Unlicensed Veterinary Activity in Texas: Animal Services That Cross the Line with TBVME

Transcript

SPEAKER_00 0:00

If you’re working with or around animals, whether it is grooming, training, boarding, even pet wellness services, there is a line where helpful becomes regulated. And crossing that line can trigger some serious legal action. This is Know Your Regulator. I’m your host, Simone Murfrey, and today we are focusing on unlicensed activity with the Texas Board of Veterinary Medical Examiners. We’re taking a look at what it is, where people get confused, and how one service can accidentally put you into multiple boards territory depending on the services you offer. To help break it down, I am joined by Kristen Stavro, a staff attorney at TBVME who handles these types of specific cases. Thank you so much for joining me, Kristen. Thank you so much for having me. Absolutely. So before we talk cease and desist for unlicensed activity, can you set the stage for us? What does TBVME regulate and how is this licensed, unlicensed activity an issue?

SPEAKER_01 0:57

Yeah, so the Texas Board of Veterinary Medical Examiners, or TBVME for short, we regulate the practice of veterinary medicine and equine dental services in the state of Texas. So our mission is to safeguard the health and well-being of Texans by establishing and upholding policies that ensure the highest standards of veterinary and equine dental services. So as an agency, our duty is to protect the public, not just from substandard veterinary and equine dental care from individuals who are licensed by TBVME, but also to protect the public from individuals who are not licensed by TBVME, that are providing veterinary and equine dental care to members of the public here in Texas. In addition, it prevents unlawful competition by individuals who have not been adequately trained and educated to provide veterinary services. So to answer the latter part of your question, unlicensed activity is a real problem here in Texas, unfortunately, because it puts animals at risk and it puts animal owners in a vulnerable position. When someone provides medical advice, they diagnose, they prescribe, they perform procedures, or they represent themselves to be a licensed veterinarian without that proper training, it can lead to delayed proper treatment, uh potential complications, and higher costs ultimately for um animal owners down the road.

SPEAKER_00 2:44

Yeah, no, it definitely sounds like it is this usually, is this activity usually intentional? Like, do people know that they are not supposed to be performing these types of services, or do most people really think that they’re operating in this kind of gray area?

SPEAKER_01 3:02

So I would say probably 75% of our cases that we see are with people who do not operate with the intention of wanting to break the law. Um that’s good. Yes, yes, it is. So unfortunately, though, there are people who they have the best of tensions. And I say unfortunately, we appreciate the fact that people have the best of intentions, but at the end of the day, they are still breaking the law. And they usually want to provide something such as dental work or vaccines to the public at a lower cost. And what these individuals don’t understand or don’t realize is that the services that they are providing fall under the definition of practicing veterinary medicine here in Texas.

SPEAKER_00 3:55

Yeah, no, it’s very important to know is if if this is a law that you’re breaking, if you’re supposed to be able to perform these types of services. So let’s look at specifics here. When you’re looking at a situation, a report, a complaint, um, you’re looking through some paperwork that’s coming, and you say this might be unlicensed activity. What are those common fact patterns that you’re seeing that kind of raise those red flags?

Red Flags: Treatment, Diagnosis, Ads

SPEAKER_01 4:23

Yeah. So first we have to know what the law defines the practice of veterinary medicine to be. And so for that, we need to look at the Texas Occupations Code, um, specifically section 801.0025. So if you bear with me, I’m gonna read you a little bit of law here, but I think it’s important for the listeners to know. Um, so in Texas, the practice of veterinary medicine is defined as a the diagnosis, treatment, correction, change, manipulation, relief, or prevention of animal disease, deformity, defect, injury, or other physical condition, including the prescription or administration of a drug, biologic, anesthetic, apparatus, or other therapeutic or diagnostic substance or technique, B the representation of an ability and willingness to perform an act that was listed in paragraph A, C the use of a title or a word or letters to induce the belief that a person is legally authorized and qualified to perform an act listed in paragraph A, or D, the receipt of compensation for performing an act listed in paragraph A. And veterinary medicine includes veterinary surgery, reproduction, and obstetrics, dentistry, ophthalmology, dermatology, cardiology, and any other discipline or specialty of veterinary medicine. So I know that was a lot. Um, and I know you asked specifically, okay, what are like red flags that we see? Um but the most common things that we will see that are immediate red flags and are if someone gave a medication or gave some form of treatment. And treatment can range from, you know, anything from I’m giving this medication to someone, or it can even go into um light therapy or PEMF, which is pulse electromagnetic therapy. Um, so if they give tr any sort of treatment to an animal with the intent to treat the animal, or if an individual examined an animal and gave that animal’s owner a diagnosis, or if even if an individual posts on social media and they say that they offer services that will ultimately be treating the animal, those are all examples that to me, if I see that, or to anyone on our legal team, we see that, that makes us go, okay, this individual is practicing veterinary medicine without a license.

Certificates vs. Licenses In Texas

SPEAKER_00 7:27

Yeah, no, I mean, you guys are really specific in that rule. You really kind of spell it out for license holders or potential license holders. Is there like a specific service that is triggering the most confusion? Is it maybe performing procedures or the advertisement or diagnosing sometimes? Um, and is it the act of doing it you mentioned, even just sort of representing yourself as being able to perform the service or willing to perform the service can can trigger a cease and desist, correct? Yes, that’s correct.

Dental Boundaries And Board Rules

SPEAKER_01 8:03

There has been a bit of confusion, and I just previously said this, with light therapy and PEMF, um pulse electromagnetic therapy, and really any sort of alternative therapy where you can go and get a certificate for. Um, so we see a lot of people who believe that if you go and get a certificate for let’s say you’re you’re taught to offer X amount of therapy, that they will be good to go, to then offer that type of therapy here in Texas. And that’s just it’s not the case. Yeah, I have to tell people all the time if they’re providing treatment to an animal with the intent to treat or to make that animal feel better, then in the state of Texas that is defined as practicing veterinary medicine, a certificate does not make it legal to do that treatment here in Texas. You either need a veterinary license or the supervision of a licensed veterinarian. We also see a lot of dental issues. So cleaning teeth, um, cleaning an animal’s teeth, that usually doesn’t trigger the issue of practicing veterinary medicine, but I do have to direct people to our board rules under the Texas Administrative Code. And there, I as I’m now talking about this, I think it’s important to give some distinction. So our agency operates under the Texas Administrative Code and the Texas Occupations Code. So both rules that we have to abide by and follow. The Texas Administrative Code is our board specific rules, and then the Texas Occupations Code is statute that is given to us by the legislator. So I did just want to give that caveat.

SPEAKER_00 10:11

Yeah, no, it’s important to know because those there’s a process for those. Um, you can make some change, but you’ve got to know who to um who petition with, you know.

Supervision Levels And Liability

SPEAKER_01 10:21

Yes, exactly, exactly. So um, and talking going back to um like the dental issues that we see, um, I direct people to section 573.19 of the Texas Administrative Code. Um, and that states that dentistry is a subset of the practice of veterinary medicine, and it is defined as one, the application or use of any instrument or device to any portion of an animal’s tooth, gum, or any related tissue for the prevention, cure, or relief of any wound, fracture, injury, or disease of an animal’s tooth, gum or related tissue, and two, preventative dental procedures, including, but not limited to the removal of calculus, soft deposits, plaque, stains, or smoothing, filing, or polishing of tooth surfaces. The rule also specifically states that a non-licensed person may not perform any invasive dental procedure as defined in Rule 573.80. And that’s relating to, it’s a part of our rules that is um definitions and as limited by subsection E of that particular particular uh rule section. Um, nothing in this regulation shall prohibit any person from utilizing cotton swabs, gauze, dental floss, um, dentrifrice or toothbrushes to clean an animal’s teeth. So in dogs and cats, a licensed veterinary technician under direct or immediate supervision of a veterinarian may extract loose teeth or dental fragments with minimal periodontal attachments by hand and without the use of an elevator. So that’s a lot of rule that I just spat at you, and I apologize. So, in conclusion, a person can, an unlicensed individual can clean another another person’s animal’s or pets’ teeth with, let’s say, a toothbrush. Um, but once they bring out a scaler or they attempt to extract teeth, that falls under the definition of practicing veterinary medicine without a license. And additionally, just something that I tell a lot of individuals who are practicing veterinary medicine without a license, a lot of the time they can continue to provide whatever services they are providing as long as they are working under the supervision of a licensed veterinarian. And that level of supervision is it’s ultimately up to the licensed veterinarian who agrees to supervise them. Because per our board rules, we do have different levels of supervision, and those could be found under board rule 573.10 and 573.80. So I apologize. I know that was a lot of just me spatting rules at you. Um, but it’s it’s important to know.

SPEAKER_00 13:49

Yeah, no, it sounds like, well, I think that’s a there’s a very distinct difference between doing some sort of surface level like toothbrushing and like you said, extracting a tooth or kind of giving some sort of treatment to make the animal feel better. It sounds like it’s really, really important to understand the scope of the work that you’re performing. And if you’re a supervisor to understand and be tuned into what your um supervisees are doing, because it’s my understanding that the if you’re a supervisor, you know, what what happens with the the licensed individuals that you’re supervising could come back to bite you as well.

SPEAKER_01 14:28

Yeah, I mean, ultimately in in our rules, we have um, there is specifically a rule that talks about supervision. And um to briefly summarize it, um, the licensee is responsible for any individuals that are um, even if they’re they’re unlicensed, they’re responsible for that individual and the acts or things that they do. So yeah, that definitely can can fall back on a licensed DVM. Absolutely.

Mobile Services And Common Pitfalls

SPEAKER_00 15:06

And looking at some of these other, there’s you know, definitely a lot of new kind of business models and services that people are offering. Do you see a lot of issues with these mobile services, whether it’s grooming or, you know, actually performing some type of veterinary care?

SPEAKER_01 15:25

Yeah, so unfortunately we do. Um, a lot of it usually deals with what I previously mentioned, cleaning teeth. More often than not, it’s people who want to provide members of the public with more affordable grooming and dental care, and they don’t realize that, for example, the removing of calculus, plaque, or stains is something that only a licensed veterinarian can do here in Texas.

SPEAKER_00 15:56

Yeah, no, I can can see where people might get um confused about that. And digging into it a little bit more, let’s kind of break down some of these confusion points. Where do you really see things, you know, start to cross the line when it comes to regulated activity that TBVME has jurisdiction over?

Where Lines Get Crossed

SPEAKER_01 16:18

Yeah, so um, as I previously mentioned, a lot of it comes from people wanting to offer different types of treatment because they have received some certificate online that says they are able to provide this treatment, or from people who think removing calculus plaque and stains from animals’ teeth is fine since they are just cleaning the animal’s teeth.

SPEAKER_00 16:49

No big deal.

SPEAKER_01 16:50

Exactly. And I I can understand where there could be some confusion, but it does clearly state in our board rules, you know, what is defined as that subset of practicing veterinary medicine. And so at the end of the day, these people have the intention of wanting to treat the animal or make that animal feel better. And these intentions are they are intentions that should solely be in the hands of a licensed veterinarian.

SPEAKER_00 17:25

And you’re explaining exactly why, you know, what the rationale is behind that for sure. Do you see a lot of this confusion come from like the terminology, what things like consult or diagnose, assess, um, or is it really just people trying to help out their friends or their family and just don’t realize that they’ve stepped the line into a regulated service?

SPEAKER_01 17:50

Yeah, so I think a lot of people just they want to be able to help different members of the public, help friends, help family. But unfortunately, if you are assessing or examining or providing any sort of diagnosis or treatment to an animal that is practicing veterinary medicine here in Texas.

SPEAKER_00 18:16

So it goes back to that, you know, understanding your scope and the language that, you know, um of of what you’re performing, the scope and the language of the services that you perform, what’s expected of you, because it does make a huge difference when it comes down to should this activity be performed by a licensed individual or not. Right, exactly.

SPEAKER_01 18:36

Um, I I think the law is very clear on what it means to practice veterinary medicine here in Texas. Unfortunately, just a lot of people are not aware of what the law actually states. And that’s why I think it’s amazing that y’all have this podcast so you can let members of the public here in Texas know and they can become aware.

Multiple Boards And Jurisdiction

SPEAKER_00 18:56

So I think it’s great. Oh, thanks. Yeah, no, it’s we um we really just want to kind of bridge that gap because there are the then the rules and regulations that govern you now could change next year, you know. So it’s very important to keep stay on top of these things and um, you know, keep your keep your mind in that industry. Let’s talk a little bit beyond the vet board, though. We kind of alluded to it in the beginning, but um, you know, depending on what type of services that you provide, the unlicensed activity can touch multiple different boards. Can you kind of explain how one case can trigger different regulators getting involved?

SPEAKER_01 19:38

Well, for instance, if a person is using some kind of sedative to keep an animal calm while they’re performing some sort of treatment, that could potentially involve the pharmacy board or even the DEA. Um, treating certain animals might draw in the Texas Animal Health Commission or the USDA. Another example is if an unlicensed uh person were to complete a health certificate for an animal using an individual’s um, a licensed individual’s license number, then that is an instance where the FDA might get involved.

SPEAKER_00 20:23

Yeah, that sounds like fraud. You know? Yes, it does. Yeah. And it sounds like a headache no one wants. I mean, you’ve got all these different agencies that could get involved, and it can get really expensive, it can get really complicated. Um, are there any specific services that even licensed individuals are confused about performing that could maybe cross into another board’s jurisdiction?

Pharmacies, Prescriptions, And Oversight

SPEAKER_01 20:51

Yes. So filling medications is a big one. Uh vets are unique as medical professionals in that most have their own pharmacies on the premises of their clinic. And technically, the board does not regulate the filling of prescriptions. This is really the jurisdiction of the pharmacy board. But we will frequently get calls from DBMs wanting to ensure that their pharmacies are in compliance with our rules, and we have to tell them that is actually outside the scope of our board’s regulation and that they may want to reach out to uh the pharmacy board for that.

Complaints Drive Enforcement

SPEAKER_00 21:44

Yeah, no, I can I can totally see. I’m glad that you’re having them call you when because it’s important that you reach out to your board. Um, but yeah, no, that absolutely makes sense that um that the pharmacy board would regulate the filling and prescription of medication. And it sounds like really the big takeaway here is that regulation follows the service, right? It doesn’t follow the intention like we’ve been talking about. You could have awesome intentions. You really just want that puppy with arthritis. Well, I guess it’d be a dog, but the dog with arthritis to get some relief. But um that can really come back to to bite you for lack of a um punnier term, but I love it. It could come back to get you. Um Kristen, you’ve handled a lot of cease and desist cases. And can you take us through the typical process when when you guys are receiving a report or complaint or you notice that there’s some unlicensed activity? How does TBVME learn about these situations and then what happens next?

Cease And Desist: How It Works

SPEAKER_01 22:51

Yeah, so bear with me because it is a little bit of a process. Um, but first and foremost, um, I do want to kind of put this disclaimer out there. A lot of people, a lot of members of the public in Texas do not realize that we are a complaint-driven agency. And so while we do inspections for our licensees, if there is an individual who is practicing veterinary medicine without a license, the only way we become aware of that activity is if a member of the public files a complaint with us. So this is my plea, please, if if if you know someone or you’ve seen someone who is you think might be practicing veterinary medicine without a license, please file a complaint with us. We because we have no other way of knowing. And we need to know because as I’ve mentioned, it’s it’s so so important for us to become aware of any activity that. But going back to the how the process works, so first our agency receives a complaint from a member of the public. And once we receive that complaint, it then gets assigned to an investigator on our enforcement team. And an investigator then investigates the complaint to determine if there has been a violation of our rules. So this is the same protocol, not just for unlicensed activity, but for all complaints that we at TBBME receive. Um but for the sake of discussing unlicensed activity, if an investigator finds that within the complaint there is unlicensed activity occurring, that investigator has to have it be reviewed and then approved by either our director of enforcement or an enforcement supervisor. Once it’s been reviewed and approved, the complaint, along with all of the investigative material that that investigator has completed or used through the investigative process, that all gets passed along to the legal team. So from there, an attorney from the legal team reviews the complaint and all of the investigative material. And if the attorney believes that legally there is a violation here of practicing veterinary medicine without a license, then the attorney will draft a cease and desist order. And I like to explain to, or I have explained to people that if they’ve caught themselves in that situation, that a cease and desist order, it’s it’s basically a warning. It’s a piece of paper that says, hey, you’ve been breaking the law and it has been brought to our attention. You must stop doing what you’re doing. Please stop this activity. Um, please and thank you. So the cease and desist orders are the attorney drafts the cease and assist order, and then they are signed by our executive director, and they are then sent out to the respondents, which also known as um the individuals who have been practicing veterinary medicine without a license. And issuing a cease and desist order is it’s it’s so important and it matters because it provides notice to the individual or the legal term being the respondent. And if they continue that unlicensed activity, then there will usually be a formal proceeding and they could be hit with a monetary penalty. Um, if they still don’t stop that unlicensed activity or they don’t pay the penalty, then they could be referred to the attorney general’s office for prosecution.

SPEAKER_00 27:09

And that’s not where you want to end up. You know, yeah. So I like what you said. It sounds like it’s kind of a warning that you guys give these individuals an opportunity to just cut it out, stop what you’re doing. You know now, you know, you can’t say you don’t know, right? Um, cut it out and, you know, um find something else to do or go get, you know, go apply for your license.

SPEAKER_01 27:33

Yeah, yeah. Or depending on whatever service they’re wanting to provide, um go see if there’s a licensed veterinarian that would be willing to supervise you.

SPEAKER_00 27:47

Yeah. No, great advice. If someone does receive contact from the board, what would you say is the best first step that they can take?

Ignoring Orders And SOAH Hearings

SPEAKER_01 27:58

So since our cease and desist orders are now issued directly from our executive director, there’s no further action that we need from that person except to please cease the unlicensed activity immediately. If they disagree with the order, they should contact us or have an attorney um contact us and see if we can reach an agreement on what that they can do.

SPEAKER_00 28:30

Yes. And I also tell our listeners to take any correspondence from the board seriously. You’ve got to respond professionally and timely. And if you’re not sure, get legal guidance. Sometimes rushing or straight up ignoring that response is really going to create more problems than the original issue itself. And are you seeing any big mistakes that people are making after they’ve been contacted? I mean, are they generally pretty um pretty receptive to the cease and desist orders?

Prevention: Read Rules And Call

SPEAKER_01 29:06

Usually yes. And I I would say um that back when, so anything um prior to 2025, any complaints that we received prior to 2025, um, those cease and desist orders that we issued, they had to be agreed um to. So how that process used to work is I would have to reach out to the respondent or the individual who is who we believed was uh practicing veterinary medicine without a license. And I had to explain the situation to them, explain the cease and desist order to them, and they had to agree to the cease and desist order and then sign it. And now it well, and I should say to answer your question, sometimes people were not wanting to sign the cease and desist order. Sure. Um, so we did, we have had pushback um and ultimately, and I’ll touch on it um, I’ll touch on it a little bit later, but essentially that could lead to us having to go to a hearing before a third-party judge um at the State Office of Administrative Hearings. So that’s like the absolute, like extreme kind of case, yeah. The scale. Um, so now that’s not the case. As I mentioned, we draft the cease and desis order, our executive director signs it, and then we just send it out to um the individuals who have been practicing veterinary medicine without a license. Um, but I think the biggest mistake that an individual can make is if someone ignores a sea syndesis order. Um, and then, as I’ve said, we would then have to take that matter to court, aka the State Office of Administrative Hearings. Um, and ultimately C syndesis orders are not something that you want to ignore.

SPEAKER_00 31:10

Yeah, no, and I think it’s great for our listeners to know and know that this the distinction in the process, too, that you used to have to agree to it and now um now we’re just telling you, you know. Yes, exactly. Well, as we come to a close, Kristen, let’s look at trying to prevent these issues altogether. If someone is building or they’re marketing their animal-related services in Texas, what are a few things that they should do to completely avoid or do their best to avoid running into um, you know, or crossing into this unlicensed practice area?

SPEAKER_01 31:49

Yeah, so I think the biggest things are one, review the Texas Texas Occupations Code and our board rules that can be found in the Texas Administrative Code. And then two, if you are confused about anything, please give us a call. You can contact our legal team and someone will be able to help answer your questions. We are very nice. We all, everyone who works at this agency, we all are, we love what we do and we feel very passionate about protecting both the people and the pets of Texas. So we want to help you if you have any questions. So please do not hesitate to give us a call.

Closing Guidance And Resources

SPEAKER_00 32:39

Yeah, that’s great advice. And I know that license holders, probably some of those who are listening, can be really hesitant about reaching out to their own licensing board. But seriously, it is one of the greatest resources that they can use when it comes to understanding the rules and regulations. And from my conversations with um, you know, board staff, it sounds like you guys are not gonna bite anyone’s head off. You’re not sitting there taking notes that Johnny Jim called on Tuesday and he maybe committed a violation that um generally you guys are wanting to be able to provide these license holders with the the best information and the correct information so they can go out and practice with compliance, you know. Yes, exactly, exactly. Well, thank you so much for joining me today, Kristen, and breaking this down in a way that is super practical, very preventative. We’ve definitely given listeners a great opportunity to review and understand exactly what is considered licensed and unlicensed activity with TBVME.

SPEAKER_01 33:43

Oh, well, thank you so much for having me. It has been such a pleasure to speak with you. And I really do hope that this was helpful to our members of the public.

SPEAKER_00 33:54

And to our listeners, if you’re working around animals, this episode is your reminder that the line can be thin, but it’s not invisible. We’ll have TBVME resources linked below so that you can explore and learn some more. And if you found this helpful, give us a follow, share with a friend or colleague. Make sure that you’re in compliance. Until next time, stay inspired and continue engaging with your regulatory agency.