STATE OF NEVADA BOARD OF VETERINARY MEDICAL EXAMINERS

STATE OF NEVADA BOARD OF VETERINARY MEDICAL EXAMINERS MINUTES Thursday, October 13, 2016 Workshop for LCB File R110-16 and R076-16 AT Nevada Veterinary Medical Association Board Meeting Peppermill Reno Hotel 2707 S. Virginia St. Reno, Nevada 89502 Board Member Present: Davyd Pelsue, DVM Staff Present: Jennifer Pedigo, Executive Director-in-training; Louis Ling, Board Counsel; Debbie Machen, Patricia Handal, DVM, Board Investigator Public Present: Dr. Jen Vittori; Dr. Michelle Peacock; Dr. Jon Pennell; Dr. Boyd Spratling; Dr. Gary Ailes; Dr. Penny Purner; Dr. Sigfried Coady; Ms. Rhodes; Ms. Jeanne Herman; Mr Zach Rhodes; Dr. Haebler; Ms. Michelle Agren; Dr. Kristy Ruby; Dr. Renee Bufkin; Dr. George Bishop; Dr. Dennis Wilson; Dr. J.J. Goicoechea, Chairman of the NVMA; Dr. David Haebler; Michelle Wagner, Executive Director of the NVMA 1

Call to order, Davyd Pelsue, DVM at 11:08 AM on October 13, 2016 Davyd Pelsue, DVM gave a brief introduction, explained the purpose of the workshop, and the structure of how the regulatory process will proceed. 1. Public Comment Zach Rhodes: - Read from an article that is attached and asked that we consider the information contained therein Jenee Rhodes: - Spoke regarding her experience as a horse trainer - Owners of horses should be able to make the choice when it comes to the individuals treating their horses - Most horse owners are not uninformed when it comes to the care of their animals - Competition will raise the skill levels of those individuals that are available to care for horses 2. (a) Opened workshop on proposed regulation RO110-16: Section 1: No Comment Section 2: Zach Rhodes: - Stated that he was against the requirement that equine dental providers (EDPs) be limited to the use of non-motorized tools - Has seen more damage done with hand floats and those tools have led to bigger issues arising in the patients mouth - The training that EDPs obtain is mostly instruction using motorized tools - Motorized tools are more precise and cause less damage and strain to the horse Boyd Spratling, DVM: - Agreed with Mr. Rhodes statement regarding the use of motorized tools Zach Rhodes: - In some circumstances, EDPs should be allowed to perform extractions - They do learn extractions in school Kristi Ruby, DVM: - Expressed concerns about the delineation between what procedures would constitute extractions, dentistry, and what would be considered oral surgery - Needs to be regulated so that people are informed and that there are clear 2

boundaries Section 3: No Comment Section 4: No Comment J.J. Goicoechea, DVM: - Asked a question regarding the maintenance of medical records and what would constitute the EDP records (e.g. SOAP notes) - Explained that the medical records would include the scope of the EDP. The supervising veterinarian would ensure the general health of the horse by establishing a VCPR - The supervising veterinarian would establish a valid VCPR being established and doing an evaluation within 12 hours of sedation and provide medical records for examinations Zach Rhodes: - Stated that in Arizona a horse gets a health check by a supervising veterinarian who then dispenses the sedative to the owner who then administers the sedation with no veterinarian on premises Dr. Ruby: - Stated that sedation by an owner still might result in a reaction that might then be a liability for the supervising veterinarian - Asked how the liability for the procedures would be structured, because the EDP is performing dental procedures and the veterinarian is responsible for the health check and sedation - Clarified that the intent is to make sure that both parties are liable for their own medicine but also to ensure that there is direct supervision of a veterinarian for sedation, establishing the VCPR, and establishing the health of the animal Zach Rhodes: - Stated that direct supervision is expensive and that the vet being on premise is not necessary; for instance, in Arizona the level of supervision is indirect - Stated that direct supervision is just that the veterinarian is on site and can communicate with the EDP Dr. Ruby: - Has concerns regarding the liability and questions how the board would assign liability since there are some grey areas in the case of a complaint - She would just like it noted that it isn't clear where the line is drawn regarding where the liability is for the veterinarian if something goes 3

wrong Louis Ling: - Addressed Dr. Ruby's question stating that the case would be reviewed individually and the Board would do their best to understand the individual circumstances of that case Zach Rhodes: - How do the EDPs avoid unfair judgement by veterinarians in cases of complaints due to maybe not understanding what the procedure is or is not accomplishing - Suggested that the Board could consider the International Associatio n of Equine Dentistry to provide investigations into complaints Debbie Machen: - In cases when it is needed, there are outside evaluations by experts in specific fields that can be done when cases require them to be done Louis Ling: - Clarified the difference between a certifying body and the Board when it comes to reviewing complaints and in cases of disciplinary action Zach Rhodes: - Asked what the mental competency provision was for in the regulations Louis Ling: - Answered that the Board uses that provision to investigate, like all our other licensees, whether or not a licensee is competent mentally and or if they have substance abuse issues Section 7: No Comment Section 8: No Comment Closed workshop on proposed regulation R110-16 at 11:48AM 2 (b) Opened workshop on proposed regulation RO73-16 at 11: 49AM Dr. Goicoechea: - Asked about the section that discussed compounding and what that means in terms of intent - Expressed that he has questions himself - The intent is that when a pet leaves a facility we want to be able to cover the time frame before an owner can obtain the prescription from a compounding pharmacy Peggy Purner, DVM: 4

- A compounding pharmacy that she uses takes longer than the 5 days, recommends extending window - Dr. Goicoechea: - Echoed that if the amount is not sufficient that they may have to wait more than 2 weeks for some medications and the window should be increased - Explained that this law goes somewhat contrary to the recommendations of the FDA and must be limited and should exist such that it is a benefit to the health of the animal Patricia Handal, DVM - Some compounding pharmacies can take more than 2 weeks for some prescriptions and recommended extending the window Dr. Pelsue - Explained that we cannot write regulations based on particular pharmacies because some of the manufacturers wouldn't be able to meet the time frame Dave Habler, DVM: - Asked if the ordered amount of the compounded could be for as much as the owner would need for the treatment of the animal - Explained that the regulations are for compounded medications that are compounded at the hospital for use before an owner can get the drug from a compounding pharmacy would only apply to what is compounded at the facility Louis Ling: - Explained that we would need to make the language more clear - Nevada sees the need for the legislation to benefit the public Dr. Purner: - Asked if she dispenses for 5 days and it isn't enough, is she able to dispense another 5 - Answered yes, as long as it is needed, but no more than 5 days at a time Jon Pennell, DVM: - Requested that the Board consider longer than 5 days Michelle Peacock, DVM: - Suggested 7 days for the window of dispensing the compounded medications Dennis Wilson, DVM: 5

- Asked the Board to consider longer in the case of holidays or days that offices might be closed - Asked to incorporate language stating that the compounded item be able to be dispensed to an authorized agent in addition to being able to dispense to owners Dr. Haebler: - Requested that the Board consider adding Veterinary Assistants (VAs) to all administration levels of compounded drugs or otherwise so that they may administer drugs Dr. Ruby: - Asked that perhaps the Board add direct supervision for VAs administering medications if that would help alleviate concerns Section 2: No Comment Section 3: No Comment Section 4: Dr. Wilson: - Would like to see the licensee be required to hold at least 10% total of veterinarians or they must be a majority ownership in order to be considered a veterinarian owned facility Section 5: No comment Section 6: No Comment Section 7: No Comment Section 8: No Comment Section 9: No Comment Section 10: Louis Ling: - The intent is so that when the larger bottles that are being broken down into smaller amounts are thrown away, we can still track the meds that came from the source container once it is gone Section 17: Dr. Wilson: - Recommends that the vaccination clinics have medical grade oxygen. 6

Dr. Ailes: - Echoed Dr. Wilson's recommendation Dr. Spratling: - Asked if this involved horses as well Debbie Machen: - Clarified that no, it only applies to dogs, cats, and ferrets Section 18: No Comment Section 19: No Comment Section 20: Dr. Coady: - Asked if this meant that groomers could scrape tartar - Clarified that this would only be in a licensed facility by a licensed Veterinarian, Veterinary Technician, or Veterinary Technician in Training - Would want to call it something other than 'cosmetic dentistry' so that it better describes the regulation and the procedure of non-anesthetic dentals Dr. Habler: - Asked if we could allow non-anesthetic dentals only after a true dental has been performed - Mandating something like that would be problematic with the FTC and could be considered a Sherman Act violation. We would want to be careful with that kind of requirement Michelle Agren: - Asked how these procedures would be monitored - Answered that it would fall into the scope of how we monitor anything going on in a veterinary facility. Dr. Vittori: - Asked if during these non-anesthetic procedures, if the gumline is probed to evaluate the decay, would that be allowable 7

- Answered than anything below the gumline would be considered subgingival and then require an anesthetic dental procedure. Section 21: No comment 3. Public Comment Dr. Pennell: With equine, it was 100 for dental and 50 for physical therapy and chiropractic. Because This was what was chosen. Ms. Machen: I think that is because they already hold a professional license; the equine dental providers do not. 4. Adjournment Adjourned at 12:45PM 8

STATE OF NEVADA BOARD OF VETERINARY MEDICAL EXAMINERS BOARD MEETING AT: Oquendo Center for Clinical Education 2425 East Oquendo Road Las Vegas, Nevada 89120 MINUTES Thursday, October 20, 2016 BOARD MEMBERS PRESENT Bill Taylor, DVM, ABVP, President Ronald Sandoval, DVM, Vice President Davyd Pelsue, DVM, DACVS Steve Damonte, DVM Kevin Collins, DVM Scott Bradley, DVM Melissa Schalles, LVT James Hengels, RN, BSN BOARD STAFF PRESENT Debbie Machen, Executive Director Jennifer Pedigo, Executive Director in Training Louis Ling, Esq., Board Counsel Patricia Handal, DVM, Investigator Christina Johnson, LVT, Inspector Dr. Taylor called the meeting to order at 9:13 A.M., took roll of Board Members, and introduced the new Public Member, Jim Hengels, RN. Presentations were made to Sherita Roger, for her three years served as the Public Member and to Debbie Machen on her twenty-one years as Executive Director of the Board. 1

1. Public Comment: None 2. Approval of Board Minutes for Possible Action A. July 28, 2016 Board Meeting Motion: Dr. Bradley moved to approve the minutes as presented. Second: Ms. Schalles Passed: Unanimous CONSENT AGENDA 3. Review & Determination of Complaints for Possible Action: A. 06-2016DVM-025 Motion: Dr. Bradley moved to dismiss the complaint. Second: Dr. Sandoval Passed: Unanimous REGULAR AGENDA 4. Review & Determination of Complaints/Disciplinary Action & Disciplinary Hearings for Possible Action: A. 06-2016DVM-18; Jonathan Snead, DVM; License #1964: Letter of Reprimand or Board decision for administrative hearing. Discussion: Mr. Ling provided the Board with an overview of the proposed Letter of Reprimand. Motion: Dr. Bradley moved to accept Letter of Reprimand as presented. Second: Dr. Pelsue Passed: Unanimous; Ms. Schalles abstained B. 06-2016LVT-20; Kelly Culbertson, LVT; License #778: Letter of Reprimand or Board decision for administrative hearing. Discussion: Mr. Ling provided the Board with an overview of the proposed Letter of Reprimand. Motion: Dr. Bradley moved to accept Letter of Reprimand as presented. Second: Dr. Pelsue Passed: Unanimous; Ms. Schalles abstained C. 06-2016DVM-22, 06-2016DVM-23 Discussion: After discussion of the complaint assessment with the review panel the Board dismissed the complaint due to the fact that there was not sufficient evidence to believe that the licensee had committed an act which constitutes a cause for disciplinary action. Motion: Dr. Collins moved to dismiss the complaint. Second: Dr. Sandoval Passed: Dr. Damonte abstained 2

D. 07-2016DVM-26 Discussion: After discussion of the complaint assessment with the review panel. The Board recommended that disciplinary action be initiated against the licensee. Motion: Dr. Taylor moved to have staff and Mr. Ling initiate action against the licensee due to there being sufficient evidence to proceed with disciplinary action. Second: Dr. Bradley Passed: Unanimous; Dr. Sandoval abstained E. 08-2016DVM-30, 08-2016FAC-34 Discussion: After discussion of the complaint assessment with the review panel the Board dismissed the complaint due to the fact that there was not sufficient evidence to believe that the licensee had committed an act which constitutes a cause for disciplinary action. Motion: Dr. Taylor moved to dismiss the complaint. Second: Ms. Schalles Passed: Unanimous; Dr. Sandoval abstained F. 08-2016DVM-31, 08-2016DVM-32 Discussion: After discussion of the complaint assessment with the review panel the Board dismissed the complaint due to the fact that there was not sufficient evidence to believe that the licensee had committed an act which constitutes a cause for disciplinary action. Motion: Dr. Pelsue moved to dismiss the complaint. Second: Dr. Bradley Passed: Unanimous; Dr. Sandoval abstained. G. 08-2016DVM-35 Discussion: After discussion of the complaint assessment with the review panel the Board dismissed the complaint due to the fact that there was not sufficient evidence to believe that the licensee had committed an act which constitutes a cause for disciplinary action. Motion: Dr. Collins moved to dismiss the complaint. Second: Dr. Sandoval Passed: Unanimous; Dr. Pelsue abstained H. 08-2016DVM-36 Discussion: After discussion of the complaint assessment with the review panel. The Board recommended that disciplinary action be initiated against the licensee. 3

Motion: Dr. Taylor moved to have staff and Mr. Ling initiate action against the licensee due to there being sufficient evidence to proceed with disciplinary action. Second: Dr. Sandoval Passed: Unanimous; Dr. Bradley abstained; Dr. Pelsue recused himself having prior knowledge of the case. I. 08-2016DVM-37 Discussion: After discussion of the complaint assessment with the review panel the Board tabled the complaint for further investigation. Motion: Dr. Pelsue moved to table the complaint until consultation with an expert can be completed. Second: Dr. Damonte Passed: Unanimous; Dr. Sandoval abstained J. 09-2016DVM-39 Discussion: After discussion of the complaint assessment with the review panel the Board dismissed the complaint due to the fact that there was not sufficient evidence to believe that the licensee had committed an act which constitutes a cause for disciplinary action. The complainant was present and addressed the Board with her concerns. Motion: Dr. Pelsue moved to dismiss the complaint. Second: Ms. Schalles Passed: Unanimous; Dr. Collins abstained and Dr. Bradley recused himself having prior knowledge of the case. K. 08-2016DVM-33 Discussion: After discussion of the complaint assessment with the review panel the Board dismissed the complaint due to the fact that there was not sufficient evidence to believe that the licensee had committed an act which constitutes a cause for disciplinary action. The complainant was present and addressed the Board with her concerns. Motion: Dr. Pelsue moved to dismiss the complaint. Second: Dr. Bradley Passed: Unanimous; Dr. Damonte abstained 5. Requests for Licensure/Reinstatement/Review of Disciplinary Action for Possible Action a. Maninder Herr, DVM-Probation review, monitor repots, hospital inspections (Dr. Bradley) Discussion: The Board reviewed Dr. Herr s progress during his probation period. Dr. Weddle s and Ms. Phlegar s reports updated the Board on Dr. Herr s progress since the last meeting. There were minimal violations at both facilities. Dr. Bradley reported that he had accompanied Ms. Phlegar at the last inspection at Blue Diamond Animal Hospital and stated that he was impressed with the improvements at Dr. Herr s facilities. 4

b. Christine Bewley, VTIT Registration Extension Discussion: Ms. Bewley submitted a VTIT application and was requesting an extension of her veterinary-technician-in-training registration. The Board reviewed all documentation including Ms. Bewley s letter stating that she had signed up for the November/December 2016 VTNE. Motion: Ms. Schalles moved to extend Ms. Bewley s VTIT registration until 1/31/2017. Second: Dr. Pelsue Passed: Unanimous. c. Penni Garwood, VTIT Registration Extension Discussion: Ms. Garwood submitted a VTIT application and was requesting an extension of her veterinary-technician-in-training registration. The Board reviewed all documentation and asked questions of Ms. Garwood regarding the length of time that she had been a VTIT, the number of times she had taken and failed the VTNE, and when she was going to take the next examination. Motion: Dr. Pelsue moved to extend Ms. Bewley s VTIT registration until 9/30/2017. Second: Dr. Collins Passed: 6-Yes; 1 Nay. Dr. Taylor recused himself. d. Rubie Gomez, VTIT Registration Extension Discussion: Ms. Gomez submitted a VTIT application and was requesting an extension of her veterinary-technician-in-training registration. The Board reviewed all documentation presented. Motion: Dr. Sandoval moved to extend Ms. Gomez s VTIT registration until 5/31/2017. Second: Dr. Pelsue Passed: Unanimous; Ms. Schalles recused herself. e. Rachel Florentz, VTIT Registration Extension Discussion: Ms. Florentz submitted a VTIT application and was requesting an extension of her veterinary-technician-in-training registration. The Board reviewed all documentation including Ms. Florentz letter stating that she had signed up for the November/December 2016 VTNE. Motion: Ms. Schalles moved to extend Ms. Florentz s VTIT registration until 1/31/2017. Second: Dr. Bradley Passed: 5-Yes; 2-Nay f. Suni Bowling, VTIT Registration Extension Discussion: Ms. Bowling submitted a VTIT application and was requesting an extension of her veterinary-technician-in-training registration. The Board reviewed all documentation and asked questions of Ms. Bowling regarding the length of time that she had been a VTIT, the number of times she had taken and failed the VTNE, and when she was going to take the next examination. Motion: Ms. Schalles moved to extend Ms. Bowling s VTIT registration until 5/31/2017. 5

Second: Dr. Sandoval Passed: Unanimous 6. Discussion of Potential Regulations Changes to NAC 638 for Possible Action A. Discussion of possible regulation changes/additions on the following topics from LCB File Number RO73-16 and R100-16: Dr. Taylor opened the workshop on R110-16 at 1:00 P.M. and Dr. Pelsue facilitated the discussion. The Board was presented with overview of the Workshop on October 13, 2016 at the NVMA Board meeting. All written public comments were also presented to the Board. Dr. Pelsue explained the process for the Workshop and how the Board will work through the regulatory workshops and hearing. General Comments: None Section 1: No comments Section 2: Dr. Sandoval, Dr. Damonte agreed that (2) (a) should not exclude motorized instruments. Mr. Wallace stated that he would like to see an allowance for extractions (wolf teeth). (2) Dr. Tom Dougherty stated that the exam and treatment (1) needs a clear definition. Section 3 and 4: No comments Section 5: Mr. Wallace spoke to his concerns regarding the requirement of direct supervision (1) (a) should be eliminated as long as there is a valid VCPR and the owner can administer the sedation at the direction of a veterinarian who has provided the owner with the drug. Section 6, 7, and 8: No comments General Comments: Mr. Pendelton, why is equine floating within the purview of the veterinary Board. Dr. Dougherty, since this procedure is being done under direct supervision, the medical records should be presented to the veterinarian at the time of service. (3), (a), (b) and (c). -- Closed workshop on RO110-16 at 1:28PM -- Dr. Taylor opened the workshop on R073-16 at 1:30 P.M. and Dr. Pelsue facilitated the discussion. Section 2: Compounding. The consensus of the discussion was that a five day supply was too short. Mr. Morgan McCloud from Road Runner Compounding Pharmacy suggested that the Board consider maintenance compounding prescriptions vs. prescriptions for acute treatment. 6

Section 3: no comment Section 4: Dr. Pelsue suggested that the language be changed to collectively 10%. Section 5 and 6: no comments Section 7: Ms. Schalles had concerns regarding malpractice insurance for technicians when they are practicing off-site. Sction11-16: no comments Section 17: Should medical grade oxygen be required for these off-site vaccination clinics. Section 18 and 19: no comments Section 20: (3) Change cosmetic to subgingival cleanings and add a definition. Dr. Taylor closed the hearing on R073-16 at 2:04 P.M. 7. Staff Reports for Possible Action A. Financial Report Discussion: Ms. Pedigo presented the financial report to the Board s satisfaction. B. Audit FY2015-2016 Discussion: Ms. Machen, presented the 2015-2016 audit to the Board for approval. Motion: Dr. Bradley approved the audit. Second: Ms. Schalles Passed: Unanimous C. Administrative Report Discussion: Ms. Pedigo presented the administrative report to the Board s satisfaction. D. Hospital Inspection Report-Christina Johnson, LVT Discussion: Ms. Johnson presented the hospital inspection report to the Board s satisfaction. E. Legal Report, Louis Ling, Esq a. Attorney General opinion on dispensing practitioners Discussion: Mr. Ling explained that staff had been notified that the draft opinion had been completed and the Board should have a decision for the January 2017 meeting. Mr. Ling explained to the Board that he had been subpoenaed by VetSource to turn over all emails and correspondence between him and the Pharmacy Board. He is compiling with that request and might have to appear for a deposition on October 26, 2016. 8. Discussion and Determination for Possible Action 7

a. Deliberation, selection, salary, and benefits of the new Executive Director, Jennifer Pedigo Discussion: The consensus of the Board members was that the starting salary for Jennifer Pedigo, as the new Executive Director, would be $73,500. Additionally, Ms. Pedigo will receive benefits including, employer paid PERS, and PEBP health insurance, and telephone. Ms. Pedigo will receive an evaluation after six months at the April 26, 2017 Board Meeting. Motion: Ms. Schalles motioned to approve the salary and benefits as discussed. Second: Dr. Pelsue Passed: Unanimous b. Transfer of authority to new Executive Director as custodian of records, including but not limited to banking (Mutual of Omaha, First Independent Bank, and all investment accounts, PERS, PEBP, signing authority on all Board accounts, and licensing. Discussion: Dr. Taylor moved to transfer authority to the new Executive Director as custodian of records, including but not limited to having signing authority at Mutual of Omaha Bank, First Independent Bank, all investment accounts, PERS, PEBP, and authority to sign all licenses. Motion: Dr. Taylor moved to transfer all signing authority to Jennifer Pedigo. Second: Ms. Schalles Passed: Unanimous F. Agenda items for next meeting 1. Hospital Inspection point system G. Public Comment: Ms. Michelle Wagner, executive Director of the Nevada Veterinary Medical Association, explained the situation that some veterinary facilities are experiencing with the Department of Taxation. There is confusion regarding how facilities should itemize their invoices to account for sales tax on items such as vaccines. H. Adjournment: Adjournment at 3:25 P.M. 8