The convergence of animal health and human health described in Chapter 1 raises a number of potentially important legal issues of which human health and veterinary providers should be aware.

Scope of Practice

In some instances, physicians have been asked to treat animals belonging to their patients. Likewise, veterinarians have been asked to treat people or provide medical advice and/or medications that could be used for human beings as well as other animals, especially when dealing with zoonotic diseases. Both human and veterinary health professionals need to be aware of the concept of professional scope of practice and the need not to overstep professional bounds in such situations.

Physicians and other human health care providers, including nurse practitioners and physician assistants, are licensed to evaluate and treat diseases in human beings. Individuals without such licenses who provide medical treatment (such as administration of prescription medication or performing a surgical procedure such as suturing a wound) are “practicing medicine without a license,” which is a violation of state professional licensing (and possibly criminal) statutes. The justification for licensing professionals is in part to ensure they are appropriately qualified and can provide necessary care. The exact scope of practice of physicians and other medical professionals is determined by medical examining boards of individual states and therefore can vary among states. For example, licensed psychologists have the authority to prescribe medications in some states but not in many others.¹ Obviously, the scope of practice for medical care providers does not include providing veterinary care for animals.

BOX 2-1 DEFINITION OF THE “PRACTICE OF VETERINARY MEDICINE” FROM THE AVMA MODEL

Rights were not granted to include this box in electronic media. Please refer to the printed book.

From American Veterinary Medical Association: Model Veterinary Practice Act, http://www.avma.org/issues/policy/mvpa.asp.

As shown in Box 2-1, the “rendering of advice or recommendation” about animal diseases is part of the practice of veterinary medicine, and this should be kept in mind by human health care providers who are discussing animal health issues with their patients. The MVPA does not include any provisions for veterinarians offering medical advice to their clients regarding human diseases. However, in addition, the oath of practice that veterinarians take when entering the profession (Box 2-2) includes a commitment to “the promotion of public health, and the advancement of medical knowledge.” Therefore counseling clients about reducing zoonotic disease risk, providing preventive care to reduce such risk, and notifying public health departments in a timely manner about human health risks would appear to be an intrinsic part of good preventive veterinary care. Failure on the part of a veterinarian to perform such activities could potentially lead to legal liability (see below). Veterinarians consequently must carefully consider ways to fulfill their public health obligations while not exceeding their professional scope of practice.³

BOX 2-2 VETERINARIAN’S OATH

Rights were not granted to include this box in electronic media. Please refer to the printed book.

From http://www.avma.org/careforanimals/animatedjourneys/aboutvets/aboutvets.asp.

Malpractice Liability

Both physicians and veterinarians are liable for malpractice (damages awarded for professional negligence). Many human health and veterinary providers carry malpractice insurance, but such insurance covers only activities within the scope of practice for that professional.

There is a growing realization of particular risks to both human and veterinary medical providers related to zoonotic diseases in terms of malpractice liability related to human-animal medicine issues, although legal precedent in this area remains sparse. There is potential malpractice liability for physicians and other human health care providers who fail to correctly diagnose an animal-related disease such as a zoonosis in their patients because they failed to take an adequate history of animal exposures or otherwise consider the diagnosis. For example, a physician who fails to obtain a history of bird contact in the household and consequently fails to correctly diagnose a disease such as psittacosis in a person who shares the household with the bird could be at risk of being sued for negligence (see Chapter 9). Management of this liability can include training for physicians and other medical providers in the recognition of zoonotic disease risk and other animal-related risks.

Veterinarians are in a knowledgeable position to warn clients about the risks of zoonoses and control the risk to human beings by competently managing disease in the animal population. Consequently, there appear to be a number of areas of potential malpractice liability for veterinarians related to negligence in the management of zoonotic disease.

The first area of potential negligence is the failure to correctly diagnose a zoonotic disease in an animal. For example, if a veterinarian fails to detect dermatophytosis in a cat used for animal therapy (see Chapter 5) and an immunocompromised person who is in contact with the cat becomes infected with Microsporum as a result (see Chapter 9), the veterinarian could be blamed for failing to diagnose the zoonotic risk. In the past, it may have been more difficult to definitively link an animal infection to a subsequent infection in a human, but the use of molecular techniques to characterize particular strains of an organism crossing from animals to human beings now allows such causative linkages to be made. Such evidence could surface in a medicolegal setting.³

Another area of malpractice liability for veterinarians related to zoonotic disease is the failure to recommend preventive measures for common zoonotic diseases. This situation could occur if a veterinarian failed to isolate an unvaccinated stray cat with bite wounds with the subsequent need for rabies postexposure prophylaxis among human contacts if the cat develops rabies (see Chapter 9). In such a case, the veterinarian could be held liable for not taking steps to control the zoonotic risk. Another example would be if a veterinarian diagnosed leptospirosis in a dog, failed to adequately warn the owner regarding the zoonotic risk of disease, and leptospirosis that could be traced back to the strain that infected the dog later develops in the owner.

In the case of exotic and wildlife pets that could harbor unusual zoonotic diseases (such as monkeypox) or pose envenomation risks (such as venomous reptiles), a veterinarian could be held liable for not warning clients about the dangers of keeping such animals. Even in the case of rare and unusual zoonoses and other disease risks related to exotic pets with which a veterinarian may be less familiar, it could be argued that the veterinarian should have referred the owner to a specialist for diagnosis or treatment of a species or condition that was not within the practitioner’s expertise (see Chapter 10). ³

An additional potential area of veterinarian malpractice liability involves a failure to advise a client to seek care from a physician for diagnosis and treatment of a zoonotic disease. This could occur if a client reports certain symptoms such as fever or diarrhea to a veterinarian after an exposure to a sick animal and the veterinarian fails to counsel that person to seek medical care.

Management techniques to avoid these malpractice liabilities include the following:

1. Educating clients about the risks of zoonotic disease and methods to reduce such risks, and documenting such education. To supplement such teaching, handouts about zoonotic disease risks can be given to clients by veterinarians to educate them. An example of such a handout is the “Pet-Scription” and “Pet-Scription for Reptile Owners” available from the CDC Healthy Pets Healthy People website. Discussions about zoonotic disease risk should be documented in the veterinary medical record.

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