Ronald Hines is a South Texas veterinarian who retired in 2002. After he retired, Dr. Hines established a website where he would answer pet owners’ questions by phone and email. Some people paid him for his help, while many questions he answered for free. He did not examine the pets in person, nor did he prescribe animal drugs.
The Texas Board of Veterinary Medical Examiners (TBVME) sued Dr. Hines in 2013 claiming it was not legal for a vet to dispense medical advice to people whose pets he had not personally examined. The TBVME argued that muzzling Dr. Hines was necessary in the pursuit of quality animal care. It took nearly a dozen years after a string of losses in court for Dr. Hines to win back his freedom of speech to convey animal advice to pet owners online. In September 2024 the 5th Circuit Court of Appeals ruled that Dr. Hines has the right to speak about animal health even for animals he did not examine. The court did not invalidate the Texas law requiring a direct physical examination before treating an animal, however.
The TBVME wanted to protect brick & mortar veterinary practices from competition by telemedicine in my opinion. The American Veterinary Medical Association and their counterparts in Texas all support regulations to inhibit telemedicine from competing with established practices. A bill in the legislature this year died when the clock ran out.
Medical boards generally oppose anything that threatens the status quo. They are supposed to protect consumers but usually end up protecting the industry they regulate. It is also typical to block competition in the name of safety. Two years after the lawsuit by TBVME, the Texas Medical Board sued TelaDoc, a telemedicine company also arguing that telemedicine was allowed only when the doctor had an existing relationship with the patient, by an in-person exam. TelaDoc ultimately prevailed in its countersuit but existing laws in Texas still protects brick & mortar veterinarians from online competition.
This topic became an issue for me because of my dog Clementine. I recently wrote about her experience at the veterinarian. She had surgery for bladder stones, but the surgery did not resolve her problems. We took her back twice more, finally getting a referral to a specialist. A veterinary internal medicine specialist did a very thorough examination costing nearly $1,500. The pathology report found cancer that had metastasized. The internist referred us to her colleague at the same specialty hospital who is a veterinary oncologist. Guess what? He wants to do his own expensive physical exam. When we asked why our dog had to be poked and probed yet again, they told us Texas law prevents treating a dog you have not examined in person. Apparently, this even applies to another veterinarian in the same clinic.
Veterinary oncology is expensive. Surgery is $500 to $5,000. Radiation is $3,000 to $10,000. A CT scan is $1,000 to $3,000, which is necessary to know where to operate or radiate. Traditional chemotherapy is often $1,000 per treatment with a course of treatment costing up to $10,000 or more. Palliating therapy is up to $500 a month. Why are prices so high? Corporations and private equity has acquired veterinary clinics to the point that 25% to 50% are corporate owned depending on where you live. About 75% of specialty vet clinics are corporate owned or owned by private equity investors. Their prices stretch the limits of believability.
The internist cautioned that oncology is likely to extend Clementine’s life by mere months rather than years. The specialty hospital could easily charge $7,000 to $10,000 for exams, pathology reports, biopsies, CT scan, and radiation, and then charge $1,000 a month for a chemo regimen that may boost Clementine’s life by a few months, while traumatizing her. By contrast, metronomic chemotherapy is relatively cheap and convenient. Metronomic chemotherapy is low-dose chemo pills you give your pet at home. Several common drugs used are Chlorambucil ($2 to $4 per pill), Piroxicam ($1 per pill), and Methotrexate ($1 Per pill).
Here is my dilemma: in an age of $7,000 to $10,000 procedures before starting $1,000 a month chemo, what are the odds of us being able to convince our vet oncologist to order a simple $150 a month alternative (from Chewy.com) that is less traumatic to Clementine and almost as good? I am betting we get a big, fat NO! I will likely have to hunt for a small, independent vet practice willing to prescribe metronomic chemo or possibly forget cancer care entirely and just try to make Clementine comfortable until the end.
If veterinary telemedicine is anything like human telemedicine, there would be all manner of specialty websites offering low-cost options for common problems like oncology. Regulations inhibiting veterinary telemedicine does not improve animal care. Rather, it reduces access to care due to excessive prices most pet owners cannot afford.
Read more at Institute for Justice: Victory For Free Speech: Texas Veterinarian Wins First Amendment Case on Giving Pet Advice Online
We had a consultation with a veterinary oncologist, and it was far worse than I anticipated. There was little in the way of tailoring care to the patient. It was packages of care with cost estimates. Radiation was estimated to be (in round numbers) $16k to $18k, but to qualify for radiation we would need nearly $6k in diagnostics (CT scan, histopathology, cystoscopy). Then there is chemo: one type would require 5 or 6 sessions at about $900 each. An alternative type of chemo required 8 sessions at about $800 apiece. These two required trekking to the hospital with the dog and leaving her there all day. Or there were 8 treatments of Vinblastine at $900 each. Only the last one is a pill medication. But, in order to qualify for it we would need a $522 BRAF test first. Let’s not forget the prescription-only NSAID Piroxicam ($4 a pill) that requires around $350 worth of monitoring twice a month.
And the take-at-home metronomic chemo (pills) that are as cheap as $150 a month (plus any monitoring)? “Oh, we don’t do that anymore.”