Performance audit, State Veterinary Medical Examining Board

              DOUGLAS R. NORTON, CPA
AUDITOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
April 26, 1984
Members of the Arizona Legislature
The Honorable Bruce Babbitt, Governor
Ms. Suzanne de Berge, Chairperson
Arizona Veteri nary Medical Examining Board
Transmitted herewith i s a report of the Auditor General , A Performance
Audit of the Arizona Veterinary ! 4edical Examining Board. T h i s report i s
i n response to an April 27, 1983, resolution of the Joint Legislative
Oversight Committee. The performance audit was conducted as a part of the
Sunset Review set forth i n Arizona Revised Statutes § § 41- 2351 through
41 - 2379.
T h i s performance audit report on the Arizona Veterinary Medical Examining
Board i s submitted to the Arizona Legislature for use i n determining
whether to continue the Board beyond i t s scheduled termination date of
July 1, 1985. The report evaluates the Board's effectiveness i n
regulating c r i t i c a l aspects of veterinary practice i n Arizona.
My staff and I will be pleased to discuss or c l a r i f y items i n the report.
Respectfully submitted,
Douglys R. Morton
Auditor General
Staff: William Thomson
Kark Fleming
Idartha Brad1 ey
Nancy Love11
Dennis Kurphy
1 1 1 WEST MONROE SUITE 600 PHOENIX. ARIZONA 85003 ( 602) 255- 4385
The Office of the Auditor General I? as conducted a performance audit of the
Arizona Veterinary IBedical Examining Board i n response to an April 27,
1983 resolution of the Joint Legislative Oversight Committee. This
performance audit was conducted as part of the Sunset review s e t forth i n
Arizona Revised Statutes ( A. FLS. ) $ § 41- 2351 through 41 - 2379.
The Veterinary Medical Examining Board's purpose i s to protect the public
heal t h y safety and we1 fare by ensuri ng that qua1 i ty veterinary services
are offered i n Arizona. The seven- member Board licenses veterinarians and
veterinary f a c i l i t i e s , c e r t i f i e s veterinary technicians and enforces the
statutes through its complaint investigations and di scipl inary proceedings.
Premises Licensing Is
Not Necessary ( Pages 11 - 1 9)
Licensing veterinary facil i t i e s , or premises 1 icensing, is not needed to
protect the public. The Board has sufficient authority without premises
licensing to hold licensed veterinarians responsible for treatment
rendered i n practices they own or i n which they are employed. If the
Legislature wishes to address the problem of non- 1 icensed owners
establishing potentially harmful pol icies i n their f a c i l i t i e s , the
statutes can be amended t o r e s t r i c t c o ~ t r o l over medical policies and
procedures to 1 icensed veterinarians.
The Legislature should consider repealing A. R. S. $ 32- 2271 e t seq. to
delete premises 1 icensi ng requirements. If A. R. S. 532- 2271 e t seq. are
repealed, the Legi s1 ature shoul d consider amending A. R. S. $ 32- 2232 to
expand grounds for di scipl inary action against i n d i vidual veterinarians to
include requirements now part of the premises licensing statutes.
The Board Has Been Slow To
Issue Legal Documents On
Several Compl aints ( Pages 21 - 25)
A1 though the Board resolves most complaints promptly, i t has failed to
issue legal documents on several complaints i n a timely manner. On seven
of the l a s t eight consent orders issued, the Goard delayed final action
for as long as 27 months. In six of these cases the legal documents had
not been prepared in a reasonable time frame. While the Attorney
General ' s Office and the Arizona State Boards Administrative Office
( ASBAO) contributed to the delays, the Goard i s ultimately responsible for
ensuring that i t s actions, including legal document preparation, are
completed. The Eoard should take steps to expedite i t s actions when
del ays are apparent.
Licensing Requirements For
Out- of- State Veterinarians Are
unnecessari 1 v Restrictive ( Paaes 27- 31 1
Veterinary Eoard statutes do n o t provide a1 ternati ve means for 1 icensing
applicants who are 1 icensed veterinarians from other states.
Consequently, the Board requires a71 applicants to meet the same
requirements for licensure, including taking both the state and national
examinations. The requirement that veterinarians 1 icensed i n other states
pass a state examination appears to be a reasonable measure for protecting
pub1 ic heal t h y b u t requiring some out- of- state veterinarians to repeat the
national written examination di scrimi nates against those i n practice more
than five years.
The Legislature should consider amending Board statutes to el irninate the
written examination requirement for applicants who are veterinarians
licensed i n other states, and authorize the Eoard to 1 icense applicants
\ vtiose out- of- state licenses are i n good standing and who demonstrate
know1 edge of Arizona heal t h problems.
The Board Needs Authority To Discipline
Individual Licensees for Poor Record Kee~ niu
Neither the Board's statutes nor i t s rules and regulations contain a
provision to di sci pl i ne i ndi vi dual 1 icensees for i nadeqiiate record
keeping. The Board lost this power when i t transferred control over
record keeping from i t s general enabling statutes to those specifically
concerning premises licensure. Even i f premises licensing i s retained,
the Board 1 acks this authority. The Legislature shoul d consider amending
A. R. S. $ 32- 2232 to allow the Board to discipline individual licensees for
inadequate record keeping.
TABLE OF CONTENTS
Page
INTRODUCTION AND BACKGROUND. . . . . . . . . . . . . . . . . . . . . 1
S U N S E T F A G T O R S . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
FINDING I: PREMISES LICENSING IS MOT NECESSARY. . . . . . . . . . . 11
Arizona 1 aw requires 1 i censes f o r veteri nary
f a c i l i t i e s . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Board can provide adequate p r o t e c t i o n w i t h o u t
premises licensing . . . . . . . . . . . . . . . . . . . . . . . 12
Current form of 1 icensure o f f e r s minimal protection. . . . . . . 17
Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . 21
FINDING 11: THE BOARD LlAS SLOW TO ISSUE LEGAL DOCUMENTS ON
SEVERAL COMPLAINTS . . . . . . . . . . . . . . . . . . . . . . . 23
Board action has not been timely . . . . . . . . . . . . . . . . 23
The board f a i l e d t o accept the responsibil i t y f o r
ensuri ng 1 egal documents were prepared . . . . . . . . . . . . . 26
FINDING 111: LICENSING REQUIREMENTS FOR OUT- OF- STATE
VETERINARIANS ARE UNIJECESSARILY RESTRICTIVE. . . . . . . . . . . 2 9
Board makes no d i s t i n c t i o n between new applicants
and out- of- state veterinarians. . . . . . . . . . . . . . . . . . 29
Board p o l i c y discriminates against out- of- state
v e t e r i n a r i a n s . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Recommendation. . . . . . . . . . . . . . . . . . . . . . . . . . 33
. Page
FIWDING I V : THE BOARD NEEDS AUTHORITY TO D I S C I P L I N E VETERINARIANS FOR POOR RECORD KEEPING . . . . . . . . . . . . . . . . . . . . . 35
Recommendation . . . . . . . . . . . . . . . . . . . . . . . . . . 36
OTHER PERTINENT 1NFORP. IkTION . . . . . . . . . . . . . . . . . . . . . 37
AREAS FOR FURTHER AUDIT WORK . . . . . . . . . . . . . . . . . . . . . 39
AGENCYRESPONSE . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
LIST OF TABLES
Page
TABLE 1 - Veteri nary Medical Exami n i ng Board Acti v i ty Level s
Fiscal Years 1981- 12 through 1983- 84. . . . . . . . . . . L3
TABLE 2 - Veterinary Medical Examining Board Expenditures and
Revenue Fiscal Years 1981- 82 through 1983- 84. . . . . . . 3
TABLE 3 - Chronology o f Delayed Complaints. . . . . . . . . . . . . 24
INTRODUCTION AND BACKGROUNC
The Office of the Auditor General has conducted a perforrirance audit of the
Arizona State Veterinary Wedical Examining Board in response to an April
27, IS83 resolution of the Joint Legislative Oversight Coriliii ttee. This
performance audit was conducted as part of the Sunset Review set forth i n
Arizona Revised Statutes ( A. R. S. ) § § 41- 2351 through 41 - 2379.
Arizona started regulating veterinary medicine i n 1923. The Arizona
Legislature established a three- member board to examine and 1 icense
veterinarians to ensure that only qua1 ified veterinarians practice i n the
state. The laws remined virtually unchanged until 1967, when
qualifications for licensure and unprofessional conduct were further
defined and a complaint- handling process was stipulated. In 1978 the
Legislature provided for c e r t i f i c a t i o n of veterinary technicians. In 1980
the Board was given tile power to levy fines against i t s 1 icensees and to
1 icense veterinary f a c i l i t i e s .
Current Activities
The Board's purpose is to protect the public health, safety and welfare by
assuring that veterinary services offered w i t h i n the s t a t e are of high
quality. I t has the authority to 1 icense veterinarians and premises,
certify veterinary technicians and enforce the statutes through complaint
investigations and discipl i nary proceedings.
Table 1 sunlmarizes the Board's a c t i v i t i e s f o r f i s c a l years 1981- 82 and
1982- 83 and its projections for 1983- G4.
TABLE 1
Veterinary Medical Examining Board Acti vi ty
Fiscal Years 1981 - 82 through 1983- 84
Actual Actual Estimated
Licenses and Permits 1981 - 82 1982- 83 1983- 84
Veterinarians
Issued
Renewal s
Temporary
Special ( issue & renew)
Veteri nary Technicians
Issued
Renewal s
Premise
Is sue
Renwal
Ac t i vi ty
board Meetings 15 16 16
Compl ai nts ~ e c e~ i e d ( ~ ) 65 98 105
Complaints Concl ~ d e d ( ~ ) 58 7 7 85
Investigations 5 8 98 105
Informal heari ngs 10 20 3 0
Formal heari ngs 2 ( 3) 2 ( 3) 2
D i scipl inary Action Taken 14 14 -
( 1 ) In 1982 ttie statutes changed to require biennial renewal of 1 icenses
i n even- numbered years. II
( 2) These figures are based on Arizona State Boards Administrative Office
estimates and reportedly included more than just the formal ( w i t t e n )
complaints. As noted i n Sunset Factor 2 on Page 6, the Board
receives about 50 formal compl ai nts annual ly.
( 3) Both hearings \. rere on proposed premise rules and regulations. a
Source: Budget requests, fiscal year 1984- 85.
Personnel and Budget
By s t a t u t e , the Board consists of seven members: five from the veterinary
profession, one representing the general pub1 ic and one representing the
1 i vestock i ndustry. The Board 1 acks statutory authori ty to h i re personnel
and currently receives support s t a f f , one- ha1 f full - time equivalency
( FTE), from the Arizona State Boards Administrative Offive ( ASBAO).
The Veterinary Medical Examining Board i s a 90/ 10 board funded by fees for
examinations, 1 icenses, temporary permits and renewal s. Tab1 e 2
sumlnarizes revenues and expenditures for fiscal years 1981 - 82 through
1 983- 84.
TABLE 2
Veterinary Medical Examining Board Revenue and Expenditures
Fi scal Years 1981 - 82 through 1983- 84
Activity
FTE positions
Actual Actual Estimated
1981 - 82 1982- 83 1983- 84
Revenue:
Revenue received by Board $ 41 ,200 $ 76,000 $ 29,500 ( )
Less: 10% to General Fund 4,100 7,600 2,9C0
Total available to Board
Expenditures:
Personal services
Empl oyee- re1 ated
Professional
services
Travel
In- state
Out- of- state
Other operating
expenditures
Equipment
Total $ 44.3CO $ 54.700 $ 52,600
End of Year
Fund Balance
( 1 ) In 1982 the statutes changed to require biennial renewal of 1 icenses on
December 31 of even- numbered years. 1983- 84 is not a year when
veterinarians must renew licenses, so the estimated revenue for that
year is lower than the previous year.
Source: Budget requests, fiscal years 1983- 84 and 1984- 85.
A u d i t Scope and Purpose
T h i s audit was conducted to evaluate the need for and adequacy of
regul ation by the Veterinary F. ledica1 Examiners Board. Specifical ly we
exa~ inie d :
a The appropriateness of the current level and manner of premise
1 icensi ng.
0 The effectiveness of regulatory action i n complaint resolution.
0 The appropriateness of Board restrictions on out- of- state
veterinarians applying for Arizona 1 icenses.
a The need for strengthening and/ or clarifying the statutes.
Because of time constraints we were unable to examine all potential issues
identified duri ng our prel iminary audit work. The section " Areas for
Further Audit Work" describes these issues.
The Auditor General and staff express appreciation to the members of the
Veterinary Medical Examining Board, tke ASGAO support staff and the
Attorney General ' s Office for their cooperation and assistance during the
course of our audit.
SUNSET FACTORS
In accordance w i t h Arizona Revised Statutes ( A . R. S. ) S41- 2354, the
Legislature should consider the following 11 factors i n determining
whether the Arizona Veterinary Medical Examining Board shoul d be continued
or termi na ted.
1. Objective and purpose i n establishing the Board
The enabling statutes for the Veterinary Medical Examiners Board do
not contain an explicit statement of objective and purpose. 1982
session laws state that the Board's purpose
". . . i s to provide for the licensing, certification
and regulation of veterinarians and veterinary
technicians i n order to protect and promote the public
health, safety and welfare and for the enhancement of
the veterinary medical profession. "
Arizona 1 aw establ i shes the objective of assuri ng competence and
quality i n the veterinary profession by authorizing the Board to:
Examine, 1 icense, require continuing education of and
di sci pl i ne veterinarians ( A. R. S. S § 32- 2204 through 32- 2238) ;
e Exanline and certify veterinary technicians ( A. R. S. $ 5 32- 2241
through 32- 2250) ; and
e License veterinary medical premises and take action against the
licenses of the premises or the licenses of responsible parties
( A. R. S. § § 32- 2271 through 32- 2275).
2. The effectiveness with which the Board has met i t s objective and
purpose and the e f f i c i e n c y with which it has operated
The Board generally operates e f f e c t i v e l y and e f f i c i e n t l y . It has
established a regulatory program t o ensure competence and compliance
w i tl. 1 statutes. The Board 1 icenses approximately 71 0 veterinarians and
270 establisflments and investigates about 50 complaints annually.
3. The extent t o which the Board has operated w i t h i n t h e p u b l i c i n t e r e s t
The Board operates i n the public i n t e r e s t by ensuring t h a t practicing
veterinarians i n Arizona meet minimum 1 icensi ng standards and are
d i s c i p l i n e d when necessary. Board a c t i v i t i e s protect the public from
diseases transmitted by animals and contribute t o the health of
1 ivestock and pets.
However, 1 icensing veterinary f a c i l i t i e s i s unnecessary regulation and
may not be i n the public i n t e r e s t ( see Sunset Factor 11, page 10). I n
addition, delays on several Eoard actions have not been i n the public
i n t e r e s t . The Board delayed action on seven o f eight consent orders,
and s i x of these delays occurred because it f a i l e d t o see t h a t legal
documents were drafted and transmitted i n a t i m e l y manner
( see page 23).
4. The extent t o which rules and regulations promulgated by the Board are
consistent w i ti; the 1 egis1 a t i ve mandate
The Board's rules and regulations appear t o be consistent with i t s
l e g i s l a t i v e mandate. A l l rules and regulations now i n effect have
been reviewed by the Attorney General t o ensure consistency.
However, the Eoard has operated without rules and regulations for
premises 1 icensure since 1980 when the authority to regulate
veterinary premises was establ ished by statute. The Board expects
some premises licensing rules to become effective in April 1984. All
previous Board attempts to pronul gate premises 1 icensure rules and
regulations have been unsuccessful because of strong opposition from
the veterinary profession and rejection by the Attorney General
( see page 18).
5. The extent to which the Eoard has encouraged i n p u t from the public
before promulgating i t s rules and regulations and the extent t o which
i t has informed the public as to i t s actions and their expected impact
on the public
The Board has complied w i t h the Open fvieeting Law on public meetings.
The Board has submitted a listing of the locations of published or
posted notices to the Secretary of State. According to the chairman,
i t has also provided notices of rules hearings t o " the major
newspapers \ t i tlii n the state and to the professional association. " The
Board received substantial i n p u t on facil i ty 1 icensure rules and
regulations and has kept adequate minutes of i t s proceedings.
6. The extent to \ vhich the Board has been able to investigate and resolve
complaints w i t h i n i t s jurisdiction
The Eoara has adequately investigated and resolved most cornplaints
against 1 icensed veterinarians. However, Eoard inaction resulted i n
excessive delays of seven of the eight consent orders considered
between April 1981 and June 1983. The Board should take necessary
steps t o ensure that i t s actions are completed i n a timely manner ( see
page 23).
7. The extent to which the Attorney General or any other applicable
agency of State government has the authority t o prosecute actions
under enabl ing 1 egi sl ation
Full authority is avail able to enforce the Board's enabl i n g statutes.
A. R. S. S32- 2237, subsection € 3, directs the County Attorney or the
Attorney General to represent the Board i n all legal actions. The
same statute authorizes the Board to seek injunctive relief against
statute violators. A. R. S. $ 32- 2238 makes violation of any of the
enabling statutes a Class 2 misdemeanor.
8. The extent t o which the Board has addressed deficiencies i n the
enabling statutes which prevent i t from fulfil 1 ing i t s statutory
mandate
The Board has often proposed legislation to improve i t s ability t o
ful f i l l i t s objectives. Recent successful 1 egi sl ati ve proposal s have
allowed the Board t o improve the quality of examinations, impose fines
and render discipl inary action based on informal hearings. According
to the Board chairman, the Board requested introduction of 1 egis1 ation
a1 lowing i t to, among other things, hire personnel, expand the time
frame for renewal of 1 apsed 1 icenses, correct an error in the initial
fee schedules, eliminate the requirement that licensees be U. S.
citizens, and expand the Board's disciplinary authority over both
individual veterinarians and premises 1 icenses and their responsi bl e
parties.
Our research supports the Board's endeavors to correct the initial
license fee schedule and eliminate the U. S. citizenship requirement.
9. The extent to which changes are necessary in the laws of the Board to
adequately comply with the factors 1 isted i n the Sunset laws
Based on our audit work, we recommend the Legislature consider the
fol 1 owing changes i n the Veterinary Board statutes:
a El iminate Article G of the enabling statutes ( A. k. S. 532- 2271 e t
seq. ), which relates to licensure of veterinary premises ( see
page 11 );
a Transfer responsi bil i t i e s currently under f a c i l i t y 1 iccnsure
statutes to each indi vidual veterinarian by amending A. R. S.
$ 32- 2232 to include grounds for discipl inary action presently
found in A. R. S. $ 32- 2274 ( see page 12);
a El iminate the written examination requirement for appl icants who
are licensed veterinarians from other states and authorize the
Board to 1i zeilss a;~, jIicants1 ) whose out- of- state 1i censes are i n
good standing, and 2) who demonstrate know1 edge of Arizona health
problems ( see paye 29); and
Add a provision to A. R. S. S32- 2232 allowing the Board to
discipl ine individual 1 icensees for inadequate recordkeeping ( see
page 35).
10. The extent to wt- iicl. 1 the termination of the Board would significantly
harm the publ ic health, safety or we1 fare
Temi nati ng the Board could significantly harm publ ic heal t h . Because
the Veterinary Board i s a medical licensing board that i s responsible
for reviewing qual ification of medical practitioners, i t s a c t i v i t i e s
contribute significantly to public health and safety. For example,
the Board regulates veterinarians' use of dangerous prescription
drugs. Competent practioners are necessary to ensure that the qual i ty
of service provided to pets and 1 ivestock i s high. Veterinarians a1 so
play an important role in detecting and control 1 i ng publ i c heal t h
threats such as rabies and valley fever i n animals.
11. The extent to which the 1 eve1 of regulation exercised by the Board i s
appropriate and whether less or more stringent levels would be
appropriate
The Board's level of regulation for 1 icensing veterinarians i s
appropriate. However, 1 icensing veterinary facil i ties i s
unnecessary. The Board has sufficient authority without facil i ty
1 icensure to di scipl ine individual veterinarians and hold facil i ty
owners who are 1 icensed veteri nari ans responsi bl e for inadequate
f a c i l i t i e s or harmful treatment rendered i n their practices. In
addition, the Board can address problems of non- 1 icensed facil i ty
owners by restricting responsibility over medical procedures and
pol icies to 1 icensed veterinarians. T h i s method offers sufficient
protection w i t h less regulation ( see page 11 1.
FINDING I
PREMISES LICENSING IS NOT NECESSARY
The Veterinary Board does not need t o license veterinary f a c i l i t i e s t o
adequately protect the pub1 i c health, safety or we1 fare. Premises
1 icensing does not provide additional protection beyond 1 icensing
individual veterinarians. I n fact, it may reduce protection because it
redirects responsibility. I n addition, 1 icensing f a c i l i t i e s o f f e r s
minimal protection t o the public because the Board lacks adequate
enforcement authority.
Arizona Law Requires Licenses
f o r Veterinary Facil i t i e s
Veterinary f a c i l i t i e s i n Arizona must now be 1 icensed. Premises 1 icensing
was i n s t i t u t e d t o regulate mu1 t i - u n i t practices and practices owned by
non- 1 icensed individual s. When it was imp1 emented the Board thought
non- 1 icensed ownership woul d increase. However, t h i s did not occur.
I n 1980 the Legislature amended the veterinary statutes t o include
premises 1 icensing. Board members contend the Board was ". . . unable t o
regulate properly the mu1 ti- hospi t a l practice under sing1 e ownership" and
practices owned by non- 1 icensed i n d i vidual s. I n these practices the owner
was frequently absent y e t determined p o l i c i e s and procedures a f f e c t i n g the
level o f care and treatment provided. Although there are few such
practices i n Arizona, several complaints were f i l e d against veterinarians
employed a t these f a c i l i t i e s . The Board f e l t t h a t these hospitals had
". . . an overriding philosophy t h a t d i d not allow an acceptable standard
o f practice." Although the Board took action against the offending
veterinarians, it f e l t l i m i t e d i n i t s a b i l i t y t o act against the owners
who established hospital pol i c i e s , p a r t i c u l a r l y the non- 1 icensed owner
over wlron the Board had no statutory authority.
In the late 1970s some observers predicted an increase of non- licensed
and/ or corporate ownership of veterinary facil i ties. This trend was
apparent i n other medical professions and many fel t i t vioul d occur in the
veterinary profession too. Evidence suggested that this was an accurate
prediction. Ou t- of- s tate corporations had contacted Arizona veterinarians
indicating an interest in purchasing practices.
A review of ownership over the past few years, however, revealed that the
predicted trends did not occur. A 1981- 82 nationwide random sample of
3,000 practicing veterinarians indicates that practice ownership i s
remaining fairly stab1 e. According to American Veterinary Medical
Association staff, the non- licensed ownership trends found i n other
medical professions did not occur i n the veterinary profession and
non- veteri narian ownership of practices i s 1 imi ted nationwide.
Non- licensed ownership and multi- unit practices are rare i n Arizona.
Based on the Veterinary Board's preniises licensing records, 99 percent of
the veterinary practices in the state are owned by licensed
veterinarians. Only three have non- licensed owners. Of the 272 licensed
veterinary f a c i l i t i e s only 23 ( 8 percent) are part of mu1 ti- hospital
practices. In all 23 cases, a t least one of the owners i s an Arizona
1 icensed veterinarian.
Board Can Provide Adequate
Protection Ni thout Premises Licensing
The Board can adequately protect the pub1 ic without 1 icensing veterinary
premises. Premises licensing provides no additional authority t o affix
responsibility and may, i n fact, direct responsibility away from the
veterinarian rendering treatment. The Board has sufficient authority
without premises 1 icensi ng to hold 1 icensed veterinarians responsi bl e for
treatment they render, regardless of who owns the premises in which they
practice. In addition, 1 icensing i s not needed t o hold an owner
who i s a 1 icensed veterinarian responsi bl e for activities within his
practice. If premises ownership by non- 1 icensed individual s presents
specific problems, the Board statutes can be amended to limit control over
practice policies or r e s t r i c t ownership to 1 icensed veterinarians.
Responsibility Diffused - Contrary t o the Board's attempt to focus
responsi bi 1 i ty, prerni ses 1 icensi ng may reduce accountabi 1 i ty. Premises
1 icensing directs responsibility away from the individual veterinarian who
renders treatment. In addition, Board pol icy allows variation i n who may
be a premise's named responsible veterinarian, even though the Board's
purpose was to affix responsibility on the owner when possible.
With premises licensing, responsibility may be diverted from the
individual providing professional services. For example, an employed
veterinarian may have a complaint filed against him regarding services he
rendered. In some cases he could claim the error was a result of policies
determined by the responsibl e veterinarian, thereby 1 esseni ng his own
responsibility.
Likewise, a 1 icensed practice owner may re1 ieve himself of responsibility
by designating an employee as the responsible veterinarian. Each facil ity
nust have a designated responsible veterinarian to obtain a premises
license.* However, the responsible veterinarian may be the owner ( if the
owner is a 1 icensed veterinarian), the practice's managing veterinarian or
an employed veterinarian. Board policy has been to accept the owner's
designated responsible veterinarian, even i f the owner i s a licensee and
names an employed veterinarian as responsible party. This appears to
contradict the Board's purpose t o clarify responsibility i n the case of
the 1 icensed, nu1 ti- uni t owner.
* As defined i n Arizona Revised Statutes $ 32- 2201.6
" Responsibl e veterinarian means the veterinarian
responsible to the board for compliance by 1 icensed
veterinary premises w i t h the laws and regulations of this
state and of the federal government pertaining to the
practice of veterinary medicine and responsible for the
establ ishment of pol icy a t such premises. "
Individual Veteri nari ans Responsi bl e - The Board can disci pl i ne i ndi vi dual
veterinarians for treatment rendered, regardless of who owns the
facility. Prior to premises licensing the Board - did hold individual
veterinarians responsibl e in premises- related cases. A t least one other
Arizona board has a similar policy. Statutory changes are needed to
transfer responsibility for areas currently regulated by premises
1 icensing to individual veterinarians.
According to a Legislative Council memorandum, the Board has the power to
hold a veterinarian responsible for treatment he renders that violates the
practice act:
" The Board may hold a veterinarian responsible for
complaints resul ting from treatment he renders under
policies set by the facility owner if he commits any of
the acts which are grounds for disciplinary action."
Before premises 1 icensi ng the Board resol ved some premi ses- re1 ated cases
i n such a manner. The following cases illustrate Board action prior t o
premises 1 icensing."
Case 1
In this case, the Board took action against the individual
veterinarian.
A veterinary clinic offering twenty- four hour care had an
absentee owner. The owner employed Dr. Z to provide
veterinary care and llr. Y to serve as the business manager
and live- in n i g h t attendant. A client brought a dog to the
clinic for sursery. Dr. Z performed the operation and
recommended the animal remain a t the clinic overnight. tlr. Y
* Although the Board identified several cases that i t claimed justified
premises 1 icensing, case f i l e s did not contain sufficient
documentation to verify their relationship to premises 1 icensing. The
examples presented here were the only cases where a clear relationship
was evident.
did not check on the animal during the night and found the
dog dead i n the morning. The Board held that Dr. Z
". . . failed to show due care and concern . . ." by not
monitoring the dog's treatnient and by not giving adequate
instructions to the attendant.
Case 2
T h i s case i l l u s t r a t e s Board recommendations to both the
individual veterinarian and the 1 icensed owner.
Dr. A was employed by a licensed veterinarian who owned a
multi- unit practice. Dr. A performed surgery on a dog that
developed compl ications after leaving the clinic. The dog's
owner returned to the clinic the following day and found the
clinic closed. The dog's owner tried to call the clinic and
the call was transferred to another clinic of the mu1 t i - u n i t
practice. Numerous problems occurred because of poor
comclunication procedures. The practice owner, not Dr. A, had
established these procedures. However, the complaint was
filed against Dr. A. The Board determined Dr. A's medical
service was appropriate and acceptable and took no specific
action. However, the Board recommended to both the owner and
Dr. A that the comm~~ nications ystem be improved and that
animal owners be given niore concise information.
The policy of holding a 1 icensed professional responsible for the level of
care and treatment rendered i n a practice i s followed by a t least one
other Arizona board, the Arizona Board of Pledical Examiners ( BONEX).
BOFlEX staff said that the doctor i s held ultimately responsible for total
patient care and the board i s not necessarily concerned ~ i t hth e location
or ownership of a practice. If the doctor i s employed by an organization
that does not provide adequate facil i t i e s and equipment, BOMEX will hold
the doctor, not the organization, responsible for any error caused by the
inadequacies. BOMEX contends that a doctor must maintain a f a c i l i t y i n
such a manner as to protect his professional license from disciplinary
action. If conditions are unsanitary, inadequate or unsafe, the Board
will c i t e the doctor for unprofessional conduct described i n Arizona
Revised Statutes ( A. R. S.) $ 32- 1401.8( 0): " Any conduct or practice which
i s or might be harmful or dangerous to the health of the patient."
Statutory amendments are needed to c l a r i f y that licensed veterinarians are
directly responsible for areas currently regulated by premises 1 icensing.
A. R. S. § 32- 2274 states grounds for di scipl inary action against premises
1 icenses and responsible veterinarians. According t o Legislative Council,
A. R. S. $ 32- 2232, which defines unprofessional or dishonorable conduct for
i ndi vi dual veteri nari ans, s houl d be amended to i ncl ude the grounds stated
i n A. R. S. $ 32- 2274. Thus, each 1 icensed veterinarian woul d be responsible
for ensuring that these problems do not occur.
Licensed Owner A1 so Responsi bl e - Wi thout premises 1 i censi ng , the Board
has the authority to hold a f a c i l i t y owner responsible f o r a c t s comniitted
i n the f a c i l i t y i f the owner i s a licensed veterinarian. According to
Legislative Council, i f a veterinarian owns and/ or operates a practice he
i s responsible for the service and care rendered by himself - and by his
employees. Essentially, the owner i s the responsible veterinarian.
Consequently, even without premises licensing the Board can hold the
1 icensed owner responsi bl e for inadequate or unsafe pol icies and practices.
Non- Licensed Owner - A1 though hol ding individual 1 icensees responsi bl e for
their actions ( regardless of ownership) shoul d adequately protect the
pub1 ic, the Legislature may feel that control over non- 1 icensed ownerss
could be necessary. If so, two options are available: limiting control of
medical pol icy making to 1 icensed veterinarians or restricting
non- 1 icensed ownership. Of the two options, 1 imi t i ng pol icy control i s
l e s s r e s t r i c t i v e and appears to be equally effective.
Limiting control of medical pol icy making allows a non- licensed person to
own and lease f a c i l i t i e s or to employ veterinarians for medical services.
Accordi ng to Legi sl ati ve Council :
". . . prohibiting nonlicensed persons from directing
or controlling practice policies and operations which
affect treatment and care of animal patients ( means
that) 1 icensed veterinarians woul d be responsi bl e for
policies and operations which affect treatment and care
of animal patients. "
To 1 imit control of medical pol icy making would require an amendment to
the definition of practicing without a 1 icense. Legislative Council
s t a t e s t h a t nothing prohibits making such an amendment to the statutes.
The amended definition would restrict a non- 1 icensed individual from
directing or control 1 i ng practice pol icies and operations that affect the
treatment and care of the patient.
In contrast, restricting ownership prohibits non- 1 icensed individuals from
owni ng, operating or managing a veterinary practice. This procedure i s
commonly used to regulate medical practices. The Arizona Dental Board
expl ici t l y prohibits non- 1 icensed ownership, and BOtJlEX contends
non- 1 icensed ownership violates i t s statute regarding practicing without a
license. Other state veterinary boards frequently r e s t r i c t ownership. Of
15 states contacted, eight states restrict non- 1 icensed o~ inership.
Current Form Of Licensure
Offers Minimal Protection
Arizona's premises 1 icensi ng requirements offer 1 i t t l e protection to the
pub1 i c because the Board 1 acks adequate enforcement authority. The
Board's 1 icensing process does not set standards and the Board has not
been able to promulgate specific rules and regulations to enforce the
0 statutes.
Licensing process - Premises licensing offers no assurance that a licensed
facil i ty meets acceptable standards. There are no provi sions for regular
inspections of facil i ties or meaningful 1 icensure requirements.
Facilities are not inspected before receiving or renewing a license. In
fact, Arizona statutes prohibit pre- 1 icensi ng or renewal inspections.
A. K. S. 532- 2271 , subsection C, reads:
" A veterinary premises shall not be subject to
inspection by the board unless a specific investigation
or proceeding conducted by the board warrants such an
inspection. "
Rithout an inspection program the Board cannot distinguish between
acceptable and unacceptabl e facil i ties.
Premises 1 icenses are easily obtained. State statutes require only that
"[ alny person who desires to operate, maintain or
establish premises a t or from which veterinary services
are offered . . . f i l e with the board an
application . . . accompanied by the license fee."
( A. R. S. $ 32- 2272 . A)
The application must contain the following information:
the name and location of the premises,
the name of the person owning the premises,
e a description of services provided a t the premises or from
mobile units, and
e the name and signature of the responsible veterinarian.
The Arizona State Boards Admini s t r a t i ve Office ( ASBAO) staff reviews the
applications and refers any applications w i t h discrepancies or questions
to the Board. The Board has never denied a facility a license.
Rules and Regulations - The Board lacks authority for effective regulation
of veteri nary facil i ties. Effective premises 1 icensing programs require
detailed rules and regulations. The Board has not been able to promulgate
the necessary rules and regulations and as a result lacks standards to
enforce the statutes.
Although few state veterinary boards license veterinary premises, those
w i t h strong premises 1 icensing programs require inspections and have
detailed rules and regulations. Gle identified three states - Virginia,
California and Florida - w i t h strong programs. Each of these states
requires a pre- 1 icense inspection and regularly inspects each facil ity to
ensure that standards are maintained. These states also have stringent
rules and regulations stipulating f a c i l i ty and equipment requirements.
The Board has been unable to establish adequate rules and regulations for
premises 1 icensing, a t l e a s t partly because of concern that these rules
may r e s t r i c t competition. In 1980 the Arizona Veterinary Board proposed
rules and regulations similar to those of California, Virginia and
Florida. While some veterinarians favored the proposed rules and
regulations, others, particularly those w i t h rural or 1 arge- animal
practices, expressed considerable opposition.
Based on public hearings the Board revised the proposals i n 1981 and again
i n 1982. In October 1983 the Attorney General's Office denied
c e r t i f i c a t i o n f o r a portion of the proposed rules and regulations stating
". . . the rules do not articulate sufficiently specific standards to
permit objective enforcement."
Since that time the Board has resubmitted a portion of the rules and
regulations and expects Attorney General certification i n April 1984.
However, other than the record keepins rules and regulations, the proposed
language provides 1 imi ted standards. For example, the section for
equipment standards requires that each f a c i l i t y be equipped to provide
services a t a level consistent w i t h the standards of veterinary practice
within the community. Specific rules stipulate facil i ties for proper
storage of biologics, supplies and medication; use of oxygen equipment and
supplies when general anesthesia is administered to small animals; and
proper sterilization of instruments and surgical packs for surgery.
The proposed rules and regulations do not address requirements for cages
and s t a l l s for f a c i l i t i e s that hold animals, clean1 iness of f a c i l i t i e s and
sanitization of surfaces such as examination and surgical tab1 es, and
adequate lighting, heating and ventilation for the animal's comfort.
States w i t h strong premises 1 icensi ng programs have specific rules and
regulations regarding these areas, thereby providing specific guide1 ines
for 1 icensees.
With present statutory language and the lack of rules and regulations, the
Board says i t has been limited in i t s ability to take action against
possible premises violations. According to the board chairman, the Board
rarely deals w i t h premises licensing issues when they are revealed in
complaint investigations. The Board feel s that without rules and
regulations the statutes do not give i t sufficient legal basis t o act
because they lack adequate, detailed guidelines for the licensees. A
review of the proposed rules and regulations does not indicate that
detailed guidelines will be provided. Because the Board has not
promul gated rules and regul ati ons i t i s impossible to determine whether
its proposals would restrict competition. However, our analysis ( page 12)
shows that premises 1 icensi ng is unnecessary because a1 ternati ves provide
sufficient protection to the public w i t h less regulation.
CONCLUSION
Premises 1 icensing i s not needed. Pl acing ul timate responsi bil i ty with
the 1 icensed veterinarian would provide sufficient protection to the
pub1 ic. If the Legi sl ature deems control over non- 1 icensed owners
necessary, 1 imi ting pol icy control would provide a less restrictive
a1 ternative than premises 1 icensing. Statutory amendments are necessary
to accompl ish these tasks.
RECOMHENDATIONS
1. The Legislature should consider repealing A. R. S. S32- 2271 e t seq.
( Article 6) t o delete premises 1 icensing requirements.
2. If A. R. S. $ 32- 2271 e t seq. are repealed, the Legislature should
consider amending A. R. S. $ 32- 2232 to clearly affix responsibil i ty on
the individual veterinarian, including as grounds for disciplinary
action:
0 Failure t o maintain sanitary facil i ties.
a Violation of $ 32- 2233 or any rule or regulation issued pursuant to
that section.
Failure t o maintain accurate records or reports as required by
this chapter or by federal or state laws and regulations
pertaining to the storing, 1 abel ing, sell ing, dispensing,
prescribing and administering of control 1 ed substances.
Failure t o maintain control led substances, surgical and other
equipment in a safe, efficient and sanitary manner.
0 Failure to keep written records of a1 1 animals receiving
veterinary services, failure t o provide a summary of such records
to the client upon request or failure to produce such records a t
the request of the board.
FINDING I1
THE BOARD HAS BEEN SLOW TO ISSUE LEGAL DOCUMENTS ON SEVERAL COMPLAIEITS
The Veterinary Board has failed to issue legal documents i n a timely
manner. A1 though the Board resol ves most complaints promptly, i t del ayed
final action for as long as 27 months on seven of the last eight consent
orders issued. While the Attorney General's Office and the Arizona State
Boards Admini s t r a t i ve Office ( ASBAO) contributed to the delays, the Board
i s s t i l l responsible for ensuring that i t s actions, including the
preparation of 1 egal documents, are compl eted promptly.
Board Action Has Not Been Timely
In seven of eight cases invol ving consent orders the Board took between 22
and 27 months* to complete i t s disciplinary actions. The excessive time
taken i n these cases limits the Board's ability to carry o u t disciplinary
stipulations and may affect the veterinarians' right to due process.
The seven complaints involved were filed w i t h the Board between Flarch and
July of 1981. The Board reached a decision to offer a consent order i n
each of the conplaints within six months of the date received. However,
the complaints remained open for an additional 17 to 26 months because the
Board did not ensure timely transmittal of the consent orders to the
veterinarians invol ved.
Table 3 contains a brief chronology of the seven complaints.
* During the 27 morrth period the Board issued eight consent orders and
one order of censure.
TABLE 3
CHRONOLOGY OF DELAYED COMPLAINTS
Date Date Board Voted Date Consent Order Time Elapsed
Complaint Received to Offer Consent Order Sent by Board ( Months)
A Plarch 1981 April 1981 June 1983
B April 19~ 1 ) August 1981 June 1983
C April 1981 September 1981 March 1983 23
0 April 1981 October 1981 June 1983 2 6
E May 1981 October 1981 March 1983 2 2
F July 1981 ( 2 ) July 1981 June 1983 23
G July 1981 July 1981 June 1 983 23
( 1 ) Board minutes show that the Attorney General Representative presented
this consent order to the Board for approval in October 1981. The
Board chairman could not recall why the ~ o a r d delayed completing this
action.
( 2 ) The Board initiated these actions and no formal complaint was ever
filed. Therefore, the date shown is the date the Board f i r s t
discussed the compl ai n t .
Although one case involved a second offense regarding misuse of drugs by a
veterinarian, the Board did n o t issue a suspension order until 22 months
of the 3- year suspension had elapsed. In this case the veterinarian's
license had previously been suspended after conviction for the sale of
dangerous drugs. During the suspension he misrepresented himself
as a 1 icensed veterinarian from another state to obtain drugs illegally.
As a result, the Board decided i n August 1981 to continue his suspension
for another 3 years beginning November 6, 1980.* The Attorney General
representative presented the order to the Board i n October 1981, b u t the
Board did not send the consent order to the 1 icensee until June 1983.
In a second case, the Board could no longer take action against the
veterinarian as originally intended. Originally , the Board had voted to
offer the veterinarian a consent order that required him, i n part, to
prepare an instructional manual for his assistants out1 i n i n g requirements
and responsibilities. However, by the time the veterinarian received the
consent order 17 months l a t e r , he was employed a t a different clinic and
was no longer responsible for instructing the assistants a t the other
clinic. Thus, the actual consent order sent to the veterinarian contained
no requirement to prepare the manual.
In the same case, the veterinarian cited voiced serious concern to the
Board about the Board's a b i l i t y to resolve complaints i n a tinely manner
and the Board's regard for his r i g h t to due process. In a l e t t e r to the
Board, the veterinarian ' s attorney stated:
" I am seriously concerned about my c l i e n t ' s r i g h t to
due process, and whether the Board takes as much time
to deal w i t h a l l complaints as i t did i n this
case. . . . There i s nothing i n the materials with
which you provided me to explain the Board's silence
for more than fourteen months after its investigation
had apparently closed. I find t h i s very, very
disturbing. "
A1 though four of the seven consent orders invol ved technical conpl aints
such a s f a i l u r e to renew licenses and practicing before a temporary
license was issued, the remaining three consent orders included a
suspension, a censure and a probation, representing some of the strongest
- k The Board made the suspension date retroactive to the l a s t day of the
previous 5- year suspension. Hence, the effective actual suspension
period was 27 months.
2 5
disciplinary actions the Board has taken i n resolving complaints. The
Board's inability to act promptly i n these cases indicates that the Board
may not be able to effectively resol ve some of i t s most serious complaints.
The Board Failed to Accept the Responsibility
for Ensuring That Legal Documents Were Prepared
The excessive delays in preparing six of the consent orders occurred
because the Board did not take action to ensure the timely preparation of
1 egal documents. * A1 though the Board's Attorney General representative
and ASBAO contributed to the delays, the Veterinary Board i s u l timately
responsible for the timely preparation of consent orders and should have
followed up on the orders sooner.
Prior to 1582 the Attorney General ' s Office prepared legal documents for
the Board. The Board minutes show that the Board directed i t s Attorney
General representative to prepare the consent orders and that the Attorney
General representative agreed to do so. However, some time after
accepting this responsi bi 1 i ty the Attorney General representati ve
discontinued the practice of drafting consent orders for the Board. While
documentation on this matter i s scarce, Board minutes reveal that 14
months after the Board had voted to send the last of the consent orders
the Board was s t i l l concerned about whether the Attorney General
representative was acting sufficiently to ensure the documents'
preparation.
Responsibil i ty for preparing 1 egal orders was unclear. The Attorney
General representative contends that preparing the consent orders was the
responsibility of ASBAO staff. ASBAC staff said the Attorney General
representative was responsible for drafting legal documents for the Board.
* As mentioned on page 24, the Attorney General representative prepared
one of the seven consent orders two months after the Board voted t o
offer it. Therefore, Board delays were due t o legal document
preparation for six of the seven consent orders.
ASBAO's failure to maintain the status report sheet may have also
contributed to the delays i n t r a n s ~ i t t i n g the seven consent orders.
During most of the tine between the date the Board voted to offer a
particular consent order and the date the consent order was sent, the
seven complaints were not l i s t e d on the monthly status report sheet
compiled for the Board by ASBAO s t a f f . The status report sheet i s an
internal control device to keep a record of current or active complaints
for the Board. Therefore, the Board lacked formal information on the
status of the complaints.*
Ultimately, however, the Board i s responsible for the execution of i t s
regulatory duties as mandated by statute. The Board's f a i l u r e t o take the
i n i t i a t i v e and specifically request that the necessary documents be
prepared and completed i n a timely manner led to the excessive delays i n
the t r a n s ~ i t t a l of the consent orders.
The Board chairman contends that the Board lacks sufficient control over
the Attorney General representative and ASBAO staff to resolve the legal
document problem. We found that when the Board d i d take action to resolve
the problem, i t s action came a f t e r long delay and was 1 imited.
* Recently, however, ASBAO has taken the i n i t i a t i v e to resolve the
corisent order problem. By reassigning existing personnel , ASEAO has
been able to appoint a staff member to prepare legal documents for
nine of the 10 boards it serves, including the Veterinary Board. This
staff member drafts the documents and coordinates their review by the
Attorney General ' s Office. In addition, ASBAO pl ans to become more
i nvol ved i n the investigation of complaints by coordinating the
administrative duties associated with the investigations.
CONCLUSION
The Board acts responsibly in most complaints against licensed
veterinarians. However, the Board's fail ure to accept i t s statutory
responsibil i ty has 1 ed to untimely delays in the drafting and transmittal
of seven of the last eight consent orders issued.
RECOMMENDATIOt* i
The Board should monitor the preparation and approval of i t s legal orders
and skoul d take steps to expedite the delivery of orders when delays are
apparent.
FINDING 111
LICENSING REQUIREMENTS FOR OUT- OF- STATE VETERINARIANS ARE UNNECESSARILY
RICTIVt
Arizona 1 icensing requirements for veterinarians a1 ready 1 icensed i n other
states unnecessarily restrict the licensure of these veterinarians i n
Arizona. The Eoard has the same requirements for all 1 icense applicants,
regardless of whether an applicant holds a valid license from another
state. The requirement that veterinarians licensed i n other states pass a
state examination i s a reasonable measure for protecting pub1 ic heal t h y
but requiring some out- of- state veterinarians to repeat the national
written examination discriminates against those i n practice more than 5
years.
The Board Piakes No Distinction Between
New Applicants and Out- of- State
Ve teri nari ans
Board 1 icensing requirements are the same for a1 1 appl icants, regardless
of their 1 icensure status i n other states."
Arizona kevised Statutes ( A. R. S.) $ 32- 2212, subsection A requires
applicants to pass an examination and be otherwise knowledgeable regarding
veterinary medicine:
" If the appl icant satisfactorily passes the exami nation
given by the board and demonstrates a scientific and
practical knowledge of the art and science of
veterinary medicine and, i n addition, compl ies w i t h the
provisions of this chapter, the board shall issue a
license to the applicant to practice veterinary
medicine i n this state."
* The Board's enabling statutes make no provision for licensure by
reciprocity or endorsement. Endorsement i s a unilateral decision by
one state to allow qualified out- of- state applicants to be 1 icensed
without examination. Reciprocity i s a mutual agreement between two
states to license each other's licensees and i s potentially more
restrictive for licensees moving between states.
A. R. S. S32- 2215 reiterates the examination requirement:
" An applicant for a license issued under this chapter
shall :
1. Be a citizen of United States.
2. Be of good moral character.
3. Be a graduate of verterinary college or hold a
c e r t i f i c a t e issued by the educational commission
for foreign veterinary graduates of the American
veterinary medical associati on.
4. Satisfactorily pass the written and practical
examination given by the board as provided in this
chapter." ( emphasis added)
The Board requires a l l applicants to take the national written examination
and a practical examination, which consists of three parts: the
nationally- based clinical competency examination and state- developed slide
identification and oral questions.
The Board considers national ( written) scores valid for 5 years. After
passing the national examination an applicant has 5 years to pass the
state examination and receive a license. This policy applies to both new
applicants and those licensed i n other states.
Board Pol icy Discriminates
Against Out- of- State Veterinarians
Some testing of out- of- state veterinarians wishing to practice i n Arizona
i s reasonable, b u t requiring experienced veterinarians to retake the
national written examination i s discriminatory. Ari zonal s cl imate and
environment present unique medical problems that may be new to
veterinarians from other states. However, requiring the national
examination of practicing veterinarians who passed the same examination
more than 5 years prior to applying for a license i n Arizona i s an unfair
1 icensure restriction.
Arizona Health Problems - The Board appears to be acting to protect the
pub1 ic health by requiring a l l applicants to take the state portion of the
1 icensure examination. Diseases indigenous to Arizona or the southwest
appear to be serious enough that veterinarians 1 icensed i n Arizona should
be knowl edgeabl e about them. Such diseases include valley fever, which
has a particularly high mortal i ty rate i n dogs, photosynthetizati on
diseases and reactions to local poisonous plants and animals. Since the
state portion of the examination reportedly t e s t s applicants on their
knowledge of these diseases, the Board i s not unnecessarily restrictive i n
requiring that a l l applicants, including veterinarians licensed in other
states, take the state portion of the examination. Of 20 states allowing
alternative forms of licensure for out- of- state licensees, a t least seven
require the applicant to take a state exanination.*
National Written Examination Requirement i s Unfair - Although the Board
appears justified i n requiring the state examination of out- of- state
veterinarians, the Board's national written examination requirement
discriminates against those who have not taken the national examination i n
the past 5 years. Since the Board does not require the same of i t s
resident 1 icensees, i t s actions coul d r e s t r i c t competition.
The Board requires all applicants, including those 1 icensed i n other
s t a t e s , t o repeat the national examination i f they have not taken i t i n
the past 5 years. However, the Board does not require Arizona licensed
veterinarians to repeat the national written examination every 5 years.
The Board reasons that the national written examination requirement
ensures that veterinarians coming from other states have sufficient
knowl edge of current veterinary practices. Since veterinarians may
* These states are Arkansas, Iowa, Mary1 and, Massachusetts, Plicliigan,
Oklahoma and Rhode Island.
3 1
" r e t i r e " here from other states, the Board i s concerned t h a t they may not
have s u f f i c i e n t or current veterinary know1 edge. For example, the Board
said t h i s can be a problem when veterinarians owning large- animal
practices i n other states move t o the Phoenix or Tucson metropolitan areas
and begin t r e a t i n g small animal s.
However, the Board c u r r e n t l y makes no additional denlands on an Arizona
veterinarian 1 eavi ng a 1 arge- animal practice i n northern Arizona and
moving t o the southern portion o f the state t o t r e a t small animals, f o r
exanpl e. Thus, the Board's pol i c y regarding the national examination
discriminates against out- of- state veterinarians and coul d r e s t r i c t
competition.
Benjamin Shimberg, i n Occupational Licensing : A Publ i c Perspecti ve,*
1 abel s such examination requirements as " an almost insurmountabl e b a r r i e r
t o mature out- of- state p r a c t i t i o n e r s " and states:
" It i s d i f f i c u l t t o see how such a p o l i c y could
possibly serve the residents of the state because
out- of- staters seeking licensure may already be as
competent and as experienced as those practicing w i t h i n
the state. The requirement seems t o the author t o be
u n f a i r because it imposes a higher standard on
out- of- state p r a c t i t i o n e r s than it does on those
a1 ready practicing w i t h i n the state. In- state
p r a c t i t i o n e r s who were licensed a t about the same time
as out- of- state applicants are not required t o
demonstrate t h a t they meet current standards. If a
state seriously desires t o insure t h a t a l l
p r a c t i t i o n e r s have kept up- to- date and maintained t h e i r
s k i l l s, it should i n s t i t u t e a mandatory reassessment
process f o r a1 1 1~ censees." ( emphas~ s added)
* Benjamin Shimberg, Occupational Licensing: A Publ i c Perspective,
Princeton, New Jersey: Center f o r Occupational and Professional
~ ssessment, Educational Testing Service, 1982, p. 65.
The Board does not need the written examination to ensure that
out- of- state veterinarians are sufficiently competent to practice i n
Arizona. The Board can ensure competency by licensing only applicants
whose out- of- state 1 icenses are i n good standing i n the states i n which
they are 1 icensed and who demonstrate a satisfactory knowledge of Arizona
veterinary medical problems. *
CONCLUSION
The Board's requirement that appl icants who are out- of- state 1 icensees
must repeat the national examination i f they passed it more than 5 years
before coming to Arizona i s discriminatory. Board statutes should be
amended to authorize the Board to grant licensure by endorsement.
The Legislature should consider amending Board statutes to eliminate the
written examination requirement for applicants who are veterinarians
1 icensed i n other states, and authorize the Board to 1 icense applicants
whose out- of- state licenses are i n good standing and who demonstrate
knobdl edge of Arizona heal t h probl ems.
* Knowledge of Arizona medical problems i s currently tested as part of
the state practical examination, which includes a national ly- based
clinical conipetency examination as well a s s l i d e identification and
oral questions. Additional research i s necessary to determine whether
the cl inical competency examination is necessary and advisable for
ou t- of- state appl icants.
FINDING IV
THE BOARD NEEDS AUTHOP\ ITY TO DISCIPLIIJE VETERINARIANS FOR POOR RECORD
KEEPING.
Neither the Board's statutes nor its rules and regulations contain a
provi sion to di sci pl i ne i n d i vi dual 1 icensees for inadequate record
keeping. Board authority to take action i n cases involving record keeping
deficiencies is currently 1 imi ted to discipl inary action against 1 icensed
premises and not individual veterinarians.
Prior to 1980 the Board's rules and regulations contained a provision for
disci pl i n i ng veterinarians for inadequate record keepi ng. In 1980 the
Board attained 1egisl ation to establ ish premises 1 icensing. The
legislation a1 so added a record keeping requirement to the new Article G
on premises 1 icensi ng. Arizona Revised Statutes ( A. R. S. ) $ 32- 2274 ( under
Article 6) reads, i n part:
" The board, after notice and pub1 ic hearing, may
revoke, suspend, refuse to issue or refuse to renew a
1 icense or may fine the responsible veterinarian or
take action as to both the license and the licensee for
any of the following grounds:
4. Failure to maintain accurate records or reports as
required by this chapter or by federal o r s t a t e laws
and regulations pertaining to the storing, 1 abel ing,
sell i ng, di spensi ng, prescribing and admi ni s t e r i ng of
controlled substances.
6. Failure to keep written records of a l l animals
recei vi ng veterinary services, fai 1 ure to provide a
sumary of such records upon request to the c l i e n t or
failure to produce such records a t the request of the
board. I'
When the Board attempted to promulgate rules and regulations for premises
1 icensing i t deleted the general record keeping rule w i t h the intention of
including i t under the premises 1 icensing rules and regulations. The
Board expects i t s record keeping rule for premises 1 icensing t o become
effective in April 1954.*
However, regard1 ess of whether premises 1 icensi ng i s retained, the Board
s t i l l lacks authority to di scipl ine individual veterinarians for record
keeping problems. The Board chairman said that the Board intended the
language i n A. R. S. S32- 2274 ( part of the premises 1 icensing statutes) to
cover both i ndi vi dual 1 i censes and premi ses 1 icenses. The current
language does n o t accomplish this goal. First, the statute limits the
Board's action regarding specific i ndi vidual 1 icensees to the premi ses'
named responsible veterinarian. Second, the statute does not clearly
explain who i s referred to in the phrase ". . . take action as to both the
license and the 1 icensee. . . ." ( emphasis added).
Board members feel that control over record keeping i s a necessity because
several veterinarians keep poor records of their patients. In at least
one instance the Board was unable to discipline a licensee for his poor
record keeping. The case involved the death of a cat, allegedly caused by
negl i gence.
CONCLUSION
Board statutes contain no provision for discipl ining individual 1 icensees
for poor record keeping. Regardless of whether premises licensing i s
retained, Board statutes should be revised t o provide sufficient
disciplinary authority to the Board regarding this matter.
RECOMMENDATION
The Legislature S I I O U ~ d consider adding a provision t o A. R. S. $ 32- 2232 that
woul d a1 1 ow the Board to di sci pl i ne i ndi vi dual 1 icensees for inadequate
record keeping.
* See Finding I, page 11, for further discussion of premises licensing
rules and regul ations.
3 6
OTHER PERTINENT INFORP! ATION
The Veterinary Board has expressed concern over i t s statutory i nabil i ty to
hire personnel. Recent dissatisfaction w i t h the level and control of
service from Arizona State Boards Administrative Office ( ASBAO) has
prompted the Board to seek legislation that will enable it to hire an
executi ve secretary.
The Board feels that it requires a more professional level of service than
ASBAO i s currently capable of providing. ASBAO now provides clerical
services to the Veterinary Board, including preparation of meeting minutes
and board correspondence, i ssui ng 1 icenses and recei vi ng and f i 1 i ng
consumer complaints. The Board believes that i t needs an executive
secretary to admi ni ster the Board's regul atory functions and ensure time1 y
and consistent completion of i t s actions.
The Board i s also concerned w i t h i t s inability to exercise direct control
over ASBAO staff assigned to the Board. Although ASBAG provides services
to the Board, ASBAO employees are responsible to the Department of
Administration. The Board contends that this 1 ack of control contributed
to past problems of slow preparation of legal documents by the ASBAO staff
member assigned to the Veterinary Board. The Board believes the problem
of control will be solved i f i t i s empowered to employ an executive
secretary.
ASBAO is currently undergoing staff reorganization in an attempt to
upgrade services. The ASBAO director said ASBAO plans to provide such
professional services as preparation of 1 egal documents, coordination of
administrative functions i n complaint investigations and substitution of
staff as needed.
Beyond the reorganization proposed by ASBAG, additional changes have been
made i n other states to increase the level of service. Flany states are
creating umbrell a agencies to provide services t o occupational 1 icensing
boards. Powers and duties generally given to these agencies include:
appointing an executive secretary for each 1 icensi ng board, receiving
appl ications for a 1 icense o r c e r t i f i c a t e , mailing and processing 1 icense
renewals on a staggered basis, training new board members, maintaining
central records, prornul gating rules and regulations to implenlent 1 icensing
laws, scheduling discipl inary hearings, and inspecting 1 icensee f a c i l i t i e s .
As long as Arizona r e l i e s on ASBAO to serve the Veterinary Board the Board
may never achieve the degree of control i t desires over ASBAO s t a f f and
services. Beyond the Board's 1 ack of admi n i s t r a t i ve control over ASBAO
s t a f f , a written agreement outlining the duties and services ASBAO is to
provide t o the Board is not presently enforced. According to ASBAO s t a f f ,
a previous agreement for services between the Board and ASBAO is outdated
and does not reflect current services or costs. ASBAO is drafting a new
contract b u t no specific completion date has been planned.
Hiring i t s own staff could substantially increase Veterinary Eoard costs.
In fiscal year 1984 the Board will pay $ 23,200, 44 percent of its
operating budget, to ASBAO. Salaries and employee- related expenditures
for executive secretaries employed by other boards w i t h a comparative
nurriber of licensees range from about $ 29,700 to $ 30,900.* If the Board
employed its own executive secretary i t would s t i l l have to pay for
services such as accounting, word processing and rent, which are presently
provided by ASBAO.
IJe do not have sufficient data to determine which alternative for
administrative services woul d be most beneficial to the Veterinary Board
and the state. Either alternative may increase costs. Further analysis
will be necessary to determine which a1 ternati ve is more cost effective.
* These boards are Chiropractic, Osteopathic, and Structural Pest
Control .
AREAS FOR FURTHER AUDIT WORK
During the course of our audit we identified potential problems requiring
further audit work i n several areas related to the Veterinary Medical
Examining Board. Cue to tine and staffing constraints we were unable to
review these areas. These potential issues are:
1. Does the state need to certify veterinary technicians?
2. Is the Veterinary Board's state examination valid?
3. Is i t necessary to require the clinical competency examination of
applicants who hold valid 1 icenses from other states?
4. \/ hat i s the most cost- effective staffing arrangement for the
Veterinary Board?
1645 W. JEFFERSON - ROOM 312
PHOENIX. ARIZONA 85007
602- 255- 3095
April 25, 1984
Mr. Douglas R. Norton
Auditor General
111 W. Monroe, Suite 600
Phoenix, AZ 85003
Dear Mr. Norton:
Enclosed please find the Response of the Arizona State Veterinary
Medical Examining Board to your agency's revised draft report on the
Board's Sunset Review Audit.
I sincerely appreciate the cooperation extended by your staff, and
especially the small extension granted in the allotted time for
preparation of this Response. As I'm sure you are aware, this Board
has no administrative staff to prepare such a Response on its behalf,
and it is time- consuming to elicit input from Board members scattered
throughout the state.
Should you have any questions or need further input from myself or the
Board, please do not hesitate to contact me.
Sincerely,
Chairperson
SdB: clf
Enclosure
INTRODUCTION
The Arizona V e t e r i n a r y Medical ~ x a m i n i n g Board has been
s c r u t i n i z e d by t h e Arizona Auditor G e n e r a l ' s O f f i c e under t h e
" Sunset Review'' process in 1981 and in 1983. In both of t h e s e
r e c e n t a u d i t s , t h e Audit Teams have reached t h e g e n e r a l conclu-s
i o n t h a t the Board of V e t e r i n a r y Medical Exaniners has acted and
c o n t i n u e s t o a c t in the p u b l i c i n t e r e s t .
The Audit completed in 1981 recommended t h a t a number of
changes, s t a t u t o r y , r e g u l a t o r y and a d m i n i s t r a t i v e , be made t o
improve the e f f i c i e n c y , f a i r n e s s , and c o s t of t h e Board's a c t i v -
i t i e s . The Board implemented most of t h e recommended s t a t u t o r y
changes in the 1982 l e g i s l a t i v e s e s s i o n , e f f e c t i v e during mid-
1982. Administrative changes were made more r a p i d l y ; changes t o
r u l e s and r e g u l a t i o n s took l o n g e r .
The p r o c e s s of s t a t u t o r y , a d m i n i s t r a t i v e and r e g u l a t o r y
change is not complete. The L e g i s l a t u r e has passed House B i l l
2051, and a number of r u l e s and r e g u l a t i o n s have been c e r t i f i e d
by t h e Attorney G e n e r a l ' s Office. Many of t h e c o n c e r n s a d d r e s s e d
in t h i s Audit r e p o r t have been obviated by p a s s a g e o f t h e l e g i s -
l a t i o n and c e r t i f i c a t i o n of t h e r u l e s .
C e r t a i n of t h e a d m i n i s t r a t i v e concerns noted in t h i s r e p o r t
have not been addressed or remedied a s y e t , l a r g e l y because the
S t a t e Boards Administrative O f f i c e d o e s not o f f e r a d m i n i s t r a t i v e
s u p p o r t . The p o s i t i o n s a l l o t t e d to ASBAO i n c l u d e only c l e r i c a l
and s e c r e t a r i a l p e r s o n n e l , no a d m i n i s t r a t i v e p e r s o n n e l , and t h u s
ASBAO cannot m e e t t h i s Board' s a d m i n i s t r a t i v e support needs.
SUNSET FACTORS
The m a t e r i a l i n " S u n s e t F a c t o r s " ( p g s 5 - 10) g e n e r a l l y sum-m
a r i z e s t o p i c s covered i n d e t a i l i n t h e " FINDING" s e c t i o n s . How-e
v e r , t h e r e a r e a few r e f e r e n c e s which b e a r d i s c u s s i o n .
The Board is concerned w i t h t h e s t a t e m e n t found i n Sunset
F a c t o r # 4, " A l l p r e v i o u s Board a t t e m p t s t o promulgate p r e m i s e s
l i c e n s u r e r u l e s and r e g u l a t i o n s h a v e b e e n u n s u c c e s s f u l b e c a u s e o f
s t r o n g o p p o s i t i o n from t h e v e t e r i n a r y p r o f e s s i o n and r e j e c t i o n by
t h e A t t o r n e y G e n e r a l ( see page 1 8 ) I' [ e m p h a s i s a d d e d ] . T h i s
c l e a r l y i m p l i e s b o t h r e p e a t e d a t t e m p t s t o promulgate r u l e s , and
c o n t i n u e d o p p o s i t i o n from t h e v e t e r i n a r y p r o f e s s i o n , b o t h circum-s
t a n c e s b e i n g u n t r u e .
The Board h e l d two p u b l i c h e a r i n g s on t h e " package" of r u l e s
and r e g u l a t i o n s it had p r e p a r e d b o t h t o modernize and better o r -
g a n i z e its e x i s t i n g r u l e s , and f o r premise l i c e n s i n g . On t h e
b a s i s of t h e s e h e a r i n g s , w r i t t e n i n p u t r e c e i v e d , and d i s c u s s i o n s
a t t h e B o a r d ' s r e g u l a r m e e t i n g s , a s i n g l e package of r u l e s was
s u b m i t t e d t o t h e Attorney G e n e r a l ' s O f f i c e . A p o r t i o n of t h e s e
were deemed u n c e r t i f i a b l e , t h u s f o r c i n g r e j e c t i o n of t h e e n t i r e
package ( t h e A t t o r n e y G e n e r a l ' s O f f i c e is n o t s t r u c t u r e d t o per-m
i t p a r t i a l c e r t i f i c a t i o n o f s u c h s u b m i t t a l s ) . In a l e t t e r
r e s p o n d i n g t o our s u b m i t t a l , t h e A t t o r n e y General s t a t e d : " W e
have d e t e r m i n e d t h a t r u l e s R3- 11- 04! ~ 3 - 1 1 - 5 2 , R3- 11- 70, R3- 11-
73, R3- 11- 76 a r e i n p r o p e r form and w i t h i n t h e B o a r d ' s a u t h o r i t y
t o a d o p t , and we w i l l c e r t i f y such r u l e s i f s u b m i t t e d independ-e
n t l y . . ." These were r e s u b m i t t e d and h a v e b e e n c e r t i f i e d . Work
c o n t i n u e s on t h e r e j e c t e d p o r t i o n .
F u r t h e r , t h e Board has enjoyed t h e s u p p o r t of t h e v e t e r i n a r y
p r o f e s s i o n i n its 1983 l e g i s l a t i v e e f f o r t s , and o b j e c t s t o t h i s
R e p o r t ' s i m p l i c a t i o n t h a t t h e r e remains s t r o n g o p p o s i t i o n w i t h i n
t h e p r o f e s s i o n t o p r e m i s e s l i c e n s i n g .
Other s t a t e m e n t s i n t h e Sunset F a c t o r s s e c t i o n of t h e Report
w i t h which t h e Board d i s a g r e e s i n c l u d e t h e f i r s t t h r e e " b u l l e t -
t e d " i t e m s u n d e r S u n s e t F a c t o r # 9 ( p g 9 ) . These t h r e e i t e m s
r e l a t e t o p r e m i s e s l i c e n s i n g and t o l i c e n s i n g r e q u i r e m e n t s f o r
a p p l i c a n t s a l r e a d y l i c e n s e d i n a n o t h e r s t a t e and a r e d i s c u s s e d i n
d e t a i l i n FINDINGS I and 111. The f o u r t h b u l l e t t e d i t e m h a s been
o b v i a t e d by c e r t i f i c a t i o n of t h e c u r r e n t r u l e s s u b m i t t a l i n t h e
A t t o r n e y G e n e r a l ' s O f f i c e .
The Board a l s o d i s a g r e e s with t h e ~ u d i t Team's c o n c l u s i o n s
r e g a r d i n g p r e m i s e s l i c e n s i n g r e f l e c t e d i n Sunset F a c t o r # 11, b u t
w i l l a d d r e s s t h e s e on a f i n d i n g by f i n d i n g b a s i s . And, a l t h o u g h
a small p o i n t , t h e Board n o t e s t h e a p p a r e n t d i s c r e p a n c y between
t h e number of c o m p l a i n t s i n v e s t i g a t e d a n n u a l l y a s l i s t e d i n Sun-set
F a c t o r # 2 ( pg 6) and t h e number of c o m p l a i n t s i n v e s t i g a t e d
a n n u a l l y a s d i s p l a y e d i n TABLE 1 ( pg 2 ) .
FINDING I : PREMISES LICENSING
The Board s t r o n g l y d i s a g r e e s n o t o n l y w i t h t h e Audit Team's
c o n c l u s i o n t h a t p r e m i s e s l i c e n s i n g is u n n e c e s s a r y , b u t w i t h t h e
arguments u t i l i z e d i n t h i s r e p o r t t o s u p p o r t t h e Team's conclu-s
i o n . F u r t h e r , it is a p p a r e n t t h a t t h e Audit Team f a i l s t o g r a s p
t h e c o m p l e x i t y of t h e i s s u e and of t h e n a t u r e of s e r v i c e s pro-vided
a t v e t e r i n a r y p r e m i s e s . I n a n e f f o r t t o compare t h e V e t e r -
i n a r y Board with t h e " BOMEX model", t h e Audit Team has i g n o r e d
s i g n i f i c a n t d i f f e r e n c e s between t h e n a t u r e of medical d o c t o r s '
p r a c t i c e s and v e t e r i n a r y p r e m i s e s and between t h e range and v a r i -
e t y of b o a r d s and a g e n c i e s which o v e r s e e a c t i o n s and p r e m i s e s
r e l a t e d t o human m e d i c i n e .
In a d d i t i o n , t h e s o l u t i o n s o f f e r e d by t h e Audit Team a r e
s i m p l i s t i c , and n e g l e c t t o a d d r e s s a r e a s of concern r a i s e d by
Board members i n t h e e x i t c o n f e r e n c e and d r a f t r e s p o n s e c o n f e r -
e n c e , e i t h e r from t h e s t a n d p o i n t of p r e s e r v i n g t h e p u b l i c
i n t e r e s t o r with r e g a r d t o a n t i - c o m p e t i t i v e m a t t e r s .
The p a r a g r a p h s i n t h i s r e p o r t b e q i n n i n q on page 11 under t h e - -
heading " Arizona Law Requires L i c e n s e s f o r v e t e r i n a r y F a c i l i t i e s 1 '
and c o n t i n u i n g t h r o u g h t h e f i r s t t h r e e p a r a g r a p h s o f p a g e 12 - -
f a i r l y a c c u r a t e l y o u t l i n e , i n b r i e f , t h e d i r c i m s t i n c e s r e s u l t i n g
i n t h e Board s e e k i n g p r e m i s e s l i c e n s i n g . To s t a t e t h e B o a r d ' s
p o s i t i o n most s i m p l y , t o o many c a s e s were a r i s i n g i n which t h e
i n d i v i d u a l v e t e r i n a r i a n r e n d e r i n g t r e a t m e n t had o n l y l i m i t e d , i f
any, r e s p o n s i b i l i t y f o r t h e c i r c u m s t a n c e s c a u s i n g a p u b l i c com-p
l a i n t t o a r i s e .
In reviewing a v a i l a b l e i n f o r m a t i o n on t r e n d s of m u l t i p l e -
premise ownership and n o n - l i c e n s e e ownership, t h e Board d e t e r -
mined t h a t a p r e m i s e s l i c e n s e which c l e a r l y i d e n t i f i e d t h e
l i c e n s e e a c c e p t i n g r e s p o n s i b i l i t y t o t h e Board f o r compliance was
t h e most s u i t a b l e way t o p r o c e e d . P r e m i s e s l i c e n s i n g , open t o
l i c e n s e e s and n o n - l i c e n s e e s , r a i s e s n e i t h e r a n t i - t r u s t nor a n t i -
c o m p e t i t i v e q u e s t i o n s . The Board b e l i e v e s r e s p o n s i b i l i t y is t h u s
c o r r e c t l y a s s i g n e d : f o r m a t t e r s of s p e c i f i c t r e a t m e n t s r e n d e r e d ,
r e s p o n s i b i l i t y is w i t h t h e i n d i v i d u a l l i c e n s e e . or m a t t e r s of
pol i c y and f a c i l i t y compliance, r e s p o n s i b i l i t y lies with t h e p r e -
m i s e owner and/ or " r e s p o n s i b l e v e t e r i n a r i a n " .
The Audit Team r e p o r t s t h a t c o n t r a r y t o expected t r e n d s ,
v e t e r i n a r y premise ownership remained r e l a t i v e l y s t a b l e d u r i n g
1981- 82. I t is worth n o t i n g t h a t a t l e a s t one r e a s o n f o r t h e
r e p o r t e d s t a b i l i t y of p r a c t i c e ownership d u r i n g t h a t p e r i o d is
t h e g e n e r a l l y p o o r economy. I n v e s t o r s were n o t i n v e s t i n g a s
f r e e l y a s t h e y might have d u r i n g b e t t e r t i m e s , and faced w i t h
d i m i n i s h i n g f i n a n c i a l p r o f i l e s , owners l i k e l y d i d n l t seek ( o r
could n o t f i n d ) s u i t a b l e b u y e r s . Thus, it is n o t s u p r i s i n g t h a t
a n t i c i p a t e d changes i n ownership p a t t e r n s d i d n o t a r i s e .
The b a l a n c e of t h e m a t e r i a l p r e s e n t e d under Finding I is
unsupported by f a c t ; is c h a r a c t e r i z e d by s t a t e m e n t s of o p i n i o n
which could a s e a s i l y be made t o s u p p o r t t h e c o n v e r s e ; demon-s
t r a t e s f a i l u r e t o comprehend t h e c o m p l e x i t y of t h e problem a s
p e r c e i v e d by t h e Board; and i g n o r e s t h e i n v a l i d i t y of comparisons
between v e t e r i n a r i a n s and d e n t i s t s , or v e t e r i n a r i a n s and medical
d o c t o r s . F u r t h e r , a l t h o u g h L e g i s l a t i v e C o u n c i l ' s o p i n i o n s on
i n t e r p r e t a t i o n and e n f o r c e m e n t of t h e s t a t u t e s which a p p e a r
t h r o u g h o u t t h e Audit Report a r e i n t e r e s t i n g , t h e Board must r e l y
on t h e o p i n i o n s of t h e agency which has t h e r e s p o n s i b i l i t y of
p r o v i d i n g t h e B o a r d ' s l e g a l s e r v i c e s , t h a t is, t h e Attorney Gen-e
r a l ' s O f f i c e .
D i v e r s i o n Of ~ e s ~ o n s i bi ti vl
I t is c a t e g o r i c a l l y u n t r u e t h a t " premises l i c e n s i n g may d i -
rect r e s p o n s i b i l i t y away from t h e v e t e r i n a r i a n r e n d e r i n g t r e a t -
ment", a s is a l l e g e d by t h e A u d i t R e p o r t . This s t a t e m e n t c l e a r l y
i n d i c a t e s a f a i l u r e t o g r a s p t h e i n t e n t of t h e Board w i t h r e g a r d
t o p r e m i s e s l i c e n s i n g , w h i c h w a s , and is, t o be a b l e t o h o l d
a c c o u n t a b l e a p r e m i s e owner and r e s p o n s i b l e v e t e r i n a r i a n f o r
p o l i c i e s and c o n d i t i o n s w i t h i n a premise, when t h e i n d i v i d u a l
l i c e n s e e r e n d e r i n g t r e a t m e n t could not r e a s o n a b l y be held respon-s
i b l e .
The s u g g e s t i o n t h a t a l i c e n s e d p r a c t i c e owner may " r e l i e v e
himself of r e s p o n s i b i l i t y by d e s i g n a t i n g an employee a s respon-s
i b l e v e t e r i n a r i a n " ( e m p h a s i s a d d e d ) is c o m p l e t e l y f a l s e and
u n d e r s c o r e s t h e f a i l u r e of t h e Audit Team t o s t u d y t h e premise
l i c e n s e documents. I t is c l e a r l y s t a t e d on forms f o r i d e n t i f y i n g
t h e " r e s p o n s i b l e v e t e r i n a r i a n " t h a t t h i s l i c e n s e e m- ust - s i g n and
by so s i g n i n g swear t h a t he o r she is p e r s o n a l l y r e s p o n s i b l e t o
t h e Board f o r t h e compliance of t h a t premise w i t h t h e laws and
r e g u l a t i o n s of t h e s t a t e and f e d e r a l governments p e r t a i n i n g t o
v e t e r i n a r y m e d i c i n e , and r e s p o n s i b l e f o r t h e e s t a b l i s h m e n t o f
p o l i c y a t s u c h p r e m i s e s .
There is no mechanism f o r a premise owner t o " d e s i g n a t e " an
u n s u s p e c t i n g employee a s r e s p o n s i b l e v e t e r i n a r i a n . I f a v e t e r -
i n a r i a n employee has been g i v e n s u f f i c i e n t a u t h o r i t y over t h e
premise t o w i l l i n g l y s i g n and swear a s d e s c r i b e d above, then t h a t
employee is r i g h t l y t h e r e s p o n s i b l e v e t e r i n a r ia. n t h e Board h o l d s
a c c o u n t a b l e f o r c o n d i t i o n s and p o l i c i e s w i t h i n t h e premise. *
No t h i n g in p r e m i s e s l i c e n s i n g re1 i e v e s i n d i v i d u a l l i c e n s e e s
of r e s p o n s i b i l i t y f o r t h e q u a l i t y of t h e i r own medical t r e a t m e n t
o r f o r premise c o n d i t i o n s c l e a r l y under t h e i r c o n t r o l . And, t h e
R e p o r t ' s c o n t e n t i o n t h a t t h e Board a l r e a d y has s u f f i c i e n t a u t h o r -
i t y t o p r o p e r l y d i s c i p l i n e i n " p r e m i s e s - r e l a t e d " m a t t e r s is with-o
u t merit.
The c a s e s s e l e c t e d t o s u p p o r t t h e Audit Team's c o n c l u s i o n
t h a t t h e Board h a s p r e v i o u s l y a c t e d a g a i n s t an i n d i v i d u a l ' s
l i c e n s e i n " premises- type" s i t u a t i o n s ( and t h e r e f o r e d o e s n o t
need premise l i c e n s i n g ) , prove t o t h e c o n t r a r y .
Case 1, d e s c r i b e d on p a g e 1 4 , d i d n o t r e s u l t i n d i s c i p l i n e
of t h e i n d i v i d u a l l i c e n s e e f o r p r e m i s e - r e l a t e d v i o l a t i o n s ,
b u t f o r t h a t l i c e n s e e ' s i n d i v i d u a l r e s p o n s i b i t y i n t h e c a s e
f o r f a i l i n g t o p e r s o n a l l y monitor t h e d o g ' s t r e a t m e n t and
f o r n o t g i v i n g a d e q u a t e i n s t r u c t i o n s t o t h e a t t e n d a n t . The
p r e m i s e - r e l a t e d v i o l a t i o n s were n o t a d d r e s s e d by t h e Board.
Case 2 , a s d e s c r i b e d on page 15 a c c u r a t e l y s t a t e s t h a t t h e
Board d e t e r m i n e d t h e i n d i v i d u a l l i c e n s e e ' s medical s e r v i c e
was a p p r o p r i a t e and a c c e p t a b l e and took no s p e c i f i c a c t i o n .
The d e s c r i p t i o n f u r t h e r s t a t e s , " However, t h e Board recom-mended
t o b o t h t h e owner and D r . A t h a t t h e communication
system be improved and t h a t animal owners be g i v e n more con-cise
i n f o r m a t i o n . " I f it is t h e Audit Team's c o n t e n t i o n
t h a t a recommendation by t h e Board t o a premise owner over
which it had n o t t h e s l i g h t e s t power c o n s t i t u t e s proof t h a t
t h e Board is s u f f i c i e n t l y empowered t o h a n d l e p r e m i s e s -
r e l a t e d m a t t e r s w i t h o u t premise l i c e n s i n g , t h e y v a s t l y m i s -
c o n s t r u e t h e weight of such a " recommendation".
" BOMEX" Model
While it may be t r u e t h a t BOMEx h o l d s i t s l i c e n s e e s u l t i -
m a t e l y r e s p o n s i b l e f o r t o t a l p a t i e n t c a r e , t h e V e t e r i n a r y Medical
Examining Board d o e s n o t f i n d t h i s a v a l i d means of d e a l i n g w i t h
its l i c e n s e e s or t h e p u b l i c i n t e r e s t i n r e l a t i o n t o t h e c a r e o f
l i v e s t o c k and p e t s . Human medical f a c i l i t i e s g e n e r a l l y a r e reg-u
l a t e d , l i c e n s e d and s u p e r v i s e d by a number of a g e n c i e s , a l t h o u g h
i n d i v i d u a l d o c t o r s ' o f f ices a r e a p p a r e n t l y n o t s u p e r v i s e d . Un-l
i k e a d o c t o r ' s o f f i c e where s e r v i c e s a r e l a r g e l y l i m i t e d t o
examination and d i a g n o s i s , i n v e t e r i n a r y p r e m i s e s , s e r v i c e s may
r a n g e from s i m p l e b o a r d i n g ( h o t e l f u n c t i o n s ) , t o t h e most complex
and s p e c i a l i z e d s u r g e r i e s and p o s t - o p e r a t i v e c a r e , i n c l u d i n g
emergency t r e a t m e n t . Although t h e BOMEX model may be s u i t e d t o
t h e medical p r o f e s s i o n , it is n o t s u i t e d t o t h e v e t e r i n a r y pro-f
e s s i o n .
P r o h i b i t i o n s on Non- Licensed O- n- w- e r s
The Audit Team s u g g e s t s t h a t i n t h e c a s e o f n o n - l i c e n s e d
premise owners, medical policy- making be 1 i m i t e d t o l i c e n s e e s .
F u r t h e r , L e g i s l a t i v e Council is quoted t o t h e e f f e c t t h a t pro-h
i b i t i n g n o n - l i c e n s e d p e r s o n s from t h e s e a c t i v i t i e s would mean
t h a t l i c e n s e e s were r e s p o n s i b l e f o r same. I£ we understand t h i s
c o r r e c t l y , n o n - l i c e n s e d p e r s o n s ( o v e r whom t h e ~ o a r d h a s no
s t a t u t o r y power) would be p r e v e n t e d from a c t i n g in medical pol i c y
a r e a s , and t h a t employed l i c e n s e e s would be p e r m i t t e d by such
n o n - l i c e n s e d owners t o make a l l d e c i s i o n s r e l a t i n g t o " p o l i c i e s
and o p e r a t i o n s which a f f e c t t r e a t m e n t and c a r e o f a n i m a l
p a t i e n t s " .
I n o r d e r t o p r o v i d e t h e Board w i t h a u t h o r i t y t o l i m i t medi-c
a l p o l icy- making t o 1 i c e n s e e s , t h e Report s u g g e s t s s t a t u t o r y
amendment t o i n c l u d e a s a d e f i n i t i o n of p r a c t i c i n g v e t e r i n a r y
medicine w i t h o u t a l i c e n s e , a t t e m p t i n g t o c o n t r o l p o l i c i e s and
o p e r a t i o n s a f f e c t i n g t h e t r e a t m e n t and c a r e of a n i m a l s . Prac-t
i c i n g v e t e r i n a r y medicine w i t h o u t a l i c e n s e , with p a s s a g e of HB
2051, is a C l a s s One misdemeanor. Any c a s e s of t h i s n a t u r e a r e
r e f e r r e d t o t h e a p p r o p r i a t e County A t t o r n e y , s i n c e t h e Board h a s
j u r i s d i c t i o n o n l y over l i c e n s e e s . The p r o s e c u t i o n of C l a s s One
misdemeanors by County A t t o r n e y s is n o t o r i o u s l y l a c k i n g . Many
more s e r i o u s v i o l a t i o n s occupy t h e i r t i m e and b u d g e t s . Thus, i f
a n y n o n - l i c e n s e d owner a c t e d i n p r e m i s e - r e l a t e d pol i c y a r e a s , an
employeed l i c e n s e e ' s o n l y r e c o u r s e would be t o immediately r e s i g n
employment t o p r o t e c t h i s l i c e n s e , and t h e B o a r d ' s o n l y r e c o u r s e
would be t o n o t i f y t h e a p p r o p r i a t e County A t t o r n e y . Such c a s e s
would d i s a p p e a r i n t o an over taxed system, and consumer i n v o l v i n g
premise i s s u e s c o m p l a i n t s would g o u n r e s o l v e d .
In a d d i t i o n , t h e Board f a i l s t o u n d e r s t a n d how, under t h e
s u g g e s t e d s t r u c t u r e , it would d e t e r m i n e which among s e v e r a l
e m p l o y e e v e t e r i n a r i a n s is r e s p o n s i b l e t o t h e Board f o r s u c h
policy- making f u n c t i o n s . Non- licensee owners could i n no way be
r e q u i r e d t o d e s i g n a t e an employee v e t e r i n a r i a n a s r e s p o n s i b l e f o r
pol i c y .
Rules and R e g u l- a-- t i o n s
The r e g u l a t o r y p r o c e s s is never f i n i t e , and i f an agency is
doing its j o b , r u l e s and r e g u l a t i o n s a r e c o n s t a n t l y undergoing
change and u p d a t i n g . The Board expended c o n s i d e r a b l e e f f o r t i n
p r e p a r i n g t h e f i r s t r u l e s s u b m i t t a l , however, s c r u t i n y by t h e
A t t o r n e y G e n e r a l ' s Off ice d e t e c t e d i n s u f f i c i e n c i e s . A s t h e s e a r e
being a d d r e s s e d , new s i t u a t i o n s w i l l a r i s e r e q u i r i n g modif i c a -
t i o n , a d d i t i o n and e l i m i n a t i o n of r u l e s a l r e a d y c e r t i f i e d . The
r u l e s and r e g u l a t i o n s d e n i e d c e r t i f i c a t i o n by t h e A t t o r n e y
G e n e r a l , a l t h o u g h a p p r o v e d b y t h e G o v e r n o r ' s R e g u l a t o r y Review
Committee, were t h e f i r s t s u b m i t t e d by t h i s Board i n i n t e r p r e t i n g
and d e l i n e a t i n g a c o m p l e t e l y new program. ~ f our agency were
s u p p l i e d w i t h an a d m i n i s t r a t o r , t h e p r e p a r a t i o n o f r u l e s and
r e g u l a t i o n s might proceed more r a p i d l y . N e v e r t h e l e s s , we a r e
p r o c e e d i n g , and we t h i n k it is not y e t t i m e l y t o judge t h e merit
o f t h e e n t i r e program.
FINDING 11: ISSUANCE OF LEGAL DOCUMENTS
The Board d o e s n o t d i s p u t e t h e lengthy d e l a y s i n t h e c a s e s
noted by the Audit Report. We would hasten to p o i n t out s e v e r a l
of f a c t o r s overlooked by t h e Audit Team, however.
1. Of the seven documents l i s t e d in TABLE 3 ( pg 24) four
were of a t e c h n i c a l n a t u r e r e l a t i n g to u n t i m e l y r e n e w a l ,
f a i l u r e to s e c u r e s u f f i c i e n t Continuing Education cred-i
t s f o r r e n e w a l , e t c . A l l of t h e s e v i o l a t i o n s were
cured within days of the Board's d e t e r m i n a t i o n and the
i s s u a n c e of documents was a f o r m a l i t y . In none of t h e s e
c a s e s was t h e p u b l i c i n t e r e s t a t r i s k .
2. Contrary to the i m p l i c a t i o n s of t h i s Report, the Board
did not simply ignore t h e s e d e l a y s . A budgetary " over-s
u f f i c i e n c y " during 1982 enabled the Board t o h i r e a law
c l e r k through the Attorney G e n e r a l ' s o f f i c e t o , among
o t h e r t a s k s , help f i n a l i z e p r e p a r a t i o n of t h e l e g a l doc-uments
in q u e s t i o n .
3. The Audit Team has c a t e g o r i z e d a s " o u t s i d e t h e a u d i t
period" o t h e r a c t i o n s taken on a t i m e l y b a s i s by the
Board which were of a s i m i l a r l y s e r i o u s n a t u r e . The
Board has been unable t o c l e a r l y determine t h e period of
its a c i t i v i t y defined by t h e Audit Team a s " t h e Audit
P e r i o d " . I n reviewing Board a c t i o n s over a wider t i m e
f r a m e , it is a p p a r e n t t h e s e r e p r e s e n t anomolous i n -
s t a n c e s in the Board's h i s t o r y of complaint r e s o l u t i o n .
4. The Audit Report f a i l s t o t a k e n o t e of t h e f a c t t h a t
most of t h e s e documents were o r i g i n a l l y approved by t h e
Board ( pending n e g o t i a t i o n , i f any, and p r e p a r a t i o n )
during t h e t i m e of t h e p r i o r Sunset Review, when t h e
i n q u i r i e s of t h e previous Audit Team were occupying a
g r e a t d e a l of t i m e of Board members and those persons in
t h e S t a t e B o a r d ' s O f f i c e and t h e A t t o r n e y G e n e r a l ' s
Office who provide support t o the Board's a c t i v i t i e s .
5. The Board experienced a s i g n i f i c a n t turn- over of members
d u r i n g 1982 and t h e new members wished t o r e v i e w i n
d e t a i l t h e c a s e s which t h e documents r e f e r r e d t o i n
order to s a t i s f y themselves t h a t they would a f f i x t h e i r
s i g n a t u r e s . his was e s p e c i a l l y t r u e i n r e g a r d t o the
two s u b s t a n t i v e , or non- technical c a s e s .
FINDING 111: LICENSURE REQUIREMENTS FOR OUT- OF- STATE LICENSEES
The Board v e r y s t r o n g l y d i s a g r e e s w i t h t h e c o n c l u s i o n of t h e
Audit Team t h a t t h e Board u n n e c e s s a r i l y r e s t r i c t s l i c e n s u r e in
Arizona o f o t h e r s t a t e s ' l i c e n s e e s . This e n t i r e s e c t i o n of t h e
r e p o r t is based on g e n e r a l i z a t i o n s and i n v a l i d comparisons. No
documentation is provided t h a t a n y c o m p e t e n t a p p l i c a n t 1 i c e n s e d
i n a n o t h e r s t a t e h a s g o n e u n l i c e n s e d i n A r i z o n a . The A u d i t
Report p r o v i d e s no f i g u r e s on f a i l u r e by such a p p l i c a n t s l i c e n s e d
i n o t h e r j u r i s d i c t i o n s compared t o u n l i c e n s e d a p p l i c a n t s , nor any
f i g u r e s on what p o r t i o n of t h e examination ( N a t i o n a l or Arizona)
was f a i l e d by such l i c e n s e d a p p l i c a n t s .
The s u g g e s t i o n t h a t t h e Board l i c e n s e by endorsement a p p l i -
c a n t s who a r e l i c e n s e d i n o t h e r s t a t e s , may have t h e p r a c t i c a l
e f f e c t o f A r i z o n a becoming a s t a t e t h r o u g h which m a r g i n a l l y
q u a l i f i e d p r a c t i t i o n e r s can e a s i l y s e c u r e a l i c e n s e a s " i n s u r -
ance" a g a i n s t l o s s of l i c e n s u r e e l s e w h e r e .
L i c e n s i n g . by endorsement would r e q u i r e t h e Arizona Board t o
assume t h a t :
1. o t h e r s t a t e s a c t i v e l y e n f o r c e q u a l i t y s t a n d a r d s t o t h e
same d e g r e e t h a t we do;
2. o t h e r s t a t e s r e q u i r e s i m i l a r l e v e l s of Continuing Educa-t
i o n t h a t we do, and t h a t o t h e r s t a t e s ' a s s o c i a t i o n s
make t h e same q u a l i t y of Continuing Education programs
r e a d i l y a v a i l a b l e a s does A r i z o n a ' s ;
F u r t h e r , t h e c r i t e r i o n of " good s t a n d i n g " i n a n o t h e r s t a t e
is not a d e q u a t e . D i s c l o s u r e and p r i v a c y c o n s i d e r a t i o n s may pre-v
e n t s t a t e b o a r d s from r e v e a l i n g t h a t a l i c e n s e " i n good stand-ing"
may be under i n v e s t i g a t i o n or s u b j e c t t o o t h e r p r o c e e d i n g s .
P r e v i o u s e x p e r i e n c e h a s shown t h a t l i c e n s e e s under i n v e s t i g a t i o n
or t h r e a t of d i s c i p l i n e o f t e n remove t h e m s e l v e s t o o t h e r s t a t e s ,
e s p e c i a l l y s t a t e s with l e n i e n t l i c e n s u r e p r a c t i c e s . Thus, t h e y
l e a v e a s t a t e while t h e i r l i c e n s e is " i n good s t a n d i n g " .
Other s t a t e b o a r d s may then f a i l t o complete t h e i r a c t i o n s
due t o c o s t or o t h e r c o n s i d e r a t i o n s , not t h e l e a s t of which is
t h a t - t- h e i r problem h a s d i s a p p e a r e d . Even i f i n f o r m a t i o n l a t e r
r e a c h e s t h i s Board t h a t a c t i o n is impending o r has been taken
a g a i n s t a l i c e n s e e i n a n o t h e r j u r i s d i c t i o n , i f t h i s ~ o a r d had
a l r e a d y l i c e n s e d by endorsement, it can a s a p r a c t i c a l m a t t e r
t a k e no a c t i o n a g a i n s t t h e s u b j e c t l i c e n s e e even i f v e r y s e r i o u s
v e t e r i n a r y misconduct were i n v o l v e d . The c o s t s of " re- hear ing"
t h e c a s e i n our s t a t e , i n v e s t i g a t i n g , t r a n s p o r t i n g w i t n e s s e s , and
SO f o r t h , n o t t o mention t h e concommitant t i m e d e l a y s would pro-h
i b i t t h e Arizona Board from a d e q u a t e l y p r o t e c t i n g t h e p u b l i c
i n t e r e s t i n t h i s r e g a r d .
Non- Veter i n a r y Members
In 1979 t h e S t a t e L e g i s l a t u r e d e t e r m i n e d t h a t l a y p e r s o n s
should s e r v e on p r o f e s s i o n a l l i c e n s i n g b o a r d s , i n p a r t t o s e r v e
a s watchdogs of t h e p u b l i c i n t e r e s t so t h a t p r o f e s s i o n s c o u l d n o t
h a v e a f r e e hand i n r e s t r i c t i n g c o m p e t i t i o n or t h e e n t r y i n t o
Arizona of q u a l i f i e d c o - p r o f e s s i o n a l s . The r e a d e r may f i n d it
e n l i g h t e n i n g t h a t b o t h n o n - v e t e r i n a r i a n s on t h e Board a r e
c o m p l e t e l y opposed t o l i c e n s u r e by endorsement. One of t h e non-v
e t e r i n a r i a n members of t h i s Board, when f i r s t a p p o i n t e d , was
w h o l e h e a r t e d l y i n f a v o r o f t h e c o n c e p t of r e c i p r o c a l l i c e n s i n g .
However, p e r s o n a l e x p e r i e n c e i n t h e t e n e x a m i n a t i o n s which have
been h e l d d u r i n g t h i s member's t e n u r e have r e s u l t e d i n a c a t e g o r -
i c a l s h i f t . T h i s s h i f t t o s t r i c t o p p o s i t i o n t o l i c e n s u r e by
endorsement o r o t h e r form of r e c i p r o c a l l i c e n s u r e h a s a r i s e n from
r e p e a t e d l y being p r e s e n t e d w i t h l i c e n s e e s o f o t h e r s t a t e s who
were p l a i n l y no l o n g e r competent t o p r o v i d e v e t e r i n a r y s e r v i c e s .
Arizona P r a c t i t i o n e r s
The Audit R e p o r t , however s u g g e s t s t h a t s i n c e " o l d e r " A r i -
zona l i c e n s e e s a r e n o t s u b j e c t e d t o p e r i o d i c e x a m i n a t i o n s , o u r
p r o c e d u r e s d i s c r i m i n a t e a g a i n s t i n c o m i n g v e t e r i n a r i a n s . The
Board d i s a g r e e s . Throughout t h e i r t e n u r e of p r a c t i c e w i t h i n t h i s
s t a t e , Arizona l i c e n s e e s have been s u b j e c t t o b o t h Continuing Ed-u
c a t ion r e q u i r e m e n t s f o r 1 i c e n s e r e n e w a l , and p o t e n t i o n a l s . The
r e a d e r may f i n d it en1 i g h t e n i n g t h a t b o t h non- veter i n a r i a n s on
t h e Board a r e c o m p l e t e l y opposed t o l i c e n s u r e by endorsement.
One of t h e n o n - v e t e r i n a r i a n members of t h i s Board, when f i r s t
a p p o i n t e d , was w h o l e h e a r t e d l y i n f a v o r of t h e c o n c e p t o f r e c i p r o -
c a l l i c e n s i n g . However, p e r s o n a l e x p e r i e n c e i n t h e t e n examina-t
i o n s which h a v e b e e n h e l d d u r i n g t h i s m e m b e r ' s t e n u r e h a v e
r e s u l t e d in a c a t e g o r i c a l s h i f t . This s h i f t t o s t r i c t o p p o s i t i o n
t o l i c e n s u r e b y e n d o r s e m e n t o r o t h e r form of r e c i p r o c a l l i c e n s u r e
h a s a r i s e n from r e p e a t e d l y b e i n g p r e s e n t e d w i t h l i c e n s e e s o f
o t h e r s t a t e s who were p l a i n l y no l o n g e r competent t o p r o v i d e v e t -
er i n a r y s e r v i c e s .
Arizona P r a c t i t i o n e r s
The Audit R e p o r t , however s u g g e s t s t h a t s i n c e " o l d e r " A r i -
zona l i c e n s e e s a r e n o t s u b j e c t e d t o p e r i o d i c e x a m i n a t i o n s , our
p r o c e d u r e s d i s c r i m i n a t e a g a i n s t i n c o m i n g v e t e r i n a r i a n s . The
Board d i s a g r e e s . Throughout t h e i r t e n u r e of p r a c t i c e w i t h i n t h i s
s t a t e , Arizona l i c e n s e e s have been s u b j e c t t o b o t h Continuing
Education r e q u i r e m e n t s f o r 1 i c e n s e r e n e w a l , and p o t e n t i a l d i s c i -
p l i n a r y a c t i o n i n any c o m p l a i n t s which might a r i s e a g a i n s t them.
The Board h a s i n t h e p a s t o f f e r e d r e - e x a m i n a t i o n a s an
a l t e r n a t i v e t o being forced t o r e l i n q u i s h a l i c e n s e subsequent t o
a competency hearing . A d d i t i o n a l l y , i n c a s e s r e s u l t i n g in d i s c i -
p l i n a r y a c t i o n r e l a t e d t o reduced competency, the Board o f t e n
makes it a c o n d i t i o n of its d i s c i p l i n e t h a t t h e s u b j e c t l i c e n s e e
study s p e c i f i c a r e a s of v e t e r i n a r y medicine over and above t h e
Continuing Education c r e d i t s r e q u i r e d for renewal. Thus, a l -
though t h e a p p l i c a t i o n of q u a l i t y s t a n d a r d s is somewhat d i f f e r e n t
i n e x e c u t i o n f o r l i c e n s e e s p r a c t i c i n g for some t i m e in Arizona
compared t o v e t e r i n a r i a n s applying f o r l i c e n s u r e a f t e r some y e a r s
of p r a c t i c e elsewhere, each group is t r e a t e d in a manner consis-t
e n t with the Board's s t a t u t o r y purpose, and w e b e l i e v e , f a i r l y .
F u r t h e r , one of t h e B o a r d ' s r e c e n t l e g i s l a t i v e r e q u e s t s
( 1982) s u c e s s f u l l y t i g h t e n e d s t a t u t o r y language on renewal of
l i c e n s e s allowed t o l a p s e . P r e v i o u s l y , any v e t e r i n a r i a n once
l i c e n s e d in Arizona who allowed t h i s l i c e n s e t o l a p s e could r e i n -
s t a t e simply by paying a " l a t e penalty" and the c u r r e n t renewal
f e e , r e g a r d l e s s of how long t h e l i c e n s e had l a p s e d , or whether
t h e v e t e r i n a r i a n had been p r a c t i c i n g or maintaining s u i t a b l e Con-t
i n u i n g Education elsewhere. Under t h e old s t a t u t e , t h e r e was
s u b s t a n t i a l q u e s t i o n whether the Board could have p r o h i b i t e d such
r e i n s t a t e m e n t even i f t h e l i c e n s e e had during t h e l a p s e acted in
a manner which would have r e s u l t e d in suspension or r e v o c a t i o n of
t h e l i c e n s e .
FINDING IV: AUTHORITY TO DISCIPLINE FOR POOR RECORDKEEPING
R u l e s p e r t a i n i n g t o r e c o r d k e e p i n g were c e r t i f i e d by t h e
A t t o r n e y G e n e r a l ' s O f f i c e on A p r i l 24, 1984. S i n c e t h e s e were
a d o p t e d p e n d i n g c e r t i f i c a t i o n , t h e y w i l l be e f f e c t i v e immediately
upon f i l i n g with t h e S e c r e t a r y of S t a t e ' s O f f i c e .
The s p e c i f i c r u l e , R3- 11- 52, a p p e a r s i n Article 5, P r o f e s -
s i o n a l E t h i c s and S t a n d a r d s and t h u s p e r m i t s t h e Board t o
d i s c i p l i n e i n d i v i d u a l v e t e r i n a r i a n s . F u r t h e r , t h r o u g h HB 2051
t h e Board has amended s t a t u t o r y l a n g u a g e i n 32- 2274 w i t h r e g a r d
t o p r e m i s e s l i c e n s i n g t o e l i m i n a t e any p o t e n t i a l c o n f u s i o n a s
r e f e r r e d t o i n t h e Report ( pg 3 6 ) . Note f u r t h e r t h a t t h e s t a t e -
ments c o n t a i n e d i n t h e f i r s t p a r a g r a p h t h a t t h i s r u l e would a p p l y
o n l y t o p r e m i s e s a r e i n c o r r e c t , which a b r i e f p e r u s a l of t h e
r u l e s s u b m i t t a l would have r e v e a l e d .
OTHER COMMENTS
A u d i t Timing
In a p p r o x i m a t e l y June of 1981, a S u n s e t Review was begun on
t h e Board o f V e t e r i n a r y Medical Examiners. The Report a r i s i n g
from t h i s review was p r e s e n t e d t o t h e J o i n t Committee of Refer-ence
d u r i n g November of 1981. In a d d i t i o n t h e n e c e s s a r y r e i n -
s t a t e m e n t l e g i s l a t i o n , a number of s t a t u t o r y changes were sought
by t h e Board i n r e s p o n s e t o t h e Review. The 1981 Sunset Review
d i d n o t e v a l u a t e premise l i c e n s i n g , t h e r e f o r e t h e 1982 l e g i s l a -
t i o n a l s o set t h e n e x t Sunset Review f o r an u n u s u a l l y s h o r t t i m e
frame and scheduled t h e Board t o t e r m i n a t e on June 30, 1985.
Among t h e changes made i n r e s p o n s e t o t h e 1 9 8 1 S u n s e t Review
were a move t o b i - a n n u a l l i c e n s i n g ; a d d i t i o n of t h e a b i l i t y t o
t a k e c e r t a i n r e s t r i c t e d t y p e s of d i s c i p l i n a r y a c t i o n on t h e b a s i s
of i n f o r m a l Board h e a r i n g s ; u s e of a p r o f e s s i o n a l l y - p r e p a r e d ,
n a t i o n a l l y - a d m i n i s t e r e d Cl i n i c a l Competency e x a m i n a t i o n ; and pro-c
e d u r a l changes i n r e l a t i o n t o our s t a t e e x a m i n a t i o n .
Approximately 12 months f o l l o w i n g t h e i n s t i t u t i o n of most of
t h e 1981 Audit Team1 s recommendations, t h e d i s c o v e r y p e r i o d of
t h e second Audit began. Thus, it a p p e a r s t h a t w i t h r e g a r d t o
g e n e r a l c r i t e r i a , t h e 1983 Audit covered a p e r i o d of from approx-i
m a t e l y mid- 1981 t o t h e end of 1983, a r e l a t i v e l y s h o r t p e r i o d of
t i m e . When it is c o n s i d e r e d t h a t t h e e f f e c t i v e d a t e of recom-mended
changes may have been a s l a t e a s mid- t o l a t e - 1 9 8 2 , t h e
p e r i o d reviewed by t h e 1983 Audit Team which c o u l d b e e x p e c t e d t o
r e v e a l Board a c t i o n s a s based on changes i n s t i t u t e d a f t e r t h e
p r i o r A u d i t , s h r i n k s even f u r t h e r .
C o n s i d e r i n g t h a t t h e Board had been so r e c e n t l y reviewed,
it would h a v e been more a p p r o p r i a t e t o s c h e d u l e t h i s p r e s e n t
a u d i t t o b e g i n d u r i n g 1984. The due d a t e f o r p r e s e n t a t i o n of
t h i s r e p o r t t o t h e J o i n t Committee of Reference is October 1,
1984; t h u s t h e Audit could have s t a r t e d i n 1984 and s t i l l have
been completed p r i o r t o t h e due d a t e . This would h a v e a l l o w e d
t h e Board a d d i t i o n a l t i m e t o a d m i n i s t e r and u t i l i z e c h a n g e s
i n s t i t u t e d a s a r e s u l t o f t h e p r i o r A u d i t . And, t h e p r e s e n t
Audit c o u l d have covered a l o n g e r p e r i o d , t h e r e b y p r o v i d i n g a
more a c c u r a t e p i c t u r e of t h e B o a r d ' s a c t i v i t i e s under t h e new
s t a t u t e s , r e g u l a t i o n s and a d m i n i s t r a t i v e c h a n g e s .
A b i l i t y t o Respond
The g e n e r a l t i m e l i n e a l l o t e d f o r the Audit procedure is not
made known t o t h e s u b j e c t agency except ( a s noted above) in re-gard
to t h a t agency's allowed response t i m e s . As a small 90/ 10
agency, with support s e r v i c e s provided s o l e l y by employees of t h e
S t a t e Boards Administrative O f f i c e , the Sunset Review process is
q u i t e burdensome.
Personnel of t h e S t a t e Boards O f f i c e a r e shared by t e n sep-a
r a t e agencies. In t h i s Board's c a s e , ASBAO provides approxi-mately
one- half of a s e c r e t a r y , a p o r t i o n of a bookkeeper's t i m e ,
and some c l e r i c a l s u p p o r t .
Board members l i v e throughout t h e s t a t e , and the Board meets
only once a month. Since Board members c a n n o t b e expected t o
keep complete f i l e s o t h e r than the c e n t r a l f i l e s maintained by
ASBAO, response to Audit Team i n q u i r i e s , u s u a l l y r e q u i r e d " on t h e
spot" whether by phone o r i n person, a r e from memory and consul-t
a t i o n of f i l e s is not permitted by t h e process. Members not
l i v i n g in Phoenix a r e l a r g e l y prevented from p a r t i c i p a t i n g i n t h e
Board's response, s i n c e response p e r i o d s a r e l i m i t e d t o ten work-ing
days.
Other Personnel Matters
Both t h i s response and the Audit Report make r e f e r e n c e to
the f a c t t h a t the Board is not happy with t h e l e v e l of s e r v i c e s
t h e S t a t e Boards O f f i c e is p r e s e n t l y capable of p r o v i d i n g . Due
in p a r t perhaps t o t h e n a t u r e of v e t e r i n a r y medicine and t h e emo-t
i o n a l attachments of c l i e n t s t o t h e i r p e t s , t h e Board r e c e i v e s a
d i s p r o p o r t i o n a t e number of complaints t o t h e number of l i c e n s e e s
it governs. T h e r e f o r e , a l t h o u g h it is a " small Board'' it has
a d m i n i s t r a t i v e needs beyond t h o s e of s i m i l a r l y s m a l l b o a r d s .
The shared employees within ASBAO a r e c l a s s i f i e d a s secre-t
a r i e s , c l e r k s and bookkeepers; none a r e a d m i n i s t r a t o r s . The
monthly meetings Board members a r e a b l e to v o l u n t e e r away from
t h e i r p r a c t i c e s and b u s i n e s s e s should l a r g e l y be s p e n t on p o l i c y
m a t t e r s . However, the bulk of t h i s t i m e is s p e n t a d m i n i s t e r i n g
much of t h e b a s i c b u s i n e s s of the Board, and o n l y l i m i t e d t i m e is
a v a i l a b l e to devote t o p o l i c y m a t t e r s .
Some Boards served by ASBAO c o n t i n u e t o o f f i c e t h e r e , and
r e c e i v e c l e r i c a l and bookeeping s u p p o r t , b u t provide t h e i r own
a d m i n i s t r a t i v e p e r s o n n e l . Other ~ o a r d sh ave chosen t o s e v e r
t h e i r r e l a t i o n s h i p with ASBAO. The Board's most r e c e n t l y passed
l e g i s l a t i o n f o r t h e f i r s t t i m e empowers it t o h i r e p e r s o n n e l
o t h e r than an i n v e s t i g a t o r . The Board w i l l now begin t o e v a l u a t e
how it might b e s t improve i t s a b i l i t y t o f u n c t i o n in r e l a t i o n t o
t h i s new empowerment.
Cost E f f e c t i v e n e s s
The Auditor G e n e r a l ' s budget o u t l i n e f o r t h i s r e c e n t Audit
p r o v i d e s $ 2 3 , 5 0 0 f o r t h e s a l a r i e s , b e n e f i t s and e x p e n s e s o f
employees a t t h e Audit Team l e v e l and above. The d o l l a r v a l l u e
a l l o t t e d f o r a g e n c y o v e r h e a d and s e c r e t a r i a l s u p p o r t i s n o t
i n c l u d e d . I t is n o t p o s s i b l e t o c a l c u l a t e t h e c o s t t o t h e sub-ject
agency i n terms t i m e expended by Board members, by A t t o r n e y
G e n e r a l ' s O f f i c e employees, o r by t h e v a r i o u s employees of t h e
S t a t e Boards O f f i c e whose t i m e is s h a r e d by t h i s Board.
However, u s i n g simply t h e $ 23,500 f i g u r e , t h e 1983 Audit
budget c o n s t i t u t e s over h a l f of what it is p r o j e c t e d t h a t t h e
B o a r d ' s annual e x p e n d i t u r e f o r f i s c a l 1983/ 84 w i l l be. A t t h e
end of t h e t h i r d f i s c a l q u a r t e r , t h e Board h a s s o f a r u t i l i z e d
$ 3 3 , 0 9 8 o f i t s a p p r o p r i a t i o n . Even c o n s i d e r i n g t h e upcoming
e x p e n s e o f a h e a r i n g i n N o r t h e r n A r i z o n a , it is d i f f i c u l t t o
i m a g i n e t h a t t h e Board w i l l s p e n d a s much a s $ 4 5 , 0 0 0 i n t h i s
f i s c a l y e a r .
No where i n t h e A u d i t R e p o r t a r e t h e r e any f i n d i n g s o r sug-g
e s t e d programs which would p r o v i d e s a v i n g s o r g e n e r a t e r e v e n u e s
a p p r o a c h i n g t h e economic v a l u e o f t h e f u n d s e x p e n d e d i n t h i s
Audit. F u r t h e r , a s a 90/ 10 agency, t h e Board p r o v i d e s t e n per-c
e n t of i t s annual revenues t o t h e General Fund. Because of t h e
B o a r d ' s b i - a n n u a l l i c e n s u r e it is n e c e s s a r y t o look a t a two- year
p e r i o d t o d e r i v e an e s t i m a t e d annual f i g u r e . Combining a c t u a l
income f o r f i s c a l 1982/ 83 and a n t i c i p a t e d r e v e n u e s f o r f i s c a l
1 9 8 3 / 8 4 , Board a n n u a l r e v e n u e f o r f i s c a l 1 9 8 2 / 8 3 and 1983/ 84
should a v e r a g e $ 61,800. Thus t h e General Fund can a n t i c i p a t e an
a v e r a g e d a n n u a l r e c e i p t from t h e Board t h i s y e a r o f $ 6,180, or
f a r less t h a n t h e $ 23,500 f i g u r e .
A s was t h e c a s e i n t h e 1981 Audit Report, t h i s r e c e n t Audit
Report g e n e r a l l y g i v e s t h e Board p o s i t i v e marks. Suggested l e g -
i s l a t i v e and o t h e r c h a n g e s h a v e b e e n p r o m p t l y i n i t i a t e d . In
f a c t , some of t h e l e g i s l a t i v e and r e g u l a t o r y changes recommended
i n t h i s r e c e n t Report were a n t i c i p a t e d by t h e Board by more than
two y e a r s . This c u r r e n t Report i n c l u d e s t h e f o l l o w i n g s t a t e m e n t s
c h a r a c t e r i z i n g t h e Board:
1. " g e n e r a l l y o p e r a t i n g e f f e c t i v e l y and e f f i c i e n t l y ..."
2. " o p e r a t e s i n t h e p u b l i c i n t e r e s t by e n s u r i n g p r a c t i c i n g
v e t e r i n a r i a n s . . . meet minimum l i c e n s i n g s t a n d a r d s and a r e
d i s c i p l i n e d when n e c e s s a r y ."
3. " r u l e s and r e g u l a t i o n s appear t o b e c o n s i s t e n t with its
l e g i s l a t i v e mandate."
4. " has complied w i t h Open Meeting Law on p u b l i c meetings."
5. " h a s a d e q u a t e l y i n v e s t i g a t e d and r e s o l v e d m o s t com-p
l a i n t s ..."
6. ( h a s ) f u l l a u t h o r i t y . . . a v a i l a b l e t o enforce the Board's
enabling s t a t u t e s ."
7. " t e r m i n a t i n g the Board could s i g n i f i c a n t l y harm p u b l i c
h e a l t h .
8. " l e v e l of r e g u l a t i o n f o r l i c e n s i n g v e t e r i n a r i a n s is
a p p r o p r i a t e . "
I t seems a p p r o p r i a t e to suggest a t t h i s p o i n t t h a t t h e S t a t e
L e g i s l a t u r e may wish t o review t h e g u i d e l i n e s u t i l i z e d for Sunset
Review of small a g e n c i e s , par titularly 90/ 10 agencies.