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The Supreme Court refused last month to review a Texas veterinary free speech case, leaving in place a Fifth Circuit ruling that could affect how veterinary telemedicine rules are enforced.

The United States Supreme Court's refusal last month to review an appellate ruling marks the end of a case that hovered over veterinary telemedicine for 13 years.

The denial of review allows a 2024 Fifth Circuit decision to stand. The court found state regulators violated the free speech rights of a Texas veterinarian when they penalized him for advising clients by email without having first conducted a hands-on patient exam.

Texas, like many states, generally requires a veterinarian to examine the animal or make a medically appropriate visit to the premises where the animal is kept before establishing a veterinarian-client-patient relationship (VCPR), which is a prerequisite to diagnosing and prescribing. The principle is based on the understanding that veterinary patients cannot speak for themselves and tell the veterinarian how they feel.

The Fifth Circuit did not strike down Texas' VCPR law across the board. It held that, as applied to the veterinarian's advice practice, the state's enforcement action regulated speech and failed First Amendment scrutiny.

Proponents and opponents alike of the in-person-exam requirement are interpreting the Fifth Circuit decision as supporting — or, at least, not contradicting — their positions.

The Texas case began long before the current veterinary telemedicine boom. In 2012, the Texas State Board of Veterinary Examiners disciplined Dr. Ronald Hines, a Brownsville practitioner who was providing online consultations to pet owners. The regulators alleged that Hines was practicing without a VCPR, which "may not be established solely by telephone or electronic means."

It would be years before the Covid-19 pandemic in 2020 pushed much of society online. In the interest of avoiding unnecessary in-person interactions that could spread the highly infectious disease, regulators across the country loosened restrictions on telemedicine for human and veterinary patients.

After lockdowns lifted, expectations for virtual care remained. Established pet product companies and start-ups launched veterinary telemedicine businesses that strain against VCPR restrictions, even as the country's largest veterinary trade group fights to keep the standard in place.

Each side interprets the now-established court decision quite differently.

Dutch, a digital platform that provides veterinary consultations through videos and messaging, describes the Supreme Court's decision to let the appeals ruling stand as unambiguous support for easier access to telemedicine.

"It's important to make it very clear what the U.S. Supreme Court ruled and affirmed: a physical exam is not necessary to establish a VCPR," Dr. Kate Elden, chief medical officer for Dutch, told the VIN News Service by email.

(Technically, the Supreme Court did not affirm the Fifth Circuit. It declined to review the case, without weighing in on the merits.)

Dutch, formerly known as Dutch Pet, has taken a prominent role in supporting lobbying efforts to remove state in-person VCPR requirements for remote care almost from its start in 2021.

The American Veterinary Medical Association, a staunch opponent of relaxing the in-person VCPR requirement, is pushing back on the idea that the case outcome means the hands-on exam rule is doomed.

In a blog post on April 22, it wrote: "Some will claim these decisions signal the end of in-person VCPR requirements or that they end the regulation of telemedicine. That interpretation doesn't hold up." The AVMA goes on to make a distinction between veterinarians' speech and veterinarians' conduct.

Lawsuit twists and turns

Physically disabled and retired from in-person practice, Hines had been giving veterinary advice via email, often free of charge or for a small fee, for more than a decade before he had any trouble with regulators.

"Half of what I did, I didn't charge anybody," Hines, 82, said recently. "I just enjoyed it."

When, in 2012, the veterinary medical board said Hines was flouting state rules, he did not contest the allegations, records show. The following year, he was penalized with a year's probation and a $500 fine and was required to retake the jurisprudence section of the licensing exam.

He then sued the board, challenging the physical-examination requirement on First Amendment grounds. Ultimately, the Fifth Circuit rejected that lawsuit, ruling that Hines' professional veterinary advice was not protected speech but rather akin to occupational conduct, much like surgery. The U.S. Supreme Court declined to hear the appeal.

But elements of Hines' free speech argument were revived in June 2018, when the U.S. Supreme Court ruled in National Institute of Family & Life Advocates v. Becerra that First Amendment protections do apply to professional speech. The case, commonly referred to as NIFLA, involved a California law requiring certain pregnancy centers to provide notices about state-sponsored reproductive health services, including abortion.

The high court determined that the First Amendment protects the speech of professionals, including those who must obtain a license to practice.

Hines refiled after NIFLA. The district court initially dismissed his claims, but the Fifth Circuit revived the First Amendment claim and sent the case back for the district court to decide whether Texas was regulating speech or conduct. The district court ruled in favor of the state, finding the statute content-neutral and valid.

Hines appealed again. This time, the Fifth Circuit judges determined that the physical-examination requirement regulated Hines' speech directly because the only thing that "triggered coverage" under the statute was Hines' email communications. The three-judge panel left open the question of whether the law was content-based or content-neutral, writing in the decision that, either way, "this regulation fails to survive even intermediate scrutiny" on multiple grounds.

These include:

• The state did not show real harm. The Fifth Circuit said the state's own literature review found no published reports of harm caused by veterinary telemedicine without a prior exam, and expert testimony could only say that Hines "potentially" or "likely" harmed animals over nearly 20 years of practice. "This testimony cannot be characterized as anything more than conjecture and speculation," Circuit Judge Don R. Willett stated in the decision.
• The statute is internally inconsistent in allowing establishment of a VCPR in some cases by a premises visit alone, without a physical exam, which undermines the state's claim that an exam is essential.
• The state law requiring a "recent" physical exam to establish a VCPR does not necessarily alleviate the harm of potential misdiagnosis. "Why would a 'recent' physical examination in the last year or two provide any better insight into an animal's condition than a real-time telehealth appointment without a preceding physical examination?" Willett wrote.

During the life of Hines' lawsuits, enforcement for veterinary medicine in Texas was transferred to the Texas Department of Licensing and Regulation (TDLR). Neither the veterinary board nor TDLR responded to VIN News questions about what the case means from an enforcement perspective.

Raphael Moore, general counsel for the Veterinary Information Network — an online member community for the profession and parent of VIN News — offered thoughts on how the decision could affect future enforcement action by Texas regulators.

"If the board wants to keep enforcing in this area, it will need to distinguish future cases from Hines in concrete ways," Moore said. "Regulators would be on firmer ground where a case involves conduct or enforcement interests beyond advice alone, such as prescribing medication, dispensing or administering drugs, physically treating an animal, performing a procedure, issuing legally operative certifications, practicing without a license, making false or misleading claims, misrepresenting services, or causing actual harm."

Moore added, "The more the facts involve only advice, the closer the case is to Hines."

The AVMA versus Dutch

In the blog post providing its perspective on the Hines case outcome, the AVMA referenced another medicine-related free speech case decided by the U.S. Supreme Court in March. Though not about veterinary medicine, the case relates to the question of when professional regulation crosses into speech regulation. 

In the case, Chiles v. Salazar, a mental health professional named Kaley Chiles sued the state of Colorado over a 2019 law that banned licensed therapists from talking with minor patients about "conversion therapy" related to sexual orientation or gender identity. Chiles argued that the law violated her right to free speech. Like Hines, Chiles' practice involved only speech, in the form of talk therapy. She neither prescribed medications nor employed physical treatment.

The Supreme Court ruled that the Colorado law violated Chiles' First Amendment right because it was a content-based regulation of speech that favored state-imposed viewpoints.

The AVMA wrote: "These cases, whether taken together or separately, do not eliminate existing VCPR laws and regulations. They address government regulations that impact speech versus government regulations that largely address conduct. They acknowledge that even when a statute generally regulates conduct, it can still violate First Amendment protections for speech 'as applied' to an individual's specific facts and circumstances."

The AVMA said the issue addressed in the veterinary case "focused only on how this law applied to Hines, where it found that the state's enforcement action over the VCPR was triggered by Hines' speech, not conduct."

The AVMA said that conduct, such as prescribing, is unaffected by the ruling.

Dutch, for its part, interprets the Hines case outcome much more broadly.

"The ruling validates the model we have been building since day one: licensed veterinarians using their judgment to meet pets where they are," Chief Medical Officer Elden said in an email responding to an inquiry from VIN News.

"Hines did not happen in a vacuum," she said. "There are hundreds of cases relevant here on the broader telehealth and professional-speech landscape, including the dozens of decisions cited in Hines itself. The bigger trend is what matters most. Courts and legislatures across the country are being asked, fairly, whether outdated in-person-only rules really protect animals or just protect the status quo."

As such, she said, the ruling is meaningful for not just one telemedicine company, but the broader profession and pet owners, and she suggested that the AVMA's resistance to easy access to telemedicine comes at animals' expense. "When a major trade association spends its energy fighting telemedicine instead of working with it, pets pay the price," she said.

She added, "The Fifth Circuit just made clear that the path forward includes telemedicine — not in spite of good medicine, but as an extension of it."

Dutch employs approximately 200 licensed veterinarians across all 50 states. On its website, Dutch says that veterinary care provided through its platform can include clinical advice, treatment plans, prescriptions, product discounts and referrals to brick-and-mortar hospitals. Services vary by state.

In an appearance on The Tucker Carlson Show in late 2025, Dutch founder and CEO Joe Spector said the company would lobby legislators in 12 states to relax telemedicine laws this year. Part of that effort is a Dutch-created website called savepuppies.com that provides a form for pet owners to contact their lawmakers to ask them "to support policies that expand veterinary telemedicine."

'Veterinary medicine needs to change'

Today, Hines keeps his hand in veterinary medicine advising Texas agencies, including Texas Parks and Wildlife, on wildlife rehabilitation. After 13 years of legal wrangling, Hines said, he was gratified to have won but the case isn't about him.

"I only did this for the next generation of veterinarians," he said. "This is kind of a moment in history where veterinary medicine needs to change."

Hines offered the advent of tractors replacing horses in farming as a metaphor. He said veterinarians of the time, mostly large animal practitioners, thought the technology spelled the end of the profession. A similar technological leap is occurring today in the form of the internet, he said.

"The internet expands how veterinary medicine will be delivered," he said. "It ought to be the pet owner's decision if they want that to be by direct hospital appointments or conversations with veterinarians delivering that information online. If boards don't keep up with reality, corporate entrepreneur middlemen and artificial intelligence will rapidly fill that void."

Hines conceded that moving forward with telemedicine will have pitfalls. "It isn't all going to be good," he said. "There will be winners and losers."

Andrew Ward, one of two attorneys representing Hines for the Institute for Justice, a nonprofit constitutional law firm, said the case is about one practitioner, not all of telemedicine. He added, though, that the decision is a boon for all practitioners.

"I know there have been conflicting views on veterinary telemedicine," he said. "I think this is important for vets because ultimately, it means the First Amendment protects them, too."

The ruling, he said, will help protect practitioners who "express opinions that go against the grain."