Before Ronald Hines opened up a letter from the Texas Board of Veterinary Examiners last March, it had never occurred to him that he might be breaking the law.
At the age of 69, Hines has spent almost his entire adult life helping and caring for animals. After graduating veterinary school in 1966, he traveled to all corners of the globe while enlisted in the U.S. Public Health Service. He left the service in the 1980s after suffering a debilitating injury, and later became a veterinarian.
Hines ran his own clinic in Sarasota, Fla. and at one point worked on the staff at SeaWorld. "I've lived in Israel," Hines recalls. "I've run a little veterinary practice – the only one – in Galilee near the Lebanese border. I spent much time in Mexico and today I speak Spanish as much during the day as English."
But in 2002 Hines retired for good and settled down in Brownsville, Texas, where he began writing articles about veterinary care for his website.
"My disabilities limit the amount of time I can actually see clients," he explains. "And my situation here in Brownsville limited the availability of people who really needed my level of expertise. So the internet was just a blessing for me. When I realized what I could do, I just sort of gravitated to it."
It wasn't long before people began to notice. Desperate pet owners searching Google for medical information began landing on his page and he was soon bombarded with requests for vet advice.Though a few emails came from fellow Texans, the overwhelming majority originated from other states and countries.
"I received emails from Africa, the former Soviet Union, little islands, places where there just isn't any veterinary knowledge base," he says. "And the only thing required is that we be able to find a common language."
Hines soon found himself spending hours every day answering people's questions, writing long, detailed responses and, in some cases, calling pet owners by phone when he thought a case was particularly urgent. At some point, in order to weed out the less serious inquiries, he began charging a small fee of $8.95 per patient. His take-home pay, however, never amounted to more than $2,000 in a single year, he claims.
But in March—after more a decade of dispensing veterinary advice over the Web for a small fee— the Texas Board of Veterinary Medical Examiners sent Hines a letter claiming the department "has received a complaint alleging you have and are currently operating an internet consultation service which provides medical recommendations to clients." This practice, the letter continues, "may constitute the practice of veterinary medicine in violation of the Veterinary Licensing Act 801.351."
The law—which Hines claims he never heard about—says "a veterinarian-client-patient relationship may not be established solely by telephone or electronic means." In other words, it has been effectively illegal to treat an animal over the internet in the state of Texas since the law was passed in 2005, at least in cases in which the veterinarian has had no direct contact with the animal in question. Since that first letter was sent Hines has faced fines and even a suspension of his veterinary license.
So Hines decided to fight the state, claiming the law is a violation of his free speech rights and is merely a product of economic protectionism.
Nicole Oria, executive director of the Texas State Board of Veterinary Medical Examiners, said she hadn't yet seen the lawsuit and so couldn't comment on it.
Jeff Rowes, a lawyer for the Institute for Justice, a libertarian public interest law firm that has taken on Hines as its client, claims that the Veterinary Licensing Act is one of many state laws passed in recent years at the behest of industry groups that seek to inoculate themselves from outside competition.
"It's telling that the [veterinary] law was enacted right about the time that the internet was really making inroads, when people were able to get cheap, effective information off the internet without having to make these expensive in-person visits," he says, pointing out that Texas adopted the model language from the American Veterinary Medical Association, the national umbrella lobbying organization for U.S. veterinarians.
For years, Rowes has taken on clients like Hines in the hope that the U.S. Supreme Court would one day answer one central question: Is it constitutional for states to pass laws for no other reason than to protect politically-connected industries from competition? How the federal courts answer this question could have profound implications for those who, like Hines, seek to give medical advice over the internet.
Occupational licensing laws have proliferated in the past several decades. According to a report produced by the Institute for Justice last year, only one in 20 workers in the 1950s needed a license to work. Now it's one in three. In many cases, the report found, license requirements were applied to relatively low-paying professions, like shampooers and florists. The requirements are also inconsistent from one state to another. Why do 10 states require at least four months of training to become a manicurist while Iowa only requires nine days?
"Do manicurists in, say, Alabama and Oregon really need so much more training?" the Institute for Justice's Dick Carpenter asks rhetorically in a video promoting the report.
In instances in which a client is merely attempting to practice a profession, the Institute for Justice argues against the law by invoking the due process and equal protection clauses of the 14th Amendment. But cases like Hines's, where a person is being prosecuted for giving advice are ripe for First Amendment challenges.
Last January, North Carolina blogger Steve Cooksey received a call from the executive director of the North Carolina Board of Dietetics/Nutrition, which told him he was breaking the law for giving nutrition advice without a license. Cooksey, who had been diagnosed in 2009 with Type 2 diabetes, claims to have cured himself of the disease by adopting the paleolithic diet—also often referred to as the caveman diet—and used his blog to proselytize such methods to other diabetics. A lawsuit filed in Federal District Court on behalf of Cooksey states that his advice "ultimately amounts to recommendations about what to buy at the grocery store—more steaks and avocados and less pasta, for example."
Cooksey, who still blogs regularly but is more careful in how he words his posts, believes he's being targeted because his diet advice threatens the various industries that profit from treating diabetics, from "Big Pharma" to professional nutritionists. "You'd be naive to assume that nutritionists do not want to protect their situation," he says. "In my opinion it's essentially a union situation where they want to keep the rates high for their members, and for me or someone else to simply tell diabetics to eat some vegetables and to keep your carbs at 30 or below—you don't need to study 10 hours to learn that, much less go to a four-year school."
In a response posted on its website, the North Carolina Board of Dietetics/Nutrition states that it reached out to Cooksey after a complaint was submitted and "no legal action has ever been threatened or taken." It also argues that "unless a person is otherwise exempt, a license is required to provide nutrition care services."
Whether these types of licensing laws are a violation of the First Amendment is a question largely unexplored by the courts. In the Supreme Court case Lowe v. SEC, the court sought to determine whether a person who writes an investment newsletter would be considered an investment adviser and therefore subject to regulation by the SEC. In a concurring opinion, Justice Byron White wrote that "the power of government to regulate the professions is not lost whenever the practice of a profession entails speech." But he ultimately concluded that "at some point, a measure is no longer a regulation of a profession but a regulation of speech or of the press; beyond that point, the statute must survive the level of scrutiny demanded by the First Amendment." For this particular case, White found that the investment newsletter fell under this second category and was therefore protected as free speech.
Alan Howard, a law professor at Saint Louis University who teaches a course on the First Amendment, points out that there are many professions with services that primarily involve speech. "If you think about it, most things lawyers do require speech," he says. "They write legal opinions, they write briefs, they advise clients. So mainly what they're doing is speech. It doesn't follow that everyone has a First Amendment right to do the same thing."
But Hines, unlike Cooksey, actually has a license associated with the advice he's giving. He is, after all, a veterinarian. In his case, Texas isn't saying he can't give medical advice for pets, it's limiting the mediums with which he can give that advice. Howard predicts the state will argue that a veterinarian would not be able to perform his job competently by just having symptoms described to him over the phone or email, but he says this argument is a "longshot." "If it can be shown that the advice the vet is giving over the internet based on what he's told is the same advice he would give in his office if the patient showed up, then I don't think that it should turn on the medium by which he's giving the advice,"
Some experts are skeptical that a veterinarian would be able to give high quality advice without examining the animal in person. Patricia Wohlferth-Bethke, the assistant director for the American Veterinary Medical Association's field services division, argues that in nearly all instances it's better to treat an animal in person as opposed to online. "You get the physical exam, you're able to question the owner, and it's that interaction that has the value – having the animal examined prior to treatment," she says.
Wohlferth-Bethke says that it may be appropriate in some cases for a vet to answer follow-up questions after an examination via email or other electronic means, but even then the vet's ability to give quality advice diminishes the longer it's been since the animal was seen in person.
"Depending on the disease process, sometimes a week is too much, sometimes a month is too much," she says. "So that's where the judgment of the veterinarian comes in."
Texas' case against Hines may be complicated by the vet's insistence that he doesn't actually "treat" any animals, and instead merely acts as a sounding board and second opinion. "I don't claim to be able to cure an animal over the internet, or that I have any kind of clairvoyant powers," he says. "But I've done this so long that I kind of know statistically what occurs and I try to find them the nearest source of decent veterinary care and get them there."
New Yorker Cynthia Herrli already had a vet for her 17-year-old Russian Blue cat Sam when she reached out to Hines, who she says responded to her inquiries at all hours.
"When someone you love or your pet is really ill, you don't always think of the right questions to ask while you're at the vet's office," she says. "And for me especially, those questions came at night or when my cat was hurting or when I walked home from the vet. And he was always there, an email away."
It was Hines, she says, who urged her to take Sam straight to the hospital when the cat was experiencing alarming symptoms, and it was Hines who was there for her when Sam finally passed away. "He had so much more patience than my local vet. To hear that his approach is in jeopardy makes me angry."
Jean Cervi reached out to Hines after the death of her golden retriever Dakota. The dog had died an early death, in her opinion, and she suspected that the vets she had taken Dakota to had misdiagnosed its ailments. Hines requested years worth of blood tests and then came back to her with a detailed report that confirmed many of her suspicions.
"The man is excellent at looking at tests you've had done or suggesting that you check this or check that," Cervi says. "He doesn't try to treat the animal over the phone. That wasn't my experience at all. But what he does is take the information you give him and paint a picture using his experience with animals, and then he tells you what you might go to the vet and have checked out."
To this day, Hines has no idea who initially submitted a complaint against him, but in March the Texas veterinary board officially reprimanded him, fined him $500, required him to retake the law portion of the veterinary-licensing exam, and suspended his license for a year. Asked what he'll do if his lawyers prevail and a court rules that his rights have been violated, Hines says he'll simply place the contact button back on his web site and resume corresponding with animal owners. "I don't know, I won't be doing this much longer," he elaborates. "I'm old, and it's not a financial thing. But perhaps a younger vet would enjoy doing what I do, and I don't think that should be illegal."
In the meantime, he has plenty to keep him busy; he raises bees, works in his garden, and he likes to fix clocks. Regardless of what happens to him, he says, the world has evolved, and eventually the powers that be will need to recognize that the internet has changed the equation.
"They are just going to have to adjust to the century we live in. The internet has just made a lot of things possible and desirable that probably weren't desirable or possible during the horse and buggy days," Hines says. "And we're just going to have to learn to confront those things."