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LEARNING IN PRACTICE
Members of the veterinary profession have a responsibility to uphold standards to ensure the public has access to safe , quality veterinary care . When those standards are compromised , the College responds . Every veterinarian can learn from these situations and publishing the details of complaints received and resolved is intended to support that learning . The example below is taken from an actual case and is offered as a self-reflection tool to improve practice across the province .
MEMBER GIVEN GUIDANCE ON MEDICAL RECORDS , LYME DISEASE
CASE SUMMARY
The member examined a male , neutered , Retriever-cross dog who was lethargic and not eating well . The member suggested the dog had gotten into something . No diagnostic tests were performed and no treatment was initiated . Four days later , the dog was returned to the member . The dog now appeared to be in pain , had trouble walking , was not eating well and was vomiting . After performing blood work , the member dispensed Metacam , a non-steroidal anti-inflammatory , and doxycycline , an antibiotic , for suspected Lyme disease .
Two days later , the dog returned to the clinic a third time as he was not improving , not eating better , and not drinking much . At this time , Advantage Multi was dispensed and the dog was signed up for a “ wellness ” plan . In four days , the dog returned to the clinic for radiographs . The member indicated the dog ’ s intestines were full but there was no need to change the treatment plan .
The client called the next day and made another appointment for the following day after reporting the dog was no better , had passed a black stool , and continued to pant . The client requested an earlier appointment that morning but the dog died before the afternoon appointment . A post mortem was performed and a rare form of leukemia was diagnosed .
CASE CONSIDERATIONS
In consideration of this complaint , a panel reviewed the material provided .
The panel was concerned the clients did not appear to have understood the member ’ s suspicion of Lyme disease . While the member submitted that he / she did explain Lyme disease to the clients , there was no record of a discussion offering additional diagnostic testing such as a quantitative C6 test or urinalysis to assess for proteinuria .
The complete blood count appeared to have been performed twice on the same sample ; however there was no record of interpretation or concern for the leukocytosis ( high white blood cell count ) or severe thrombocytopenia ( lack of platelets ) on the printed report , or a notation that a blood smear was performed to validate the findings . The clients felt the dog had been on a program to protect him from ticks , but there was no note of a tick management discussion , review of access to ticks or preventative products used .
The panel was concerned the member failed to look more deeply into the dog ’ s illness despite the client ’ s request . While some cases of Lyme disease can start as vague malaise , the dog continued to deteriorate despite treatment , and there was no indication the client declined services . The panel was of the impression the client respected the member ’ s recommendations and had confidence that he / she was doing all that was required .
The panel noted a lack of completeness in the medical records . The panel was unable to evaluate the member ’ s consideration or communication of options , rule outs , assessments and plans .
The panel was also concerned the member dispensed Apo-Meloxicam knowing the dog was not eating or drinking , was vomiting and there was evidence of anemia and thrombocytopenia .
The panel also examined the radiographs . Although they were not properly identified , the panel did not suspect they did not belong to the dog . The panel hopes the lack of identification markings on the radiograph , which is required to identify the patient , the clinic , the date and the view , was an isolated error .
The panel considered that failure to offer a second opinion is not necessarily an
omission ; however it might have been a valid consideration in a clinic with multiple veterinarians to discuss a difficult case .
The panel further noted it was unfortunate the clinic staff failed to accommodate the request for an earlier appointment when the dog ’ s condition was critical . While this would not have changed the outcome , it is important that veterinary staff not expect clients to be able to indicate when a patient is “ critical ”. Because the dog had been in poor condition for so long , it would have been difficult for the clients to evaluate deterioration .
The panel expressed its condolences to the clients on their loss . The panel was of the opinion the clients respected the member ’ s judgement . While they are not holding the member liable for the dog ’ s death , as it was ultimately determined he had a rare cancer with a grave prognosis , they are holding the member responsible for the poor quality of his last 13 days .
CASE OUTCOMES
The Complaints Committee panel decided that the nature of the allegations made against the member did not warrant a discipline hearing and therefore directed that this matter not be referred to the Discipline Committee . However , the member was invited and agreed to participate in an undertaking to address the panel ’ s concerns .
Through participation in the undertaking , the member completed two separate written studies addressing Lyme disease in dogs and secondly the use of non-steroidal inflammatory drugs in dogs . The member ’ s records were reviewed by a peer reviewer and a medical records workshop was provided to the member and the clinic staff .
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