The Florida Senate
                      BILL ANALYSIS AND FISCAL IMPACT STATEMENT
                  (This document is based on the provisions contained in the legislation as of the latest date listed below.)
                                 Prepared By: The Professional Staff of the Committee on Rules
BILL:               CS/CS/CS/SB 1040
INTRODUCER:         Rules Committee; Fiscal Policy Committee; Regulated Industries Committee; and
                    Senator Bradley
SUBJECT:            Veterinary Practices
DATE:               February 27, 2024               REVISED:            2/29/24
             ANALYST                      STAFF DIRECTOR                 REFERENCE                                 ACTION
1. Kraemer                              Imhof                                  RI             Fav/CS
2. Kraemer                              Yeatman                                FP             Fav/CS
3. Kraemer                              Twogood                                RC             Fav/CS
                        Please see Section IX. for Additional Information:
                                       COMMITTEE SUBSTITUTE - Substantial Changes
    I.     Summary:
           CS/CS/CS/SB 1040 creates an act that may be cited as the Providing Equity in Telehealth
           Services (PETS) Act (PETS act), which establishes a framework for the practice of veterinary
           telehealth.
           In Florida, the practice of “veterinary medicine” means the diagnosis of medical conditions of
           animals, and the prescribing or administering of medicine and treatment to animals for the
           prevention, cure, or relief of a wound, fracture, bodily injury, or disease. Veterinarians are
           licensed and regulated by the Board of Veterinary Medicine (board) in the Department of
           Business and Professional Regulation (DBPR), pursuant to ch. 474, F.S., relating to the statutory
           standards for veterinary medical practice (practice act). The purpose of the practice act is to
           ensure that every veterinarian practicing in Florida meets minimum requirements for safe
           practice to protect public health and safety.1
           Current law defines a “veterinarian/client/patient relationship” (VCPR) as one in which a
           veterinarian has assumed responsibility for making medical judgments about the health of an
           animal and its need for medical treatment. Veterinarians are permitted to prescribe drugs in the
           course of veterinary practice; however, the veterinarian must be either personally acquainted
           with the keeping and caring of the animal and have recently seen the animal, or have made
1
    Section 474.201, F.S.
BILL:   CS/CS/CS/SB 1040                                                                                          Page 2
         medically appropriate and timely visits to the premises where the animal is kept before
         prescribing drugs in the course of practice.
         The use of electronic communications to facilitate patient health care (telehealth) is not
         addressed in the practice act and is not specifically prohibited or authorized in Florida. However,
         medical doctors may practice telehealth in Florida and may establish a patient relationship with a
         patient evaluation via telehealth under certain circumstances.2
         The regulatory framework for the PETS act establishes a framework for the practice of
         veterinary telehealth, provides in part as follows:
          Defines “veterinary telehealth” to mean the use of synchronous or asynchronous
             telecommunications technology (occurring or not occurring simultaneously) by a telehealth
             provider to provide health care services. This includes, but is not limited to, assessment,
             diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data;
             patient and professional health-related education; public health services; and health
             administration.
          Authorizes a veterinarian to use veterinary telehealth to perform an initial patient evaluation
             to establish the veterinarian/client/patient relationship, if the evaluation is conducted using
             audiovisual communication at the same time that the evaluation occurs (synchronous,
             audiovisual communication); the evaluation may not be performed using audio-only
             communications, text messaging, questionnaires, chatbots, or other similar means;
          Requires that if the initial patient evaluation is performed using veterinary telehealth, certain
             information must be supplied to the client, including the veterinarian’s contact information;
          Requires that a veterinarian practicing telehealth inform the client that, if medication is
             prescribed, the client may obtain a prescription that may be filled at the pharmacy of his or
             her choice;
          Authorizes a veterinarian practicing veterinary telehealth to order, prescribe, or make
             available medicinal drugs or drugs as defined in s. 465.003, F.S., the Florida Pharmacy Act.
          Prohibits a veterinarian from using veterinary telehealth to prescribe a controlled substance
             as defined in ch. 893, F.S. (Drug Abuse Preventions and Control), unless the veterinarian has
             conducted an in-person physical examination of the animal or made medically appropriate
             and timely visits within the past year to the premises where the animal is kept.
          Allows veterinarians who are personally acquainted with the caring or keeping of an animal
             or group of animals for food-producing animal operations, who have recently seen the
             animals or made medically appropriate and timely visits to practice veterinary telehealth for
             these animals.
          Specifies that only Florida licensed veterinarians may practice veterinary telehealth, and
             grants the board jurisdiction over the practice of veterinary telehealth.
         According to the Department of Business and Professional Regulation (DBPR), there is no
         impact expected on state or local government revenues and expenditures.3 See Section V, Fiscal
         Impact Statement.
         The bill has an effective date of July 1, 2024.
2
 See s. 456.47, F.S., relating to the use of telehealth to provide healthcare services.
3
 See Department of Business and Professional Regulation, 2024 Agency Legislative Bill Analysis for HB 849 (identical to
SB 1040 at 5 (Dec. 13, 2023) (on file with the Senate Committee on Regulated Industries).
BILL:     CS/CS/CS/SB 1040                                                                                            Page 3
    II.    Present Situation:
           Veterinary Medicine, the Practice of Veterinary Medicine, and Exempted Persons
           In 1979, the Legislature determined the practice of veterinary medicine to be potentially
           dangerous to public health and safety if conducted by incompetent and unlicensed practitioners
           and that minimum requirements for the safe practice of veterinary medicine are necessary.4 The
           Board of Veterinary Medicine (board) in the Department of Business and Professional
           Regulation (DBPR) implements the provisions of ch. 474, F.S., on Veterinary Medical Practice.5
           A veterinarian is a health care practitioner licensed to engage in the practice of veterinary
           medicine in Florida under ch. 474, F.S.6 In Fiscal Year 2022-2023, there were 13,285 actively
           licensed veterinarians in Florida.7
           Veterinary medicine8 includes, with respect to animals:9
            Surgery;
            Acupuncture;
            Obstetrics;
            Dentistry;
            Physical therapy;
            Radiology;
            Theriogenology (reproductive medicine);10 and
            Other branches or specialties of veterinary medicine.
           The practice of veterinary medicine is the diagnosis of medical conditions of animals, and the
           prescribing or administering of medicine and treatment to animals for the prevention, cure, or
           relief of a wound, fracture, bodily injury, or disease, or holding oneself out as performing any of
           these functions.11 Veterinarians who are incompetent or present a danger to the public are subject
           to discipline and may be prohibited from practicing in the state.12
           Eleven categories of persons are exempt from complying with ch. 474, F.S.:13
4
  See s. 474.201, F.S.
5
  See s. 474.204 through 474.2125, F.S., concerning the powers and duties of the board.
6
  See s. 474.202(11), F.S.
7
  See Department of Business and Professional Regulation, Division of Professions Annual Report Fiscal Year 2022-2023, at
page 18, at http://www.myfloridalicense.com/DBPR/os/documents/Division%20Annual%20Report%20FY%2021-22.pdf
(last visited Feb. 1, 2024).
8
  See s. 474.202(13), F.S.
9
  Section 474.202(1), F.S., defines “animal” as “any mammal other than a human being or any bird, amphibian, fish, or
reptile, wild or domestic, living or dead.”
10
   The Society for Theriogenology, established in 1954, is composed of veterinarians dedicated to standards of excellence in
animal reproduction. See https://www.therio.org/ (last visited Feb. 1, 2024).
11
   Section 474.201, F.S. See s. 474.202(9), F.S. Also included is the determination of the health, fitness, or soundness of an
animal, and the performance of any manual procedure for the diagnosis or treatment of pregnancy, fertility, or infertility of
animals.
12
   See s. 474.213, F.S., on prohibited acts, and s. 474.214, F.S., on disciplinary proceedings.
13
   See s. 474.203, F.S.
BILL:   CS/CS/CS/SB 1040                                                                                                  Page 4
            Faculty veterinarians with assigned teaching duties at accredited14 institutions;
            Intern/resident veterinarians at accredited institutions who are graduates of an accredited
             institution, but only until they complete or terminate their training;
            Students in a school or college of veterinary medicine who perform assigned duties by an
             instructor (no accreditation of the institution is required), or work as preceptors15 (if the
             preceptorship is required for graduation from an accredited institution);
            Doctors of veterinary medicine employed by a state agency or the United States Government
             while actually engaged in the performance of official duties at the installations for which the
             services were engaged;
            Persons or their employees caring for the persons’ own animals, as well as part-time or
             temporary employees, or independent contractors, who are hired by an owner to help with
             herd management and animal husbandry tasks (excluding immunization or treatment of
             diseases that are communicable to humans and significant to public health) for herd and flock
             animals, with certain limitations; however, the exemption is not available to a person
             licensed as a veterinarian in another state and temporarily practicing in Florida, or convicted
             of violating ch. 828, F.S., on animal cruelty, or of any similar offense in another jurisdiction,
             and employment may not be provided for the purpose of circumventing ch. 474, F.S.;
            Certain entities or persons16 that conduct experiments and scientific research on animals as
             part of the development of pharmaceuticals, biologicals, serums, or treatment methods or
             techniques to diagnose or treat human ailments, or in the study and development of methods
             and techniques applicable to the practice of veterinary medicine;
            Veterinary aides, nurses, laboratory technicians, preceptors, or other employees of a licensed
             veterinarian, who administer medication or provide help or support under the responsible
             supervision17 of a licensed veterinarian;
            Certain non-Florida veterinarians who are licensed and actively practicing veterinary
             medicine in another state, are board certified in a specialty recognized by the Florida Board
             of Veterinary Medicine, and are assisting upon request of a Florida-licensed veterinarian to
14
   Sections 474.203(1) and (2), F.S., provide that accreditation of a school or college must be granted by the American
Veterinary Medical Association (AVMA) Council on Education, or the AVMA Commission for Foreign Veterinary
Graduates. The AVMA Council on Education is recognized by the Council for Higher Education Accreditation (CHEA) as
the accrediting body for schools and programs that offer the professional Doctor of Veterinary Medicine degree (or its
equivalent) in the United States and Canada, and may also approve foreign veterinary colleges. See
https://www.avma.org/education/center-for-veterinary-accreditation/accreditation-policies-and-procedures-avma-council-
education-coe/coe-accreditation-policies-and-procedures-accreditation (last visited Feb. 1, 2024). The AVMA Commission for
Foreign Veterinary Graduates assists graduates of foreign, non-accredited schools to meet the requirement of most states that
such foreign graduates successfully complete an educational equivalency assessment certification program. See
https://www.avma.org/professionaldevelopment/education/foreign/pages/ecfvg-about-us.aspx (last visited Feb. 1, 2024). In
turn, the Council for Higher Education Accreditation, a national advocate for regulation of academic quality through
accreditation, is an association of degree-granting colleges and universities. See http://chea.org/about (last visited
Feb. 1, 2024).
15
   A preceptor is a skilled practitioner or faculty member, who directs, teaches, supervises, and evaluates students in a clinical
setting to allow practical experience with patients. See https://www.merriam-
Webster.com/dictionary/preceptor#medicalDictionary (last visited Feb. 1, 2024).
16
   See s. 474.203(6), F.S., which states that the exemption applies to “[s]tate agencies, accredited schools, institutions,
foundations, business corporations or associations, physicians licensed to practice medicine and surgery in all its branches,
graduate doctors of veterinary medicine, or persons under the direct supervision thereof. . . .”
17
   The term “responsible supervision” is defined in s. 474.202(10), F.S., as the “control, direction, and regulation by a
licensed doctor of veterinary medicine of the duties involving veterinary services” delegated to unlicensed personnel.
BILL:   CS/CS/CS/SB 1040                                                                                                Page 5
             consult on the treatment of a specific animal or on the treatment on a specific case of the
             animals of a single owner;
            Employees, agents, or contractors of public or private animal shelters, humane organizations,
             or animal control agencies operated by a humane organization, county, municipality, or
             incorporated political subdivision, whose work is confined solely to implanting radio
             frequency identification device microchips in dogs and cats in accordance with s. 823.15,
             F.S;18
            Paramedics or emergency medical technicians providing emergency medical care to a police
             canine19 injured in the line of duty while at the scene of the emergency or while the police
             canine is being transported to a veterinary clinic or similar facility; and
            Veterinarians who hold an active license to practice veterinary medicine in another
             jurisdiction in the United States, are in good standing in such jurisdiction, and who perform
             dog or cat sterilization services or routine preventative health services at the time of
             sterilization as an unpaid volunteer under the responsible supervision of a veterinarian
             licensed in Florida. Out-of-state veterinarians practicing pursuant to this exemption are not
             eligible to apply for premises permits for veterinary establishments.
         Persons who are eligible faculty veterinarians, intern veterinarians, resident veterinarians, or state
         or federal veterinarians exempt from complying with ch. 474, F.S., are deemed to be duly
         licensed practitioners authorized to prescribe drugs or medicinal supplies.20
         Veterinarian/Client/Patient Relationship
         The practice act defines a “patient” as any animal for which a veterinarian practices veterinary
         medicine.21
         The practice act defines a “veterinarian/client/patient relationship” (VCPR) as one in which a
         veterinarian has assumed responsibility for making medical judgments about the health of an
         animal and its need for medical treatment.22
         Veterinarians are permitted to prescribe drugs in the course of veterinary practice, but may be
         disciplined by the board for certain related violations, including ordering, prescribing, or making
         available medicinal drugs or drugs23 or controlled substances24 for use other than for the specific
         treatment of animal patients for which there is a documented VCPR and without:
18
   See s. 823.15(5), F.S., which authorizes such persons to perform microchipping of dogs and cats.
19
   Section 401.254, F.S., defines the term “police canine” as “any canine that is owned, or the service of which is employed,
by a state or local law enforcement agency, a correctional agency, a fire department, a special fire district, or the State Fire
Marshal for the principal purpose of aiding in the detection of criminal activity, flammable materials, or missing persons; the
enforcement of laws; the investigation of fires; or the apprehension of offenders.” A paramedic or an emergency medical
technician who acts in good faith to provide emergency medical care to an injured police canine is immune from criminal or
civil liability.
20
   See s. 474.203, F.S. (flush left language).
21
   Section 474.202(8), F.S.
22
   Section