audit to review fiscal year 1996
complaints noted the following case example as an instance in which the investigation
appeared deficient.
n The Board dismissed, without ever interviewing the veterinarian involved, a complaint
regarding failure to correctly diagnose a dog=s condition. The veterinarian examined
the dog and prescribed antibiotics based on the diagnosis of a respiratory infection. The
dog=s condition subsequently worsened and the owner had the animal examined by
another veterinarian, who diagnosed it with heartworm infestation. The Veterinary
Board found that the first veterinarian=s failure to correctly diagnosis the dog was not
a violation and dismissed the case; however, the medical records indicated that this
veterinarian had not performed heartworm testing. The consultant concluded that the
first veterinarian should have been interviewed to determine why he had failed to
recognize the symptoms of heartworm disease in his diagnosis.
Investigator did not follow up on potential violationsCAuditors accompanying the
investigator on four clinic inspections identified potential violations that merited further
review at two of the clinics. However, the investigator did not recognize the potential
violation in either case. These instances suggest that further investigator training is needed.
n In a July 1996 inspection an investigator noted six violations regarding maintaining and
dispensing controlled substances. The investigator also saw that the veterinarian had
written numerous pages of prescriptions for Percodan, a narcotic. Upon questioning by
an auditor, a Board member stated that the number of prescriptions written for that
particular narcotic was highly unusual and should warrant further investigation.
Although Board members stated that an investigation later found no violation, the
investigator did not inform the Board about this potential violation until February 1997.
n During another July 1996 inspection, an auditor noticed that a cat in a cage that was
marked as having a contagious, incurable disease was touching a noninfected cat in an
adjacent cage. However, the investigator was unaware that this disease was contagious,
and therefore this cat should not be housed with other animals.
Training could help investigators become more familiar with all aspects of the Board=s
statutes, and obtain knowledge of veterinary medical practice and knowledge of
appropriate investigative techniques. To date, the Board=s investigators have not received
any investigative training. One option for investigator training is the International Council
on Licensure, Enforcement, and Regulation (CLEAR), which provides
investigators/inspectors training specifically for licensing and regulatory boards. This
training is used by other Arizona health regulatory agencies and other states= veterinary
boards. CLEAR=s National Certified Investigator/Inspector Training curriculum offers
training in interviewing techniques, evidence development, administrative law, and report
writing.
In addition, in one instance Board staff did not forward a potential violation to the Board
for their consideration. Most investigations involve the investigator obtaining answers to
the Board=s specific investigation questions. However, in some cases the investigator may
discover new information that could warrant additional sanctions against the veterinarian
in question, as illustrated by the following case example.
n In June 1995, the Board received a complaint alleging that a veterinarian was allowing
nonveterinary employees to practice veterinary medicine using her name. While
investigating these allegations, the investigator also discovered additional allegations
from five former employees and a veterinarian. According to the former employees and
the veterinarian, the veterinarian in question euthanized animals with bleach and floor
cleaning solutions and placed animals in plastic bags while they were still alive, all of
which contradicts proper veterinary practice. In December 1995, the investigator wrote
a report concerning the additional allegations. However, the Board was apparently
unaware of these additional circumstances until notified by auditors in November 1996.
The Board states that this situation is now an ongoing investigation. However, a review
of the investigation file found no evidence of investigative activity since December
1995.
Board=s Extensive Involvement in
Directing Investigations Impairs
Its Role As Complaint Adjudicator
The Board needs to extricate itself from complaint investigations. It currently provides very
specific direction as to which complaints are to be investigated and how the investigations
are to be conducted, and through informal interviews, it also becomes involved in the
evidence-gathering process. Such a role can raise questions about the Board=s ability to act
as an impartial adjudicator.
Board is heavily involved in deciding which complaints to investigate and what questions
to askCThe Board is extensively involved in screening complaints for further
investigation. When a complaint is received, it is initially assigned to a Board member, who
reviews the written complaint and the medical records that are requested from the
veterinarian against whom the complaint was filed. The Board member then presents his
or her recommendation to the Board, which has also received copies of the written
complaint and medical records. The Board dismisses the complaint, or provides specific
direction as to what further investigation staff should conduct, or it may also schedule an
informal interview without further investigation. Most complaints are dismissed without
further investigation.
Further, the Board at times becomes involved in the evidence-gathering process itself,
through informal interviews. These interviews are held with the veterinarian against
whom the complaint was filed and may also involve the complainant. Board members use
the interview to gather information and evidence, and as part of the interview they then
determine whether, on the basis of the information they have gathered, a violation
occurred. The Board, however, conducts informal interviews prior to obtaining a thorough
investigation, and instead uses the informal interview for both investigation and
adjudication purposes. This mixture of investigation and adjudication inhibits the Board=s
ability to objectively adjudicate complaints as discussed below. To improve the process, the
Board should allow its investigators to complete the investigation before proceeding with
an informal interview.
Extensive involvement blurs investigative and adjudicative functionsCMany other
regulatory boards do not involve the entire board in the investigative process. Instead, they
rely on the investigator and a board member to determine the nature and extent of
complaint investigations. This approach is consistent with advice provided to state
agencies by the Attorney General in the Attorney General=s Arizona Agency Handbook:
ADo not permit the hearing officer or decision-maker [the Board] to participate directly in the
investigation of a charge [complaint]. Normally, the investigation can be accomplished by the
agency=s staff. Once the investigation is completed, the decision-maker may decide, or participate
in the decision, whether the results of the investigation warrant a formal hearing.@
[Parenthetical comments added]
Separating the investigation and adjudication processes helps ensure that adjudicators
have a clear and objective mind when considering the facts of a case.
Board Needs To Develop
Written Investigation Policies
The Board needs to develop written policies specifying an appropriate investigation
process. At present, the Board=s policies do not address the investigation process.
Incorporating the complaint investigation process into the Board=s written policies could
help ensure that criteria exist for proper investigation and that consumers= concerns are
addressed.
A revised investigative process addressing the concerns raised in this finding should work
as follows. When complaints are received, the Executive Director should assign complaints
to the investigator and an individual Board member who can provide medically related
guidance. Working together, these two should determine the investigatory steps needed,
eliminating the need for the Board to gather evidence through informal interviews. The
investigator should also be free to pursue any other allegations that surface as a result of
investigating a complaint. When the investigation is completed, an investigation report
containing a summary of the potential violations should be provided to the Board for
adjudication. These procedures reflect common investigatory practices at other regulatory
agencies.
Recommendations
1. The Veterinary Board should develop and establish in its policies a complaint
investigation process that:
a. Allows the Board investigator to perform comprehensive complaint investigations
and pursue all allegations uncovered during the investigation;
b. Removes the Board from the complaint investigation process;
c. Requires that all complaint-related information discovered during an investigation
is presented to the Board;
d. Requires that each complaint be investigated prior to resolution, including
interviewing the complainant in every case;
e. Requires an investigation report containing potential violations be prepared and
provided to the Board; and
f. Allows the Board to conduct informal interviews only after it has received the
investigative report.
2. The Veterinary Board should send its investigators to investigative training, such as the
course offered by the International Council on Licensure, Enforcement, and Regulation.
FINDING III
THE VETERINARY BOARD NEEDS TO
IMPROVE PUBLIC ACCESS TO INFORMATION
The Veterinary Board can take a number of steps to improve public access to information.
Although the Board recently revised its public information policy to make information
about complaint histories more readily available, the information Board personnel
provided during four of five test phone calls was incorrect or incomplete. Additionally, the
Board does not ensure that complaints are logged against the correct veterinarian, and it
retains most complaint files for only four years. In addition to resolving these problems,
the Board can further improve public information by distributing a list of disciplinary
actions taken against veterinarians.
The Veterinary Board
Needs To Ensure Adherence
to Its Public Information Policy
Until recently, Board policies created considerable obstacles for consumers requesting
information about veterinarians. The Board has revised the policy in ways that should
make such information more obtainable; however, initial attempts to obtain information
resulted in Board staff giving incorrect or incomplete responses.
The Veterinary Board recently improved its public information policyCIn June 1996, the
Board developed a new policy addressing concerns raised in the Auditor General=s 1995
report, A Special Study of the Health Regulatory System (Report 95-13). That report found that
the State=s 23 health regulatory boards, including the Veterinary Board, limited the public=s
ability to obtain information about licensees= disciplinary history. The report also found
that regulatory boards created barriers to obtaining the information that was available, and
that the Veterinary Board was among the 5 most restrictive of the 23 Boards studied. At the
time of the Special Study, the Veterinary Board=s public information policy created
obstacles for consumers requesting information, such as requiring consumers to submit a
notarized information request form before providing any complaint information, which
it retained in the veterinarian=s licensing file. Additionally, the Board required consumers
to schedule an appointment to review files. It also provided only the number and general
nature of disciplinary actions or letters of concern to callers requesting information, and
did not provide any information regarding dismissed or pending complaints.
In response to the Health Regulatory System report, the Board adopted a public
information policy to provide consumers, either in person or over the phone, with the
following information:
ü Status of the veterinarian=s license;
ü Disciplinary action taken by the Board against the veterinarian;
ü Number of complaints filed against the veterinarian;
ü Nature of the complaint allegations; and
ü Disposition of each complaint.
Additionally, the Board=s policy provides that staff will mail information to consumers, or
allow them to personally review complaint files, if consumers request further information.
The Board also developed a public information brochure to inform the public of the
Board=s function and how to file a complaint. The Board supplies the brochures to
veterinarians for distribution at their clinics. In addition, the Board mails brochures to
consumers who request complaint forms, and also has the brochure available at the Board
office.
Veterinary Board staff does not adequately follow Board policyCAlthough the Veterinary
Board adopted an improved public information policy, Board staff does not adequately
follow the policy. Auditor General staff posing as members of the public made three phone
calls to the Board office requesting information about various veterinarians, and Board
staff provided incorrect information in two of the phone calls and incomplete information
in the third.
n In 1 phone call, a Board staff member was asked for information regarding a
veterinarian who had 24 complaints, had been disciplined 3 times, and recently had his
license revoked. The staff member, however, responded that the Board did not have a
current listing for the veterinarian, and did not inform the caller that the Board had
revoked the veterinarian=s license.
n Another call was placed requesting information about a veterinarian with three
complaints and one disciplinary action. Board staff informed the caller that the
veterinarian=s license was active and in good standing. The staff member further
informed the caller that the veterinarian had not received any complaints, and had
never been disciplined by the Board.
n During a third phone call, Board staff correctly informed the caller about 11 complaints
filed against a veterinarian, as well as a letter of concern the Board issued. However,
the staff member provided information for the past 4 years only, and did not inform the
caller about a complaint that was filed prior to that time.
After being informed of the test results, the Board=s Chair and Executive Director requested
that they be allowed three weeks to train staff, and that auditors retest staff at the end of
that time. When retested, Board staff once again failed to provide complete and accurate
information in one of two calls. In the first call, staff correctly informed the caller about the
complaints and disciplinary actions against the veterinarian; however, in the second phone
call, the staff member refused to answer the caller=s question regarding what type of
information the Board maintained on veterinarians. The second caller was informed only
that she would have to leave a message for the investigator, who was unavailable at that
time.
The Veterinary Board
Should Improve Complaint
File Processing and Retention
The Veterinary Board should ensure that complaints are logged against the correct
veterinarian, and should increase the amount of time it retains complaint files.
The Board fails to ensure that complaints are logged against the correct veterinarianCThe
Board=s Executive Director stated that it is the Board=s unwritten rule to log a complaint
under the name the consumer provided. If a consumer names only the veterinary clinic on
the complaint form, Board staff log the complaint under the name of the responsible
veterinarian for that clinic.1 If a consumer names a specific veterinarian on the complaint
form, Board staff log the complaint under that veterinarian=s name. In either case, the
veterinarian under whose name the complaint is logged might not be accountable for the
treatment or policy that prompted the complaint. This policy of not ensuring that
complaints are logged under the correct veterinarian=s name prevents consumers from
obtaining complete information on each veterinarian and further prevents them from
making fully informed decisions regarding their animals= care. For example:
n A consumer filed a complaint due to a payment policy established by Dr. A, a clinic=s
responsible veterinarian. On the complaint form, however, the consumer named Dr. B,
a veterinarian employed by Dr. A=s clinic. Staff logged the complaint under Dr. B=s
name, not Dr. A=s name, even though the complaint involved a policy issue for which
1 A Aresponsible veterinarian@ is the veterinarian responsible to the Board for the policies of the veterinary
facility. (A.R.S. '32-2201[11]).
Dr. A, as responsible veterinarian, was accountable. During the audit, a local news
reporter visited the Board office and requested to review this complaint against Dr. A.
Staff looked up Dr. A=s complaint records, could not locate this complaint because it
was logged under Dr. B=s name, and informed the news reporter that this complaint
involving a payment policy had not been filed. Staff later located the complaint by
looking under the complainant=s name, and provided the complaint to the reporter.
The Veterinary Board should retain complaint files longerCThe Board currently retains
most complaint files for only four years, which is not a sufficient period to fully document
veterinarians= complaint histories. The Board apparently recognized this problem and, at
the November 1996 Board meeting, modified its record retention policy to retain certain
complaints for a ten-year period. Complaints that resulted in probation, suspension, or
revocation will be retained for a ten-year period, whereas complaints that were dismissed
with no violation, or that resulted in a consent agreement or civil penalty, will be retained
for four years. While the modified policy=s increased retention time is an improvement,
other Health Regulatory Boards in Arizona, and veterinary boards in other states, retain
complaint files for a longer period. For example, the Arizona Board of Nursing
permanently retains all complaint files that result in discipline. Additionally, the
Washington Veterinary Board retains complaint files that did not result in discipline for 25
years, and complaint files that did result in discipline for 75 years. To protect consumers,
the Board should retain complaint files that result in discipline for a length of time that is
sufficient to encompass each veterinarian=s career.
The Veterinary Board Should Consider
Implementing Additional Procedures To
Improve Access to Public Information
The Veterinary Board can further improve access to public information by implementing
additional procedures. The Board should distribute a list of disciplinary actions taken
against veterinarians. The Board may also want to consider requiring veterinarians to
display disciplinary orders at their clinic.
The Veterinary Board should publish disciplinary actionsCTo further improve public
information, the Board should publish and distribute at least annually a list of disciplinary
actions that includes the disciplined veterinarian=s name, the violation, and the discipline
imposed. The Board should mail the disciplinary listing to licensed veterinarians,
interested consumers, and the media. The Board could additionally distribute the listing
at Board meetings and through the Board office. A veterinary board newsletter, as used by
some other states, is one option for dispersing disciplinary information.
Displaying disciplinary ordersCThe Board may also wish to require veterinarians to
display some disciplinary orders in their clinics. California=s Veterinary Board frequently
requires veterinarians to display disciplinary orders. For example, the California Board can
require a veterinarian whose license has been suspended or revoked to conspicuously
display the disciplinary order in his or her place of business. In Arizona, the Board of
Dental Examiners requires dentists whose licenses are revoked to post the orders.
Displaying a disciplinary order that restricts such things as the veterinarian=s ability to
handle controlled substances, perform surgery, or practice without direct supervision could
also help to inform consumers of potential problems.
Recommendations
1. The Board should ensure that Board staff have knowledge of and consistently follow
its public information policy.
2. The Board should adopt a policy to ensure that complaints are logged under the correct
veterinarian=s name.
3. The Board should retain complaint files that result in discipline for a length of time
sufficient to encompass the veterinarian=s career.
4. The Board should produce and distribute at least annually a list of disciplinary actions
that contains the disciplined veterinarian=s name, the violation, and the discipline
imposed.
FINDING IV
VETERINARY FACILITY
INSPECTIONS NEEDED
The Board needs to conduct additional inspections of veterinary facilities. These additional
inspections can help ensure that veterinary facilities meet standards for sanitation,
controlled substances, medical records, and other areas. The Board has sufficient resources
to conduct additional facility inspections.
Veterinary Facilities Not
Randomly Inspected
Currently, the Veterinary Board does not conduct routine inspections of the 520 veterinary
facilities it regulates. The Board has authority to Ainspect any site at which a veterinarian
offers veterinary services to the public.@ Despite this authority, the Board=s staff conducts
inspections only when facilities are first established, when there is a major change in the
scope of veterinary services offered, or when there is a change in the facility=s ownership
or location. In addition, the Board may order a facility inspection in response to a
complaint. As a result, according to the Board=s investigator, approximately 50 veterinarian
facilities have never been inspected,1 and about 250 facilities have not been inspected in
the last 5 years.
Inspections Needed
While routine annual inspections of all facilities are not possible with the current staffing
level, a program of inspecting facilities, chosen at random, would help ensure a minimum
standard of care at veterinary facilities. An inspection of a veterinary facility covers many
areas: sanitation, medical records, adequate equipment and supplies, proper storage of
medications, and proper and sanitary animal housing facilities. In their review of
complaint files, our consultants noted that medical records are frequently inadequate. One
consultant reported that the records were barely legible, uniformly brief, and lacked
evidence of specific diagnostic procedures the animal=s owner had consented to.
1 In 1980, the Board began requiring inspections of veterinary facilities prior to issuing a premise license.
Facilities licensed prior to 1980 were not required to be inspected to maintain a facilities license.
Random inspections can be beneficial. California=s random inspection program of
veterinary facilities in fiscal year 1996 completed 384 inspections and issued 434 notices
of violations to offenders. In California, veterinarians should demonstrate, at a minimum,
sufficient knowledge of sanitation, recordkeeping, minimum standards of practice, and the
statutes regulating veterinary medicine. Moreover, one of the consultants believes that
AInspections help to create a climate of regulation which is beneficial to licensees and
public alike.@
Sufficient Resources
Available
The Board has sufficient resources to conduct random inspections of veterinary facilities.
In fiscal year 1996, the Board conducted 65 statutorily mandated inspections. Based on our
observations, an investigator can complete most inspections in approximately 2 hours,
including travel time. Currently, the Board has one full-time and one part-time
investigator, who was added in fiscal year 1997. This additional investigator would allow
the Board to complete approximately 50 additional inspections per year.
Recommendation
1. The Board should randomly inspect Arizona=s licensed veterinary facilities.
FINDING V
VETERINARY BOARD NEEDS
MORE PUBLIC REPRESENTATION
The Legislature should consider increasing the number of public members on the
Veterinary Medical Examiners Board. While current statutes limit public representation on
the Board, a recent study cites the importance of increased public membership to consumer
protection.
Public Representation Still
Below Recommended Standard
The Legislature should consider adding one more public member to the Veterinary Board.
The Auditor General=s 1995 Special Study of Arizona=s Health Regulatory System report
recommended increasing public membership to 50 percent on all health regulatory boards.
This report noted that there is a trend toward increasing public membership. In addition,
according to one study, increasing proportions of public members is associated with
stronger board disciplinary sanctions. Currently, the Board is composed of five licensed
veterinarians and three lay members, two representing the general public and one
representing the livestock industry. Converting one of the five licensed veterinary positions
to a public member would allow the Board to meet the 50 percent public membership
standard.1
Recommendation
1. The Legislature should consider increasing the number of public members on the
Veterinary Medical Examiners Board by converting one licensed veterinarian board
member position to a lay person who represents the general public.
1 In 1995, the Legislature increased the Board=s public membership from two to three by adding an additional
Board member. According to the minutes from the Senate Committee on Professions and Employment, this
action was taken as a result of numerous consumer concerns voiced at the Board=s 1994 Sunset Hearing.
SUNSET FACTORS
In accordance with A.R.S. '41-2954, the Legislature should consider the following 12
factors in determining whether the Arizona State Veterinary Medical Examining Board
should be continued or terminated.
1. The objective and purpose in establishing the Board.
Laws 1995, Chapter 156, '4, states that the purpose of the Veterinary Medical
Examining Board is to provide for licensing and regulation of veterinarians and
veterinary medical premises and certification and regulation of veterinary
technicians in order to protect and promote the public health, safety, and welfare
and to enhance the veterinary medical profession.
Arizona law establishes the objective of assuring competence and quality in the
veterinary profession by authorizing the Board to:
n Examine, license, require continuing education of, and discipline veterinarians;
n Examine and certify veterinary technicians;
n License veterinary medical premises and take action against the licenses of the
premises or the licenses of responsible parties;
n Take action against unlicensed practitioners; and
n Regulate the dispensing of drugs and devices.
2. The effectiveness with which the Board has met its objective and purpose and
the efficiency with which the Board has operated.
The Board can improve its effectiveness and efficiency in fulfilling its statutory
responsibility to protect public health, safety, and welfare. The audit found that the
Board often does not impose discipline when warranted and must overcome its
reluctance to discipline veterinarians (see Finding I, pages 5 through 10). The
Board=s record of weak disciplinary actions may be partly attributable to its failure
to adequately investigate most consumer complaints (see Finding II, pages 11
through 15).
In addition, the Board should conduct random inspections of licensed veterinary
facilities (see Finding IV, pages 23 through 24). The Board could improve its efforts
to better inform the public by distributing a listing of disciplinary actions and by
providing more thorough information concerning the nature and disposition of
complaints (see Finding III, pages 17 through 21).
The Board should consider studying whether staggering the renewal dates of
biennial licenses and certificates could improve operational efficiency. Currently, all
veterinarians, veterinary technicians, and veterinary facilities renew their biennial
licenses and certificates on the same day. The volume of work in the renewal period
is very large and requires a temporary employee to assist in processing renewals.
To reduce the need for temporary help, the Board could renew licenses biennially
according to the licensee=s date of birth. Under the staggered system used in some
other state agencies, such as the Board of Nursing, and in other states, licensees
renew during their birth month, and licensees born in even-numbered years renew
in even-numbered years. Changing to this system would allow staff to handle
approximately 2,000 renewals over a 24-month period rather than encountering
year-end peaks. Further, the reduced need for temporary help may allow the Board
to implement the new system at little or no cost increase.
3. The extent to which the Board has operated within the public interest.
Although the Board operates in the public interest by ensuring practicing
veterinarians in Arizona meet minimum licensing standards, it fails to take
adequate enforcement actions to properly protect the public from incompetent and
potentially dangerous veterinarians. In addition, inappropriately allowing some
veterinarians to continue their current practice may place the public at risk.
Furthermore, the Board could do more to make disciplinary information about
veterinarians available to the public. The Board has adopted a public information
policy; however, as of December 1996, the policy was not being followed. According
to the Board, however, staff will, upon request, provide complainants with
recordings of Board meetings in which their complaints are discussed.
4. The extent to which rules adopted by the Board are consistent with the
legislative mandate.
Although current rules are consistent with its statutes, the Board plans to draft
revisions to update and clarify several of its rules. In addition, our report
specifically indicates several changes and additions needed in the Board=s rules. The
following changes and additions to the Board=s rules are needed:
n Establish disciplinary guidelines;
n Adopt minimum standards of practice;
n Adopt a cite and fine program for minor offenses; and
n Conduct random inspections of veterinary facilities.
5. The extent to which the Board has encouraged input from the public before
promulgating its rules and regulations and the extent to which it has informed
the public as to its actions and their expected impact on the public.
The Board holds monthly meetings to discuss disciplinary and licensing matters.
As required by statute, the Board informs the public of its actions by complying
with the Open Meeting Law requirements regarding notifying the public of its
meetings by placing public hearing notices with the Secretary of State.
According to the Agency, as part of its rule-making process, the Board encourages
input from the public as well as the professional associations. The Board indicated
that it intends to encourage public input on its upcoming rule revisions.
6. The extent to which the Board has been able to investigate and resolve
complaints that are within its jurisdiction.
Statutes and rules provide the Board authority to investigate and resolve complaints
concerning licensed practitioners. However, experts noted the Board is
inappropriately dismissing some complaints and does not consider complaint
histories when imposing discipline (see Finding I, pages 5 through 10). In addition,
because of the Board=s extensive involvement with the complaint resolution process,
investigators are unable to adequately investigate complaints (see Finding II, pages
11 through 15).
7. The extent to which the Attorney General or any other applicable agency of
state government has the authority to prosecute actions under the enabling
legislation.
A.R.S. '32-2237(B)(2) authorizes the Board to request the County Attorney or
Attorney General to file criminal charges against persons violating Board statute.
In addition, the Attorney General representative provides counsel to the Board at
its meetings and assists in prosecuting violators of Board statutes.
8. The extent to which the Board has addressed its deficiencies in its enabling
statutes which prevent it from fulfilling its statutory mandate.
According to Board staff, numerous changes have been made to agency statutes
over the years. For example, revisions to statutes in 1991 gave the Board authority
to issue cease-and-desist orders to unlicensed practitioners. More recently, in 1994
the statutes were revised to change what licensees perceived to be an unfair
category of Aunprofessional conduct@ for violations such as failing to renew licenses
on time or failing to notify the Board of an address change, to now reflect
Aadministrative violations.@
9. The extent to which changes are necessary in the laws of the Board to
adequately comply with the factors listed in the sunset review statute.
The Legislature should consider the following statutory change to improve
veterinarian regulation:
n Increase the Board=s number of public members to 50 percent.
10. The extent to which the termination of the Board would significantly harm the
public health, safety, or welfare.
Terminating state regulation of veterinary medical practice would significantly
endanger the public because it would eliminate the testing and licensing of
veterinarians, licensure of veterinary premises, and the voluntary certification of
veterinary technicians. Without state regulation, the public could be subject to
untrained and unskilled veterinary practice that could impact the health and well-being
of their pets, livestock, other farm animals, animals in zoos, and wildlife. In
addition, human health could suffer from inadequate treatment of sick animals.
Further, without regulation, veterinarians could not dispense prescription
medicines for animals. No other state in the nation allows unregulated veterinary
medical practice.
Although regulation of veterinary medicine is necessary, the Legislature may need
to consider placing regulatory responsibilities with another entity if the current
Board fails to address problems identified in this audit. We recommend that the
Legislature continue the current Board for a period of five years. This will provide
the Board sufficient opportunity to develop the recommended standards of practice
and disciplinary guidelines, and to promulgate needed rules changes. Five years
will also provide sufficient time to assess the impact of these changes once
implemented. Although serious concerns were raised at the 1994 Sunset hearing,
no specific recommendations were given to the Board. This audit provides specific
recommendations to address problems.
If the Board has not rectified these problems after the five-year period, the
Legislature should consider other alternatives to ensure that the State=s regulatory
responsibilities are carried out and that the public is protected. The Legislature may
wish to fundamentally change the nature of the Board by making all, or a majority
of, Board members Apublic members.@ Another option would be to eliminate Board
oversight and place this regulatory function in another agency.
11. The extent to which the level of regulation exercised by the Board is
appropriate and whether less or more stringent levels of regulation would be
appropriate.
We found the current level of regulation for veterinarians and veterinary technicians
to be appropriate. However, the audit found that the Board needs to inspect
additional veterinary facilities (see Finding IV, pages 23 through 24).
12. The extent to which the Board has used private contractors in the
performance of its duties and how the effective use of private contractors
could be accomplished.
The Agency has used private contractors for activities such as hearings, testing, and
investigations. Due to the nature of the Agency=s functions, the Board=s use of
private sector contractors appears to be appropriate.
Agency Response