wv-wv-18498: 26-04 — Standards of Practice

6/15/2026 11:44:30 AM Office of West Virginia Secretary Of State NOTICE OF PUBLIC COMMENT PERIOD AGENCY: Veterinary Medicine TITLE-SERIES: 26-04 RULE TYPE: Legislative Amendment to Existing Rule: Yes Repeal of existing rule:No RULE NAME: Standards of Practice CITE STATUTORY AUTHORITY: §30-10-1 COMMENTS LIMITED TO: Written DATE OF PUBLIC HEARING: LOCATION OF PUBLIC HEARING: DATE WRITTEN COMMENT PERIOD ENDS: 07/16/2026 4:00 PM COMMENTS MAY BE MAILED OR EMAILED TO: NAME: Trish Holstein 5509 Big Tyler Road, Suite 3 ADDRESS: Cross Lanes, WV 25313 EMAIL: wvbvm@wv.gov PLEASE INDICATE IF THIS FILING INCLUDES: No RELEVANT FEDERAL STATUTES OR REGULATIONS: (IF YES, PLEASE UPLOAD IN THE SUPPORTING DOCUMENTS FIELD) INCORPORATED BY REFERENCE: No (IF YES, PLEASE UPLOAD IN THE SUPPORTING DOCUMENTS FIELD) PROVIDE A BRIEF SUMMARY OF THE CONTENT OF THE RULE: Veterinary Standards of Practice and Facility Requirements SUMMARIZE IN A CLEAR AND CONCISE MANNER CONTENTS OF CHANGES IN THE RULE AND A STATEMENT OF CIRCUMSTANCES REQUIRING THE RULE: To provide clarity and update the law. SUMMARIZE IN A CLEAR AND CONCISE MANNER THE OVERALL ECONOMIC IMPACT OF THE PROPOSED RULE: A. ECONOMIC IMPACT ON REVENUES OF STATE GOVERNMENT: N/A B. ECONOMIC IMPACT ON SPECIAL REVENUE ACCOUNTS: N/A C. ECONOMIC IMPACT OF THE RULE ON THE STATE OR ITS RESIDENTS: N/A D. FISCAL NOTE DETAIL: Effect of Proposal Fiscal Year 2026 2027 Fiscal Year (Upon Increase/Decrease Increase/Decrease Full (use "-") (use "-") Implementation) 1. Estimated Total Cost Personal Services Current Expenses Repairs and Alterations Assets Other 2. Estimated Total Revenues E EXPLANATION OF ABOVE ESTIMATES (INCLUDING LONG-RANGE EFFECT): N/A BY CHOOSING 'YES', I ATTEST THAT THE PREVIOUS STATEMENT IS TRUE AND CORRECT. Yes Patricia A HolsteinBy my signature, I certify that I am the person authorized to file legislative rules, in accordance with West Virginia Code §29A-3-11 and §39A-3-2. 26CSR4 TITLE 26 LEGISLATIVE RULE WEST VIRGINIA BOARD OF VETERINARY MEDICINE SERIES 4 STANDARDS OF PRACTICE §26‐4‐1. General. 1.1. Scope. ‐‐ This rule establishes the standards of practice and professional conduct required of veterinarians licensed and regulated by the West Virginia Board of Veterinary Medicine. 1.2. Authority. ‐‐ W. Va. Code §30‐10‐1 et seq. 1.3. Filing Date. ‐‐ May 8, 2017. 1.4. Effective Date. ‐‐ July 1, 2017. 1.5. Sunset Provision. ‐‐ This rule shall terminate and have no further force or effect upon the expiration of August 1, 2037. §26‐4‐2. Definitions. 2.1. “Advertising” means communication designed to inform the public about the availability, nature, and prices of products or services, or to attract clients or business. 2.2. "Ambulatory practice facility" means a professional visit to the location of a patient or client the location of which the veterinary services are provided at a location other than an emergency, mobile, or stationary veterinary facility and includes house calls and farm calls. 2.3. “Convenient access” means capable of being utilized without delay. 2.4. “Dental procedure" means the application or use of any instrument or device, to any portion of on an animal's tooth, gum, or any related tissue for the prevention, treatment cure, or relief of any wound, fracture, injury, disease, injury, or other condition, including procedures performed under sedation or general anesthesia., of an animal's tooth, gum, or related tissue. 2.5. “Emergency facility clinic” means the location of which the veterinary services are providing a facility that provides after hours or 24 hour emergency care. 2.6. “Exercise run” means an enclosed, area under roof, and climate controlled of sufficient size to allow for free ambulation for the comfort and exercise of patients for or kenneled animals that are housed within the facility. 2.76. “General anesthesia” means the inducement and maintenance of a complete absence of sensation and consciousness by the administration of injectable drugs or inhalation gas. 2.8. “Humane disposal” means euthanasia by or under the general supervision of a veterinarian or 1 26CSR4 by an euthanasia technician. 2.9. “Immunization clinics” means an event conducted to provid e easy access to the public for routine preventative health care for their animals. The clinics may occur at a veterinarian’s permanent facility location or alternative sites for easy public access. 2.107. “Impervious” or “impervious surface” means incapable of being penetrated by water or other liquids. 2.118. “Prescription drugs” mean drugs that are approved by the U.S. Food and Drug Administration (FDA) and that are required by federal, state, or local or state law to be dispensed to the public only on prescription by a licensed provider. 2.129. “Mobile facility” means a veterinary unit a facility that may be transported or moved from one location to another. With this type of practice, the patient, where veterinary medicine is practiced is examined and treated in the mobile unit. 2.1310. “Sedation” means the administration of a drug to calm calming of mental excitement or reduction reduce of physical activity in an animal, by the administration of a drug. 2.1411. “Stationary facility” means a fixed, non‐moveable structure where veterinary medicine is practiced. 2.1512. “Sterile surgery” means surgical procedures conducted using in which aseptic technique is practiced in patient preparation, instrumentation, and surgical attire to prevent infection. 2.1613. "Surgery" means that branch the discipline of veterinary medical science which uses operative measures for treating diseases, deformities, injuries, and for reproductive sterilization or elective operative procedures. 2.1714. "Veterinarian" means a person who is licensed to practice veterinary medicine pursuant to WV Code §30‐10‐1 et. seq. 2.15. "Veterinarian‐client‐patient relationship" or VCPR means a relationship between a veterinarian, a client, and a patient, and exists when: 2.15.1. A veterinarian assumes responsibility for medical judgments regarding the health of an animal and the client who is the owner or other caretaker of e t animal agrees to follow the veterinarian's instructions; and 2.15.2. A veterinarian, through personal examination of an animal or a representative sample of a herd, flock, or litter, obtains sufficient information to make at least a general or preliminary diagnosis of the medical condition of the animal, herd, or flock, which diagnosis is expanded through medically appropriate visits to the premises where the animal, herd, or flock is kept. 2.15.3. A veterinarian may, without an established VCPR, provide consultation services, including the review and evaluation of an animal’s condition, medical information, and diagnostic tests, on behalf of a buyer or seller; however, such consultation mayn ot include the treatment of, or prescribing to, the animal. 2 26CSR4 2.1816. “Veterinarian in charge" means a veterinarian holding who holds an active West Virginia license in West Virginia and who is responsible for ensuring the maintaining a veterinary practice meets all applicable within the standards set pursuant to by the W. Va. Code §30‐10‐1 et seq. and W.Va. Code R. §26‐1‐1 et. seq. 2.1917. “Veterinary practice facility” means the location any ambulatory, emergency, mobile, or stationary practice wherein veterinary medicine or surgery is conducted. §26‐4‐3. General Professional Ethics. 3.1. It is unprofessional and a violation of this rule for ayn veterinarian to represent conflicting interests, except by express consent of all persons concerned, given after a full disclosure of the facts. Within the meaning of this rule, a veterinarian represents conflicting interests if, when employed by a buyer to inspect an animal for soundness, he or she accepts a fee from the seller. Acceptance of a fee from both the buyer and seller is prima facie evidence of fraud. 3.2. A veterinarian may not make any effort, direct or indirect, which in any manner is calculated to influence the sound professional judgment of another veterinarian. It is the right of any veterinarian, without fear or favor, to give proper advice to those seeking relief against unprofessional or neglectful veterinary services. A veterinarian shall have the right to exercise independent professional judgment in the provision of a medical opinion. No veterinarian shall be subject to professional discipline, solely for providing a medical opinion that differs from a previous diagnosis or treatment plan, provided such opinion is based on generally accepted veterinary medical standards. 3.3. A veterinarian may, shall expose without fear or favor, before the proper tribunal of the Board any and all report any malpractice, incompetence, corrupt, or dishonest conduct in the profession to the appropriate authorities. 3.4. A veterinarian shall not render any service or advice contrary to the law and A veterinarian shall also advise clients to observe all applicable laws and regulations the law. 3.5. A veterinarian shall not render any services or advice directed toward the intended to corruption of corrupt any person or persons exercising a public office or private trust, or and shall not participate in deception, or betrayal of the public. 3.6. Any veterinarian who uses a present or past position, or an office of trust, deliberately to create an individual professional advantage, or to coerce, or to deceive the public is in violation of this section. 3.7. A veterinarian whose accreditation has been disciplined by state or federal authority may be subject to disciplinary action by the Board upon proof of removal of accreditation by that authority. 3.8. A veterinarian shall exercise professional discretion in determining which medical cases will be accepted. decide what medical cases will be accepted in his or her professional capacity. In the event the veterinarian chooses not to provide services, the client shall be notified. If a veterinarian chooses not to provide services, the client shall be promptly notified. 3.9. The professional services of a veterinarian shall not b econtrolled or exploited by any lay agency, personal or corporate, which intervenes between the client and the veterinarian. A veterinarian 3 26CSR4 shall avoid all relationships which could result in interference or intervention in the veterinarian's practice by any person or entity. A veterinarian is responsible for his or her own actions and is directly responsible to the client and for the proper care and treatment of the patient. This is to include information on how clients may receive emergency care when the veterinarian is not available. 3.10. A veterinarian shall exercise the same degree of humane care, skill, and diligence in treating patients as is ordinarily used in the same or similar circumstances by reasonable members of the veterinary medical profession. 3.11. A veterinarian in this State shall not issue a certificate of health unless he or she knows through actual inspection and appropriate tests of the animals, that the animals meet the requirements for the issuance of the certificates. has personally inspected the animals and conducted appropriate tests to verify that the animals meet the requirements for such certification. 3.12. It is professionally dishonest for a veterinarian to guarantee a cure. A veterinarian shall avoid bold and confident assurances to clients. giving bold or absolute assurances to clients regarding outcomes. 3.13. A veterinarian shall conduct his or her practice with honesty, integrity, and fair dealing to clients in time and services rendered. 3.14. A veterinarian shall not violate his or her confidential relationship with the clients. 3.15. A veterinarian may represent himself or herself as a specialist only if they have completed the process of Board certification in a an American Veterinary Medical Association recognized veterinary specialty area. To become Board certified, a veterinarian must have a credential review and examinations set by the given specialty area. The Board shall annually, before the first of January, provide a list of AVMA approved veterinary specialty organizations for the next calendar year. 3.16. Veterinary Medical Records are considered privileged and confidential. Disclosure of records is prohibited unless the client has provided written or documented verbal consent. A veterinarian shall provide a client’s medical records within 30 days of request. However, records may be released by court order, subpoena, or compliance with local, state or federal, law as deemed necessary to protect the animal or public health. Sharing of necessary medical information between veterinarians or facilities is allowed for treatment, boarding, and diagnosis without client consent. Reasonable cost for copying the medical record and or images may be charged. 3.1716. A veterinarian may not initiate or knowingly participate in any form of advertising or solicitation that contains a false, deceptive or misleading statement or claim. In order to advertise 24 hour emergency service, a practice must shall be a facility that is open 24 hours provides that service. §26‐4‐4. Classification of Veterinary Practices. 4.1. The following are classifications of veterinary practices: 4.1.a1. Ambulatory 4.1.b2. Emergency 4 26CSR4 4.1.c3. Mobile 4.1.d4. Stationary §26‐4‐5. Mandatory Standards for the Practice of Veterinary Medicine and Facility Standards. 5.1. All classifications of veterinary practice as referenced or defined by §26‐4‐4 shall meet these mandatory standards. 5.1.a1. A veterinarian shall deliver veterinary care in a competent and humane manner. 5.1.b2. A veterinarian shall perform all aspects of veterinary medicine and surgery in a manner compatible with current veterinary medical practice. 5.1.c3. Upon the formation of a veterinarian/client/patient relationship, in order for a veterinarian to exercise properly the rights granted by a veterinary license, the veterinarian shall: 5.1.c.13.a. Perform a physical examination of the animal. A group of animals of one species under single ownership may be considered as a single entity. A veterinarian/client/patient relationship is established for the whole group if a representative number of animals have been examined the same species under single or shared ownership may be considered a single entity. A veterinarian‐client‐ patient relationship is established for the group when the veterinarian has examined a representative sample of the animals which allows sufficient knowledge of the health status and management of the group to provide veterinary care consistent with the standard of care for the species. 5.1.c.23.b. Discuss with the client a diagnostic assessment and treatment plan, including medications and follow up recommendations. This information shall be entered into the patient's medical record. 5.1.d4. Licenses, registrations, certifications, and permits issued by the Board shall be posted in a place conspicuous to the public at the establishment where veterinary services are being provided. Licensees and registrants who do relief or temporary work in an establishment shall carry a license with them or post it at the establishment. Ambulatory veterinary pra ctices that do not have an office accessible to the public shall carry their licenses, registrations, and permits in their vehicles. 5.1.e5. The practice and facility shall comply with federal, state, and local regulations in regards to the maintenance and disposal of all chemical and pharmaceutical agents. 5.1.f6. A veterinarian who performs euthanasia shall do so in a competent and humane manner. 5.1.g7. A veterinarian shall provide and maintain sanitary methods for the disposal of deceased animals in compliance with the federal, state, and local, state, and federal health rules and regulations, and provide refrigeration exclusively for carcasses of companion animals that require storage for 12 hours or more. 5.1.h8. A veterinarian The practice and facility shall ensure that the disposal dispose of medical waste, including sharps, is in accordance with federal, state, and local, state, and federal laws. 5 26CSR4 5.1.i9. Equipment currently in use shall be maintained in working order within manufacturer guidelines. 5.1.j10. Current veterinary journals, and textbooks, or immediate internet access to such information shall the information provided by current veterinary journals and textbooks need to be available for ready reference. 5.1.k11. A veterinarian shall have a method of obtaining the weight of correctly weighing an animal. 5.1.12. Veterinary facilities shall be maintained in a clean, safe, orderly and sanitary manner. 5.2. Patient Medical Records 5.2.a1. A veterinarian shall maintain individual records at his or her place of business in such a way that any veterinarian shall be able to proceed with the cotn inuity of care and treatment of that patient which records shall include, but not be limited to, identification of the patient, the patient's medical history, immunization records, diagnostic procedures performed, diagnosis, and treatment plan.A veterinarian, who provides veterinary medical services, shall prepare and maintain accurate, legible, and complete patient medical records for each patient at his or her veterinary facility. 5.2.1.a. Patient medical records may be maintained in written or electronic format and shall be readily retrievable for inspection by the Board. 5.2.1.b. Patient medical records shall contain sufficient information to document the patient’s condition, support the diagnosis, justify treatment, and permit another veterinarian to continue the immediate care of the patient. 5.2.2. Required Content of Patient Medical Records. Veterinary patient medical records shall include, at a minimum: 5.2.2.a. The name, address, and contact information of the client or owner. 5.2.2.b. Sufficient information to identify the patient. 5.2.2.c. Reason for visit to include the date of examination, presenting complaint, and relevant medical history. 5.2.2.d. Examination findings 5.2.2.e. Diagnostic procedures, reports, and findings 5.2.2.f. Treatment and procedures 5.2.2.g. Medication(s) 5.2.2.h. Progress and outcome 5.2.2.i. Immunizations 5.2.2.j. Follow‐up recommendations 5.2.2.k. Anesthesia logs 6 26CSR4 5.2.2.l. Each entry in the medical record shall identify the veterinarian or authorized staff member making the entry. Electronic patient medical records shall include a method for identifying the author and recording the date and time of entries. 5.2.b. The practice owner shall keep and maintain current patient records on the business premises for a period of 3 years beyond the last patient visit and the records are the responsibility and property of the owner of the veterinary practice. If the practice is closgin or being sold and the location of the practice moving, clients shall be notified a minimum of four weeks prior to a permanent practice closing or moving as to how they may acquire a copy of their animal’s medical records. Records must be made available for client retrieval at convenient times and accessible locations for a period of no less than one month. 5.2.c3. When appropriate, the words "herd", "flock", “litter”, or other collective group terms may be used in place of the word "patient" in subdivision a and b of this subsection. Records maintained on these animals may be kept in a daily log or the billing records; provided that the information that is entered is adequate to substantiate the identification and treatment of these animals. When appropriate, herd, flock, or litter, patient medical records may be maintained in lieu of individual patient medical records and shall be in accordance with all the requirements of this Section. 5.2.4. Patient Medical Record Ownership and Confidentiality 5.2.4.a. Veterinary patient medical records are the property of the veterinary practice that created them. 5.2.4.b. Veterinary patient medical records shall be treated as confidential and shall not be released except: 5.2.4.b.1. With a written or documented client authorization; however, necessary medical information may be released without client consent to other veterinarians or facilities providing boarding, grooming, daycare, or other animal care services. 5.2.4.b.2. To another veterinarian involved in the care or treatment of the patient when such disclosure is necessary to ensure continuity of care. 5.2.4.b.3. By court order, subpoena, or compliance with federal, state, or local laws as deemed necessary to protect the animal or public health. 5.2.4.b.4. A reasonable fee may be charged for processing records. 5.2.5. Client Access to Records 5.2.5.a. Upon request, a veterinarian shall provide a copy of the patient’s medical record to the client or the client’s authorized representative. 5.2.5.b. Records shall be provided within fourteen (14) days of the request. 5.2.5.c. A reasonable fee may be charged for processing records. 5.2.5.d. If the practice is closing or the location of the practice is moving, clients shall be notified a minimum of thirty (30) days prior to the event as to how they may acquire a copy of their 7 26CSR4 animal’s patient medical records. Records shall be made available for client retrieval at convenient times and accessible locations for a period of no less than thirty (30) days. 5.2.6. Patient Medical Record Retention 5.2.6.a. Shall be retained for a minimum of three (3) years from the date of the last patient encounter, unless otherwise required by law. 5.2.6.b. May be stored electronically or on paper. 5.2.6.c. Shall be stored securely and capable of being reproduced as needed. 5.2.7. Patient medical records shall be made available to the Board or its authorized representatives during an investigation or inspection as required by law. 5.3. Pharmacology 5.3.a1. A veterinarian shall not prescribe, dispense, or administer any prescription drug without the establishment of a veterinarian/client/patient relationship. 5.3.b2. The veterinarian shall be responsible for assuring that any drugs, biological agents, or other products prescribed for use in the veterinary practice are properly administered. 5.3.c3. The veterinarian shall be responsible for maintaining accurate patient medical records in the patient’s medical history which shall include the strength, dosage, and quantity, and number of refills of all medications used or prescribed. 5.3.d4. The veterinarian shall provide appropriate instruction to clients on the storage and administration of drugs. 5.3.e5. The veterinarian shall maintain all drugs and biological agents in compliance with federal, state, and local state and federal laws. Expired drugs shall not be dispensed. No drugs shall be dispensed that are beyond the date of expiration. 5.3.f6. Special handling requirements for drugs (eg. refrigeration or light sensitive) shall be included in your instructions. A veterinarian shall store all repackaged drugs dispensed for animals in approved safety closure containers. This provision does not apply to drugs dispensed to a person who requests that the medication not be placed in these containers, or to drugs in such form or size that they cannot be dispensed reasonably in these containers. 5.3.g7. All drugs dispensed, including repacked drugs, shall be labeled with the following: 5.3.g.17.a. The name, address, and telephone number of the practice; 5.3.g.27.b. The name of the prescribing veterinarian; 5.3.g.37.c. The date dispensed; 5.3.g.47.d. The client's name; 8 26CSR4 5.3.g.57.e. The patient's name; 5.3.g.67.f. The directions for use; 5.3.g.77.g. The name of the drug; 5.3.g.87.h. The strength of the drug if more than one dosage form exists; 5.3.g.97.i. The quantity or volume dispensed; 5.3.g.107.j. The number of refills, if any; and 5.3.g.117.k. The expiration date. 5.3.h8. A veterinarian that has a Federal Drug Enforcement Administration (DEA) number and that uses, dispenses, administers, dispenses, or prescribes controlled substances shall comply with the federal, and state, and local laws pertaining to the dispensing, prescribing, storage, and usage of controlled substances; including and maintaining maintain a register, which shall indicate the following: 5.3.h.18.a. The name of the prescribing veterinarian; 5.3.h.28.b. The name of the medication administered, dispensed, or prescribed; 5.3.h.38.c. The quantity administered, dispensed, or prescribed; 5.3.h.48.d. The dosage of the medication, if applicable; 5.3.h.58.e. The number of refills, if any; 5.3.h.68.f. The date of the administered, dispensed, or prescribed dispensing or prescribing; 5.3.h.78.g. The name of the client and patient name and name of the client record; 5.3.h.88.h. The expiration date of the medication; 5.3.h.98.i. The method used for prescribing, such as written script, phone, fax or any other electronic means; and 5.3.h.108.j. The name and phone number of the pharmacy or pharmaceutical agent which received the script from the veterinarian, if not delivered directly to the client. 5.3.i9. Veterinarians shall honor a client’s request for a prescription in lieu of dispensing. 5.3.j10. Prescriptions may be refilled for up to one year or the maximum number of refills prescribed from the examination date at the prescribing veterinarian’s discretion. After 1 year, the patient shall be re‐examined before an additional prescription is validated. 5.4. Laboratory Services 9 26CSR4 5.4.a1. Each practice shall maintain laboratory services using either an in‐house and/or an outside laboratory in order to meet the current standards of care for the profession. 5.5. Radiological Services (if performed) 5.5.a1. A veterinarian shall store and maintain radiographs (including dental images), whether in film or digital format for a minimum of three (3 years) from the date of last patient encounter. 5.5.b2. All radiographs in any format shall have a permanent identification bearing the client’s name, the patient’s name, the date, and either left or right markers. 5.5.c3. Diagnostic x‐ray equipment shall be kept in compliance with state and federal, state, and local laws, rules and regulations. 5.5.d4. Practices using x‐ray equipment must shall have: 5.5.d.14.a. Lead aprons and gloves; 5.5.d.24.b. Thyroid shields and; 5.5.d.34.c. Personal radiation exposure badges and corresponding monitoring reports. 5.6. Surgical Services (if performed): 5.6.a1. A veterinarian shall practice surgery in accordance with species specific standard of care. 5.6.b2. The following surgical technique and attire is required for aseptic surgery; 5.6.b.12.a. The disinfection of the surgeon's hands using a disinfecting solution; and 5.6.b.22.b. A veterinarian shall wear clean clothing and sterile gloves should be changed between patients. 5.6.b.32.c. Clean water shall be accessible to the sites of the surgical procedure. 5.6.b.42.d. Emergency drugs for cardiac and pulmonary resuscitation readily accessible. 5.6.c3. A veterinarian shall use an acceptable method of sterilization of all appropriate equipment sufficient to kill spores on all instruments, packs, and equipment intended for use in sterile surgical procedures. A steam pressure sterilizer or an appropr iate method of sterilizing instruments shall be used. 5.6.d4. The use of sterilization indicators, both internal and external, are required on all surgical packs. A sterilized date shall be marked on all sterilized item The date that the equipment was sterilized shall be marked on the outside of any packs or pouches. 5.6.e5. The veterinarian shall provide a method for the client to obtain emergency advice pertaining to surgical and post treatment problems after the animal is released to the owner or agent 10 26CSR4 following the completion of the surgery or treatment; 5.7. Dental Services (if performed) 5.7.a1. All Dental procedures shall be carried out by a veterinarian, technician or veterinary assistant under the general supervision of a veterinarian. 5.7.b2. Dental instruments shall be clean and/or sterilized as appropriate between patients. 5.8. General Anesthesia/Sedation Ventilation Services (if performed) 5.8.a1. A method of respiratory monitoring, such as observing chest movements, watching the rebreathing bag, or use of a respirometer. Some method of cardiac monitoring is required, and may include use of a stethoscope or electrocardiographic monitor. During general anesthesia, the patient's respiratory and cardiovascular functions shall be evaluated and recorded at intervals adequate for determining anesthetic depth and physiological status, thereby optimizing patient safety. 5.8.a.11.a. Respiratory monitoring shall include, at a minimum, direct observation of respiratory rate and effort and may include auscultation, capnography, pulse oximetry, or other clinically accepted respiratory monitoring equipment appropriate to the patient and procedure. 5.8.a.21.b. Cardiac monitoring shall include auscultation with a stethoscope and may include electrocardiographic (ECG) monitoring, pulse rate monitoring via pulse oximetry, or other appropriate cardiac monitoring equipment. 5.8.a.31.c. Monitoring methods shall be appropriate to the level of sedation and sufficient to allow timely detection of respiratory or cardiac compromise. 5.8.b2. Any patient recovering from general anesthesia or sedation shall be observed by veterinary personnel until it has been determined that the patient can be released. 5.8.b3. A veterinarian within the facility shall provide every animal with a pre‐surgical assessment within twelve (12) hours prior to the administration of an anesthetic, and the results of this examination shall be noted in the patient’s medical record. 5.8.c4. A veterinarian, or his or her assistant, or a registered veterinarian technician shall monitor every animal as long as the patient is under general anesthesia. The monitoring data shall be included in the patient’s medical record. 5.8.d5. A veterinarian shall not release any patient from veterinary supervision to the owner or client until it is responsive and recovered from anesthesia. A veterinarian is not required to comply with the provisions of this subdivision if the client demands to take the animal home against the veterinarian’s advice and judgment. In this case, the veterinarian shall request that the client sign a release form stating that the client has been advised to leave the animal; realizes the risks involved; and is taking the animal against the advice and judgment of the attending veterinarian. §26‐4‐6. Mobile and Stationary Mandatory Facility Standards. 6.1. In addition to the requirements of §26‐4‐5, mobile and stationary facilities must shall meet the 11 26CSR4 following facility standards: 6.1.a1. A reception room and office, or a combination of the two; 6.1.b2. An examination area, species suitable, which is separate from other areas of the facility of sufficient size to accommodate the veterinarian, technician or assistant, patient, and client. The area shall also at a minimum have: 6.1.b.12.a. Lighting adequate to perform a thorough physical examination; 6.1.b.22.b. Convenient access to a sink with hot and cold running water. 6.1.c3. Indoor lighting sufficient for the safety of staff and patients. 6.1.d4. A kennel, stall or housing area where animals can be retained for treatment and post surgical observation. This area shall have separate compartments for each animal which shall be maintained in a sanitary manner and allow for the comfort of the animal. If animals are retained for treatment or post‐surgical observation, each animal shall be h uo sed in a separate compartment appropriate for its species, size, and condition. Housing areas shall be maintained in a clean and sanitary manner and shall provide for the animal’s comfort and well‐being. If the animal is deemed contagious, the animal shall be maintained in a designated isolation area or implement effective isolation protocols sufficient to reduce the transmission of contagious or infectious diseases. 6.1.e. If animals are housed overnight, an isolation area with the proper protocol to handle infectious diseases. 6.1.f5. Examination table with an impervious surface which can be easily cleaned and disinfected. An examination table is optional in large animal mobile practices. 6.1.g6. All floors, counter tops, and wall surfaces in the traffic or working areas of the hospital constructed with an impervious material that can be easily washed and disinfected. 6.1.h. Small animal practices which house animals overnight must have at least 1 exercise run maintained in a clean and sanitary condition. The surfaces (walls and flooring) shall be impervious so that they can be sanitized and disinfected. 6.1.i7. Surgical Services 6.1.i17.a. A room designated solely for surgery, separated by doors, and distinct from all other rooms. The room shall have at a minimum: 6.1.i27.b. Lighting adequate to perform surgery. A surgery room shall be equipped with either a ceiling mounted or free standing surgery light with a light source capable of being adjusted or redirected. Backup emergency lighting is required of sufficient intensity to conclude surgery in case of power outage; 6.1.i37.c. A surgery table with an impervious surface which can be cleaned and easily disinfected. 12 26CSR4 6.1.i47.d. An illuminated X‐ray viewer or a device to view digital images readily accessible to the surgery room; 6.1. i57.e. Walls, floors, and counter tops constructed with an impervious material capable of being cleaned and routinely disinfected. 6.2. In addition to the mandatory standards, Emergency facilities shall have maintain all mandatory standards in compliance with §26‐4‐5, and a veterinarian shall be present or immediately available to return to the facility, to provide veterinary services during the posted hours of operation. 6.2.a. An electrical cardio graphic monitoring device. 6.2.b. A veterinarian on the premises at all times during the posted hours of operation. §26‐4‐7. Veterinarian in Charge. 7.1. The veterinarian‐in‐charge of a veterinary establishment is responsible for: 7.1.a1. Being on site as necessary to provide routine oversig ht to the veterinary establishment ensuring for patient safety and compliance with federal, state or local laws and regulation. 7.1.b2. Performing or overseeing the biennial controlled substance inventory and ensuring compliance at the facility with any federal, state or local or state laws relating to controlled substances. The performance of the biennial inventory may be delegated to another licensee, provided the veterinarian‐in‐ charge signs the inventory and remains responsible for its content and accuracy. 7.1.c3. Notifying the Board in writing of the closure of the permitted facility ten (10) days prior to closure. 7.1.d4. Notifying the Board immediately if no longer acting as the veterinarian‐in‐charge. 7.1.e5. Ensuring the establishment maintains a current and valid permit issued by the Board. 7.2. Upon any change in veterinarian‐in‐charge, these procedures shall be followed: 7.2.a1. The veterinarian‐in‐charge registered with the Board remains responsible for the establishment and the stock of of all controlled substances until a new veterinarian‐in‐charge is registered or for five days, whichever occurs sooner. 7.2.b2. An application for a new permit, naming the new veterinarian‐in‐charge, The Board shall be notified in writing by the new veterinarian‐in‐charge within shall be made five (5) days prior to the change of the veterinarian‐in‐charge. If no prior notice was given by the previous veterinarian‐in‐charge, an application for a new permit naming a new veterinarian‐in‐charge shall be filed as soon as possible but no more than 10 days after the change. 13 26CSR4 7.2.c3. The previous establishment veterinary facility registration is void on the date of the change of veterinarian‐in‐charge and shall be returned by the former veterinarian‐in‐charge to the Board five (5) days following the date of change. 7.2.d4. Prior to the opening of the business, on the date of the change of veterinarian‐in‐charge, the new veterinarian‐in‐charge shall take a complete inventory of all Schedule II‐V drugs on‐hand. He shall date and sign the inventory and maintain it on‐premises for three years. That inventory may be designated as the official biennial controlled substance inventory. Prior to opening or on the date of the change, the new veterinarian‐in‐charge shall perform a complete inventory of all Schedule II–V drugs on‐ hand, date and sign the inventory, and maintain it on‐premises for a minimum of three (3) years. This initial inventory may serve as the official biennial controlled substance inventory. §26‐4‐8. Facility Inspections and Registration. 8.1. A new veterinary facility shall notify the Board in writing sixty (60) days prior to opening, and. be inspected by the Board prior to opening. If the inspection is delayed for reasons not associated with the practice or its operators, Tthe Board, shall grant an authorization to begin operation while the facility awaits its initial inspection if this inspection is delayed for reasons not associated with the practice or its operators. A veterinary facility can be owned by a non‐veterinarian. 8.2. A registered veterinary facility shall be inspected by the Board on a rotating basis every two 2 years, except when the Board requires a re‐inspection due to the facility not meeting all requirements for that type of facility at the routine inspection. Additionally, the Board may inspect a facility at any time for just cause. Only after the Board determines that the facility meets the respective provisions for operation under this rule may it lawfully operate. A veterinary facility may lawfully continue operations only after the Board determines that the facility meets the respective provisions for operation under this rule. If the Board deems appropriate, a facility may be permitted to continue operations pending the satisfaction of identified inspection deficiencies. The Board shall order the immediate closure of a facility for operation if the inspection deficiencies endanger patient, public, or worker safety. 8.3. Should a veterinary facility change ownership, the new owner shall notify the Board within 5 days of such purchase and will be subject to re‐inspection. 8.4. An owner of veterinary practices operating shall complete and file annually, on or before June 30, on a form approved by the Board, an annual veterinary practice registration, and shall pay the veterinary practice annual permit registration renewal fee, as prescribed by 26CSR6. 8.5. If the owner of a veterinary practice does not file an nanual veterinary practice registration renewal by June 30 and the Board performs inspections in the region without knowledge of the existence of the facility, the veterinary practice is liable for the additional trip to inspect the non‐ compliant practice, and the fee for inspection is double the usual and customary fee for practice inspection as specified in the Schedule of Fees. 8.6. The Board shall not issue a renewal license to a veterin arian who is an owner of a veterinary facility situated in this state that has not filed an annual facility registration, or that has refused to allow a representative of the Board to inspect the veterinary facility during the facilities regular business hours. 14 26CSR4 8.7. The Board may revoke or suspend a facility registration for not being in compliance with this Rule. §26‐4‐9. Abandoned Animals. 9.1. An "abandoned animal" means any animal placed for treatment or boarding by its owner or an agent of the owner in the care and custody of a veterinarian, w hich is not retrieved by the owner or agent of the owner from the veterinarian within 72 hours of the veterinarians specified release date of a hospitalized animal or the scheduled release date of a boarded animal. The owner or agent of the owner shall be sent a certified letter to his or her last known address, return receipt requested, informing him or her that the animal is available for pickup. The letter to the owner or agent of the owner shall also state the amount owed, if any, to the veterinarian for the treatment and care of the animal, set by the W.Va. Code R. §26‐4‐9.2. That the veterinarian may elect the humane disposal of an abandoned animal no sooner than 7 days after the veterinarian has mailed a certified letter. An abandoned animal is any animal left by its owner, or an agent of the owner, in the care and custody of a veterinarian that is not retrieved by the owner or agent within seventy‐two (72) hours o f the veterinarian’s specified release date. 9.2. Notification to the owner or agent shall include the following: 9.2.1. Documentation of notification of certified mail, return receipt requested, to their last known address. 9.2.2. Information that the animal is ready for pickup. 9.2.3. Amount owed, if any, for the treatment and care of the animal, 9.2.4. That the animal may be subject to humane euthanasia orp lacement of the animal pursuant to this section. 9.23. A veterinarian may elect to proceed with the humane euthanasia disposal or placement of an abandoned animal no sooner than seven (7 days) after the veterinarian the certified letter has been mailed a certified letter to the owner or agent of an abandoned animal indicating his or her intent to humanely dispose of the animal. If delivery of the letter cannot be confirmed, humane euthanasia or placement may occur after seven (7) days provided proof of mailing is documented. In the event the owner or agent cannot be notified by certified mail, return receipt requested, the veterinarian may elect humane disposal any time after(7) days following the mailing of the certified letter, providing the veterinarian has a posted receipt from the mailing entity verifying the mailing date of the certified letter. The veterinarian shall keep an accurate record of the date and method of disposal, and the name, address, and telephone number of the person or shelter receiving the animal, if it is not destroyed. 9.34. The humane disposal of abandoned animal shall not relieve the owner or agent of any financial obligation incurred for treatment, boarding or care by the veterinarian. Alternatively, an animal may be placed in a suitable home or animal shelter, which shall not include any home or shelter which engages in animal experimentation or, by sale or otherwise, makes animals available for the purpose of animal experimentation. The veterinarian shall document accurate patient medical records including: date, method of humane euthanasia or placement. If the animal is placed, the name, address, and phone number of the individual or shelter receiving the animal shall be documented in the patient 15 26CSR4 medical records and kept confidential from the previous owner. The animal may be placed in a suitable home or animal shelter, provided the home or shelter does not engage in animal experimentation or make the animal available for the purpose of animal experimentation. 9.45. Notification and humane disposal as provided in this section relieves the veterinarian of any further liability regarding the abandoned animal. 9.56. The veterinarian shall post a copy of this section in a conspicuous location at the veterinary facility. §26‐4‐10. Immunization Clinics. 10.1. Immunization clinics shall be operated by a veterinarian licensed by the Board who is employed by has a registered veterinary practice in the county or adjoining counties where the clinic is being held. Any immunizations provided at the clinic other than rabies vaccinations shall be administered by a veterinarian or a registered veterinary technician supervised by the veterinarian on site and shall have a current veterinary‐client‐patient relationship. §26‐4‐11. Non‐Typical Emergency and Disaster Situations. 11.1. In the event of a natural disaster or local malfunctiono f utilities, veterinary practices may temporarily operate their businesses outside of these standards of practice if the veterinarian makes amends to alleviate as much as possible the problems associated with the temporary loss of facilities, utilities, or transportation. All efforts are directed to keep patients safe while continuing to provide needed veterinary and lifesaving services. Every effort will be made by the practice owner to bring the facility into full compliance with the standards of practice as quickly as possible. 16