Pet/Client/Veterinarian MedicoLegal Relationship

Debbie writes:
Dear Dr. Randolph, Does a cat have to be examined to have Revolution flea control [and heartworm preventive]prescribed? My cat was last examined December of 2008 (17 months ago). He is a healthy, happy cat who has been treated with Revolution monthly for 2+ years with no problems. His next shots are not due till next year and unless he is sick I do not want to take him in and really don’t have the money to spend if there is no reason. Is it required by law that he be examined (since it is more than a year since the last one) before his doctor can re-prescribe it?
Lori writes:
Hello. We decided to let a stray cat come into our house. We have other cats so I gave the stray (otherwise perfectly healthy in appearance) a dose of Revolution to prevent the spread of fleas. The poor thing died a week later. Did I kill her by giving her the Revolution? I worry that maybe she had heartworms and it killed the worms and clogged her heart?

Dr. Randolph replies:
Doctor-client-patient relationship is a veterinary medicolegal term, the “human equivalent” of which is doctor-patient relationship.

We won’t get bogged down in the technical attorney language that defines the relationship, but the foundation is that a doctor has seen a patient within a specified time period which varies by state law.

How does this legal relationship affect you and your pet? That also varies, according to the demands placed on the relationship.

Let’s start with an extreme: no doctor-client-patient relationship. Veterinarians sometimes get phone calls such as this one: “My cat got bitten by something and the wound is infected. How much would some antibiotics cost for him?”

Antibiotics are prescription medications, the use of which is regulated by both federal and state law. Just as surely as a physician who has never seen you or your child wouldn’t prescribe antibiotics over the phone, veterinarians are identically bound by the same law.

If I had seen this kitty before, but it had been several years, the law would consider our doctor-client-patient relationship to have lapsed. To “renew” it would require an examination of the patient to determine its basic health, as well as the specific medical and surgical needs the wound would present.

A general rule of thumb is that medicolegal relationships expire after one year.

Other constraints also affect a veterinarian’s relationship with his patients. Certain requirements apply to refills, for example.

Take heartworm preventives. While most veterinarians recommend that your pet be examined every six months as a way to catch undiagnosed problems early, heartworm tests must be performed at a maximum of a twelve-month interval. This rule applies even if your pet has his heartworm preventive administered on schedule every month, with no doses missed. Why? Because every medication has a known failure rate. If your pet’s heartworm preventive fails there are two considerations. One, you want to know right away that he has heartworms so that treatment is begun before significant damage can be done. Two, dogs who are infected with heartworms and receive heartworm preventive may have a reaction, and that reaction can be fatal.

That’s why your pet’s doctor requires a test prior to authorizing a refill for heartworm preventives of all kinds.

Seizure medications and thyroid supplements are other examples of medications requiring regular testing. In both cases the reason for regular testing is to know if a patient’s metabolism has caused a change in blood concentration of the medication outside therapeutic levels.

A medication at the opposite extreme from the first example, above, might be an allergy-blocking medication for a pet with chronic allergies. Because certain allergy medications have minimal risk for complications and side effects some leeway might be allowed for refills.

Only your own veterinarian can tell you the exact guidelines he follows for his own practice.

Remember, too, that the most important thing that happens on every patient visit is the physical examination. In answer to the part of Debbie’s post, “if there is no reason,” the best reason for her kitty to see the doctor is that he hasn’t had an examination  for a year and a half.

Likewise, Lori “violated” the guideline of administering medication dispensed to another pet. While the Revolution probably wasn’t a factor in the new cat’s death, sharing medication is never a good idea. At the very least a phone call to the doctor’s office is in order prior to any action on which you are unsure.

Both of these readers’ questions clearly indicate the reason the federal Food and Drug Administration (FDA) saw fit to place this and many other medications under doctors’ control as prescription medications.

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