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Chapter 1: IntroductionAs of 2012, the U.S. Bureau of Labor Statistics estimated there were atleast 84,800 individuals practicing in the field of veterinary technology.Veterinary technicians generally work in private clinical practicesbut are also employed in other areas such as biomedical research,the pharmaceutical industry, zoo/wildlife medicine, the military, andlivestock health management. Veterinary technicians also serve thepublic in the Hawai‘i Department of Agriculture’s Division of AnimalIndustry, helping to ensure the state remains free of rabies.National organizationsand examinationNational Association for Veterinary Technicians in AmericaThe national professional body for veterinary technicians is the NationalAssociation for Veterinary Technicians in America (NAVTA). Formedin 1981, NAVTA’s mission is to represent and promote the professionof veterinary technology. NAVTA extends membership to anyone inthe veterinary industry, including credentialed veterinary technicians,veterinary assistants, veterinarians, educators, and students. However,voting rights are extended only to veterinary technicians who havegraduated from a program accredited by the American VeterinaryMedical Association (AVMA) or who are otherwise licensed, certified, orregistered as a veterinary technician.American Veterinary Medical AssociationThe AVMA, established in 1863, is the national veterinary organizationrepresenting more than 85,000 veterinarians. In addition to advocatingfor veterinarians, the AVMA offers consultation on the education ofveterinary technicians, their use, regulation, and other related matters.The AVMA has a committee on veterinary technician education andactivities that provides and monitors the accreditation of veterinarytechnology programs across the country. All AVMA-accredited programsin veterinary technology must meet the committee’s standards to ensurethe quality of veterinary technology education and the assessment ofstudent knowledge and skills. The only AVMA-accredited veterinarytechnology program in Hawai‘i is at the University of Hawai‘i’sWindward Community College on O‘ahu.The AVMA also advocates uniformity in veterinary nomenclature,including the term “veterinary technician.” Both the AVMA and NAVTAproduced model veterinary practice acts to guide states in creating andamending their respective laws governing the veterinary field, and bothorganizations promote similar definitions of who is to be considereda veterinary technician: an individual who is a graduate of an AVMAaccredited program in veterinary technology.2Report No. 14-15 / December 2014

Chapter 1: IntroductionVeterinary Technician National ExaminationThe Veterinary Technician National Examination (VTNE) is a nationallyadministered test to evaluate entry-level veterinary technicians’competency to practice and be credentialed. In many jurisdictions thatregulate veterinary technicians, a passing score on the VTNE serves asone criterion for credentialing. The VTNE consists of 170 multiplechoice questions that cover the major areas of responsibility deemedessential for an entry-level veterinary technician. This score is acceptedand transferrable between jurisdictions that use the VTNE as a criterionfor credentialing.Regulation in otherstatesHawai‘i is one of only 13 states that do not regulate veterinarytechnicians. In 11 of these 13 states, veterinary technicians haveaccess to voluntary credentialing programs. For example, Florida doesnot regulate veterinary technicians, but veterinary technicians in thatstate can choose to obtain certification as a veterinary technician fromthe Florida Veterinary Technician Association, a private non-profitassociation.Of the 37 states that do regulate veterinary technicians, 14 requireregistration, nine require certification, and 14 require licensure.Exhibit 1.1 shows the various states’ regulatory programs.Exhibit 1.1Regulation of Veterinary Technicians in the U.S.Source: Office of the Auditor based on information from the AVMA and the American Association of Veterinary State BoardsReport No. 14-15 / December 20143

Chapter 1: IntroductionProposal to regulateveterinary techniciansin Hawai‘iSB No. 2502, SD 1, would establish requirements for regulatingveterinary technicians and the practice of veterinary technologyunder Chapter 471, HRS, Veterinary Medicine. The measurecontains provisions relating to registration requirements; educationalrequirements; limitations on the use of titles; grounds for refusal to grant,revoke, or suspend registration; hearings; and criminal penalties. Keyprovisions of the bill are: On July 1, 2018, the Board of Veterinary Examiners would beginissuing certificates of registration to qualified individuals toengage in the practice of veterinary technology as a veterinarytechnician; Definitions for direct supervision, indirect supervision, induce,practice of veterinary technology, and veterinary technicianor registered veterinary technician would be added toSection 471-1, HRS; No one will be allowed to practice veterinary technology orrefer to themselves in such a way as to imply he or she is apractitioner of veterinary technology unless that person has avalid registration as a veterinary technician obtained from theBoard of Veterinary Examiners. Exceptions to the registrationrequirement are also enumerated; No one can be registered to practice veterinary technology unlessthey are at least 18 years old, have successfully completed aveterinary technology program accredited by the AVMA, andsuccessfully passed the VTNE exam; The Board of Veterinary Examiners is given the power to refuseto grant, revoke, or suspend a veterinary technician registration;and Penalties are imposed for practicing veterinary technologywithout a valid registration.The Hawai‘i Veterinary Medical Association (HVMA) testified insupport of SB No. 2502. HVMA argued that veterinary techniciansare key team members in the veterinary profession and regulationwould improve the delivery of veterinary services. The Hawai‘i Boardof Veterinary Examiners recommended deferral of the bill until thecompletion of a sunrise analysis. The Pacific Pet Alliance, a communityorganization, supported the purpose and intent of the proposed regulatorymeasure but expressed reservations that the bill could disenfranchisepart-time employees and those individuals currently working asveterinary technicians who lack formal training from an AVMA-4Report No. 14-15 / December 2014

Chapter 1: Introductionaccredited veterinary technology program. The Humane Society ofthe United States supported the intent of the measure. The Departmentof Commerce and Consumer Affairs commented that the bill does notadequately establish qualifications or the scope of practice of a veterinarytechnician, lacks clarity regarding which veterinary technician activitieswould require supervision by a veterinarian, and fails to enumerate thetypes of conduct that would give rise to disciplinary action.Objectives of theAnalysis1. Determine whether the regulation of veterinary technicians and thepractice of veterinary technology is warranted.2. Assess the probable effects of the proposed regulation and theappropriateness of alternative forms of regulation.3. Make recommendations as appropriate.Scope andMethodologyTo determine whether the proposal to regulate veterinary technicians andthe practice of veterinary technology as proposed in SB No. 2502, SD 1,is consistent with state law, we applied the criteria for regulation set forthin Chapter 26H, HRS, the Hawai‘i Regulatory Licensing Reform Act.The Legislature established policies in Section 26H-2, HRS, to ensurethat regulation of an occupation takes place only for the right reason: toprotect consumers. Regulation is an exercise of the State’s police powerand should not be imposed lightly. Consumers rarely initiate regulation;more often, practitioners themselves request regulation for benefits thatgo beyond consumer protection. For example, members of a professionsometimes believe regulation will enhance their profession’s statusor reputation. The policies set forth in Section 26H-2 reinforce thatconsumer protection is the primary purpose of regulation by stipulating: The State should regulate professions and vocations only wherereasonably necessary to protect consumers; Regulation should protect the health, safety, and welfare ofconsumers and not the profession; Evidence of abuses should be given great weight in determiningwhether a reasonable need for regulation exists; Regulation should be avoided if it artificially increases thecosts of goods and services to the consumer, unless the cost isexceeded by potential dangers to the consumer;Report No. 14-15 / December 20145

Chapter 1: Introduction Regulation should be eliminated when it has no further benefit toconsumers; Regulation should not unreasonably restrict qualified personsfrom entering the profession; and Aggregate fees for regulation and licensure must not be less thanthe full costs of administering the program.We were also guided by the publication Questions a LegislatorShould Ask, published by the Council on Licensure, Enforcement, andRegulation (CLEAR), a national organization. According to CLEAR,the primary guiding principle for legislators should be whether anunregulated profession presents a clear and present danger to the public’shealth, safety, and welfare. If it does, regulation may be necessary; ifnot, regulation is probably unnecessary and wastes taxpayers’ money.In addition to the regulatory policies in Chapter 26H, HRS, and theguidance from CLEAR, we considered other criteria, including whetheror not: The incidence or severity of harm based on documentedevidence is sufficiently real or serious to warrant regulation; Any other alternatives provide sufficient protection to consumers(such as federal programs, other state laws, marketplaceconstraints, private action, or supervision); and Most other states regulate veterinary technicians for the samereasons.In assessing the need for regulation and the specific regulatory proposal,we placed the burden of proof on proponents to justify the need forregulation. We evaluated their arguments and data against the criteriastated above. We examined the regulatory proposal and determinedwhether proponents have made a strong enough case for regulation. Itis not enough that regulation may have some benefits. We recommendregulation only if it is demonstrably necessary to protect the public.We also scrutinized the language of the regulatory proposal,SB No. 2502, SD 1, for appropriateness. We determined whether theproposed legislation appropriately fits one of the three approaches tooccupational regulation. These approaches, from most restrictive to leastrestrictive, are:6Report No. 14-15 / December 2014

Chapter 1: IntroductionMethodology Licensing. A licensing law generally gives persons who meetcertain qualifications the legal right to deliver services—that is,to practice a profession (for example, social work). Penaltiesmay be imposed on those who practice without a license. Toinstitute and monitor minimum standards of practice, licensinglaws usually authorize a board that includes members of theprofession to establish and implement rules and standards ofpractice; Certification. A certification law usually restricts the use ofcertain titles (for example, social worker) to persons who meetcertain qualifications, but does not bar others who do not use thetitle from offering such services. This restriction is sometimescalled title protection. Government certification should not beconfused with professional certification, or credentialing, byprivate organizations. For example, social workers, who mustbe licensed by the state under Section 467E-5, HRS, may alsoreceive professional certification from the National Associationof Social Workers; and Registration. A registration law simply requires practitioners toenroll with the State so that a roster or registry is created and toenable the State to keep track of practitioners. Registration maybe mandatory or voluntary.We reviewed literature on veterinary technicians, their regulation inother states, and practices, including standards promulgated by relevantnational bodies. We inquired about enforcement actions filed by the stateOffice of Consumer Protection and complaints made to the RegulatedIndustries Complaints Office of the Department of Commerce andConsumer Affairs and the Hawai‘i Better Business Bureau.We interviewed representatives of Hawai‘i’s Board of VeterinaryExaminers, the Hawai‘i Veterinary Technician Association, the Hawai‘iVeterinary Medical Association, the Department of Commerce andConsumer Affairs, the Windward Community College veterinarytechnology program, and a non-profit organization with a vested interestin the issue of regulating veterinary technicians. We attempted toidentify the costs and possible impacts of the proposed regulation.Our work was performed from May 2014 to October 2014 in accordancewith the Office of the Auditor’s Manual of Guides.Report No. 14-15 / December 20147

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Chapter 2Regulation of Veterinary Technicians Is NotNecessaryThis chapter presents our findings and recommendations on theproposal to regulate veterinary technicians and the practice of veterinarytechnology as proposed in Senate Bill No. 2502, Senate Draft 1(SB No. 2502, SD 1), of the 2014 legislative session. The Hawai‘iRegulatory Licensing Reform Act, Chapter 26H, Hawai‘i RevisedStatutes (HRS), limits the regulation of certain professions and vocationsto situations in which it is reasonably necessary to protect the health,safety, and welfare of consumers. We found that although regulatingveterinary technicians would provide some benefits, it is unnecessary toprotect the public. We conclude that SB No. 2502, SD 1, should not beenacted.Summary ofFindings1. Regulation of veterinary technicians is not necessary becauseproponents failed to provide sufficient evidence indicating regulationis demonstrably necessary to protect consumers. Additionally,current alternatives to regulation exist and provide sufficientconsumer protection.2. The proposed regulatory measure is problematic.Regulationof VeterinaryTechnicians Is NotNecessaryThe proposed regulatory measure, SB No. 2502, SD 1, does not meetcriteria for the regulation of professions or vocations in Chapter 26H,HRS. We found no evidence of abuses by veterinary technicians tomerit regulation. Other than anecdotal risks of harm, we did not findany evidence to support a need to protect consumers’ health, safety, orwelfare from the activities of veterinary technicians. Furthermore, theserisks are satisfactorily mitigated by existing requirements that veterinarytechnicians work under the direct supervision of a veterinarian. Wefound that most states regulate veterinary technicians but that the currentproposal is motivated primarily by an industry effort to establish nationalprofessional standards. We also found that the proposed regulationwould restrict certain qualified individuals from entering the fieldof veterinary technology, and that the effect of regulation on cost toconsumers is unknown. On balance, there is no demonstrable need forthe State to regulate veterinary technicians in Hawai‘i.Report No. 14-15 / December 20149

Chapter 2: Regulation of Veterinary Technicians Is Not NecessaryAbsence of abusesweighs heavily againstregulationStatutory criteria for evaluating whether a profession or vocation meritsstate regulation require that proponents of regulation provide evidencesupporting this need to engage the state’s police powers. Evidencemust show that serious harm can result to consumers if the professionor vocation remains unregulated. Although veterinary technicians areintegral to delivering veterinary care, we found no evidence that throughtheir activities they pose a clear and present danger to consumers—apoint that weighs heavily against the need for regulation. We foundthat although most other states regulate veterinary technicians, thesupervisory oversight provided by veterinarians is a sufficient alternativeto regulation. We also found the impetus for the regulatory proposal isthe result of national professional trends and industry interests.No evidence of threat to consumers’ health, safety, or welfareFor a profession or vocation to be regulated, evidence is needed todemonstrate a risk to consumers’ health, safety, or welfare from theactivity to be regulated. We sought evidence of abuse or threat of harmposed to consumers of veterinary services and the general public. Whilewe found that health risks exist, in the form of diseases that can betransferred from animals to humans, we found no data showing that theunregulated activities of veterinary technicians pose a threat to publichealth or consumers’ (that is, pet owners’) welfare.We researched complaints about veterinary technicians made to theDepartment of Commerce and Consumer Affairs’ (DCCA) Office ofConsumer Protection and Regulated Industries Complaints Office, thestate Ombudsman, and the Hawai‘i Better Business Bureau (BBB) in thelast three years. The BBB reported it has 20 complaints related to theveterinary industry since 2011; however, none of these were specificallyattributed to veterinary technicians. The other agencies reported theyhave received no complaints regarding veterinary technicians.We also asked representatives of the Hawai‘i Veterinary MedicalAssociation (HVMA), Hawai‘i Veterinary Technician Association(HVTA), and the state Board of Veterinary Examiners (BVE) whetherthey knew of any evidence of abuse or threat to public or consumerhealth, safety, or welfare posed by veterinary technicians. Althoughone proponent pointed out that veterinary technicians play a role inpreventing and controlling the spread of zoonotic (of animal origin)diseases1 from animals to humans, none of these stakeholders was ableto provide any evidence showing that the presence, absence, or ability ofveterinary technicians has adversely impacted public health.110Examples of zoonotic diseases are anthrax, dengue, Ebola hemorrhagic fever, E. coli and salmonellosis infection, Lyme disease,malaria, bubonic plague, and West Nile viral infection.Report No. 14-15 / December 2014

Chapter 2: Regulation of Veterinary Technicians Is Not NecessaryBoth the veterinarians and veterinary technicians we interviewed stressedthe strong emotional connection between owners and their pets, arguingthat regulation would provide assurance to consumers that their animalsare receiving care from qualified provid

veterinary technicians, their use, regulation, and other related matters. The AVMA has a committee on veterinary technician education and activities that provides and monitors the accreditation of veterinary technology programs across the country. All AVMA-accredited programs in veterinary technology must meet the committee's standards to ensure