Federal Court Upholds Physical Exam Requirement

On March 27, the U.S. Court of Appeals for the Fifth Circuit found that Texas’ requirement that veterinarians must conduct a physical examination of an animal or its premises before they can practice veterinary medicine with respect to that animal does not violate the First or Fourteenth Amendments of the U.S. Constitution. The rule, similar to that found in the AVMA Model Veterinary Practice Act, states that a veterinarian-client-patient relationship (VCPR) may not be established solely by telephone or electronic means. Plaintiff Dr. Ronald Hines is a Texas-licensed veterinarian who used a website to provide veterinary advice to specific pet owners about their pets via email and telephone calls without conducting a physical examination of the patient. Dr. Hines charged a flat fee of $58 for his veterinary advice, though he would waive this fee if a pet owner could not afford to pay. At times, he refused to give advice if he felt that a physical examination was required.

The court rejected the First Amendment challenge to the Texas rule by finding that it does not regulate the content of any speech, require veterinarians to deliver any particular message, or restrict what can be said once a VCPR is established. Writing for the court, Justice Patrick Higginbotham explained that states have broad power to establish standards for licensing practitioners, and state regulation of a profession, even though it may have an incidental impact on speech, does not violate the Constitution. The court also upheld dismissal of Dr. Hines’ equal protection and due process claims, concluding that the physical examination requirement is rationally related to a legitimate government interest. According to the opinion, the requirement that veterinary care be provided only after the veterinarian has seen the animal is, at a minimum, rational; it is reasonable to conclude that the quality of care will be higher, and the risk of misdiagnosis and improper treatment lower, if the veterinarian physically examines the animal in question before treating it. A footnote states that while not decisive, the fact that the physical examination requirement was imposed following a change to the AVMA Model Veterinary Practice Act further supports the conclusion that the regulation is rational.

The plaintiff may appeal the decision to the U.S. Supreme Court. For now, the decision is expected to impede the development of Internet veterinary advice services.

6 thoughts on “Federal Court Upholds Physical Exam Requirement

  1. Bravo for a common sense decision by the courts. There is simply no substitute for “hands on” in improving diagnostic acumen. Palpation and auscultation are absolutely essential in a complete physical examination and often detect additional problems the owner/client may not be aware of. These additional problems could impact treatment advice and would be missed by an internet diagnosis, potentially harming the patient. Good decision!

  2. Dr. Hines needs to rethink practicing “online” veterinary medicine because the very first step in keeping with the “standards of care” begins with a competent, hands-on examination by a licensed veterinarian; and this only the minimum of standard care that is often considered in the outcome of many liability actions.

  3. Does this affect the ability of a radiologist or other specialist to give advice on the basis of electronically-transmitted images, even though such specialist may not have seen the patient? I am an orthopedist, and up until now I have received many images with requests from practitioners to advise them on what course of action may be advisable. Does this law put me in violation if I continue to do this? J. Roush DVM

    • Dr. Roush, what you are describing would fall into the realm of consultation between veterinarians and therefore not a violation of the VCPR rule.

  4. Its good effort to protect the profession and the animal heath concern with the accurate diagnosed by physical examination is must for better understand the disease o the behalf of sign and symptoms.