A performance audit of the Veterinary Medical Examining Board

              STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
A PERFORMANCE AUDIT
OF THE
VETERINARY MEDICAL
EXAMINING BOARD
NOVEMBER 1981
A REPORT TO THE
ARIZONA STATE LEGISLATURE
REPORT 81 - 1 5
DOUGLAS R. NORTON. CPA
AUDITOR GENERAL
STATE 0.6 ARIZONA
OFFICE OF THE
AUDITOR GENERAL
November 18, 1981
Members of the Arizona Legislature
The Honorable Bruce Babbitt, Governor
Mrs. Suzanne de Berge, Chairperson
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 i n
response t o a January 30, 1981, resolution of the J o i n t Legislative
Oversight Committee. The performance audit was conducted as a p a r t of the
Sunset review s e t f o r t h i n A. R. S. SS41- 2351 through 41- 2379.
The blue pages present a summary of the report; a response from the
Chairperson is found on the yellow pages preceding the appendices.
My s t a f f and I w i l l be pleased t o discuss or c l a r i f y items i n the report.
Respectfully submitted,
~ o u a a Rs. Norton
Auditor General
Staff: Gerald A. Silva
William Thomson
Brent Nelson
U r s C. Bauder
Enclosure
LEGISLATIVE SERVICES WING SUITE 200 STATE CAPITOL PHOENIX. ARIZONA 85007 255- 4385
OFFICE OF THE AUDITOR GENERAL
A PERFORMANCE AUDIT OF THE
VETERINARY MEDICAL EXAMINING BOARD
A REPORT TO THE
ARIZONA STATE LEGISLATURE
REPORT 81- 15
TABLE OF CONTENTS
SUMMARY
INTRODUCTION AND BACKGROUND
SUNSET FACTORS
FINDINGS
FINDING I
The manner i n which the Board prepares and administers
its written p r a c t i c a l examination t o veterinary
candidates needs t o be improved. Also, t h e n a t i o n a l
examination is not graded i n accordance with
s t a t u t o r y requirements.
CONCLUSION
REC OMMENDATI ONS
FINDING I1
The Veterinary Medical Examining Board has
aggressively investigated and resolved
complaints against licensed veterinarians;
however, improvements are needed i n the
Board's complaint handling process.
CONCLUSION
RECOMMENDATIONS
FINDING I11
Changes are needed to improve t h e e f f i c i e n c y
and effectiveness of the Veterinary Medical
Examining Board.
CONCLUSION
REC OMMENDATI ONS
WRITTEN RESPONSE TO THE AUDITOR GENERAL REPORT
Page
i
1
3
SUMMARY
The Office of the Auditor General has conducted a performance audit of the
Veterinary Medical Examining Board in response to a January 30, 1980,
resolution of the Joint Legislative Oversight Committee. This performance
audit was conducted as a part of the Sunset review set forth in Arizona
Revised Statutes ( A. R. s.) $$ 41- 2351 through 41- 2379.
Veterinary medicine is concerned with the diagnosis and treatment of
disease and injury in animals, and is based on scientific animal studies
dating back to those conducted by Hippocrates in 400 B. C. Animal medicine
became a distinct branch of medicine during the Renaissance and culminated
in the establishment of schools of veterinary medicine in Europe in the
late 1700s.
The Arizona Legislature established a three- member Board in 1924 to
examine and license veterinarians and ensure that only licensed
veterinarians practiced. Present Board membership includes five licensed
veterinarians, a representative of the livestock industry and a lay
person. Present Board authority includes licensing of veterinarians and
veterinary facilities and certification of veterinary technicians.
Our review showed the Board needs to improve the manner in which it
prepares and administers the State practical examination because the Board
has not revised examination questions since June 1979. Also, the Board
has not graded the examination in a consistent manner, and has graded the
examination on a curve. In addition, the Board's grading procedures and
pass/ fail decisions are not documented adequately in Board minutes.
( page 9 )
Further, the National Board Examination ( NBE) administered by the Board is
not graded for State candidates in accordance with statutory
requirements. However, if those statutory grading requirements were
followed strictly, a candidate could fail the NBE because his score was
too high. ( page 9)
We found the Board has investigated and resolved complaints against
licensed veterinarians aggressively in that it has: 1) investigated
adequately each notarized complaint it receives, 2) imposed sufficiently
stringent penalties against those licensees who are the subjects of valid
complaints, and 3) closely scrutinized those licensees who are the
subjects of multiple complaints. However, improvements are needed in the
Board' s complaint- handling process. ( page 19)
Finally, our review has shown the Board's efficiency and effectiveness in
renewing veterinary licenses can be increased by amending veterinary
statutes to provide for biennial license renewal. ( page 27)
Consideration should be given to the following recommendations:
1. The Legislature amend A. R. S. $ 32- 2214, subsection C, to allow the
Board to use a nationally prepared examination, such as the
clinical competency test prepared by the Professional Examination
Service, in lieu of its own practical examination.
2. If the Board is to continue administering its own practical
examination it should:
- Revise questions for each examination,
- Grade examinations consistently, and
- Adequately document in its minutes decisions regarding
examination grading methods and pass/ fail decisions.
Further, the Legislature should evaluate the Board's practice of grading
examinations on a curve, to ascertain if that practice is in consonance
with Legislative intent.
7. The L e g i s l a t u r e amend A. R. S. $ 32- 2214, subsection E, t o s e t the
passing point f o r the n a t i o n a l examination a t one- and- a- half
standard deviations below the mean.
4. The Board e s t a b l i s h a procedure t o n o t i f y complainants of Board
meetings a t which t h e i r complaints may be discussed o r resolved.
I n a d d i t i o n , the Board should i n v i t e a complainant t o a t t e n d t h e
informal discussion of h i s complaint i f it has i n v i t e d he
v e t e r i n a r i a n who is the subject of the complaint t o appear.
5. The Arizona S t a t e Boards' Administrative Office forward
non- notarized complaints t o Board members f o r review, a s d i r e c t e d
by the Board a t its November 20, 1980, meeting.
6. The L e g i s l a t u r e e n a c t l e g i s l a t i o n t o allow the Board t o impose
censure, p r o b a t i o n o r temporarily suspend a l i c e n s e a s a r e s u l t
of an informal hearing.
7. The L e g i s l a t u r e amend A. R. S. $$ 32- 2218, 32- 2246 and 32- 2272 t o
allow the Board t o renew l i c e n s e s b i e n n i a l l y .
8. The L e g i s l a t u r e amend A. R. S. § $' 32- 2219, 32- 2250 and 72- 2273 t o
allow the Board t o charge a higher l i c e n s e f e e b i e n n i a l l y .
iii
INTRODUCTION AND BACKGROUND
The Office of the Auditor General has conducted a performance audit of the
Veterinary Medical Examining Board in response to a January ' 30, 1980,
resolution of the Joint Legislative Oversight Committee. This performance
audit was conducted as a part of the Sunset review set forth in Arizona
Revised Statutes ( A. R. s.) $$ 41- 2351 through 41- 2379.
Veterinary medicine is concerned with the diagnosis and treatment of
disease and injury in animals and is based on scientific animal studies
dating back to those conducted by Hippocrates in 400 B. C. Animal medicine
became a distinct branch of medicine during the Renaissance and culminated
in the establishment of schools of veterinary medicine in Europe in the
late 1700s.
The regulation of veterinarians is centuries old. Animal doctors were
mentioned specifically in the Code of Hammurabi.* In the U. S., bills
regulating veterinary medicine were introduced in four states by 1890. By
1905, 22 states had such laws.
The Arizona Legislature established a three- member Board in 1923 to
examine and license veterinarians and ensure that only licensed
veterinarians practiced. The laws remained virtually unchanged until
1967, when: 1) Board membership was expanded to five, 2) qualifications
for licensure and unprofessional conduct were further defined, and 3) a
complaint- handling process was stipulated.
In 1978 the Board's membership was expanded to include a representative of
the livestock industry and a lay person; at the same time, veterinary
technicians came under its jurisdiction. During the 1980 Legislative
Session, the Board was given the power to levy fines against its licensees
and to license veterinary facilities.
* The earliest complete civil code known to history, named for its
designer Hammaurabi, King of Babylon, circa 1800 BC.
The Board's primary objective is t o maintain a high standard of veterinary
medicine for the protection of the public. This is achieved through the
examination and licensing of applicants and handling of complaints.
Revenues are derived from fees for examinations, l i c e n s e s , temporary
permits and renewals. Table I d e t a i l s the Board's revenues and
expenditures for f i s c a l years 1977- 78 through 1981- 82.
TABLE 1
REVENUES AND EXPENDITURES
FISCAL YEARS 1977- 78 THROUGH 1981- 82
Personal services $ 3,794
Employee- relat ed 27
Professional services 11,849
Travel:
In- State 1,339
Out- of- State 430
Other operating expenditures 1,589
Equipment
Total
Revenues ( 90 percent)* $ 20,700
Excess ( d e f i c i t )
Source: Budget requests, f i s c a l years 1979- 80 through 1981- 82.
The Auditor General expresses gratitude to the members of the Veterinary
Medical Examining Board and support s t a f f of the Arizona S t a t e Boards'
Administrative Office ( ASBAO) for cooperation, assistance and
consideration during the course of the audit.
* By s t a t u t e ten percent of Board revenues are deposited by the Board
i n t o the S t a t e General Fund. 2
SUNSET FACTORS
SUNSET FACTOR : OBJECTIVX AND
PURPOSE IN ESTABLISHING THE BOARD
The Veterinary Xedical Examining Board stated its goals to be:
" Regulate the practice of veterinarians and veterinary
technicians as appropriate for the protection of the
public and to establish and maintain high standards of
qualification and performance for those who are
licensed or certified."
In order to ensure that quality veterinary care is provided in Arizona,
the Board has the statutory authority to:
1. Prescribe rules and regulations for the administration of State
veterinary statutes. ( A. R. s. $ 32- 2204)
2. Examine and license veterinarians and certify veterinary
technicians. ( A. R. s. $ § 32- 2212, 32- 2214 and 32- 2244)
3. License veterinary medical premises. ( A. B. s. 532- 2271)
4. Investigate complaints. ( A. R. S . 532- 2237)
5. Revoke or suspend licenses or impose civil penalties or fines for
violations of the veterinary law. ( A. R. s. $ § 32- 2233, 32- 2249 and
32- 2274)
SUNSET FACTOR: THE DEGREE TO WHICH
THE BOARD HAS BEEN ABLE TO RESPOND
TO THE NEEDS OF THE PUBLIC AND THE
EFFICIENCY WITH WHICH IT HAS OPERATED
The Board has made commendable efforts in investigating and resolving
complaints against veterinarians. Every notarized consumer complaint,
including fee disputes, has been pursued and actively investigated. Board
investigations have resulted in some type of disciplinary action on all
valid complaints. However, it appears that the Board's complaint- handling
could be improved by notifying complainants of the time and place of their
complaints' discussion and/ or resolution. ( page 19)
Board members have stated the efficiency of the Board is impaired by a
lack of adequate, available facilities in which to hold meetings, formal
hearings and examinat'~ ons.
Our review showed the efficiency of the Board could also be improved if
the statutes were amended to provide for biennial renewal of licenses
instead of the current annual license renewal cycle. ( page 27)
SUNSET FACTOR: THE EXTENT TO WHICH THE
BOARD HAS OPERATED WITHIN THE PUBLIC INTEREST
The Board examines applicants for licensure to practice veterinary
medicine. In addition, it licenses veterinary medical premises to ensure
the safety of animals under the treatment of a veterinarian. The Board
also is in the process of promulgating rules and regulations to
better- protect the public by establishing standards of veterinary practice
and professional ethics.
SUNSET FACTOR: THE EXTENT TO ' dHICH
RULES AND REGULATIONS PROMULGATED BY THE
90ARD ARE CONSISTENT WITH L E G I S L A T I V E MANDATE
A review of the rules and regulations which have been promulgated by the
Board i~ dicates that present rules and regulations are consistent with
legislative mandate.
SUNSET FACTOR: THE EXTENT TO WHICH THE BOARD
HAS ENCOURAGSD INPUT FROM THE PUBLIC BEFORE
PROTUJLGATING I T S RULES AND REGULATIONS AND THE
EXTENT TO \ ZfICH I T HAS INFORMED THE PUBLIC AS TO
I T S ACTIOIIS AND THEIR EXPECTED IIJIPACT ON THE PUBLIC
The Board has made sufficient efforts to encourage input from the public
before promulgating rules and regulations. Currently, the Board:
1) sends a copy of proposed rules to licensees, informing them of the time
and place they will be discussed and requesting verbal or written
comments, 2) places a newspaper notice to inform the general public, and
3) forms a committee of licensees to receive input on proposed rules and
regulations and provide recommendations to the Board.
The Board informs its licencees and the public of its activities by
sending newly adopted rules and regulations to licensees and issuing press
releases regarding disciplinary actions taken against licensees.
SUNSET FACTOR: THE EXTENT TO WHICH THE BOARD
HAS BEEN ABLE TO INVESTIGATE AND RESOLVE
COMPLAINTS THAT ARE WITHIN I T S J U R I S D I C T I O N
The Board has pursued and actively investigated complaints. It appears
that the Board has imposed sufficiently stringent disciplinary sanctions
against those veterinarians found to be in violation of State laws or
Board rules and regulations.
SUNSET FACTOR: THE EXTENT TO WHICII THE
ATTORNEY GENERAL OR OTHER APPLICABLE AGENCY
OF STATE GOVERNMENT HAS THE AUTHORITY TO
PROSECUTE ACTIONS UNDER ENABLING LEGISLATION
A. R. S. $ 32- 2238 identifies seven acts which constitute class 2
misdeameanors. The Attorney General and county attorneys have sufficient
authority to prosecute those acts identified in A. R. S. $ 32- 2278.
SUNSET FACTOR: THE EXTENT TO WHICH THE
BOARD HAS ADDRESSED D E F I C I E N C I E S I N I T S
ENABLING STATUTES WHICH PREVENT I T FROM
FULFILLING I T S STATUTORY MANDATE
The Board has been active in addressing deficiencies in its enabling
statutes. The Board was instrumental in the passage of two bills in 1978
and 1980 which included the following provisions:
1978 : 1. Board authority to adopt rules and regulations regarding
continuing education requirements. ( A. R. s. $ 32- 2204. C)
2. Further definition of what constitutes unprofessional and
dishonorable conduct. ( A. R. s. $ 32- 2232.11- 14)
3. Board authority to appoint a Board investigator. ( A. R. S.
532- 2237 . C)
4. Board certification of veterinary technicians. ( A. R. S.
$ $ 32- 2241 to 32- 2250)
1980 : 1. Board authority for access to veterinarian documents or
records which relate to specific Board investigations.
( A. R. s. $ 32- 2237 . D)
2. Board authority to subpoena witnesses and records. ( A. R. s.
$ 72- 2277 . E)
3. Board registration of veterinary medical premises. ( A . R. s.
$$ 32- 2271 to 32- 2274)
4. Board authority to impose civil penalties against
veterinarians. ( A . R. s. $ 32- 2233)
SUNSSrI FACTOR: THE EXTENT TO WHICH
CHANGES A9E NECESSARY IN THE LAVS OP
THE WARD TO ADEQUATELY COMPLY WITH THE
FACTORS LISTED IN THIS SUBSECTION
Board members have expressed dissatisfaction with the provision of A. R. S.
$ 32- 2218.~ which allows a veterinarian to reinstate his license without
submitting to examination. According to Board members, this provision
allows a veterinarian on inactive status, who has not practiced veterinary
medicine for several years, to renew his license without passing an
examination to show he still is competent to practice.
We recommend the following statutory changes be made:
1. Amend the veterinary statutes to provide the Board with authority
to impose censure, probation or temporarily suspend a license as
a result of an informal hearing similar to authority provided to
other Arizona health regulatory boards. ( page 25)
2. Amend A. R. S. $ 32- 2214. C to allow the Board to use a nationally
prepared examination in lieu of a Board- prepared practical
examination. ( page 13)
3. Amend A. R. S. $ 32- 2214.~ to set the passing grade for the national
examination only in terms of one and one- half standard deviations
below the mean. ( page 14)
4. Amend A. R. S. § $ 32- 2218, 32- 2246 and 32- 2272, which require annual
renewal of licenses, to allow for a biennial renewal cycle.
( page 27)
FINDING I
THE MAFINER IN ! aICH THE BOARD PREPARES AND ADMINISTERS ITS WRITTEN
PFACTICXL EXAM1 NATION TO VETERINARY CANDIDATES NEEDS TO BE IMPROVED.
ALSO. THE TTATIOIIIIL FXAMINATION IS NOT GMDED IN ACCORDANCE WITII STATUTORY
REQUIREMENTS.
A. R. S. $ 32- 2214 requires that applicants for a license to practice
veterinary medicine pass a Veterinary National Board Examination ( NBE) and
the State's Veterinary Medical Examining Board practical examination. The
practical examination, which is prepared and administered by the Board,
consists of two garts, a 70- question multiple choice examination relating
to slides presented on a screen and an oral examination lasting about 15
minutes. The scores on both parts of the practical examination are
averaged and an applicant must score 75 percent to pass.
Our review of the State practical examination revealed that the manner in
which the Board prepares and administers the examination needs to be
improved because the Board:
- Has not for all intents and purposes revised examination since
June 1979,
- Has not graded examinations in a consistent manner, and
- Does not document grading procedures and ~ ass/ fail decisions in
its minutes.
These deficiencies could be eliminated if the Board used the nationally
prepared clinic examination currently used by 20 states.
We also found the Board grades the practical examination on a curve which
may not be in consonance with Legislative intent.
Finally, we found the NBE is not graded for State candidates in accordance
with Arizona statutory requirements. As a result, during 1980 and 1981,
21 Arizona candidates who did not meet the statutory requirement for the
TBE received passing grades.
Examination Questions Have Not Been Revised
The Board administers the State practical examination twice each year,
usually in June and December. It consists of: 1) 70 multiple- choice
questions relating to slides presented on a screen, and 2) an oral
examination lasting about 15 minutes. Scores on the two parts are
averaged to arrive at a final score.
The four practical examinations administered by the Board from June 1979
to December 1980 contained the same 70 questions. For the May 1981
examination, only three questions were changed.
It is generally accepted that examination questions should not be repeated
exactly, in order to protect the integrity of examination. This is
particularly true if applicants may retake the examination, as is the case
with the Soard's practical examination. The Professional Examination
Service which prepares the NBE, has a policy that "... because of the
continuing concern for examination security ... examinations are to be
composed of all new ( i. e., not previously used) questions."
We found further that when 70 percent or more of the applicants miss a
question the Board often does not count such questions in grading an
examination. We did identify five questions that had been missed by 70
percent or more of the applicants during four of the last five
examinations. However, none of these questions were among those three
questions replaced by the Board for the May 1981 examination.
Examinations Are Not Graded In a
Fair and Consistent Manner
Although the Board has, for all intents and purposes, used the same 70
questions during its last five practical examinations, it has used two
different methods to grade the examinations with each method yielding
different results.
In grading the June 1979 and December 1980 examinations the Board threw
out those questions missed by 70 percent or more of the applicants. The
percentage score for each applicant was calculated by dividing the number
of correct answers for each applicant, exclusive of the questions thrown
out, by the number of correct answers for the applicant with the highest
score. The method used by the Board to grade the December 1979, June 1980
and Bay 1331 examinations differed in that no questions were thrown out in
calculating the number of an applicant's correct answers. Thus, whether
an applicant achieved a passing score on a particular examination was, in
part, determined by the number of questions thrown out, if any, and the
number of correct answers for the applicant with the highest score.
Eecause of the Board's inconsistent grading methods, two candidates failed
the June la80 examinations whose test performance would have passed the
June 1979 and December 1980 examinations.
According to a May 20, 1981, Legislative Council opinion, a licensing
board has the responsibility to administer examinations in a fair and
consistent manner. In that opinion, the Legislative Council stated, " The
board as the administrator of the examination and licensing process has
the responsibility to administer examinations to ensure the fair and
consistent application of examination requirements ... equal protection
requires that different treatment of persons similarly situated be
justified by an appropriate state interest."
The Board's grading procedures do not appear to constitute fair and
consistent application of examination requirements, and the resultant
different treatment of persons similarily situated does not seem justified
by a State interest.
Examinations are Graded on a Curve
The Board's practice of t r e a t i n g the highest applicant raw score as a
basis for calculating the percentage scores for other applicants
c o n s t i t u t e s " curvingw.
A. R. S. 572- 2214, subsection E, s t a t e s , i n part:
" A score of seventy- five per cent s h s l l be required to
successfully pass the p r a c t i c a l examination."
Vebster's Rew Collegiate Dictionary, defines a curved examination as one
that measures i n d i v i d u a l s a g a i n s t one another rather than against a
standard:
"... a d i s t r i b u t i o n indicating the r e l a t i v e performance
of individuals measured against each other t h a t is used
especially i n assigning good, medium or poor grades to
usually predetermined proportions of s t u d e n t s r a t h e r
than i n assigning grades based on predetermined
standards of achievement." (~ mphasis added)
The Board's grading practices have resulted i n applicants' passing the
p r a c t i c a l examination with raw scores as low as 60 percent. Therefore,
the Board's grading practice may not be i n consonance with Legislative
intent .
Inadequate Documentation of Examination Grading
Procedures and ~ a s s / ~ aDi elc isions of the Board
A. R. S. $ 38- 471.01 requires t h a t Board l e g a l actions be conducted a t public
meetings and documented i n its minutes. A " legal action" is a c o l l e c t i v e
decision made by the Board consistent with its l e g i s l a t i v e mandate.
According to the Legislative Council, Board decisions regarding how grades
w i l l be determined and what c o n s t i t u t e s a passing grade a r e l e g a l actions
and, therefore, must be recorded i n Board minutes.
Our review of Board minutes from January 1979 to May 1981 revealed that
its minutes do no?; include information as to how the Board determined
grades, in spite of Board decisions to: 1) use two different methods to
grade examinations, 2) throw out those questions missed by 70 percent of
the applicants for two of five examinations, and 7) curve examination
scores.
Further, the Board has not abided by some decisions that are recorded in
its minutes. For example, minutes of the November 21, 1979, meeting
report that the Board decided to use the same procedures and questions for
its December 1979 examination that were used for its June 1979
examination. However, the Board had thrown out those questions missed by
at least 70 percent of the applicants during its June 1979 examination,
but did not follow that practice for its December 1979 examination.
Alternative to the Practical
Examination Pre~ ared bv the Board
A Study of Professional and Occupational Licensing in California,
published in 1977, cited a national authority on occupational licensing,
who explained the problems of locally developed examinations:
" According to Benjamin Shimberg of the Educational
Testing Service ( ETS) and author of several studies on
occupational licensing, a source of many problems
afflicting the examination process of licensing boards
is the fact that:
"' Board members have taken it upon themselves to
develop and administer examinations without any
training for the task and without outside help.'"
(~ m~ hasiasdd ed)
According to Shimberg of the ETS, the problems of Board- prepared
examinations could be avoided if boards turned the job of designing tests
over to outside testing experts or used the national testing programs
developed by many of the trade and professional associations.
The Professional Examination Service ( PES), which prepares the NBE for
veterinarians used by Arizona and all but two of the other 50 states,
recently 3as developed a clinical competency test ( CCT) for veterinarians
which is equivalent to the Board's practical examination.
In : Jay 1981 the CCT was administered by 20 state veterinary boards and, as
of September 1981, it was a licensing requirement of 15 state veterinary
boards.
In order for the Board to use the CCT two changes must occur. One, A. R. S.
$ 32- 2214 must be amended in that it requires " A practical examination
which shall be prepared by the board.. . ." If that language were
eliminated, the Board could use the CCT. Two, PES must begin to offer the
examination two times per year. Currently, the CCT is only offered one
time per year, but the Board conducts examinations two times per year.
However, we have been informed by PES that it appears the CCT will be
offered two times per year, possibly as early as 1982.
Several Board members endorse the idea of using the CCT in place of the
Board's practical examination.
The Mational Examination Is Not
Graded According to Statutory Requirements
The NBE is not graded according to Arizona statutory requirements. As a
result, during 1980 and 1981, 21 Arizona candidates who did not meet the
statutory requirements for the NBE received passing grades. However, if
those statutory grading requirements were strictly adhered to, a candidate
could fail the NBE because his score was too high.
A. R. S. 572- 2214, subsection E, s t a t e s " A grade of seventy- five percent,
plus or minus one and one- half standard d e v i a t i o n , s h a l l be required t o
s u c c e s s f u l l y p a s s the n a t i o n a l board w r i t t e n examination." A s t r i c t
i n t e r p r e t a t i o n of A. R. S. $ 32- 2214 r e q u i r e s t h a t a score equal t o 75
percent of the t o t a l possible p o i n t s on the NBE be developed and t h a t , i n
order t o pass the examination, a candidate would have t o achieve t h a t
score o r be within one- and- a- half s t a n d a r d d e v i a t i o n s , * p l u s o r minus, of
t h a t score. However, i n p r a c t i c e t h e P r o f e s s i o n a l Education Service
( PES), which conducts and grades the NBE f o r Arizona candidates, s e t s a
passing score a s one- and- a- half standard deviations below the mean or
average score f o r a l l candidates taking the NBE.
The following h y p o t h e t i c a l NBE examination i l l u s t r a t e s the d i f f e r e n c e
between the grading requirements according t o A. R. S. $ 32- 2214 and the
manner i n which PES grades Arizona candidates taking the NBE:
Given t o t a l possible p o i n t s 1,000
75 percent requirement per A. R. S. $ 32- 2214 750
Mean ( average) score
One- and- a- half standard deviations
Based on the above information, A. R. S. $ 32- 2214 would r e q u i r e a candidate
t o score between 600 and 900 p o i n t s i n order t o pass the NBE, c a l c u l a t e d
a s follows:
750 ( 75%) plus 150 ( one- and- a- half standard d e v i a t i o n s ) equals 900
( upper l i m i t )
750 ( 75%) minus 150 ( one- and- a- half standard d e v i a t i o n s ) equals 600
( lower l i m i t )
* A standard deviation is a s t a t i s t i c a l measure which shows the spread
of scores on the examination. Approximately 93 percent of candidates
w i l l pass the examination when the passing point is s e t equal t o 1.5
standard deviations below the mean.
PES, however, does not grade Arizona candidates taking t h e NBE i n
accordance with the requirements of A. R. S. 532- 2214. I n s t e a d , u s i n g t h e
same information shown, PES would consider an Arizona candidates who
scores 500 i n NBE a s having passed the examination, c a l c u l a t e d a s follows:
650 ( mean score) minus 150 ( one- and- a- half standard d e v i a t i o n s ) equals
500 ( passing score)
A s shown, PES grading of the NBE f o r Arizona candidates is not as
s t r i n g e n t as the grading requirements of A. R. S. 572- 2214. A s a r e s u l t ,
during 1980 and 1981, 21 of the 122 Arizona candidates who passed the NBE
would not have done so if the examinations had been graded i n accordance
with A. R. S. 532- 2214.
F i n a l l y , it should be noted t h a t , i n the example, a s t r i c t i n t e r p r e t a t i o n
of A. R. S. 532- 2214 r e s u l t s i n an i l l o g i c a l proposition t h a t a candidate
who scored higher than 900 on the NBE would f a i l the examination. That
would occur because A. R. S. $ 32- 2214 r e q u i r e s a candidate t o score 75
percent - plus or minus one- and- a- half standard deviations i n order t o pass
the NBE. Thus, a score h i g h e r t h a n 75 percent plus one- and- a- half
standard d e v i a t i o n s , or 900 i n our example, would not meet the
requirements of A. R. S. 932- 2214.
Vhen a u d i t s t a f f asked the Board why the n a t i o n a l examination was not
graded according t o A. R. S. 932- 2214, the response was t h a t t h e members
thought t h a t it was, and provided copies of a September 29, 1978, l e t t e r
from the Board to PES advising of t h e s t a t u t o r y grading requirements of
A. R. S. $ 72- 2214. When we contacted PES we were t o l d t h i s correspondence
could not be located. However, PES provided us with a copy of its
January 2, 1979, l e t t e r t o the Board, which s t a t e d t h a t PES was
e s t a b l i s h i n g a p a s s i n g s c o r e o f 75 percent as one- and- a- half standard
deviations below the mean. A s noted previously, t h i s method does not
conform t o s t a t u t o r y requirements.
It should be noted, however, that it is unusual to adjust percentile
scores by a standard deviation as the statute requires. Standard
deviations related to the distribution of a population from the mean have
no relationship to a predetermined percentile. As a result, 33 of 35
states whose passing point is known by PES base passage of the NBE on a
calculated mean or average.
CONCLUSIONS
The Board needs to improve the manner in which it administers its written
practical exanination because questions are not changed or revised
periodicaliy to protect its integrity. The Board has not been grading the
examination in a consistent manner, and has graded the examination on a
curve. Also, the Eoard's grading procedure decisions are not documented
adequately in Board minutes.
Finally, the NBE is not graded for State candidates in accordance with
Arizona statutory requirements. However, if those statutory grading
requirements were strictly followed, a candidate could fail the NBE
because his score was too high.
REC OMY4ENDATI ON
Consideration should be given to the following options:
1. The Legislature amend A. R. S. $ 32- 2214, subsection C, to allow the
Board to use a nationally prepared examination, such as the
clinical competency test, in lieu of its own practical
examination.
2. If the Board is to continue administering its own practical
examination it should:
- Revise the questions for each examination,
- Grade examinations on a consistent basis, and
- Adequately document in its minutes decisions regarding
examination grading methods.
Further, t h e L e g i s l a t u r e should evaluate the Board's p r a c t i c e of grading
examinations on a curve t o a s c e r t a i n i f t h a t p r a c t i c e is i n consonance
with L e g i s l a t i v e i n t e n t .
5. The L e g i s l a t u r e amend A. X. S. $ 32- 2214, subsection E, t o s e t the
passing point f o r the n a t i o n a l examination a t one- and- a- half
standard deviations below the mean.
FINDING I1
TI- IE VETGRINARY X3DICAL EXAMINING BOARD HAS AGGRESSIVELY INVESTIGATED AND
RITSOLVED COTPLAINTS AGAINST LICENSED VETERINARIANS; HOWEVER, IMPROVEMENTS
ARE XNEIIED IF3 THE BOARD ' S COIPLAINT- HANDLING PROCESS.
The Sosrd has aggressively investigated and resolved complaints against
licensed veterinarians in that it has: 1) adequately investigated
complsints, 2) imposed sufficiently stringent penalties on licensees
against whom xilid complaints have been made, and 3) closely scrutinized
those licensees who are the subjects of multiple complaints.
However, improvements are needed in the Board's complaint- handling
process. Specifically:
1. The Board should notify complainants of meetings during which
their complaints may be discussed or resolved.
2. ASBAO, which handles its support functions, should forward
non- notarized complaints to the Board.
' 3. The veterinary statutes should be amended to provide the Board
with authority to hold informal hearings on complaints, similar
to the authority of five other Arizona health regulatory boards.
The Board Has Aggressivelv Investigated
and Resolved Complaints
The Board has made substantive and sufficient efforts to investigate and
resolve consumer complaints against licensed veterinarians. During the
19- month period from January 1, 1980, to July 31, 1981, the Board imposed
some types of disciplinary action for 26 percent of all complaints
resolved. In addition, the Board has closely scrutinized those licensees
against whom multiple complaints have been made.
Current Complaint- Handling Process
The Board has no full- time support staff. Support functions are provided
by ASBAO. The Board employs only a part- time investigator to gather
information on complaints filed with the Board.
The Board encourages complainants to submit complaints on its notarized
complaint forms prior to initiating investigations. However, the Board
does investigate non- notarized complaints and also initiates
investigations on its own volition. When a complainant contacts the Board
by letter or phone ASBAO staff sends a complaint form to the person making
the complaint. Upon receipt of a properly notarized complaint form, ASBAO
staff normally forwards copies of the complaint to the licensee who is the
subject of the complaint and consulting veterinarians,* asking them to
provide written responses, including applicable patient medical records,
laboratory reports and X- rays. The Board may request additional
information, hold an informal discussion at a Board meeting with the
parties to the complaint, assign its investigator to the case or even
obtain expert assistance.
We reviewed 104 complaints that were received by the Board from January 1,
1980, to July 31, 1981, and found that the Board consistently investigates
each complaint in the manner described above. In fact, the Board has
followed these procedures even when the complaint involved fee disputes.
Of the 81 complaints which the Board resolved from January 1, 1980, to
July 31, 1981, 36 required the Board to obtain information in addition to
written responses and medical records.
* A consulting veterinarian is someone who either treated the subject
animal or was otherwise involved in the case.
Disciplinary Actions Taken by the Board
The Board has imposed s u f f i c i e n t l y s t r i n g e n t p e n a l t i e s against those
licensees against whom valid complaints have been made. Of the 81
complaints resolved during the 19- month period from January 1, 1980, to
July 31, i981, the Board imposed penalties for 21 of them, or 26 percent,
involving 18 licensees. Two v e t e r i n a r i a n s had more than one complaint
f i l e d against them. Table 2 summarizes the d i s c i p l i n a r y actions taken by
the Board for these 2 i complaints.
TABLE 2
DISCIPLINARY ACTIONS TAKEN ON COMPLAINTS DURING
THE PERIOD FROM JANUARY 1, 1980, TO JULY 31, 1981
Tme of D i s c i ~ l i n a r vA ction
Number of
Licensees Number of Complaints
Revocation 2* 3
Suspension and probation 3 3
Probation only 2 4
Warning 9"" 9
Censure 1 1
Nonreinstatement of revoked license - 1 - 1
Total -- 18 - 21
We also reviewed the f i l e s of the e i g h t v e t e r i n a r i a n s against whom three
or more complaints had been made during the six- and- a- half year period
from January 1, 1975, t o June 30, 1981. Based on our review, it appears
that the Board investigated and monitored these v e t e r i n a r i a n s adequately
and imposed appropriate sanctions against them.
* Includes one license which was surrendered voluntarily. ** Includes one warning against unlicensed a c t i v i t y .
2 1
Improvements Can Be Made i n the
Board's Complaint- Handling Process
Although the 9oard adequately i n v e s t i g a t e s and resolves every notarized
complaint it receives, its complaint- handling p r o c e s s c a n be improved.
S p e c i f i c a l l y : 1) the Board should n o t i f y complainants of meetings during
which t h e i r complaints may be discussed or resolved, 2) ASBAO s t a f f
should forward non- notarized complaints t o the Board, and 3) the
v e t e r i n a r y s t a t u t e s should be amended t o provide the Board with a u t h o r i t y
t o hold informal hearings similar t o the a u t h o r i t y of other Arizona h e a l t h
regulatory boards.
Complainants Bot Notified of Board Meetings
The Board does not n o t i f y comglainants of r e g u l a r l y scheduled Board
meetings a t which t h e i r complaints may be discussed or resolved. Further,
while the Board informed us t h a t it does i n v i t e complainants t o appear a t
scheduled informal discussion meetings with l i c e n s e e s regarding
complaints, during the 18- month period from January 1, 1980, t o June 30,
1981, the Board held informal discussions with v e t e r i n a r i a n s on 16
d i f f e r e n t complaints but a v a i l a b l e documentation i n d i c a t e s t h a t the Board
i n v i t e d t h e complainants t o a t t e n d only e i g h t of these discussions.* The
past chairman of the Board t o l d u s t h a t , i n one or two i n s t a n c e s ,
v e t e r i n a r i a n s were i n v i t e d t o appear f o r other business and the Board
ended up discussing the complaints because the v e t e r i n a r i a n s were there
and a v a i l a b l e . These circumstances a r e not, however, reported i n Board
minutes or the complaint f i l e s . I f i n f a c t the Board is not i n v i t i n g
complainants t o informal hearings such a p r a c t i c e c r e a t e s not only the
appearance of Board b i a s i n favor of l i c e n s e e s , but may not be i n keeping
with the i n t e n t of the S t a t e ' s open- meeting law.
* According t o the Board chairwoman, the Board should have n o t i f i e d a l l
of these complainants and the f a c t t h a t such n o t i f i c a t i o n s a r e not
documented is a record keeping problem.
Under current Board policy, a v e t e r i n a r i a n a g a i n s t whom a complaint has
been f i l e d generally has the opportunity t o respond to the complaint,
whereas a complainant is not usually afforded the same opportunity to
review the written response of the veterinarian. This policy may account
for the f a c t t h a t most complainants f e e l the Board did not properly
consider t h e i r complaints or favored the veterinarian. An Auditor General
surve? of those persons who had f i l e d complaints with the Board revealed
t h a t , of those responding, 65 percent do not believe the Board's decisions
are f a i r and 16 percent expressed a desire to appear personally before the
Board regarding t h e i r complaints.
Inviting complainants to attend Board meetings also would seem t o be i n
keeping with the i n t e n t of the S t a t e ' s open- meeting law.
Arizona's open- meeting law requires t h a t " a l l meetings of any public body
s h a l l be public meetings and a l l persons so desiring s h a l l be permitted to
attend and l i s t e n t o t h e d e l i b e r a t i o n s and proceedings." ( A. R. s.
538- 431.01) The Attorney General, i n a communication to S t a t e agencies,
noted t h a t , " an ' open meeting' is open only i n theory i f the public has no
knowledge of the time and place a t which it is to be held." Agencies are
required to post meeting notices a t a place described i n a statement f i l e d
with the Secretary of State. I n addition, the Attorney General held that
" the governing body must give additional notice as is reasonable under the
circumstances. " (~ mphasis added) It appears t h a t notifying complainants
of Board meetings a t which t h e i r complaints w i l l be discussed and resolved
would be i n keeping with the i n t e n t of t h i s law.
* O f the 70 persons surveyed 58 responded, f i v e surveys were returned as
undeliverable and seven persons did not respond.
The Board chairwoman has told us she does not favor notifying complainants
of every meeting at which t h e i r complaints might be discussed and/ or
resolved because: 1) complaints may be continued to l a t e r meetings i f the
Board does not receive a l l the information it requires and complainants
might appear unnecessarily, 2) Board meetings might take longer i f
complainants were i n attendance, and 3) the Board would incur increased
costs to provide such n o t i f i c a t i o n . Inasmuch as the Board receives only
an average of six complaints a month, and hearing complaints is an
important Board function, it appears t h a t t h e b e n e f i t s of notifying
complainants outweigh r e s u l t a n t d i f f i c u l t i e s .
Non- Notarized Com~ laints Are Not
Forwarded t o the Board bv ASBAO
Whenever an i n i t i a l complaint against a veterinarian is received by phone
or l e t t e r the ASBAO sends a Board complaint form t o the complainant to be
f i l l e d out and notarized. Some persons never submit the notarized Board
complaint form and t h e i r complaints are not forwarded t o the Board for
investigation.
A t its November 20, 1980, meeting the Board decided t h a t such
non- notarized complaints should be sent to each Board member and placed i n
the v e t e r i n a r i a n ' s f i l e . The Board could i n i t i a t e an i n v e s t i g a t i o n i f it
decided one was warranted. A s of July 21, 1981, there were 19 written
complaints for which notarized complaint forms had not been received.
However, ASBAO had not forwarded these 19 complaints to Board members as
directed. When asked why, the ASBAO secretary assigned t o the Board
responded t h a t she had not had time.
Veterinary S t a t u t e s Regarding
Complaint- Handling Can Be Improved
Arizona Revised S t a t u t e s 532- 2274 requires the Board to conduct a formal
hearing before revoking or suspending the license of a veterinarian, or
before placing a veterinarian on probation. A review of other Arizona
health regulatory boards' enabling s t a t u t e s revealed t h a t a t l e a s t f i v e
can, as a r e s u l t of informal hearings, censure o r place on probation
licensees who have committed violations t h a t a r e not of s u f f i c i e n t
seriousness to merit suspension or revocation. I f the violations are
serious enough to merit suspension or revocation the board is authorized
t o hold formal hearings. Table 3 compares f i v e Arizona health regulatory
boards' powers with those of the Veterinary Medical Examining Board."
TABLE 3
COZPARISON OF HEALTH REGULATORY BOARD
STATUTES RELATING TO INFORMAL HEARINGS
Health Authority t o Action Available Based on Informal Hearing
Regulatory Hold Informal Temporary
Board Hearings Censure Probation ~ u s p e n s i o n / ~ e s t r i c t i o n
Podiatry
Dentistry
Medical
Optometry
Osteopathic
VETERINARY
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes N o No
No
N 0
Yes
No
Yes
No
By being able to censure, place licensees on probation or temporarily
suspend licensees a s a r e s u l t of informal hearings regulatory boards are
able to take stronger, more e f f e c t i v e action a g a i n s t l i c e n s e e s without
having to hold a formal hearing. Also, the avoidance of formal hearings
saves boards cost and time.
* It should be noted t h a t our review was r e s t r i c t e d t o those health
regulatory boards which are similar t o the Veterinary Medical Examining
Board i n t h a t t h e i r licensees function as physicians or provide primary
care for p a t i e n t s i n t h e i r health- care realm. The boards reviewed were
Podiatry, Dentistry, Medical, Optometry, Osteopathic, Veterinary,
Naturopathic and Chiropractic. A s a r e s u l t , the information i n Table 3 is
not intended t o be all- inclusive.
From January 1, 1980, t o July 31, 1981, the Board held two formal hearings
t o place licensees on probation and issued ten l e t t e r s of warning or
censure without holding formal hearings. I f the Board could have imposed
censure, probation or temporarily suspended a license as a r e s u l t of an
informal hearing, it may not have held the two formal hearings or might
have taken stronger action than l e t t e r s of warning i n some cases.
It should be noted that c u r r e n t l y t h e Board can impose censure, probation
or temporarily suspend a license as a r e s u l t of an informal hearing, but
only i f t h e l i c e n s e e consents t o the Board's action.
The Veterinary Medical Examining Board has investigated and resolved
complaints against licensed v e t e r i n a r i a n s aggressively i n t h a t it has:
1) adequately investigated a l l notarized complaints it receives,
2) imposed s u f f i c i e n t l y s t r i n g e n t p e n a l t i e s against those licensees who
are t h e s u b j e c t s of valid complaints, and 3) closely scrutinized those
licensees who are the subjects of multiple complaints. However,
improvements are needed i n the Board's complaint- handling process.
RECOMMENDATIONS
Consideration should be given t o the following recommendations:
1. The Board e s t a b l i s h a procedure t o notify complainants of Board
meetings a t which t h e i r complaints may be discussed or resolved.
In addition, the Board should i n v i t e a complainant t o a t t e n d t h e
informal discussion of h i s complaint i f it has invited the
veterinarian who is the subject of the complaint to appear.
2. The Arizona S t a t e Boards' Administrative Office forward
non- notarized complaints t o Board members for review, as directed
by the Board a t its November 20, 1980, meeting.
3. The Legislature enact l e g i s l a t i o n to allow the Board to impose
censure, probation or temporarily suspend a license as a r e s u l t
of an informal hearing.
FINDING 111
CHANGES ARE NEEDED TO IiilPROVE THE EFFICIENCY AND EFFECTIVENESS OF THE
VETERINARY TmDICAL EXAMINIBG BOARD.
The Board can improve the efficiency and effectiveness of its operations
i f s t a t u t o r y and procedural changes are made to e s t a b l i s h a two- year
license renewal system.
A. R. S. $ 532- 2218, 32- 2246 and 32- 2272, s t a t e t h a t v e t e r i n a r y , v e t e r i n a r y
technician and veterinary premises licenses s h a l l be valid for one year,
expiring on December 71, n e c e s s i t a t i n g t h a t licenses be renewed annually.
Because of the limited support services available t o the Board, annual
renewals hinder t h e e f f i c i e n c y and effectiveness of the Board by
s i g n i f i c a n t l y increasing the workload of the Board's support s t a f f .
The Board has no full- time support s t a f f of its own. Support services are
provided by ASBAO, which a l s o serves a s the support s t a f f for nine other
S t a t e boards or commissions. Our review indicates t h a t the workload of
ASBAO could be reduced i f A. R. S. § $ 32- 2218, 32- 2246 and 32- 2272 were
amended t o allow the Board to renew the licenses of v e t e r i n a r i a n s ,
veterinary technicians and veterinary premises b i e n n i a l l y . P u r t h e r , our
review has shown t h a t such a change could r e s u l t i n cost savings to the
Board of approximately $ 3,690 i n four years. The costs of printing
renewal notices, licenses and mailing costs would be reduced, and support
s t a f f could be used i n more c r i t i c a l areas.
It should be noted t h a t amending the veterinary s t a t u t e s t o provide for
biennial renewal of licenses would also necessitate a change i n A. R. S.
$ 532- 2219, 32- 2250 and 32- 2273, concerning renewal fees which the Board
may impose to allow the c o l l e c t i o n of a fee equal to double the annual
renewal fee. The higher f e e would be required to help finance the Board's
operations for two years.
A review of 13 other professional occupational licensing boards i n Arizona
reveals t h a t two boards renew licenses on a t r i e n n i a l basis and four
o t h e r s b i e n n i a l l y . Five of these boards changed from an annual cycle l a s t
year.
COXC LUST ON
Our review of the Veterinary Medical Examining Board has shown that
s t a t u t o r y and procedural changes are needed. The Board's efficiency and
effectiveness i n the process of renewing veterinary licenses can be
increased by amending veterinary s t a t u t e s to provide for b i e n n i a l l i c e n s e
renewal.
RECOMMENDATIONS
Consideration should be given t o the following recommendations:
1. The Legislature amend A. R. S. $ 532- 2218, 32- 2246 and 32- 2272 to 4
allow the Board to renew licenses on a biennial basis.
2. The Legislature amend A. R. S. § $ 32- 2219, 32- 2250 and 32- 2273 to
allow the Board to charge a higher license renewal fee biennially.
1645 W. JEFFERSON - ROOM 418
PHOENIX. ARIZONA 85007
602- 255- 3095
November 12, 1981
Douglas R. Norton
Auditor General
State of Arizona
Phoenix, Arizona 85007
Dear Flr. Norton:
The attached report represents the response of the Arizona State
Veterinary Medical Examining Board to the performance audit conducted
by your Sunset Review Team.
If any questions should arise, please feel free to contact me.
D Sincerely,
, ,
fw LC ?<( 1 ,<- YL<
J Suzanne de Berge
B Chairperson
cc: Gerald Silva, Performance Audit Manager
INTRODUCTION
The Arizona Board of Veterinary Medical Examiners is pleased to
express its appreciation to the Auditor General's Sunset Review Team for
their handling of the review of this Board's activities. Board members
have worked diligently to administer their primary legislative charge,
that is, to ensure the public a high quality of veterinary services. It
is therefore gratifying to read in this report that the Board has " made
conimendable efforts in investigating and resolving complaints against
veterinarians", and " has imposed sufficiently stringent disciplinary
sanctions against those veterinarians found to be in violation" of the
various statutes and Board rules and regulations.
In addition, the Auditor General's Review Team determined for those
" Sunset Factors" requiring a positive or negative evaluation ( as distinct
from those dealing with factual matters of enabling legislation), that
the Board has operated substantially within the public interest, has been
responsive to public needs, and has taken action to meet its own legislative
needs.
Further, the Board is in agreement with the majority of the recommended
legislative changes, and many of the procedural improvements recommended,
by the Review Team.
RECOl4MEMDED LEGISLATION
The Sunset Review report recommends the Legislature consider the
following amendments to the Veterinary Medical Examining Board's statutes:
1. To provide t, he Board with the authority to impose censure,
probation, or temporary suspensions of licenses as a
result of an informal hearing.
Comment:
T h e r d agrees with this recommendation. At present,
the Board avails itself of informal hearings but may
only impose the above penalties as a result of an
informal hearing if it can obtain a Consent Agreement
with the licensee. In those instances when the licensee
refuses to sign a Consent Agreement the Board presently
is forced to hold a formal hearing if it feels dis-ciplinary
action is in order.
2. To allow the Board to use a nationally- prepared
examination in lieu of a Board- prepared practical
examination.
Commen t :
T h e r d has been investigating the possibility of
utilizing such an examination, however, significant
difficulties of scheduling and contents remain to be
resolved. Therefore, while the Board agrees that
legislation permitting the use of such an examination
is desirable, at present the Board would oppose any
legislation requirinp the use of a nationally-prepared
practical examination.
3. To set the passing grade for the national examination only
in terms of one and one- half standard deviations below the
mean.
Comment :
The Board aqrees that this amendment is vital. As detailed
in the report, the present statutes, if followed to the
letter, means that candidates who achieve better than one
and one- half standard deviations above the mean score
should fail because their score is too high.
4. To allow for biennial renewal of licenses.
Conimen t :
The Board aqrees that such an amendment would enable the
Board to maie economies of both time and money. Mote that
an additional amendment would be required enabling an
increase in the renewal fees above the present annual
renewal fee.
Further, the Board would like to recommend that A. R. S. Ej 32- 2218. B
be amended. This presently allows a veterinarian who has been inactive for
any length of time to reinstate his license simply by applying to do so,
without submitting to any re- examination. Obviously, this prevents the Board
from reviewing the present competence of any licensee whose license has been
inactive for any reason, over any period of time. Although reference to this
legislative amendment was made in the text of the Sunset Review Report, and
the Sunset Review Team has verbally expressed its agreement that such an
amendment is needed, it was, in error, omitted from line- item inclusion in the
Review Team's legislative recommendations.
RECOMMENDED PROCEDURAL IMPROVEMENTS
Procedural recomniendations were divided into two areas: those dealing
with the Board's complaint handling process and those regarding the Board's
practical examination process.
Procedural Improvements: Complaint Process
The Review Team recommends that the Board institute a procedure
which makes more clearly known to complainants the times and
places at which their complaints may be discussed by the Board.
In addressing this problem the Board would like to point out
that its various communications with complainants have undergone
a number of modifications over the past two years in an effort
to improve Board communication with complainants. The Board
presently proposes further modification in its initial communication
acknowledging receipt of complaints. The proposed modifications
would explain that complaints are on the Board agenda
each month until resolved, and would make it clear that
complainants are welcome to attend Board meetings, and that
they will be specially notified if their attendance is
needed at any particular meeting. Further, it would provide
information on the scheduled dates of meetings and how to
obtain information as to specific times and locations of
meetings.
The Board's investigative and complaint handling process is
very thorough. The complainant, licensee, " consulting" or
second licensee, pathologist or other involved party are
requested to provide a detailed narrative, all pertinent
radiographs, laboratory tests and patient records, or any
other relevant data. As this material, as well as investi-gative
reports, comes before the Board, need for further
data may become apparent, and additional requests and
investigations made. Thorough investigation, combined with
the somewhat cumbersome process of monthly meetings, means
that it may take several months to resolve complaints, and
it is customary for the Board to have 15 to 20 complaints on
each meeting's agenda.
Automatic notification of complainants of each meeting for
which their complaint appears on the agenda is opposed by
the Board for the following reasons.
a. During the initial meetings much of the Board's
work is basicly fact- finding in nature as reports
are received from various parties and as investigation
proceeds. Complainants should not be made to feel
required to attend these meetings. If either the
press of time or failure to receive requested data on
a timely basis prevents the Board from discussing a
complaint in any depth, the resulting inconvenience
and disappointment for a complainant could contribute
unnecessarily to public hostilities toward the
administrative process.
b. Having made themselves present at such meetings,
complainants might unhappily find themselves unable
to enter commentary for a number of reasons. With-out
the presence of the licensee in question, the
Board would be unwise to enter into discussions with
the complainant. Further, if circumstances prevent
useful discussion of the complaint, simply allowing
the complainant to reiterate their position would be
extremely time consuming, further stressing the Board's
ability to resolve cases as rapidly as possible.
c. Notification of each complainant each time their case
appears on the Board's agenda would increase both costs
and demands on staff time.
2. In a related issue, the Review Team recommends that complainants
be invited to all meetings to which licensees are invited for
the purpose of discussing the subject complaint. This presently
- is the practice of the Board, a practice which was instituted
approximately 1S months ago. However, file documentation does
not fully support this, and procedures to assure correction of
this recordkeeping problem will be instituted.
Procedural Improvements: Practical Examination
if the Board continues to administer its own practical examination,
rather than one nationally prepared, the Review Team recommends
that the Board take steps to assure revision of this examination
prior to each administration of it. The Board has no quarrel with
this recomiliendation as a general guideline. However, since the
practical examination is based upon applicant's ability to
recognize and distinguish some 70 slides, we believe it is not
necessary to prepare an entirely new examination for each semi-annual
administration. Partial revision, even reorganization
of slide order would prevent the application of rote answers
memorized ( or acquired) from previous sittings; the applicant
would still have to have sufficient expertise to comprehend
the specific slides in order to correctly answer the questions.
2. Further, the Review Team recomniends that the Board grade
examinations on a consistent basis, and adequately document the
methods used in examination grading. The Board is aware that
adequate documentation has not been available previously as to
the specific grading methods applied, and at the time of the
;, lay, 1981, examination discussed development of a manual of
procedure to be made available to all Board members. Such a
manual will not only provide adequate documentation of methods,
but will assure consistency of application of these methods.
It has been the practice of the Board of Veterinary Medical Examiners to
grade its practical examination on a curve basis, that is, measuring individual
performance against that of the group with which that individual sits for exam-ination.
The Auditor General's Review Team has included in its report a request
that the legislature clarify its intent in this regard.
The Board believes it is important to be able to grade examinations in this
manner, especially if its practical examination is repeatedly revised. Such
frequent revisions may impact the relative difficulty of the examinations and
an arbitrary " raw score" grading method would prevent the Board from making
procedural adjustments to take such matters into consideration. In all its
actions, the Board wishes to be in consonance with legislative intent, and
we hope the legislature will permit the use of the curve method of grading as
the most reasonable to apply to examinations of this nature.
OTHER CObII4EF. ITS
The preceding comments of the Veterinary Board i n response to the Sunset
Review of its activities are somewhat brief. As you are aware, the Board is one
of the State's smaller professional licensing boards; its members serve
largely on a volunteer basis, meeting once a month for an eight to ten
hour sitting. Its only staff support is provided on a time- sharing basis
by the State Soards' Administrative Office.
The Auditor General's Sunset Review Team began its review approximately
12 months ago, and conlpleted the field work portion in August, 1981. A
preliminary oral report was presented at our September meeting, indicating
in very general terms the areas to be covered by the findings and describing
the overall tenor of the report as positive. The first written draft was sent
to Board members, allowing a ten working day period within which the Board was
to review the report and prepare for a meeting at which it would be discussed
for possible revision. Unfortunately, the draft was mailed third class and
most Board menlbers did not receive their copies until the deadline had nearly
passed.
Working from a copy hand delivered to the Chair by the Auditor General's
Office, and in an effort to accomodate that office's time schedule, the Board
agreed to the revision meeting within the original deadline. Pursuant to
this meeting, a number of substantive changes of both fact and conclusion were
agreed to. The second draft was mailed ( first class) on November 2, 1981, with
a deadline of tlovember 5, 1981, for the Board's written comments-- scarcely
sufficient time for thoughtfully prepared comments based on the input of Board
Plembers who are dispersed throughout the state. This deadline was later
extended to llovember 11, 1981.
This history of the process is included to indicate the difficulty the
Sunset Review procedure imposes on boards such as ours which are not supported
by full time staff and whose members must relinquish time from their pro-fessional
lives in order to meet the demands of even the regular business of
the Board. The staff of full time boards and agencies must be hard pressed to
provide timely cooperation and input to the Auditor General's Office; it is
very di- fficult for the part- time boards.
Additionally, as a result of both the press of activity within the
Auditor General's Office, which conducts a number of Sunset Reviews, and the
short time frames permitted at the close of the process, their own report has
suffered. The casual reader, glancing at the precis in the table of contents
and the summary, might easily conclude that the overall report is of a
negative nature. In the hasty revisions, language extracted from the original
detailed findings was not fully revised in accordance with the many changes
agreed to. While the Sunset Review Team has verbally expressed its present
conclusions that the Veterinary Examining Board, although in need of some
refinements of procedure and legislative changes, is acting well within the
parameters of the public interest, the Report's summary portions fail to
convey this impression.
The Board of Veterinary [ vledical Examiners feels confident that despite
problems engendered by hasty revisions of early drafts of the Sunset Review
Report, it will be readily apparent to the legislature that the Board has
competently pursued its legislative charge and has done so with a careful
eye to the public interest. The public members of this Board have been very
pleased with the attitude and actions of the members of the profession who
have served on the Board. It is often trying and unpleasant for professionals
to participate, however justifiably, in the investigation and discipline of
fellow niembers of their profession. The veterinarians who have served and who
presently serve on this Board have never shown any inclination to shrink from
such unpleasant duties, nor has there been any evidence of any intent or effort
to restrict access to the profession.
It is most gratifying for all members of the Board- to hear from their
support staff, their Assistant Attorneys General, and even members of the
Auditor General's Sunset Review Team that the Board of Veterinary Medical
Examiners is " one of the best" of the boards in terms of diligence,
thoroughness and fairness.
It was, however, disappointing. to read in the Report that their " survey
results" suggested an unflattering view of the Board among complainants. While
it is more to the point to be fair and thorough than to be popular, public
' hppreciation" would be welcome. However, the Board believes that review of
the reported public attitudes must be tempered with understanding of two basic
factors.
First, there is some serious question as to the validity of the survey. The
field of public attitude and opinion research is a highly sophisticated and
technical one. In order to obtain reliable information, uninfluenced by
questionnaire wording, designer objectivity, sequencing and respondent " mind- set",
and other factors, it is recommended that the services or consultation of a
professional be utilized. Blanket mailing of undifferentiated and oversimplified
questionnaires to all complainants, without regard to the type or nature of
their complaint, as well as failing to distinguish among the replies by validity,
type and resolution of the complaint, seriously calls into question the validity
of any statements based on the response.
The second basic factor ameliorating this condition is perhaps more
difficult to explain briefly, and is certainly among the most difficult aspects
of the Board's work. Complainants all too frequently bring with them an unusual
accumulation of emotive and subjective values. The vast majority of cases which
are brought to our attention involve household companion animals, many of which
are naturally reqarded as niembers of the family by their owners. That statement
alone, " regarded- as members of the family by their owners", itself expresses
the primary dichotomy with which the Board deals.
As you can appreciate, the life of a pet in which one has invested
substantial emotion is, especially in the initial stages of veterinary servicing,
of primary concern. Even in those situations which are not life- threatening,
or in which matters of ability to pay for services are discussed " up- front",
owner decisions are frequently clouded with emotions. However, it often later
occurs that the animal in question devolves to the status of an owned object
when payment for services are required. At this point, then, consumer attitudes a
more akin to those applied to unsuccessful auto repair than to the inexactitudes
o f medicine, come into play. Most of these complainants would never pursue the
reimbursement of human medical treatments which have failed of the desired
result, yet in a great many instances, reimbursement of monies paid to a
veterinarian are an important part of the remedy sought. Although circumstances
( including particularly misrepresentation or fraudulently applied charges) may 4
permit the Board to require licensees to reimburse some monies, in most cases
the Board must leave monetary questions to civil proceedings or other routes of
redress. Thus, despite the Board's best efforts to be fair, and to take dis-ciplinary
action against licensees where appropriate, complainants often are
left without any action taken by the Board in regard to the financial remedy
they desire.
The Board takes exceptional effort in its closure of cases, especially
those wherein complainants were not active on a face- to- face basis with the
Board, to explain the nature of the information which lead us to our conclusions.
Both veterinary and non- veterinary members cooperate in drafting letters to
resolution or closure in order to provide as much information to complainants
is practical and possible. The Board strongly believes that the dichotomy
of emotions which surround a " companion" which one " owns", and the inability of
the Board to provide financial redress, especially where no disciplinable
offense has occurred, heavily impact on public " satisfaction" with the Board's
activities. Me continue to address this situation by attempting to communicate
fully with the public, to the best of our ability.